Vol. 219 October 1, 2019 Vitamin D Supplement; Take It or Leave It?

October 1, 2019

Ever since the French sailors, weakened by scurvy, lost control of the seas to the British navy which was scurvy-free by vitamin C in the lime juice added to their daily ration of grog (hence the name “Limeys”), vitamins have been a subject of great interest and, even now, a lot of mystery. Everyone agrees that a little bit of them is essential for good health, but even two-time Nobel Prize winner Linus Pauling couldn’t convince all of us that a lot of vitamin C  could cure a cold. (1)

Vitamin D is currently the most popular vitamin to study because of some past research suggesting that vitamin D protects us from heart disease, particularly the elderly. A 2012 survey reported that about 20% of respondents were taking vitamin D supplements (multivitamin supplements were not included).  Supplemental vitamin D AND supplemental calcium have long been touted for preventing loss of bone density, or osteoporosis, especially in post-menopausal women. 

It is clear that Vitamin D deficiency can cause growth retardation and bone disease, particularly in the first years of life. It is a bit unclear as to how much of vitamin D we need. The American Academy of Pediatrics recommends vitamin D supplements of 400 units a day for breast-fed babies. Recommendations for minimum doses in other than infants range from 400 units to 2000 units a day. It is said to be almost impossible to be “vitamin deficient” on a normal diet nowadays, but certain very restricted vegan diets can cause some problems in rare cases.  Also, studies of Northern urban  children (less sun exposure) revealed “low” Vitamin D blood levels which stirred up a lot of discussion about its significance and about “what level was normal”. Too much of most vitamins can’t really hurt you too much. Most “excess” of vitamins ingested ( the amount over the minimum required to prevent a deficiency disease)  just ends up in the toilet via your urine.

A recent systematic review of a large number of peer-reviewed research studies on the use of supplemental Vitamin D to reduce the risk of cardiovascular disease was recently published. (2) This meta-analysis (our trade name for such huge reviews) of 21 randomized clinical trials with over 83,000 participants (mean age, 65) followed for 1 to 12 years showed that using a variety of Vitamin D supplements did NOT lower the risk for myocardial infarction, stroke, cardiovascular-related deaths, or all-cause deaths. This is “the best evidence to date that fails to support use of vitamin D supplementation for lowering cardiovascular risk.” (3)

Of course, the results of that meta analysis was muddied just a bit by another meta analysis of 52 clinical trials with over 75,000 participants (mean age, 74) with 1 year follow-up which showed that Vitamin D supplements was associated with 4 per 1000 persons fewer deaths from cancer in a small sub-group of participants. (4)  To further confuse the issue, it was noted that this small but significant difference occurred in only those people taking the D³ form of oral Vitamin D, not those taking the D² form. But, this review also revealed no cardiovascular benefits.

What about effects of vitamin D supplements on bone-density? If the recommended daily dose of vitamin D is from 400 to 2000 units, what if we took twice that? About 3% of U.S. adults take over 4000 units of vitamin D daily. A Canadian randomized study of 311 adults with pre-study normal vitamin D blood levels took either 400, 4000, or 10,000 units per day of supplemental vitamin D for three years.  Bone density actually DECREASED in those taking the higher doses. Also, the vitamin D blood levels in those taking the 400 units (recommended minimum) did not increase above normal. “The findings point to no benefit for bone integrity—and even harm—with high dose vitamin D supplementation in patients with adequate vitamin D blood levels.” (5) 

In today’s blog I offer evidence-based skepticism about the benefits of both vitamin C and vitamin D supplements. In my last blog I cautioned against vitamin E . . .at least the inhaled form. Is there a vitamin F supplement to continue my progression? Yes, there is! Vitamin F is an outdated term for omega-3 and omega-6 fatty acids,  but I think I’ll let that subject “sleep with the fishes” for the moment.

