Hello, I Must Be Going

Greetings, readers of this blog. I have good news and. . .well, good news.

The good folks at HealthCentral.com, a network of Web communities devoted to 28 health conditions and interests, have adopted my blog and now feature it on their site.

You'll find my profile and first handful of entries here. You'll notice the following changes:

• Practically none. Same format, same mission--a dedication to parsing the study-of-the-day and sorting out what it says, what it doesn't, and what, if anything, you should do about it. I will be writing (nearly) every weekday.
• Well, one change. Because HealthCentral is devoted to various niche areas, from acid reflux to sleep, you'll find my entries posted in each of those areas. You will also likely find the daily entry on the main HealthCentral home page.
• And with my HealthCentral profile, you'll see a photograph of me. Yes, it's true. I shave my head. In line with my commitment to personal health best practices, however, I always polish it with SPF 30 before leaving the house. If you look closely at the photo, you'll see the distinctive gloss.

I hope you'll follow me to HealthCentral. In any event, thanks for reading the home-rolled version of this blog. It's your support that's helped me take my show to a larger audience.

Cheers,

Craig Stoltz

You Say Lycopene, I Say Tomato

I have to admit I love it when the supplementeers are rocked back on their heels. For quite some time folks who sell the nutrient lycopene in dietary supplement form have been crowing about its benefits for vision, prostate health and cancer prevention. Some in the tomato "industry" (can vegetables have an industry?) have rallied for the FDA to permit health claims for tomato products.

Two recent studies pretty much upend those claims. Details? Funny you should ask.

Bottom line first

Lycopene does not appear to reduce risk for prostate cancer, and there is little credible evidence that tomatoes or tomato products are linked to lower cancer risk.

These studies in 50 words or less

Study 1: Researchers reporting in the journal Cancer Epidemiology, Biomarkers, and Prevention followed 28,000 men for eight years and found no link between blood levels of lycopene and risk of prostate cancer. Study 2: An FDA review of evidence about the cancer-fighting properties of tomatoes Journal of the National Cancer Institute.

Yes, but. . .

• Study 1 was not a gold-standard clinical trail; it followed a large group of men closely over time. Power of this kind of study: C. Study 2 analyzed 145 different reports with different methodologies. Depending on which side of the tomato divide you stand on, this is either a strength or weakness of the study. Earlier, less thoroughgoing studies have found some possible/minor/both benefits linked to tomato consumption.
• Study 2 leaves open the possibility that lycopene/tomato/tomato products may reduce the severity of prostate cancer, or likelihood of the cancer progressing.
• Study 1 found, as a secondary (less statistically dependable) finding, that high blood levels of beta-carotene (responsible for the orange color of carrots), was linked to a higher risk of aggressive prostate cancer. Previous studies, including those of smokers, have suggested a high beta carotene/higher cancer risk link.

So what are you going to do about it?

I like what Karen Collins, of the American Institute for Cancer Research, a D.C. nonprofit that supports the role of diet in cancer prevention, told the Boston Globe: "We don't have the evidence to jump into lycopene supplements. But we do still recommend eating tomatoes, cooked and raw, not because they have magical powers but because they are a great source of many nutrients and are part of a good, plant-based diet."

Our very good friends at Natural Standard (Truth Squadders will recognize this motif) report all that was known about lycopene until these studies came out. Funny thing: NS never gave any lycopene claims any higher grade than C.

Join SparkPeople. Says Who? A Medical Journal.

Here's something you don't see everyday: a wellness Web site endorsed by a medical journal.

A study of 18 online user groups devoted to weight loss, published in the American Journal of Medicine, cited SparkPeople as a site users should turn to for support and accurate information. The authors essentially were testing the accuracy of content in community forums. They found that larger communities with many regular posters were indeed mostly self-correcting (as Wikipedia allegedy is. But don't get me started riding that hobby horse.)

Wrote the authors, addressing clinicians seeking to help patients lose weight:
Refer patients to high-activity forums, such as the “Diet and Nutrition” or “Fitness and Exercise” forums on http://www.sparkpeople.com/ or other forums with more than 1,000 messages per month.

They also looked at the fora of CalorieKing, the delightfully named 3fatchicks, about.com and others.

Stat freaks should check out the full study linked above, which cites how many errors they found, how many were corrected by the community, how many were serious, etc. (Answers: Not many, about 1/3, very few).

As it turns out, I participated in the SparkPeople community for a year or so, as a personal experiment in online health communities. (Also I wanted to cut 10 pounds.) I can tell you it is a great source of motivation and support, plus first-rate expert advice. I don’t think I ever got a bum steer.

Of course I could have written a novel in the time I spent on the site, but that’s another story.

Antidepressant Meds and Pregnancy: Risk report

From the Where Credit is Due Dept.: the L.A. Times's Denise Gellene did an excellent report on two studies showing a link between elevated risks of birth defects when mom takes antidepressants during the first trimester of pregnancy.

