Longer life linked to specific foods in Mediterranean diet

Moral of the story: More evidence that certains foods in the mediterranean diet are really good for you. Note the information on fish, meat, cereals and dairy.

An article summary from the British Medical Journal:

(2) Longer life linked to specific foods in Mediterranean diet(Research: Anatomy of the health effects of the Mediterranean diet, The Greek EPIC prospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2175
Some food groups in the Mediterranean diet are more important than others in promoting health and longer life according to new research published on bmj.com today.
Eating more vegetables, fruits, nuts, pulses and olive oil, and drinking moderate amounts of alcohol, while not consuming a lot of meat or excessive amounts of alcohol is linked to people living longer.
However, the study also claims, that following a Mediterranean diet high in fish, seafood and cereals and low in dairy products were not indicators of longevity.
While several studies have concluded that the Mediterranean diet improves chances of living longer, this is the first to investigate the importance of individual components of the diet.
Professor Dimitrios Trichopoulos at the Harvard School of Public Health explains that they have surveyed over 23,000 men and women who were participants in the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC).
Participants were given dietary and lifestyle questionnaires when they enrolled onto the study and they were subsequently followed up for around 8.5 years with interviews. Their diets were rated from 0 to 10 based on the level of conformity to a traditional Mediterranean diet.
As part of the interview process, participants were also asked about their smoking status, levels of physical activity and whether they had ever been diagnosed with cancer, diabetes and heart disease.

The authors maintain that when high intake of vegetables, low intake of meat or moderate alcohol intake were excluded from the rating system, the benefits of following a Mediterranean diet were substantially reduced. They also note that there are clear benefits in combining several of the key components, for example high consumption of vegetables and olive oil.
Professor Trichopoulou, lead author of the study, concludes that the main reasons why the Mediterranean diet can lead to living longer are moderate consumption of ethanol (mostly in the form of wine during meals, as traditionally done in the Mediterranean countries), low consumption of meat and meat products, and high consumption of vegetables, fruits and nuts, olive oil and legumes.
Contacts: Professor Dimitrios Trichopoulos, Harvard School of Public Health, Boston, USAEmail: dtrichop@hsph.harvard.edu OrProfessor Antonia Trichopoulou, University of Athens Medical School, Athens, GreeceEmail: http://www.bmj.com/cgi/doi/10.1136/bmj.b2337

Tobacco, Public Health, and the FDA

Moral of the story: The FDA and local governments can now finally treat tobacco as the addictive substance that it is, protecting the health of Americans and decreasing costs ($96B).

Tobacco, Public Health, and the FDA
Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D.
Published at www.nejm.org June 22, 2009 (10.1056/NEJMe0905622)

More than a decade ago, David Kessler, then Commissioner of the Food and Drug Administration (FDA), launched a bold initiative to regulate tobacco. He believed that since nicotine is an addictive substance, it fell under the statutory authority of the FDA to regulate it as a drug and cigarettes as the delivery vehicle.
His effort failed, however, when the U.S. Supreme Court decided in a 5-to-4 ruling (FDA v. Brown & Williamson Tobacco Corp.) that the Food, Drug, and Cosmetic Act of 1938, which defined the FDA's authority, did not grant the agency jurisdiction to regulate tobacco. Writing for the Court, Justice Sandra Day O'Connor concluded that "it is plain that Congress has not given the FDA the authority to regulate tobacco products."1 The Court's decision was based on its reading of the statutory language in the act, not on what was best for the health of the public.
Today, President Barack Obama changed all that. With the signing of the Family Smoking Prevention and Tobacco Control Act of 2009, which was passed by sizable majorities in both the House and the Senate (and which we endorsed), the FDA has been given broad authority to regulate tobacco products. We believe that this historic legislation can have an unparalleled positive impact on the health of the American public.
The act establishes the Center for Tobacco Products, a unit within the FDA that will be funded by user fees from tobacco manufacturers and importers — $235 million in fiscal year 2010, rising to $712 million over the next 10 years. The center is charged with regulating tobacco products for the explicit purpose of protecting the health of the public. The FDA will now have the authority to require that all ingredients, compounds, and additives in tobacco products be reported to the agency, and those found to have harmful health effects may be banned. Nicotine levels in cigarettes may be regulated, but neither nicotine nor cigarettes may be banned outright. In keeping with the act's focus on protecting those under 18 years of age, flavorings in cigarettes, which are meant to appeal to young smokers, are banned, with the exception of menthol, which could be banned later if found to be a health hazard. No new tobacco product can be marketed unless first approved by the FDA.
Importantly, the act will also allow regulation of so-called modified risk tobacco products, which are typically identified by terms on the package such as "light," "low," or "mild." The use of such terms will no longer be permitted unless the product has been shown to significantly reduce harm. Warning labels on cigarette packages will be made more graphic and will require the use of color. Tobacco companies may no longer sponsor sporting events.
For the first time in almost 40 years, state and local governments will be allowed to regulate the marketing of tobacco, establishing restrictions that may be more rigorous than those of the FDA. In addition, the act requires that the 1996 Tobacco Rule, which was put in place by Commissioner Kessler and deemed unconstitutional by the Supreme Court, must be reinstated. This rule places restrictions on tobacco advertising, including a ban on outdoor advertising within 1000 ft of a school. It is anticipated that this regulation may be the focus of a constitutional challenge on the basis that such advertising represents commercial speech subject to First Amendment protection. Still, there is good reason to believe that this carefully crafted provision, which is narrowly tailored to focus on smoking prevention in the nation's young, will survive any such legal challenge.
The long-term impact of the Family Smoking Prevention and Tobacco Control Act on the health of the public will depend critically on its implementation through strict regulations, rigorously enforced. FDA Commissioner Margaret Hamburg and Principal Deputy Commissioner Joshua Sharfstein promise to be strong advocates for rigorous enforcement.
In a recent article in the Journal, Hamburg and Sharfstein laid out their new mission.2 They regard the FDA as a public health agency whose purpose is not just to regulate the nation's food and drug supplies, but to protect the health of American citizens. Hamburg has also indicated that she is eager to undertake the regulation of tobacco and said in an interview, "We now have an opportunity to really make a difference with what is probably the No. 1 public health concern in the nation and the world."3
Few threats to the health of the public are as onerous as tobacco. Each year more than 435,000 Americans die of tobacco-related illnesses, principally heart, vascular, and lung diseases. Tobacco use is also associated with substantial morbidity and diminished quality of life. More than one in five Americans still smoke, an astonishing figure given the overwhelming evidence of harm. In addition to excess morbidity and mortality, tobacco adds considerably to health care costs at a time when reducing costs is a national priority. The total annual health care expenditures caused by smoking run to $96 billion.4 Along with other critical prevention goals, such as controlling obesity and increasing levels of physical activity, the elimination of cigarette smoking is central to improving the health of our citizens and mitigating the growth of health care costs.
The Family Smoking Prevention and Tobacco Control Act of 2009 comes at a propitious moment in U.S. history. We strongly support the FDA's new leaders and urge them to implement the act aggressively. As a medical journal, we are committed to eliminating the public health threat tobacco represents to American society and the world.
Source Information
This article (10.1056/NEJMe0905622) was published on June 22, 2009, at NEJM.org.
References