References
1. “Vitamin C and The Common Cold”, Linus Pauling, 1970 and 1976.
2. JAMA Cardiology 2019 Aug; 4:765
3. NEJM Journal Watch cardiology,vol.39, Oct. 2019)
4. NEJM 2019;380:33
5. JAMA 2019Aug27;322:736

 


Vol. 213 May 15, 2019 Fake Nutritious Foods

May 15, 2019

        “Food packaging can be very confusing”

                           -Whitney Linsenmeyer, Ph.D, R.D., St. Louis University

In case you haven’t noticed, the widespread proliferation of nutritious sounding labels in food marketing continues; as in “natural”, “local”, “fresh”, “farm-to-table”, “organic’, and even “gluten-free”. Consumer Reports On Health has tracked food marketing and packaging trends for years. Its June 2019 issue highlights “8 foods that seem healthier than they really are”.

Veggie Sticks – Even if not always green, what could be more nutritious than vegetables?
A professor of nutrition at Boston University calls them “produce pretenders”. Made with potato flour and starch, oil, salt, and just enough vegetable powder to give it color, it is “not much better nutritionally than a potato chip”. A better choice: 4 cups of air-popped pop corn with less calories and much more fiber. Hold back from adding salt and butter.

Rice Cakes– Even the whole-grain brown type of rice lacks fiber and, like other rice products, may contain arsenic.
Flavored varieties can load up on sugar and salt. If you are going to use a rice cracker/cake at least put peanut butter, sliced banana, or humus with a tomato slice on it for more protein and fiber.

ARSENIC!? – It has been known for years that rice picks up arsenic from the soil in which it grows. Arsenic (chemically a “heavy metal” ) is a natural element in the soil. It’s truly “natural”, as in “found in nature”. It is found in trace amounts in all types of rice.  Brown rice can have 80% more arsenic than other types.  The region also makes a difference with Texas rice at the high end and California rice at the lower end. Can it poison you? NO. The FDA permissible arsenic level in drinking water is 10 parts per billion (ppb). One brand of rice cake grown in Mexico tested at 17 parts per billion, and the FDA directed the U.S. company importing it to change its manufacturing process.

Spinach Wraps – That healthy-looking green hue is often just due to food coloring.
The amount of spinach in it can be negligible. Most wraps are made with refined white flour so have very low fiber content.

Protein Powder – Most Americans consume enough protein in their daily food. No supplement is necessary.
The downside of these powders is that some brands have been found to have significant levels of heavy metals and other toxins. Peanut butter in your smoothie is a more reasonable way to add protein if you wish.

Turkey Burgers – They may be no more nutritious than regular beef burgers. Wait a minute, is nothing sacred?!
“Butterball ground turkey” has the same calories and saturated fat amount of a beef burger because of the inclusion of dark meat and skin, but “Butterball ground turkey breast  has about one-tenth the saturated fat.

Bran Muffins– Here it is a matter of size. Muffins are often cupcakes.
The Au Bon Pain raisin bran muffin weighs in at 5 ounces and packs 430 calories and 31 grams of sugar. If really desiring more bran, go with all-bran cereal.

Granola – How can a mixture of oats, fruit, and nuts not be good for you?
It’s the calories of the added sugars, fat, or whey protein concentrate. Better choice: make your own with shredded wheat cereal with some sugar and almonds added.

Instant Oatmeal – It is so “instantly” digested that it can give you a spike in your blood sugar and a shorter period of hunger satisfaction.  Packets flavored with brown sugar or maple syrup can contain more than 9 grams of added sugar. Cooking “steel-cut” oats (round kernels) or microwaving “rolled” oats (steel-cut oats crushed flat) and serving with fruit, a little fruit butter, or cinnamon is a better choice.

Obviously its the added sugar, salt (sodium) and/or saturated fat that belies the “nutritious” label. A recent report from the National Academy of Medicine recommends that the maximum adult daily sodium intake should be 2,300 mg. The average daily sodium intake of Americans is above 3.400 grams.

Now that restaurants are listing calorie counts in their menus you may think you are home-free in striving to eat healthy, BUT Applebee’s Cedar Salmon has only 370 calories AND 19 grams of sugar and 1530 mg of sodium, Chipotle’s Vegetarian Bowl has a whopping 11.5 grams of saturated fat and 1830 mg. of sodium, while even Panda’s Express “Black Pepper Chicken” has close to one-half of the daily requirement of salt.

