Getting to Know Herb

If a recent report from Mayo Clinic Proceedings is accurate, chances are good that you are taking some kind of herbal supplement. If so, chances are nearly half that you doing so without a clue.

Bottom line first
A new population survey supported by NIH suggests that most adults taking herbs aren't using them in a manner supported by scientific evidence.

This study in 50 words or less
Researchers surveyed U.S. adults, identified 10 commonly used herbs and asked respondents what they took them for. They then compared this information to a database of scientifically validated uses for the herbs.

Yes, but. . .
This wasn't a survey showing who's taking what and how much. But it's the first attempt to find out whether people taking herbs are doing so in a way that's consistent with the best clinical evidence.

So what are you going to do about it?

• If you're going to take herbs, head directly to the Department of Clue Procurement.
• The Natural Standard database (used by researchers in this study) is the best source of evidence-based information on herbs and dietary supplements. For these invaluable reports, visit this link of the federal government's MedlinePlus.gov site, and scroll down until you find the name of the herb or supplement in question. Here's an example of the report on garlic. Or just stick [name of herb] and "Natural Standard" in Google. Many sites have Natural Standard reports on them.
  

Reading up on your supplements and herbs will not only help you find out what's been scientifically proven and what hasn't. It will help you avoid the biggest dangers of herbal self-treatment: drug interactions; deferring or avoiding potentially more effective care; and wasting your money.

One more thing
The ten commonly used herbs studied included: echinacea, ginkgo, ginger, garlic, ginseng, kava-kava, soy, St. John's wort, ragweed (!), and peppermint.

High Carbs, High Blood Pressure: Not Quite Linked

Remember the good-carbs/bad-carbs spasm of a couple of years ago? The adventure continues.

Bottom line first
There may be a tiny link between higher-carb diets and high blood pressure--but it's so slight, and the evidence so shaky, that it's not worth doing anything about.

This study in 50 words or less
It's widely accepted that saturated fats harm heart health. Researchers analyzed 10 studies to explore whether replacing saturated fat in the diet with "healthy" (monounsaturated) fats would be better than adding carbs. In some studies, a slight link was observed.

Yes, but. . .
The finding was not statistically significant--which is to say there was not, technically speaking, an association between carbs and blood pressure at all. The studies did not examine what kind of carbs were eaten (high-fiber, whole grain or white flour and sugar, for instance).

One interesting detail
The researchers theorize (only theorize!) that higher carbs' link to high blood sugar may be responsible for higher blood pressure. This deals with the biology behind the metabolic syndrome cluster of symptoms: elevated blood sugar, low "good" (HDL) cholesterol, high blood pressure, and others. But--you guessed it--more studies need to be done to confirm that.

So what are you going to do about it?

• Don't fuss about amounts of carbs (unless you're on a prescribed diet for a medical condition such as diabetes or high blood pressure). When you eat carbs, choose higher-fiber, whole grain, whole food carbs when you can. When you're eating fats, avoid saturated (in animal products like fatty meats and whole-fat dairy) and choose "good" fats like the kind you find in fish, nuts, olive oil, avocados.
  
• If you have or are at high risk for high blood pressure, take it seriously and make some changes in your life. Untreated it can kill you, slowly but surely.

Vitamin D, Calcium: Ignore This News, Please

The Truth Squad has been awfully busy lately smacking down news stories that lead people to believe stuff that, for lack of a subtler term, ain't true.

A new report today from HealthDay is titled Vitamin D, Calcium Might Lower Breast Cancer Risk. To be fair--and the Truth Squad is rigorously fair--on the HealthDay site the story bears the key subhead, "But it's too early to recommend supplements, one expert says." On many sites, however, the subhead is suppressed.

Bottom line first
A study appearing in the Archives of Internal Medicine suggests a possible link--a possible association, not proof of cause-and-effect--between higher intake of Vitamin D and calcium and reduced breast cancer risk.

This study in 50 words or less
Researchers viewed self-reported dietary data from 30,000 women participating in Harvard's ongoing Women's Health Study. After 10 years, they found premenopausal women who got the most D and calcium had 30 percent fewer cases of breast cancer. Not so for postmenopausal women, however.

