Heart Treatments for Diabetes Causing Harm
March 16, 2010
The New York Times
By Gina Kolata
Three aggressive treatment strategies doctors had expected would prevent heart attacks among people with Type 2 diabetes and some who are the verge of developing it have proved to be ineffective or even harmful, new studies show.
The results are surprising and disappointing, heart and diabetes experts say. An estimated 21 million Americans have Type 2 diabetes, the kind once known as adult-onset, and they are at enormous risk for heart disease. The only measures proved to reduce their chances — avoiding cigarettes and taking medication to lower bad cholesterol and blood pressure — still leave diabetics with a heart attack risk equivalent to that of a nondiabetic who has already had a heart attack.
So doctors began trying other strategies they hoped would help: getting blood pressure to a normal range; raising levels of good cholesterol and lowering levels of dangerous triglycerides; or modulating sharp upswings in blood sugar after a meal.
It is not known how many doctors have been encouraging patients to take these measures, but medical specialists say it seemed reasonable and tempting to do so.
“Doctors always want to improve the lives of their patients, and that often leads to pressure to treat more and more,” said Dr. Henry N. Ginsberg, director of the Irving Institute for Clinical and Translational Research at Columbia University. The new studies, he says, could save a lot of people from taking drugs that will not help them.
The papers were presented at an American College of Cardiology meeting on Sunday and are being published online by The New England Journal of Medicine.
In Type 2 diabetes, the body is resistant to the hormone insulin, leading to abnormally high blood sugar levels that can cause eye, kidney and nerve disease. But heart disease is what kills most patients. A quarter to a third of heart attack patients have diabetes, even though diabetics constitute just 9 percent of the population. And 25 percent of heart attack patients are on the verge of diabetes, with abnormally high blood sugar levels.
High blood sugar levels themselves increase the risk of heart disease, but researchers found two years ago that rigorously controlling blood sugar did not prevent heart disease or deaths in people with Type 2 diabetes. Researchers said the failure was probably because most of those patients also had other problems that made their odds of heart disease soar, like high levels of LDL cholesterol, low levels of HDL cholesterol, high levels of triglycerides and high blood pressure. And most were older and overweight.
Type 2 diabetes “captures all these risk factors in one patient,” said Dr. David Nathan, director of the diabetes center at Massachusetts General Hospital.
It seemed logical to look at the other risk factors. One large federal study asked if getting high blood pressure down to a level considered normal, a systolic pressure of no more than 120, would help protect diabetics from heart disease and save lives.
This hypothesis was promising because studies that observed populations found that heart disease and stroke risk increase continuously as systolic blood pressure rises from 115 on up, said Dr. William C. Cushman, a study investigator and chief of the preventive medicine section at the Veterans Affairs Medical Center in Memphis.
To put the idea of a normal blood pressure to the test, half of the study’s 4,773 participants took drugs to get their systolic blood pressure to 120 or below. The rest had a blood pressure goal of less than 140.
But lower blood pressure did not prevent heart attacks or cardiovascular deaths, and those with lower blood pressure were more likely to suffer severe side effects from the drugs, like high potassium levels or dangerously low blood pressures. They also took an average of 3.4 drugs to lower blood pressure, compared with an average of 2 drugs for those with the higher pressure.
A second, less rigorous study, involving 6,400 patients with Type 2 diabetes and heart disease, asked whether getting systolic blood pressure lower than 130 was any better than getting it to 130 to 140. It found that patients actually were worse off: those with the lower blood pressure ended up with a 50 percent greater risk of strokes, heart attacks or deaths.
National blood pressure treatment guidelines call for a systolic pressure of 130 or lower. That was based on expert opinion and observational studies, Dr. Cushman said. Now, he said, it is likely to be reconsidered when the group that sets the guidelines prepares a report this year.
People with diabetes also tend to have low levels of HDL cholesterol and high levels of triglycerides, a combination known to increase the risk of heart disease. And in some studies, treating that combination with a type of drug called a fibrate reduced risk in diabetics and nondiabetics who were not taking statins. So it made sense to see if fibrates also helped Type 2 diabetics who were taking statins.
It did not, concluded another arm of the federal study involving 5,518 people with Type 2 diabetes.
“It’s a disappointment,” said Dr. Ginsberg, a lead study investigator. “But it’s very, very important,” because it says most people will not be helped by taking the additional drug.
It means, said Dr. Denise Simons-Morton of the National Heart, Lung and Blood Institute, the project officer for the federal study, that “doctors and patients now know that the inclination to do intensive treatment that people seemed to think would be better for cardiovascular risk reduction wasn’t better.”