Reading food labels can be difficult . . . confusing. . . and time-consuming.

PS: A couple of my kids and their kids are not going to like this blog since some of these foods are their favorite “healthy snacks.”


Vol. 206 January 15, 2019 Updates on 2018 Blogs

January 15, 2019

Causes of Deaths of U.S. Children in 2016
Firearms-related deaths are #2, just behind motor vehicle crashes.  60 % of the three thousand plus firearms-related deaths were homicides. 35% were suicides. Both motor vehicle and firearms-related deaths percentages have increased every year since 2013. The ratio of causes of firearms-related deaths of adults (over 20 yo.) was the opposite: 62% suicide and 37% homicide. Cancer was #3 at 9% of all children deaths both years.

Continued resistance to gun safety reform legislation has been called “another example of U.S. public health intervention being cast as an attack on individual liberty.”

Driver safety being the other example, of course.

Benefits of Aspirin in Elderly or Diabetics
Three studies published in the New England Journal of Medicine this October showed that daily low dose aspirin provided no benefit to the elderly against all types of deaths, cancer-related deaths, dementia, physical disability, or cardiovascular events. They did reveal an increase in non-fatal significant bleeding events. 3% of those taking the aspirin suffered such an event compared to 2% taking the placebo.

A fourth study published in the same issue appeared to show that low dose aspirin reduced the incidence of non-cardiac vascular events in adults (all ages) with diabetes. The percentages of adverse bleeding events (mostly gastrointestinal) was again 1% higher in those taking the aspirin. In contrast to other studies the use of aspirin did not reduce the incidence of gastrointestinal cancer.

Immigrant Children in Detention
The latest independent estimate of children held in 9 U.S. centers is 15,000. The Department of Home Security does not publish statistics, and, in fact, is not too sure itself how many they have. There have been two instances when Home Security could not account for 1400-1500 children. Most of the children are held in large centers with up to a thousand children. The length of stay has been from 104 to 240 days. Currently nearly 300 are children whose parents have already been deported, so that their eventual disposition is up for grabs. 

The recent deaths of two Guatemalan children in detention (one 7 yo. and the other 8 yo.) remain under investigation, but in reading between the lines I suspect that they were caused by flu-like illnesses in dehydrated, malnourished, and tired kids, i.e. eminently preventable deaths.

More About the Southern Border Immigrants
The number of people arrested trying to illegally cross the Mexican border has been decreasing each year since 2005 (President Bush) and is now at the lowest point since 1971. The number of “people in families” arrested monthly during the same period has increased 2.5X from under 10,000 to 25,172 this November. Hence, one reason for the recent development of an “humanitarian crisis”. The number of arrests of “unaccompanied children” has remained the same at about 5,000 per month

The Mexican border is the primary entry point for cocaine, heroin, and methamphetamine which is mostly carried by trucks through official border crossings.

Texas is the only state that has statistics on crimes by immigrants (the federal agencies have none). In 2015 the relative rates of crimes per 100,000 residents in Texas analyzed by the Cato Institute were:

All Crime – (3307 per 100,000 persons) – 
           54 % native born
           27% undocumented immigrants
          18%  legal immigrants

Larceny – (403 per 100,000 persons)
           66% native born
           15% undocumented immigrants
           18% legal immigrant

Sex crime – (64 per 100,000 persons)
            45% native born
            41% undocumented immigrants
            14% legal immigrants

Probiotics for Diarrhea/Effects on Your Microbiome
Two recent very large studies in children showed that twice daily doses of a certain probiotic did NOT shorten the duration of diarrhea or reduce the number of bowel movements per day. This is yet another study showing no real benefit from probiotics, but believers point out that maybe they were using the “wrong” probiotic. 

In other probiotic news: In contrast, another recent study suggests that probiotics can change a person’s own gut microbiome in such a way to make the person’s gut microbiome LESS protective against illnesses.

The Microbiome and Obesity
A study of multi-generational Southeast Asian immigrants showed that soon after arrival in the U.S. the diversity of their gut microbiome began to decrease to the level resembling the less-varied microbiome of European Americans. “Just living in the U.S. reduced their microbiome diversity by 15%.” At the same time their obesity rate spiked!  Previous studies indicated that the more diverse gut microbiome in people in less developed countries protected them from developing metabolic diseases like diabetes.