Yes, but. . .
The study didn't account for exposure to sunlight--a major source of vitamin D for people under 60 years old. At best this study shows an association, not cause and effect. Nobody involved with the study suggests women take D and/or calcium supplements to cut breast cancer risk.

So what are you going to do about it?
Nothing. Women near menopause often take calcium and vitamin D supplements for bone health. The evidence on that is pretty sketchy too. Worse: There's some evidence that high levels of D and calcium are linked to brain lesions in older people. Of course, that evidence is no more conclusive than today's report in Archives of Internal Medicine.

Wondering about best practices for breast cancer risk? I like this report on things you can and can't change to cut your risk from the American Cancer Society.

One more thing
This stuff is complicated.

Self-treating intuitively with supplements, or even diet, based on news headlines can result in more harm than help. Even if the study comes out of Harvard, follows a lot of people, and appears in a well-regarded peer-reviewed journal. The fact that a study is scientifically credible, and even important, has no bearing on whether it has implications for you.

So what are you going to do? Eat lots of different whole foods, and avoid eating much crap. Get exercise. Keep your brain busy. Love your family, or someone.

Everything else, for now, appears to be details.

Old Tale About Joints/Weather Proven, Sort Of

You know that old grandpa story about how a bum knee can predict the weather?

Bottom line first
New evidence backs up (but of course does not prove) that low barometric pressure and cold temperatures are linked to osteoarthritis pain.

This study in 50 words or less
Researchers compiled self-reports of arthritis knee pain from an earlier study on the possible benefits of the dietary supplement glucosamine. They compared that with local weather data on the days of the pain reports. Low temperatures and barometric pressure were linked to greater pain.

Yes, but. . .
This wasn't a gold-standard clinical trail. But in some ways it was better. Scientists exploring this question have always had to deal with the problem that subjects' perception of pain could be influenced by their expectation that weather affects it. By looking at data gathered (probably) in ignorance of local weather, they avoided this problem.

So what are you going to do about it?

• Nothing, really. You may get some comfort knowing your suspicion that aches are due to the weather may not be all in your head.
• Since the Cox-2 inhibitor Vioxx has been pulled off the market--and a lot of folks recommend steering clear of any Cox-2 drug still on the market--it's worth knowing about the alternatives. Two good sources: The Arthritis Foundation's thoroughgoing post-Vioxx report on medications and other treatments. And if you're really into this stuff, check out this 15-page MedicineNet report for doctors assembled after the Vioxx withdrawal. Also check out this Mayo Clinic report about self-care for osteoarthritis.
  

Eat Your Broccoli, Ignore This Study

Here at the Truth Squad, we love news reports like this one that crawled across the Reuters wire yesterday: "Cruciferous veggies may ward off bladder cancer"!

Bottom line first
Eat your veggies. Duh.

This study in 50 words or less
Researchers at the M.D. Anderson Cancer Center matched 697 people with bladder cancer with 708 healthy but otherwise similar people. They asked each group what they ate. The cancer group ate fewer half-cup servings per day of cruciferous veggies: 1.41 half-cup servings for the cancer group, 1.76 servings for the controls.

Yes, but. . .
The difference between the groups was statistically significant. The study advances knowledge in cancer development. But in practical terms, 1.4 half-cup servings isn't much less than 1.8 half-cup servings--a couple of broccoli florets, or cauliflower. . .knuckles, or whatever you call them.

So what are you going to do about it?
Vegetables are full of stuff that appears to make people healthy. Scientists are studying the details, which is very good. For for the rest of us, there's nothing here that says it's wise to, say, replace cucumber in your diet with broccoli, or tomatoes with cauliflower. That's just nervous self-delusion.

For a Healthy Holiday: Move, Please

Let's head into the Memorial Day weekend with three short items in our heads:

Kids with Type 1 diabetes who watch 2 or more hours of TV daily have a harder time controlling their blood sugar than diabetic kids who watch less TV. More evidence--this by very, very broad, rickety inference [hey, cut me a break, it's a holiday weekend]--that exercise [i.e., the opposite of watching TV] can help control blood sugar in diabetics. The voluminous crap often eaten while watching TV may play a role too. Research on exercise by adults with Type 2 diabetes, or just at risk for it, has shown the same thing. Exercise, even a regular mild walk, helps control blood sugar.