A final studyinvestigated the popular hypothesis that rapid rises in blood glucose after a meal were dangerous and could lead to heart disease. Many doctors were giving drugs assuming the hypothesis was correct, Dr. Nathan said.
“Every meeting you go to, some academic is talking about how postprandial hyperglycemia is really bad and that you should aim specifically to get it lower,” Dr. Nathan said. The study, he said, “is a direct test of that.”
The study, which involved 9,300 patients at high risk for diabetes because their blood sugar was high, tested the drug nateglinide, which enhances insulin secretion. It also tested a blood pressure drug. Neither decreased heart disease risk.
“Neither drug should be used in people with impaired glucose tolerance but not diabetes in order to prevent cardiovascular events unless there is another indication, like significant hypertension,” said Dr. Robert M. Califf, vice chancellor for clinical research at Duke University School of Medicine and chairman of the study.
Dr. Nathan, who wrote an accompanying editorial in The New England Journal of Medicine, agreed. “It is a negative study,” he said.
Some, like Dr. Daniel Einhorn, president-elect of the American Association of Clinical Endocrinologists, say the results of that study and the others would not necessarily dissuade him from taking such intensive measures with individual patients.
“It’s hard to make a case for a public health recommendation,” Dr. Einhorn said. “But that doesn’t mean there isn’t a benefit in an individual case.”
But no benefit has been shown, Dr. Nathan noted. The lesson, he said, is that while making logical leaps to aggressively treat patients with Type 2 diabetes was “totally understandable,” it was also dangerous.
“Lower is not necessarily better,” Dr. Nathan said.
Click here for the full report.
Doctors Calling for Trans Fat Ban
March 16, 2010
Natural News
By E. Huff
The Faculty of Public Health (FPH) in the U.K. is urging British lawmakers to ban trans-fats from the British food supply because the artificial fats are causing heart attacks, strokes, and other serious diseases. Comprised of 3,300 doctors and health specialists, FPH hopes to follow in the footsteps of places like Denmark, Austria, and Switzerland which have all banned trans-fats from their food supplies.
Trans-fats are derived from vegetable oils that have been chemically modified. They bear no nutritional value but are used by food manufacturers to bulk up foods and extend their shelf life. Typically labeled as hydrogenated or partially hydrogenated, these artificial fats are commonly found in processed baked goods and desserts, pastries, and fast foods as well as in margarine and shortening.
Experts recognize that trans-fats increase levels of “bad” LDL cholesterol which can lead to serious health problems like heart disease, diabetes and stroke. Because heart disease rates are already very high in the U.K., FPH and others hope to see trans-fats eradicated in order to improve overall public health.
The Royal Society for Public Health, the Royal College of General Practitioners, and the National Health Forum all agree with FPH about the dangers of trans-fats and are urging their removal. Since data shows that over 250,000 Britons suffer from a heart attack or stroke every year and almost 140,000 of them die as a result, these groups believe it is crucial that government officials reevaluate their position on trans-fats.
Alan Johnson, former British health secretary, requested back in 2007 that the Food Standards Agency perform an investigation into trans-fats. When the agency declared that all was well and that people were consuming on average far less than the government-established maximums for trans-fats, no action was taken. Citing this previous find, the Department of Health continues to oppose banning trans-fats.
Many British food producers are voluntarily removing trans-fats from their products to meet consumer demand, including all the members of the British Retail Consortium who pledged in 2006 to remove trans-fats from their products. These reduction efforts and others have led to an overall drop in trans-fat consumption to one percent of the total energy being derived from foods.
As it stands, there is no law mandating that manufacturers even have to list trans-fats on their ingredient labels, a transparency failure that many hope will be addressed by government officials. At the very least, people should know whether or not the foods they buy contain trans-fats so they can make informed purchasing decisions.
Click here for the full report.
Breaking Down Cholesterol
March 16, 2010
Natural News
By Dr. Julian Whitaker
I’d like to shine the spotlight on one of medicine’s sacred cows- the belief that lowering cholesterol with drugs protects against heart attacks and premature death. Our obsession with cholesterol began in the 1950s when studies linked high consumption of animal fat with high rates of heart disease. This opened the door for clinical trials that laid the foundation of a new paradigm: the cholesterol theory of cardiovascular disease.
This theory has had profound ramifications. It changed the way we eat (fats bad, carbohydrates good) and contributed to our problems with obesity and diabetes. It wormed its way into “clinical practice guidelines”- cholesterol management has become a “standard of care” that doctors are expected to follow. It spawned the invasive heart surgery industry, based on the presumption that cholesterol-laden blockages must be bypassed or propped open. And it led to the creation of the best-selling class of medications in history: cholesterol-lowering statin drugs, which generate more than $15 billion in worldwide sales every year.