We Are All Getting Heavier
In the U.S. both the average man and the average woman gained 24 pounds from 1960 to 2002.
By 2016 men had gained an average of 8 pounds more; women 7 pounds.
Both white and black men increased an inch in waist size. White woman increased their waist size by 2 inches; black women reduced theirs by an inch.
The average American man is now 5 feet 9 inches, weighs 198 pounds, and has a 40 inch waist. The average American woman is 5 feet 4 inches, weighs 171 pounds, and has a 39 inch waist. Both have a BMI near or at 30, the “high end of overweight.”
These results are from actual measurements because “ people tend to overreport their height and underreport their weight.”

Editorial note: Our local YMCA “free sign-up day” on January 1 was mobbed. On January 6 the men’s locker room was quite crowded. Overheard from the next cubicle: “Just wait 3 weeks. There’ll be plenty of room again.”
Update in the near future.


Vol. 203 November 15, 2018 Recent Updates

November 15, 2018

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Unsafe Toys for Christmas 2018
World Against Toys Causing Harm or W.A.T.C.H. has just released its 5th annual list of “worst toys for the holiday season” picked for their potential cause of choking, eye injury, or other safety hazard. In 2016 there were 240,000 toy-related injuries. During 2014 to 2016 there were 35 toy-related deaths. The top ten worst toys this year include:

  • Nickelodeon Nella Princess Sleeptime Pet Pillow – choking and suffocation (“DO NOT USE IN CRIB”)
  • Nerf Praxis Blaster- “rapid fire” projectiles could cause eye injuries
  • Marvel Black Panther Slash Claw – “it can actually slash”
  • Power Range Ninja Superstar Blade – “plastic chain saw that can actually cut”
  • Cabbage Patch Dance Time Doll – choking (Is nothing sacred?!)
  • Stomp Ultra Rocket – “fires up to 200 ft. in the air if not stopped by an eye”

Lower Your Prostate Cancer Risk by Riding a Bicycle
Men who did long-term vigorous exercise like biking, swimming, or running had a 25-30% less chance of developing advanced or lethal prostatic cancer. Exercise even lowered the risk for those men who have a specific genetic subtype of prostatic cancer seen in half of the deaths. “The influence of insulin, growth factors, and other metabolic factors” is thought to be the link between exercise and the lower risk according to this Harvard School of Public Health study of 49,000 healthy men between 1986 and 2012.

Many Nutritional Supplements Include Contaminants
Half of U.S, adults take some sort of nutritional supplements spending about $30 billion annually, and the FDA is prohibited by law to evaluate supplements for safety or efficacy PRIOR to marketing. The FDA can issue post-marketing warnings about adulterants. One study from 2007 to 2016 identified 776 supplements, mostly for sexual enhancements, weight loss, or muscle building, with either adverse events or consumer complaints,. Of the 28 products that had received two or more “FDA warnings” 19 continued to be sold. In another study of 21 supplements with “FDA warnings” because of one or more unapproved stimulants, 12 were still available in 2007 and 9 of the 12 still contained the same stimulants. Q.E.D.; FDA warnings have little effect in protecting consumers from potentially harmful effects of contaminants in nutritional supplements.

Does Drinking More Water Reduce Bladder Infections in Women?
Yes, if they had 3 or more bladder infections in the previous year and are drinking LESS than the recommended 1500 ml. (4 water bottles) a day. If they doubled the amount of water to 3000 ml. (8 water bottles) a day the reoccurrence of a bladder infection is reduced from 3.2 a year to 1.7 a year (at least in Bulgarian women). If they were already drinking over the 1500 ml. minimum a day increasing the amount had no effect on recurrence. [All the U.S. women I know, at least in Barnstable county, take a bottle of water with them when they’re just going to the post office.]