Obese adults with asthma suffer worse symptoms than normal weight people with asthma. One interpretation offered by presenters at an American Thoracic Society meeting: Severe asthmatics get less exercise, which makes them more likely to be obese.

Overweight people may get less benefit from strength training than people of average weight. This from a report in the Journal of Strength and Conditioning Research. Heavier people still got lots of strength gains, just not as much as the leaner folk.

And what does all this mean for you? Not much beyond this: Have a great holiday weekend--but be active while you do it.

Strength Training May Make Muscles "Younger"

As you know, here at the Truth Squad we are highly skeptical about the practical, on-the-ground value of a lot of scientific research. But a report about muscle aging published in the online journal PLoS One is fascinating and relevant to middle-agers pondering the value of strength training.

This study in 50 words or less
Researchers compared the molecular constitution of muscle tissue of young and old volunteers. The older people performed strength training 2 days a week for 6 months. At the end, the older folks' muscle tissue more resembled the younger people's. The old began 59 percent weaker; they ended 38 percent weaker.

Yes, but. . .
While the study wasn't blinded or placebo controlled--and the sample small--it used tissue samples and a rigorously supervised exercise program. Applicability rating: A-.

Key details

• The subjects started with one set of the more common exercises on health-club-style machines using half the weight they could lift once (i.e., if they could lift 40 pounds one time, they started with one set using 20 pounds). By the end they were doing 3 sets with 80 percent their single-rep maximum.
• This study actually shows--and we use this phrase very carefully in this blog--"reversal of muscle aging" on a molecular level (and in gene expression, which is too complex to get into in a short blog entry). Major stuff, in the world of exercise science.
  
• These researchers are not among those longevity-promising crackpots who often talk about "reversal of aging."

So what are you going to do about it?

• If you're not doing strength training, start.
  
• Hire a qualified personal trainer to get you started. I'm not just saying that; it's vital for middle-aged people for injury prevention and ensuring your program matches your goals.
  
• Here is a bunk-free article on personal trainer credentials, what to look for, etc. My only bone to pick is that it suggests an academic degree in physiology or some such is necessary. Many trainers lacking related degrees but who have certification, brains, empathy, skill and ambition, are excellent trainers. And I've met a few trainers with degrees who are outright dangerous. (Don't get me started.) AARP (hey, don't laugh) has a good guide on personal trainers too, since it focuses on trainers for middle-aged people and beyond.
• Don't think aerobic exercise will have the same benefits as shown here. You're going to need to lift weights. This point--that aerobic and strength exercise have unique benefits, and to be healthy you should get both--has been demonstrated in other studies. Here's a great story about the cardio vs. strength training debate. (Interest revealed: I'm former editor of The Washington Post health section.)
  

Big Waist? Expect Problems Below It

Today's news item would hardly be worth a nod--except that it reinforces a key point about the health risks of wearing really big pants that's worth mentioning.

This study in 50 words or less
New data suggests that as men's waistlines exceed 36 inches in circumference, their risk of what urologists call "pelvic dysfunction"--including such joys as a growing prostate, difficulty peeing, difficulty getting erections and ejaculating, even high PSA levels--increases proportionately.

Yes, but. . .
The study group was small (88 men average age of 62) and the study isn't published or peer-reviewed (it was presented at an American Urological Association meeting). It's not a clinical trail--they couldn't randomize guys to make some really fat to see what happened to life below the belt--so it can only show a link at best. Power to drive lifestyle decision: D.

So what are you going to do about it?
If you're a man with a waist larger than 40 inches, lose weight, and lose belly fat. If your belly measures 36 to 40 inches, you still should work it off.

Why this matters
A big waist circumference is one component of what doctors call metabolic syndrome, which is a cluster of symptoms (including elevated blood glucose levels, high blood pressure and low HDL cholesterol) that are linked to higher risk for heart disease, diabetes and death. This study simply adds several more good reasons to control your waist size.

And notice I say "waist size," not "weight." For more on that distinction, see this article that explains the predictive value of waist circumference as it compares to the far-more-widely-used-and-abused BMI (body mass index).

Short version: Guys with a waist bigger than 40, and women with a waist bigger than 35, have seriously elevated risks of winding up in a hospital bed or worse.

Drinking, Dementia and Doubt

Those who take comfort in reports suggesting drinking can be healthy (and you know who we are) have a new bit of research to savor--in moderation, of course.