FDA v. Brown & Williamson Tobacco Corp. 529 U.S. 120 (2000).
Hamburg MA, Sharfstein JM. The FDA as a public health agency. N Engl J Med 2009;360:2493-2495. [Free Full Text]
Harris G. New F.D.A. chief says she'll toughen enforcement efforts. New York Times. June 17, 2009:A19.
Campaign for Tobacco-free Kids. Toll of tobacco in the United States of America. April 2009. (Accessed June 22, 2009, at http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf.)

Alcohol’s Good for You? Some Scientists Doubt It

Moral of the story- Correlation is not causation. Writing from Guatemala there is little time to expand upon this excellent story, but read it! You may change your mind about "needing" that glass of wine and instead go for a walk or run.

http://www.nytimes.com/2009/06/16/health/16alco.html?ref=health

From the New York Times-

By RONI CARYN RABIN

Published: June 15, 2009

By now, it is a familiar litany. Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia. The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle.

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But what if it’s all a big mistake?

For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death — only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.

“The moderate drinkers tend to do everything right — they exercise, they don’t smoke, they eat right and they drink moderately,” said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticized the research. “It’s very hard to disentangle all of that, and that’s a real problem.”

Some researchers say they are haunted by the mistakes made in studies about hormone replacement therapy, which was widely prescribed for years on the basis of observational studies similar to the kind done on alcohol. Questions have also been raised about the financial relationships that have sprung up between the alcoholic beverage industry and many academic centers, which have accepted industry money to pay for research, train students and promote their findings.

“The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study — the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country,” said Dr. Tim Naimi, an epidemiologist with the Centers for Disease Control and Prevention.

Even avid supporters of moderate drinking temper their recommendations with warnings about the dangers of alcohol, which has been tied to breast cancer and can lead to accidents even when consumed in small amounts, and is linked with liver disease, cancers, heart damage and strokes when consumed in larger amounts.

“It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative,” said Dr. Arthur L. Klatsky, a cardiologist in Oakland, Calif., who wrote a landmark study in the early 1970s finding that members of the Kaiser Permanente health care plan who drank in moderation were less likely to be hospitalized for heart attacks than abstainers. (He has since received research grants financed by an alcohol industry foundation, though he notes that at least one of his studies found that alcohol increased the risk of hypertension.)

“People who would not be able to stop at one to two drinks a day shouldn’t drink, and people with liver disease shouldn’t drink,” Dr. Klatsky said. On the other hand, “the man in his 50s or 60s who has a heart attack and decides to go clean and gives up his glass of wine at night — that person is better off being a moderate drinker.”

Health organizations have phrased their recommendations gingerly. The American Heart Association says people should not start drinking to protect themselves from heart disease. The 2005 United States dietary guidelines say that “alcohol may have beneficial effects when consumed in moderation.”