But it’s all a house of cards. No matter what you’ve been led to believe, a high cholesterol level is not a reliable sign of an impending heart attack. In fact, growing numbers of experts question whether cholesterol matters at all. As for statin drugs, for most of the 40-plus million Americans recommended to take them for the rest of their lives, they’re an ineffective, expensive, side effect- riddled fraud.
Statin-Free Zone
When a patient taking Lipitor, Zocor, or another statin drug comes to Whitaker Wellness, we discontinue it at once. “But my cholesterol level is 240.” “My doctor told me I’ll have a heart attack if I don’t take this drug.”My father died of heart disease, so I have to take it.” I’ve heard all these justifications and more, and I still recommend that my patients get off statins. Here’s why.
First, they’re not very effective. These drugs do lower cholesterol, but so what? We’re not treating lab numbers. We’re treating patients, and the ultimate goal in cholesterol management is to reduce risk of cardiovascular disease. Except for a very limited number of people, there is absolutely no evidence that statins protect against heart attack or premature death.
Are you over age 65? Not a single study suggests you’ll receive any benefits, even if your cholesterol goes down substantially. A woman of any age? Same story. A man younger than 65 who has never had a heart attack? Ditto, no help at all. For middle-aged men who have had a heart attack, statins may lower risk of a repeat heart attack, but that’s the extent of it.
I know this is hard to buy in light of the multiple drug advertisements and glowing endorsements from doctors. But keep in mind that pharmaceutical companies do a superb job of pulling the wool over the eyes of consumers and physicians alike by withholding unfavorable study results and making false, misleading, and often deceptive claims.
A Statistic We Can Understand
That’s why I want to step around confusing statistics and tell you about an easy-to-understand measure that you’ll never hear about in drug ads. It’s called “number needed to treat,” or NNT, and it describes the number of patients who would need to be treated with a medical therapy in order to prevent one bad outcome. Experts consider an NNT over 50 to be “worse than a lottery ticket.”
Lipitor ads claim that it reduces risk of heart attack by 36 percent. Sounds pretty good until you look at the fine print, do the math (which John Carey did in a great article in Business Week), and figure out that the drug’s NNT is 100. This means that 100 people must be treated with Lipitor in order for just one heart attack to be prevented. The other 99 people taking the drug receive no benefit.
To put this into perspective, the NNT of antibiotics for treating H. pylori, the underlying cause of stomach ulcers, is 1.1. These drugs knock out the bacteria in 10 out of 11 people who take it, making them a reliable, cost-effective therapy. At the other end of the spectrum are statins, which as a class have an NNT of 250, 500, or higher depending on the study you look at. What a deal for drugs that can cost more than a thousand bucks a year and are almost guaranteed to cause problems.
Goodbye Drugs, So Long Symptoms
Statins lower cholesterol by suppressing the activity of an enzyme in the liver involved in the production of cholesterol. But this enzyme has multiple functions, including the synthesis of coenzyme Q10. CoQ10 is a key player in the metabolic processes that energize our cells. No wonder statin users often suffer from fatigue, muscle pain and weakness, and even heart failure- the cells are simply running out of juice.
The second most frequent adverse effects of statins are problems with memory, mood, suicidal behavior, and neurological issues. Other common complaints include sexual dysfunction, and liver and digestive problems. Symptoms range from minor (achiness, forgetfulness) to serious (complete but temporary amnesia, permanent memory loss) to lethal (congestive heart failure, rhabdomyolysis or complete muscle breakdown). One statin drug, Baycol, was taken off the market a few years ago after it caused dozens of deaths from rhabdomyolysis. Several studies have also linked statin drugs with an increased risk of cancer.
Because physicians rarely warn of these side effects, few patients suspect their drugs may be the reason they begin feeling bad- and it’s often a revelation when they put two and two together. Simply discontinuing these medications can result in tremendous improvements in health and well-being. Texas cardiologist Peter Langsjoen, MD, published a study showing that when symptomatic patients got off their statins and started taking 240 mg of CoQ10 per day, they had significant decreases in fatigue, myalgias (muscle aches), dyspnea (shortness of breath), memory loss, and/or peripheral neuropathy.
Not a Drug But a Program
As you can see, we need to shift away from this myopic focus on statin drugs and lowering cholesterol, and take a more holistic view. Folks, you don’t need statins- you need a program that addresses all the known risk factors for heart attack, stroke, and other cardiovascular disorders.