A new report shows that drinking up to 1 alcoholic drink per day may be linked to lower risk of the dreaded shift from "mild cognitive impairment" to full-blown dementia, of which Alzheimer's disease is the most fearsome.

Mild cognitive impairment (MCI) is a state of creeping brain dysfunction where others notice your memory loss but it doesn't (yet?) affect your daily life.

What midlifer doesn't have those what-did-I-stand-up-for moments? But since MCI often precedes Alzheimer's, it's worth knowing more about.

Unfortunately, media reports on this study notwithstanding, this research sheds little light.

This study in 75 words or less
Italian researchers used data gathered as part of a long-term population study. They found people with MCI and who had around 1 alcoholic drink per day (15 grams, if you're measuring) were less likely to progress to dementia than abstainers. Subjects who had more than one drink per day saw no benefit. Researchers followed the subjects, who were 65 to 84 years old when the study began, for about four years.

Yes, but. . .
The study group was tiny (only 121 people were followed, of whom 55 were about-a-drink-a-day-ers). The study shows, at best, an association between a little drinking and lower chance of getting dementia, not a cause-and-effect relationship. In terms of its power to guide decision-making, this study gets a D.

So what are you going to do about it?

• If you drink around one drink a day, hey, good for you. Other research suggests a variety of health benefits associated with drinking around a drink a day for women and up to two per day for men. Most significant possible benefit: lower risk of cardiovascular diseases.
• If you don't drink, don't start. Nobody should begin drinking for its health benefits. The chance of driving-related accidents, a possible increase in some cancer risks, a potential evolution into alchohol dependency, and significantly elevated lifetime risks for regrettable behavior, are well-documented too.
  

Oh, one more thing
Nobody really knows how alcohol may deliver health benefits. One theory is that it relaxes blood vessels, keeping pathways flexible and open. One theory about Alzheimer's suggests a link between poor circulation and the disease. It's tempting to connect these dots. Don't. A lot more research needs to be done.

Elsewhere in the Midlifescape
The popular midlife-improvement blog LifeTwo has a good item on three recent reports on sleep apnea: It's linked to diabetes, heart attacks and car crashes. . . .and blogger Susan Anderson on ThirdAge has an amusing take on the indignity of someone thinking you're (a lot) older than you are.

Avandia: Big Trouble, Time for Action

Today's big news suggesting that the blockbuster diabetes drug Avandia can increase risk for heart attacks and death is itself a blockbuster. It's got all of the trackmarks of a health story with serious staying power, maybe the biggest since Vioxx:

• A blockbuster drug for a condition shared by millions of people shown to be dangerous
• A study in a first-rate journal (New England Journal of Medicine) by first-rate researchers
• A big drug company (GlaxoSmithKline) claiming the findings are wrong
• A suggestion of coverup and profiteering likely to set mainstream health journalists a-slobberin'
• A huge opportunity for personal injury lawyers

Bottom line first
Diabetics taking the drug Avandia seem to have a higher risk of heart disease and death due to heart-related causes than those using other treatments.

This study in 75 words or fewer
The meta-analysis combines data from 42 existing studies with almost 28,000 participants. It compared heart attacks and heart deaths in people taking Avandia with those taking placebos or other drugs. The Avandia group had a 43 percent higher risk of heart attack and 64 percent higher risk of cardiovascular death.

Yes, but. . .
When you look at lives affected, the numbers are small: For every 1,000 Avandia patients, about 9 would have died. For every 1,000 in the control group, 4 would have died. Co-author Steven Nissen gets a lot of support from big pharma, but reports that all the money is given to charities.

Having said that. . .
Nissen of the Cleveland Clinic is one of the biggest names in cardiology research. Heart disease is the leading cause of death for diabetics, so any apparent increase in risk is worth taking a hard look at. "Only" 5 extra deaths out of 1,000 matters a lot if you're related to one of them.

So what are you going to do about it?