If you're pregnant or taking antidepressants like Zoloft or Paxil, check out Gellene's full story and the New England Journal of Medicine's two different studies on the birth defects. If not, here are the highlights:

• The risks include birth defects of the brain and skull. There is also a risk that the babies will experience withdrawal, including such symptoms as tremors.
• The risks of these problems are small, less than 1 percent--but still worth considering, as the effects themselves are serious.
• The study analyzed baby/mom pairs after mom had taken anti-depressants during the first trimester. This was not a gold-standard clinical trail, but an ambitious attempt to find a link between the drugs and negative outcomes.

The Times's story and the studies point out that the risks of untreated depression during pregnancy are significant. Therefore moms should consider therapy during the first trimester rather than continuing drugs--only in consultation with their doctors, of course.

Wine-ing About Bad Headlines

"Merlot Mouthwash?" winks a headline of an article published on MSNBC.com.

The simple answer: No, of course not. Geez.

Bottom line first
Scientists reporting in the Journal of Agriculture and Food Chemistry have discovered that wine, both red and white, has anti-bacterial properties similar to those of mouthwash.

This study in 50 words or less
Researchers, having observed that wine has anti-bacterial effects, thought that the acid content of wine may be responsible. They neutralized the acids and discovered that a variety of organic compounds is responsible.

Yes, but. . .
As the same researcher has pointed out in another current study, acidic beverages do considerable harm to dental enamel. In other words, trying to take advantage of wine's antibacterial properties to benefit your mouth will, to quote mom from a different context, "rot your teeth."

What are you going to do about it?
Ignore it. Tweaking with acidity in wine is going to muck with the taste. Imagine the wine label on the shelf: "Bison's Leap 2006 Sonoma Chardonnay: smooth with vanilla undertones and an powerful antibacterial finish."

Wondering about the proven health benefits of wine? A lot of what you'll find online is written by the wine industry. Start with Mayo Clinic's overview of alcohol's benefits--and risks--first.

Healing Skin from Within?

The L.A. Times has a solid story about the use of dietary supplements to "reverse the effects of aging." I think the report gives too much space to proponents, but it also provides some useful skepticism about the notion itself--that taking pills can undo damage and improve the way skin looks.

I'd argue there's one additional flaw in the story, and it's big enough to drive a Mini-Cooper through. The thesis upon which many supplements claim benefits to skin is this:

• Free radicals damage skin
• Anti-oxidants remove free radicals
• Therefore taking anti-oxidant pills "undamages" or at least reduces harm to skin

The problem: Many studies have shown that when anti-oxidants are taken as supplements, they can do as much mischief as they do good. The most famous example is how high doses of beta carotene appear to increase likelihood of lung cancer in those at high risk for it.

So what has been shown with decent science to improve skin health?

• Drinking plenty of water (actually the proof is weak, but the downside of drinking water is low)
• Staying out of the sun (5 to 10 minutes per day appears to be safe and beneficial for Vitamin D production)
• Not smoking
• Regular use of a moisturizer

Here is a fairly conservative take on maintaining skin health from Mayo Clinic.

Here's a more comprehensive look at skin "rejuvenation" from the Cleveland Clinic. It contains excellent research-based information about the topical application of anti-oxidants for skin health. It also talks about various dermatological interventions--you know, dermabrasion and the like.

More specifically and recently, here's a rough synopsis of a JAMA article demonstrating the value of Vitamin A when applied to the skin (not taken as a supplement).

And finally: We've said it before, we'll say it again. The Natural Standard offers a rigorous but readable rundown on the benefits/risks of nearly any supplement you want to take. Here's the main navigation. Bookmark it, and you'll be able to check out any claims made about dietary supplements.

Do Alternative Therapies Impede Pregancy? Beats Us

From the Annals of Continued Annoyance: This week's report on the link between alternative therapies and reduced chances of getting pregnant. I've got to say, this is one of the most vivid examples of lousy medical reporting I've seen in a while. (See the AP's version and ABC News')

Bottom line first
An unpublished study suggests that women who are more stressed out by infertility are more likely to use alternative treatments like acupuncture and dietary supplements. The study was not designed to see whether using those treatments results in lower fertility--it was designed to determine whether doctors should offer other interventions to reduce stress during infertility.

This study in 50 words or less
Danish researchers followed for about a year 800 women who were trying to get pregnant with IVF. The 261 who used some alternative treatment were more psychologically distressed than those who didn't--and were 20 percent less likely to get pregnant.

Yes, but. . .
The mainstream reportage on this one seriously miscast the study. To be fair, the study was presented at a medical meeting and not published, so there's no paper to read and no data to parse.

Still: The press release issued by the European Society for Human Reproduction and Embryology, upon which the Science Daily report above was based, indicates the study was designed to determine why some women chose to use alternative treatments--to control stress or to help them get pregnant? The researchers concluded that women who used alternatives were more stressed.