One-half of Obese Adolescents Started Being Overweight When 3 – 5 Years Old (at least in 50,000 healthy German children)
Most of the children who were obese at age 6 were obese as adolescents. Rates of obesity were higher in children with overweight or obese mothers. “It is an ominous sign that the number of American children with the most recalcitrant forms of obesity has increased progressively during the past 10 years.” This study suggests that physicians should start nutritional counseling if exaggerated weight gain occurs after age 2! (NEJM October 4, 2018)

Do Not Use Infant Walkers
Despite the fact that the American Academy of Pediatrics has long called for infant walkers to be banned in the U.S. as they are in Canada, infant walkers are still sold here. An average of 9,000 infants a year under 15 months of age are treated in our ERs with head or neck injuries when infant walkers go down household stairs with an infant in them. The AAP says that “there is no advantage of the walker to the infant and parents should not use them.”

A Chilling Aftermath of Our Latest Gun Violence
A friend of mine has a brother who worships at that Pittsburgh synagogue. He was not there for the October massacre, but sat Shemira (literally a bodyguard) for a member who was. After Shemira the brother called my friend to say that he had bought a gun and obtained a carry permit. My friend was incredulous, and asked him, “When are YOU going to carry a gun?” His brother’s answer, “Only when I pray”.

A Prayer for Our Times
The mid-term elections are over, but the political hyperbole and acrimony, especially from the President to the press, is not. On Veterans’ Day we sang “America the Beautiful” in church, and I was struck by the relevance of the unappreciated second verse:

“America! America! mend thine every flaw,
Confirm thy soul in self-control, thy liberty in law.”

Have a Happy Thanksgiving.


Vol. 197 August 1, 2018 GMO Tomatoes?

August 1, 2018

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“ The sad reality is that industry is not really committed to making a better tasting tomato.”
– Harry J. Klee, Ph.D., University of Florida

 

It’s August on Cape Cod, and I have yet to taste a big red luscious locally grown tomato! How long do I have to settle for the bland, tasteless, but very red (they gas green tomatoes with ethylene to turn them red) commercially grown ones?! Is there any hope for a better tasting commercial tomato?

GM (genetic modification) has been going on for centuries through selective breeding and artificial selection by the hands of mankind to improve plants and animals. Pre-Columbian natives, by selecting and re-planting those wild scrubby plants that had bigger, redder, and more fruits, started the development of the beefsteak heirloom tomato we know today. There is probably no vegetable or fruit that we eat today, including corn, soybean, and potatoes, that is not the result of mankind’s genetic selection over thousand of years.

But now those initials, GM or GMO, spark great controversy because scientists can do the genetic selections in a much shorter time in the laboratory. The initial GMO crops introduced by Monsanto in the 1990’s were “transgenic” products;. foreign DNA, even from other species, was introduced or “spliced” into the genes of plants to make them more resistant to Monsanto’s herbicides. Corn and soybean which could thrive in the rain of a new, “more effective” herbicide ignited wide-spread concern and speculation about the long-term effects of the “foreign DNA” GMO crops.

In the same year of 2012 the Tomato Genome Project completed its listing of the 900 million DNA base pairs on 12 chromosomes of the tomato AND a gene-cutting technique dubbed CRISPR  was first described.  Scientists from three universities  published their CRISPR research separately in the same year. UC Berkley , MIT, and Harvard continue the legal battles over the patent rights which will be worth billions. CRISPR is basically a pair of biological scissors that allow scientists to precisely snip and delete part of a gene. It is referred to as “gene-editing”. It is not “transgenic”. No “foreign DNA” is involved or inserted.

For example, for the past 60 years growers have been trying to develop a “jointless” tomato. The classic tomato plant develops a swollen knuckle of tissue in its stem just above the fruit. When the tomato is ripe, the stem knuckle gets a signal from the plant for its cells to die, the stem breaks at this “joint”, and the tomato falls to the ground to happily spread its seeds and make new plants. The problem for the tomato grower who is mechanically harvesting tons of tomatoes is that the residual long stem pierces lots of other tomatoes in the picking process. The damage makes them unsellable. By CRISPRing the gene responsible for the knuckle and deleting it, a “jointless” tomato plant results in a bigger, undamaged crop, and more money for the grower.