• If you're on Avandia--or any diabetes medication--talk to your doctor immediately. Expect him or her to provide a don't-panic response. But it's a good time to push for a talk about alternatives, your heart disease status, etc.
• Critics charge that Avandia isn't much better than older, cheaper drugs at controlling blood sugar. This study may shift the risk/benefit ratio in favor of other treatments.
• People with uncontrolled blood sugar can't afford to ignore it: untreated diabetes leads to heart disease, amputation, blindness and, not to put too fine a point on it, death.
• Many cases of type 2 diabetes are essentially the product of lifestyle--and reversible, or controllable--with a remarkably intuitive diet and exercise regimen: Eat less crap, lose some weight, and take a brisk, 30-minute walk nearly every day. This simple stuff often gets overlooked when people start yammering about the glycemic index, starch exchanges and so on. The American Diabetes Association has details on the diet and exercise regimen.

Oh, one more thing
Depending on your viewpoint, a meta-analysis is either the best or worst way to summarize research. (Using more data adds statistical power; mixing different studies dirties the data.) Expect GSK, the FDA, Public Citizen and doctors to be fighting this one out for a long time. And did we mention the personal injury lawyers?

Deadly Multivitamins? Here we go again. . .

Along comes another study today that, as interpreted by some media, makes it appear multivitamins are a threat. This time, the finding suggests they may make advanced prostate cancer worse--and more likely to kill. Scary stuff.

Stop us if you've heard this before: The reality is much more complicated, and there is much less to fear than the headlines suggest.

This study in 100 words or less

NIH-affiliated researchers followed almost 300,000 cancer-free middle-aged men for 5 years. Guys who reported taking more than one multivitamin per day were more likely to see prostate cancer worsen, if they got it. They were also more likely to die of the advanced cancers than were non-multi-poppers.

Taking a lot of multis did not raise their risk for getting prostate cancer, or getting the localized kind--just for making the advanced type (the sort that spreads outside the prostate gland) worse if they had it. The "multivitamins" they took often were pills that included high doses of selenium, beta carotene or zinc. The study is in the Journal of the National Cancer Institute.

Yes, but. . .

This wasn't a clinical trial that followed individual men and controlled for a lot of factors. It looked at links between vitamin intake and cancer incidence in a large group. No data was collected on how big the doses of vitamins were. Much of the data was self-reported. In terms of this study's ability to guide individual behavior, I'd give it a C+.

Having said that. . .

None of the researchers had a conflict of interest. The study was conducted rigorously, given the limitations of its design.

So what are you going to do about it?

• Don't take any specific vitamins beyond a multivitamin, unless your doctor tells you otherwise.
• But even a simply multivitamin pill (Centrum, One-a-Day, etc.) may not do you any good: Other recent (high-quality but suggestive, not conclusive) research has shown no benefits, and possibly some harm, from taking regular off-the-shelf multis.
• Taking selenium, beta carotene and zinc seem to be particularly bad for guys with a family history or other elevated risks for prostate cancer. No good reason to mess with them--again, unless your (well-informed) doc says to.
• So: Eat your fruits and veggies, which deliver vitamins and minerals in a package that includes other nutritious stuff, some of which we don't even know about. There are plenty of benefits, pretty well established, that eating a lot of fruit and vegetables is good for general health, and may cut (as this World Health Organization report nicely summarizes) risk and impact of some diseases. (But note some recent research on fruits and veggies that fails to prove a solid link; go figure.)

It certainly is unlikely to hurt. And produce has a lot fewer calories than those Oreos, bucko.

Just 10 Minutes a Day? Um, No. . .

Wow, today there's a report that says overweight women can cut their risk of death with just 10 minutes of exercise per day!

As usual, the reality is far more complex--and the well-publicized conclusion outright wrong.

Top line

A study appearing in the Journal of the American Medical Association reports that the more exercise middle-aged women got, the more they reduced some (but not the most important) risk factors for early death.

Not quite an item for the Duh Files, but not groundbreaking stuff, either.

This study in 100 words or less

The idea was to test the benefits of doing less (50 percent) or more (150 percent) of the usual 30-minutes-of-moderate-exercise-per-day public health recommendations.

Researchers gathered about 500 overweight or obese middle-aged women who were at risk for, or already had, high blood pressure.

• The low exercise group worked out about 72 minutes per week (about three 25-min sessions)
  
• The follow-the-federal-recommendations group did 136 min/wk (three 45-min. sessions)
  
• The most active group exercised 192 min/wk (three hour-long sessions)
  

They all worked out on treadmills or exercise bikes about 3 times per week at about 50 percent of their exercise capacity. (Some did 4 days, which would change the minutes/session above.) They did this for 6 months. They kept the other stuff in their lives (like diet) unchanged.