Inflammation, not high cholesterol, is the primary cause of heart disease. Harvard researchers have discovered that a high blood level of C-reactive protein, a marker of inflammation, is more predictive of heart disease than cholesterol. To get a handle on inflammation, lose weight- especially if you carry excess fat in the abdominal area. Exercise. Stop smoking. Eat plenty of vegetables and several weekly servings of salmon, sardines, and other omega-3 fatty acids, and avoid sugars and starches.
The beauty of this program is that it targets not only inflammation but other conditions that contribute to cardiovascular disease, including high blood pressure, diabetes, even cholesterol. Best of all, it’s a foundation for overall good health.
Necessary Nutrients
Your program should include a well-rounded nutritional supplement regimen, as well. My number-one suggestion for inflammation in all its guises is fish oil. This supplement also improves blood flow, discourages excess clotting, helps normalize heart rhythm, and saves lives by reducing risk of sudden cardiac death.
Folic acid and other B-complex vitamins are important because they lower levels of homocysteine, a toxic substance that damages the arteries. The mineral magnesium relaxes the arterial walls, which improves blood flow, lowers blood pressure, and helps prevent arrhythmias. And antioxidants, such as vitamins C and E, provide protection against damaging free radicals- another contributor to cardiovascular disease.
Supplements that boost the heart’s energy are recommended as well. One is coenzyme Q10. In addition to serving as a potent antioxidant, CoQ10 also increases the heart muscle’s efficiency and protects against the adverse effects of statin drugs. Another is D-ribose, a natural sugar that is the structural backbone of adenosine triphosphate (ATP), the energy that fuels cellular function.
Click here for the full report.
Erectile Dysfunction May Predict Heart Risk
March 16, 2010
Los Angeles Times
By Thomas H. Maugh II
For the first time, researchers have shown that erectile dysfunction is a strong predictor of the likelihood that men will die of heart disease.
Men who suffer from the problem, which some consider more an emotional than a physical issue, are twice as likely to succumb to cardiovascular disease or heart attacks as those who do not have the problem, German researchers reported Monday in Circulation: Journal of the American Heart Assn.
Researchers have known for years that there is a link between erectile dysfunction, commonly abbreviated as ED, and heart disease, said Dr. Sahil Parikh, an interventional cardiologist from University Hospitals Case Medical Center in Cleveland who was not involved in the study. “But now there is pretty clear evidence that there is a substantially increased risk of heart attack and death when patients have erectile dysfunction.”
The results are probably not too surprising, added Dr. Robert Kloner, a cardiologist at USC’s Keck School of Medicine, “because arteries in the penis are smaller, so atherosclerosis shows up there sooner,” perhaps three to four years before the onset of cardiovascular disease.
The take-home message, both experts said, is that when a patient seeks treatment for ED, typically from a general practitioner, he should be given a full physical work-up to look for heart disease and referred to a cardiologist.
“When they are treated aggressively early, we can prevent heart attacks and stroke and they can have many years added to their lives,” Parikh said.
Existing guidelines for treating men with ED from the Princeton Consensus Conference already state that “a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.” Kloner, a coauthor of those guidelines, said that when the guidelines are updated this year, they will probably carry a stronger recommendation that a patient presenting with ED get a cardiovascular examination.
Dr. Michael Bohm, a cardiologist at Germany’s Saarland University, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease. The men were also queried about their ED at the beginning of the study, two years into it and at the end at five years. A full 55% of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30% in the population at large.
The team reported that, in the five years of follow-up, men with ED were 1.9 times as likely to die from heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.
Disappointingly, the two drugs tested in the study, ramipril and telmisartan, did not improve the course of the ED.
That’s not surprising, said Dr. Peter Pelikan, a cardiologist at Saint John’s Health Center in Santa Monica, “because it takes years and years and years to get any resorption of cholesterol” that would reduce blockage of the penile arteries. “The study was too small and too short to see that.”
Many men with ED see a general practitioner or a urologist to get treatment and are prescribed drugs like Viagra or Cialis, Bohm said in a statement. “The drug works and the patient doesn’t show up any more. These men are being treated for ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”
Click here for the full report.
GlaxoSmithKline Knew of Drug Dangers
February 23, 2010
Natural News
By Mike Adams
GlaxoSmithKline, maker of the diabetes drug Avandia, knew the drug was linked to tens of thousands of heart attacks but went out of its way to hide this information from the public, says a 334-page report just released by the Senate Finance Committee. (http://finance.senate.gov/press/Gpr…)
This report also accuses the FDA of betraying the public trust, explaining that FDA bureaucrats intentionally dismissed safety concerns found by the agency’s own scientists.