Other CRISPR experiments are aimed at developing “self-pruning” tomato plants that are half as tall, less bushy, and with more fruits. Some experiments hope to develop plants that flower earlier, that ignore daylight clues, that require a smaller footprint, and that space their fruit on a stem like an accordion. If you discern that these efforts are all aimed at improving the tomato’s financial return in the market place, you are right. One cynic has stated that the “perfect tomato will be one that exactly matches the size of a MacDonald hamburger… A better tasting tomato always plays second fiddle to market economics.”

CRISPR is great at knocking out or deleting genes. It edits genes. The US Department of Agriculture has determined that crops developed with gene editing mutations are “indistinguishable” from those produced by traditional breeding and “do not require regulatory oversight”. It is a long way from the research lab to the market place via the three agricultural mega-conglomerates, but a variety of start-up companies are developing CRISPR-like technologies for getting cheaper, and maybe better tasting, gene-edited produce to market.

So, just when you hoped that life would be getting simpler and choices might become fewer, you now have to ask yourself a new question, “If it’s GMO, is it transgenic (jury is still out) or just gene-edited (approved)?” Although we may be a long way from getting commercially grown tomatoes that taste as good as our locally grown beefsteak heirlooms, do not fear, CRISPR may soon produce a gluten-free wheat!

Reference: “Tomorrow’s Tomato”, Stephen S. Hall, WIRED, August 2018, pg.053-061


Vol. 186 February 1, 2018 Good News For Dieters, and Some Others Who Ingest

February 1, 2018

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“The only time to eat diet food is while you’re waiting for the steak to cook.”  — Julia Child

Pizza, even bad pizza, makes you feel good.
A recent study of 10 men in Finland (there’s the Finns again!) found evidence of high level of natural painkillers in their brains after eating a pizza. Their opioid receptors literally lit right up after the pizza! Even more surprising, the pizza did not have to be good to show that opioid receptor activity. If the same nutritional value was ingested in a “nutritional goo” form, the brains had even more opioid-like activity. So, the pleasurable feeling after eating pizza has nothing to do with how good it was. Speculations abound about a “full stomach feeling” or a “return of energy” as being the cause of the source of release of this endogenous opioid-like substance. (Journal of Neuroscience, November 2017)

Coffee can be part of a healthy diet.
A mega-review of over 200 studies of coffee consumption revealed that coffee consumption was associated with more benefit than harm, at all levels of consumption. Coffee contains more than 1000 bioactive compounds, including antioxidants, so this review was timely. The largest risk reduction of adverse health outcomes was found in those people who drank 3 to 4 daily cups of coffee (caffeinated OR decaffeinated!).  Death rates from any cause,  death rates from heart disease, and death rates from associated cardiovascular diseases were 15-19% lower in coffee drinkers. High coffee consumers had a 18% lower risk for cancer while lower consumers still had a 13% lower risk compared to non-coffee drinkers. The only adverse effects of coffee consumption were found in women: some higher risks for pregnancy loss, more preterm births, more low birth weight infants, and more bone fractures. The editor of the journal, anticipating our excitement at this news, counselled that “clinicians should not recommend coffee consumption on the basis of this review.”  And, oh yeah . . . this mega-review only included studies of black coffee. If you add sugar, milk, or any other ingredient to your coffee . . . “never mind”. (BMJ 2017)

Fecal transplants now come in pill form.
Selected cases of intractable diarrhea caused by recurrent infection with C. difficile (a bacteria that overgrows in the intestine after multiple courses of antibiotics) have been treated successfully by “transplanting” other people’s normal feces (material that contains normal symbiotic bacteria) into the patient’s intestines by infusing liquid fecal material either through a nasogastric tube or a colonoscope. In a study of 116 participants with recurrent, intractable diarrhea 96% were cured by the administration of the fecal material in a pill form. That is good news, but I hope that I won’t ever have to take that pill. (JAMA, Nov. 2017)