What did they find?

• Nobody saw a drop in blood pressure, nobody lost weight, and nobody saw an improvement in key cardiovascular disease risk factors.
• But the all women did get more fit (as measured by heart-lung performance and strength) and came away with smaller waists.
• These last two were directly linked to amount of exercise. They more they did, the better the results. But even the least active group saw measurable improvements.

Yes, but. . .

Two of the researchers have taken money from the diet company Jenny Craig. Life Fitness donated the exercise equipment. And notice that the exercise didn’t improve blood pressure or lead to weight loss.

Two more caveats: We don’t know whether the findings apply similarly to men. And the minutes of exercise were divided into about 3 (sometimes 4) per week; the feds recommend exercising nearly every day.

Having said that . . .

The amount of exercise was rigorously controlled, the outcomes rigorously measured. The outside funding likely had no effect on the outcomes. The respected Cooper Institute managed the study. I’d give this study a quality rating of A-.

So what are you going to do about it?

Realize this: If you can’t follow the advice of 30 minutes of moderate activity on most days, doing some is better than none.

But don’t expect mild exercise 3 days a week alone to change your life. This study suggests it likely won’t lead to meaningful weight loss or better blood pressure or improved heart disease risk. Other studies suggest that adding other lifestyle changes--a better diet, a higher level of daily(non-exercise) activity, taking fish oil supplements (see yesterday's entry)--may help.

The sort of exercise tested here will likely make you fitter and reduce at least one risk factor for early death--a big waist. Here’s more information on the risks of big waist circumference.

Fish Oil + Exercise: Better Together

A study in a recent issue of the American Journal of Clinical Nutrition shows that fish oil does good things for your heart, and adding exercise helps a little more.

So if you're either eyeing or trying fish oil supplements for heart health, this study suggests it may help reduce your risk of bad stuff happening in your chest.

This study in 100 words or less

Researchers rounded up several dozen adults who were at least moderately overweight (not hard to find these days) and who had risk factors for heart disease. Some of them got fish oil alone, some got fish oil and exercise, and some got a placebo and exercise, some placebo alone.

Those who got fish oil took 6 (six!) grams via supplements per day.

The exercisers walked (or ran) three times a week for 45 minutes, averaging 75 percent of their estimated maximum heart rate.

The researchers watched how things developed for 12 weeks.

So what happened?

• People who used fish oil alone showed improvements on key risk factors for heart disease: higher HDL cholesterol, lower triglycerides and better behaved arteries.
• Exercise had independent happy effects on blood vessels.
• The oilers and walkers each lost body fat.

Yes, but. .

The study lasted only 12 weeks and was fairly small, as these things go. The researchers didn't try to figure out if a lower dose of fish oil would work as well. They didn't take diet into account.

Having said that. . .

The fish oil part of this was double-blind. (Neither researchers nor subjects knew whether they were getting fish oil--tuna, in this case--or a placebo.) Nobody backing the study had a financial interest in the outcome. That's getting hard to come by these days. Overall, I'd give this study a "B" grade.

So what are you going to do about it?

If you're fairly healthy but worried about your heart (a show of hands, please? Yes, I thought so), consider adding fish oil supplements to your staving-off-death-and-disease regimen.

• But 6 grams (six!) is a lot of fin grease. I take this stuff, but only two 1-gram squishgels per day. If you buy fish oil supplements at Costco, it's about 2 cents per pill, or 12 cents per day. But you can go broke on premium brands.
  
• Everything you want to know about fish oil supplements (and fish oil as it's found in fish) is in the best-of-breed Natural Standard report. It also talks about what fish oil can--and can't--do for your brain, joints and other body parts.
• It's worth noting that the exercisers in this study wore Polar Heart Rate Monitors (defunct F1 models; this newer HRM is the closest Polar unit you can come today, about $70). These devices helped them keep their tickers in the 75-percent-of-meltdown range.
• Polar's Web site has a pretty good backgrounder on heart rate and health. I'm a huge fan of Polar HRMs.
• Worried that fish oil capsules may carry some of the contaminants like mercury you hear about in top-of-the- food-chain fish. This reassuring report says: Don't be.