The association was first made in the early 20th century. In 1924, a Johns Hopkins biologist, Raymond Pearl, published a graph with a U-shaped curve, its tall strands on either side representing the higher death rates of heavy drinkers and nondrinkers; in the middle were moderate drinkers, with the lowest rates. Dozens of other observational studies have replicated the findings, particularly with respect to heart disease.

“With the exception of smoking and lung cancer, this is probably the most established association in the field of nutrition,” said Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health. “There are probably at least 100 studies by now, and the number grows on a monthly basis. That’s what makes it so unique.”

Alcohol is believed to reduce coronary disease because it has been found to increase the “good” HDL cholesterol and have anticlotting effects. Other benefits have been suggested, too. A small study in China found that cognitively impaired elderly patients who drank in moderation did not deteriorate as quickly as abstainers. A report from the Framingham Offspring Study found that moderate drinkers had greater mineral density in their hipbones than nondrinkers. Researchers have reported that light drinkers are less likely than abstainers to develop diabetes, and that those with Type 2 diabetes who drink lightly are less likely to develop coronary heart disease.

But the studies comparing moderate drinkers with abstainers have come under fire in recent years. Critics ask: Who are these abstainers? Why do they avoid alcohol? Is there something that makes them more susceptible to heart disease?

Some researchers suspect the abstainer group may include “sick quitters,” people who stopped drinking because they already had heart disease. People also tend to cut down on drinking as they age, which would make the average abstainer older — and presumably more susceptible to disease — than the average light drinker.

In 2006, shortly after Dr. Fillmore and her colleagues published a critical analysis saying a vast majority of the alcohol studies they reviewed were flawed, Dr. R. Curtis Ellison, a Boston University physician who has championed the benefits of alcohol, hosted a conference on the subject. A summary of the conference, published a year later, said scientists had reached a “consensus” that moderate drinking “has been shown to have predominantly beneficial effects on health.”

The meeting, like much of Dr. Ellison’s work, was partly financed by industry grants. And the summary was written by him and Marjana Martinic, a senior vice president for the International Center for Alcohol Policies, a nonprofit group supported by the industry. The center paid for tens of thousands of copies of the summary, which were included as free inserts in two medical journals, The American Journal of Medicine and The American Journal of Cardiology.

In an interview, Dr. Ellison said his relationship with the industry did not influence his work, adding, “No one would look at our critiques if we didn’t present a balanced view.”

Dr. Fillmore and the co-authors of her analysis posted an online commentary saying the summary had glossed over some of the deep divisions that polarized the debate at the conference. “We also dispute Ellison and Martinic’s conclusions that more frequent drinking is the strongest predictor of health benefits,” they wrote.

(Dr. Fillmore has received support from the Alcohol Education and Rehabilitation Foundation of Australia, a nonprofit group that works to prevent alcohol and substance abuse.)

Dr. Ellison said Dr. Fillmore’s analysis ignored newer studies that corrected the methodological errors of earlier work. “She threw out the baby with the bathwater,” he said.

Meanwhile, two central questions remain unresolved: whether abstainers and moderate drinkers are fundamentally different and, if so, whether it is those differences that make them live longer, rather than their alcohol consumption.

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Dr. Naimi of the C.D.C., who did a study looking at the characteristics of moderate drinkers and abstainers, says the two groups are so different that they simply cannot be compared. Moderate drinkers are healthier, wealthier and more educated, and they get better health care, even though they are more likely to smoke. They are even more likely to have all of their teeth, a marker of well-being.

“Moderate drinkers tend to be socially advantaged in ways that have nothing to do with their drinking,” Dr. Naimi said. “These two groups are apples and oranges.” And simply advising the nondrinkers to drink won’t change that, he said.

Some scientists say the time has come to do a large, long-term randomized controlled clinical trial, like the ones for new drugs. One approach might be to recruit a large group of abstainers who would be randomly assigned either to get a daily dose of alcohol or not, and then closely followed for several years; another might be to recruit people who are at risk for coronary disease.

But even the experts who believe in the health benefits of alcohol say this is an implausible idea. Large randomized trials are expensive, and they might lack credibility unless they were financed by the government, which is unlikely to take on the controversy. And there are practical and ethical problems in giving alcohol to abstainers without making them aware of it and without contributing to accidents.

Still, some small clinical trials are already under way to see whether diabetics can reduce their risk of heart disease by consuming alcohol. In Boston, researchers at Beth Israel Deaconess Medical Center are recruiting volunteers 55 and over who are at risk for heart disease and randomly assigning them to either drink plain lemonade or lemonade spiked with tasteless grain alcohol, while scientists track their cholesterol levels and scan their arteries.

In Israel, researchers gave people with Type 2 diabetes either wine or nonalcoholic beer, finding that the wine drinkers had significant drops in blood sugar, though only after fasting; the Israeli scientists are now working with an international team to begin a larger two-year trial.

“The last thing we want to do as researchers and physicians is expose people to something that might harm them, and it’s that fear that has prevented us from doing a trial,” said Dr. Sei Lee of the University of California, San Francisco, who recently proposed a large trial on alcohol and health.

“But this is a really important question,” he continued. “Because here we have a readily available and widely used substance that may actually have a significant health benefit — but we just don’t know enough to make recommendations.”