Low-dose aspirin does not raise your risk for intracranial bleeding.
A whole lot of people take daily low-dose aspirin (83 mg. – a baby aspirin) in the belief that it will reduce their risk of a fatal heart attack. The evidence actually shows that the preventative effect of low-dose aspirin is true only if you are trying to prevent your second heart attack; i.e.. the data supports its preventive effect in those people who already have clinical heart disease. Much of the general population, including me, is taking low dose aspirin in hope that it will work similarly for them. The only problem is that aspirin is an anti-thrombotic agent (it makes platelets “slippery” so that platelets don’t clump to start a clot). Such an effect raises a concern about spontaneous bleeding, particularly in the brain. A study of 400,000 people over 5 years in an established U.K. database showed that the incidence of brain hemorrhage was not significantly higher in those on the low-dose aspirin compared to those who took none. Remember also that if you have been taking low-dose aspirin for some time and decide to stop, your risk of spontaneous adverse clotting events may increase over the next 6-12 months. (Neurology, Nov. 2017)

Pasta is back!. . .  sort of.
An Italian study (no conflict of interest there I’m sure)  of 23,000 Italians revealed that the pasta lover had lower BMIs, the gold standard for definition of overweight. The researchers tout that pasta is not “just empty carbs”, but contains protein (6.7 grams per cup) and, if whole wheat pasta, it has iron, folic acid, and several B vitamins. The Italian study results are similar to a U.S. study of about 1,800 middle-aged adults, but there are a couple of caveats to consider. Italians eat much less pasta than we do in a meal because they consider it a first course, not the whole meal. The participants in the Italian study consumed an average of 3 oz. (86 grams) of pasta each meal. The study researchers did not name the “ideal amount” of pasta to eat per meal, but did note that those Italians who ate more pasta than the average tended to be obese. As we have said before, losing weight usually comes down to (no pun intended) taking in fewer calories rather than picking different kinds of calories to eat.


Vol. 181 November 15, 2017 Here’s Some More Good News …and Bad News

November 15, 2017

Do not believe in anything simply because you have heard it.
Do not believe in anything simply because it is spoken or rumored by many.
Do not believe in anything simply because it is found written in your religious books.
Do not believe in anything merely on the authority of your teachers and elders.
Do not believe in traditions because they have been handed down for many generations.

But after observation and analysis when you find out that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it.
-Buddha

THE GOOD NEWS is …
Neurosurgeons in one hospital  were able to double-book operations (operate on two patients at the same time) without increasing complications like infections and bleeding, and they had  same, good outcomes of those who didn’t double-book. The other good news is that seven separate studies of double-booked cases (all since the MGH dust-up caused by a whistle-blowing orthopedic surgeon) revealed no difference in complications compared to single cases.
THE BAD NEWS is …
The double-booked neurosurgical patients had 30 minutes longer of anesthesia and their incisions were open for 30 minutes longer (increased chance of contamination). The other bad news is that orthopedic surgeons who double-booked hip surgery have higher complications than those who didn’t. (JAMA Surgery. Nov. 15, 2017)

THE GOOD NEWS is …
Congress just passed the Elizabeth Warren (D-MA) co-sponsored 2016 bill that will allow people to obtain hearing aids (called PSAPs- “Personal Sound Amplification Products”) over the counter (OTC)without a prescription. These PSAPs will be much cheaper than the currently exorbitantly priced “professional hearing aids”, and will be just as good using upgraded technology.
THE BAD NEWS  is ...
You won’t be able to buy them for at least three years. That is how long the FDA will take to develop regulations (specifications) and approve their sale. In the meantime, some of my friends will continue to “not hear me”, and my post office box will continue to overflow with offers of “free hearing tests” from professional vendors of very expensive hearing aids. (Boston Globe November 12, 2017)