You may know where this is going: Women used alternatives because they were stressed. They were also less likely to get pregnant. Was this because they used alternatives, or because they were stressed? The researchers couldn't say.

Not only that: The researchers grouped all alternatives together, failing to distinguish between reflexology (targeted foot massage) and herbal supplements. They do not rule out that alternatives may reduce the effectiveness of medical therapies for infertility. But they do not conclude that either.

So what are you going to do about it?
If you're trying to get pregnant, know that none of the alternative treatments often recommended by practitioners and enthusiasts are not proven effective or safe. But there is no good research suggesting that they may reduce your chances of getting pregnant.

Here's a good article that planks out what's known and not about various alternative treatments for infertility.

Latest Chocolate Study: Slightly Bitter

You've undoubtedly heard that chocolate appears to have health benefits. Each time one of these studies appears the news articles are topped with some variation of this: "Finally, some sweet news for chocolate lovers. . . ." [Today's lede of the HealthDay story: "Chocolate lovers can rejoice again: More research has found that the antioxidants in dark chocolate can help slightly lower blood pressure." ]

AP also writes up the lastest study in this continuing series, which appears in this week's JAMA. It deserves a careful tasting.

Bottom line first

Eating small amounts of dark chocolate may lower blood pressure for people with borderline-to-moderate hypertension. Key words: "small amounts" and "may"

This study in 50 words or less

German researchers gave subjects 30g of Ritter Sport dark chocolate (approx. 1.5 Hershey's kisses) daily, or the same dose of white chocolate. After two weeks the dark group averaged about a three-point drop in blood pressure; the others didn't.

Yes, but. . .

The study was small (44 people) and brief (18 weeks). The effect during the study period was small. To invite a responsible inference, the study must be replicated with more people for a longer time. None of the people in the study had the usual cluster of linked to being overweight, coronary heart disease, smoking, etc.

So what are you going to do about it?

Gorge on chocolate daily to improve your cardiovascular health.

Joking, of course.

Previous studies have found a possible link between kinds of phenols, antioxidants found in cocoa and red wine, with improved cardiovascular health. This study suggests that the amount needed to get a benefit is really small--one square of dark chocolate per day, or 30 calories' worth.

The health risks associated with chocolate derive from the high-sugar,high-fat, high-calorie funbombs that they are delivered in.

Previous researchers, and those associated with this study, have suggested that small amounts of dark chocolate, added to a heart-healthy diet (such as the DASH diet designed to control high blood pressure) is okay, and -- who knows? -- could have a small benefit.

Nobody has said eating a daily Hershey bar, especially a milk (not dark) chocolate type, is a good idea. Achieving caloric balance, getting regular exercise and controlling salt in your diet will have a much more profound effect in high blood pressure than red wine, chocolate or any other foods purported to deliver health benefits.

Here's a good two-feet-on-the-ground reality check from last year by the folks at Harvard.

Fat Chance: New Fat Study is Still in the Lab

You probably caught yesterday's newswave on the link between fat and stress, based on a report in the journal Nature Medicine. Riveting reading; important science. Limited applicability to you. Let's dig in.

Bottom line first

Scientists may have discovered a mechanism by which junk food + stress becomes fat, at least in mice.

This study in 50 words or less

Researchers subjected mice to stress (standing in cold water an hour a day or being caged with an aggressive alpha for 10 minutes) and fed them high-sugar, high-fat diets. After two weeks, only those who ate junk food and were stressed got fat.

Yes but. . .

Needless to say: This was done on mice, not people. The mechanism of controlling the stress/fat interaction involves blocking certain neuropeptides, which may have unknown side effects when done on people. The researchers have applied for a patent and are pursuing commercial applications. Studies in people aren't expected to begin for two years.

So what are you going to do about it?

The behavioral implications of this research are suspect: If I control my stress, can I eat garbage and not gain weight? Data suggest otherwise.

Way far down the road, if this research pans out as the commercial boosters hope, there could be a shot or pill on the market that disrupts the process that makes stress + junk become belly fat. Then, as usual, we'll all have to look at the safety profile, the size of the benefit, which populations are best served, etc. We will inevitably be told we still need to eat healthy and get exercise.

Still, it's not a bad opportunity to take a look at the role of stress in your life if you're overweight or obese. A link between stress and obesity is fairly well established (if still controversial in some scientific quarters.)

So: Stop us if you've heard this before:

• Eat less crap.
• Get more exercise, which not only incinerates fat but moderates stress.
• Consider meditation or relaxation, which has been shown not only to reduce measurable stress but also confers cardiovascular benefits.
• Consider counseling to cope with major, chronic stressors like a troubled marriage or a bad boss.
• Eat less crap (oh, sorry, we already mentioned that).

Find a decent source on stress control and its relation to weight gain at about.com.