THE GOOD NEWS FOODS of  Thanksgiving are…
1. Turkey – Lower calories than a standing rib roast and a lot less sodium than spiral ham. The myth of tryptophan making us drowsy has been debunked several times.
2. Pumpkin – That’s “pure” pumpkin spice. No sugar. Pumpkin pie filling with 27 grams of sugar in a half-cup is a no-no.
3. Sweet potatoes – cooked in just a little olive oil only. Casseroles and canned variety are to be avoided.
4. Cranberries –  It is high fiber and has rich plant compounds to help you metabolize the sugar which they grudgingly admit you have to add to make it taste good.
5. Hot cocoa – Make your own, of course, with unsweetened cocoa, low-fat milk, and a teaspoon (a whole teaspoonful?!!) of sugar.
6. Shrimp cocktail – This is my favorite. I am so glad nutritionists suggest it over cheese and crackers. Forget about its cholesterol (dietary cholesterol has little impact on your blood level), but go easy, of course, on the high sodium cocktail sauce. (You knew the nutritionists had to ruin a good thing eventually).
THE BAD NEWS FOODS are …
1. Egg Nog – 224 calories and 20 grams of sugar per half-cup (Whoever drinks only half a cup?)
2. Coffee drinks made with peppermint flavor, 2% milk, and 13 teaspoons of sugar. (A holiday grande latte at Starbucks can contain as much sugar as 7 glazed Dunkin Donuts.)
3. Pecan pie – A surprise. Twice the calories of pumpkin pie!
4. Green bean casserole – Another surprise. The word “casserole” is the tip-off. A half cup of green beans has 20 calories. A half cup of the green bean casserole with creamy mushroom soup and crispy fried onions weighs in at 227 calories a half cup.
5. Cranberries – What? They were labeled “good” above. Yes, but their medical benefits (separate from their nutrition ones) have been debunked. (On Health, Consumer reports, December 2017)

THE GOOD NEWS is …
A daily dose of  a 83 mg.baby aspirin  reduces your chances of a cardiac event, either a repeat event  or even a primary cardiac event if you are at high risk.
THE BAD NEWS is …
If you stop taking that aspirin for any reason your chance for a cardiac event in the next year increases by 37%, … at least for 1 out of every 74 Swedes in this study. “This study provides strong evidence for continuing aspirin indefinitely…” (NEJM Journal Watch Cardiology, Nov. 2017)

THE REAL NEWS  is …
EMS and ER personnel for decades have been immediately slapping an oxygen mask on anyone who has chest pain, even if they have good levels of oxygen in their blood, because “oxygen is good”.
THE BAD NEWS is …
Since 1950 we have “known” that oxygen doesn’t really help. In 1976 a prospective, randomized study showed that the patients receiving oxygen had larger infarcts and a slight trend toward higher mortality than those who didn’t receive oxygen. “Notwithstanding the results of this trial, for the next 40 years, oxygen therapy continued to be administered routinely to patients with acute coronary symptoms even though their oxygen blood levels were normal.”  A current study of 6629 Swedes (what is it with all these studies of Swedes?) with chest pain and normal oxygen levels in their blood showed that those who received 100% oxygen rather than ambient air had no benefit from it. “It is clearly time for clinical practice to reflect this definitive evidence.” (NEJM September 28, 2017)

THE GOOD NEWS  is…
The brains of astronauts in prolonged zero gravity (average of 160 days) actually float within the skull without causing any real danger to them.
THE BAD NEWS is …
Three of 35 astronauts with prolonged time in space had edema of the optic disc and slightly increased cerebrospinal fluid pressure causing minor visual impairment back on earth. Actually, this was good news for the researchers because it gave them a publishable article justifying expensive use of MRIs, including cine MRIs, to define a new syndrome, VIIP (“visual impairment and intracranial pressure syndrome”. (NEJM November 2, 2017)

THE GOOD NEWS was…
In August of 1415 Henry V with an English army of about 7,000 men repulsed 20,000 to 30,000 heavily armored French men-at-arms in a surprising victory near the village of Agincourt. Celebrated by Shakespeare as a triumph of English rhetoric, historians point to the self-defeating crush of the French charge as the cause.
THE BAD NEWS is …
Exercise physiologists recently dressed volunteers in 15th century armor weighing from 30 to 50 kilograms and ran them on a treadmill while monitoring their oxygen consumption. The armor caused at least a doubling of the volunteers’ metabolic requirements. The same amount of weight worn in a backpack only caused a 70% increase. The weight of the armor distributed over the French arms, hands, legs, feet, and head as the men-at-arms slogged through 300 yards of deep mud to reach the English probably helped make it the “final charge” for many of them. (Scientific American October 2011)


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