The report says that Big Pharma’s drugs “put public safety at risk because the FDA has been too cozy with drug makers and has been regularly outmaneuvered by companies that have a financial interest in downplaying or under-exploring potential safety risks.” Sales of Avandia were $3.2 billion (yes, billion) in 2006.
According to a statistical analysis in the report, if all the diabetics currently taking Avandia were put on a “safer” drug, it would avert 500 heart attacks and 300 cases of heart failure every month in the United States alone. Presently, hundreds of thousands of Americans are still taking this drug, and hundreds will continue to die each month as a result, according to the report estimates.
This report, championed by U.S. Senators Grassley and Baucus, is the result of investigators pouring through more than 250,000 pages of documentation gathered from GlaxoSmithKline and the FDA. The document reveals some rather startling facts about the dangers of Avandia, including evidence from the FDA’s own scientists who concluded that Avandia was associated with 83,000 heart attacks.
GlaxoSmithKline intimidates scientists
This investigative report also reveals that GSK engaged in the intimidation of physicians, saying: “GSK executives attempted to intimidate independent physicians, focused on strategies to minimize or misrepresent findings that Avandia may increase cardiovascular risk and sought ways to downplay findings that a competing drug might reduce cardiovascular risk.”
“Patients trust drug companies with their health and their lives, and GlaxoSmithKline abused that trust.” said Sen. Baucus. (Gee, really? Is anyone really surprised that GSK put its own financial interests ahead of a few thousand human lives?)
A separate letter sent to FDA Commissioner Margaret Hamburg by Senators Baucus and Grassley added, “the totality of evidence suggests that GSK was aware of the possible cardiac risks associated with Avandia years before such evidence became public.”
The FDA’s own research also showed Avandia to be associated with a significant increase in heart attack risk, yet the FDA did nothing to protect the public. The agency’s own scientists wrote in 2008, “There is strong evidence that rosiglitazone [Avandia] confers an increased risk of [heart attacks] and heart failure compared to pioglitazone [a rival drug on market].” This evidence went completely ignored at the FDA.
The FDA’s famous Dr David Graham — the key whistleblower on the Vioxx scandal — concluded from his own research, “Rosiglitazone should be removed from the market.”
Even the American Medical Association — a long-time defender of Big Pharma’s drugs — admitted Avandia was dangerous. Its journal, JAMA, wrote in 2007: “Among patients with impaired glucose tolerance or type 2 diabetes, rosiglitazone use for at least 12 months is associated with a significantly increased risk of myocardial infarction and heart failure, without a significantly increased risk of cardiovascular mortality.”
The New England Journal of Medicine also warned about the safety of the drug in an article published in 2007.
Despite these multiple warnings, an FDA panel voted 22 – 1 in favor of keeping Avandia on the market. This is no surprise, of course, to those who know how the FDA really operates (and where its priorities really lie).
To continue reading this report, click here.
Stress Really Can Cause Heart Attacks
January 18, 2010
DailyMail.co.uk
Getting stressed really is bad for your heart, according to new research.
For years, stress has been linked to heart attacks and other heart complaints but with very little medical evidence to back it up.
Now a major trial by doctors at University College London has proved for the first time that people who get stressed are also likely to have heart disease.
The study involved 514 men and women, with an average age of 62. None had signs of heart disease.
Each underwent stress tests and then levels of cortisol – a chemical produced by the body at times of stress and which causes arteries to narrow – were measured. Their arteries were also scanned for any signs of furring and narrowing.
Those people who were stressed by the tests were twice as likely to have furred arteries as those who remained calm, the study in the European Heart Journal found.
Cardiologist Professor Avijit Lahiri said: ‘This study shows a clear-cut relationship between stress and silent coronary artery disease. This is the first clear proof.’
Click here for the full report.
New York Pushes for 25% Reduction of Salt in Food
January 11, 2010
New York Times
By William Neuman
First New York City required restaurants to cut out trans fat. Then it made restaurant chains post calorie counts on their menus. Now it wants to protect people from another health scourge: salt.
On Monday, the Bloomberg administration plans to unveil a broad new health initiative aimed at encouraging food manufacturers and restaurant chains across the country to curtail the amount of salt in their products.
The plan, for which the city claims support from health agencies in other cities and states, sets a goal of reducing the amount of salt in packaged and restaurant food by 25 percent over the next five years.
Public health experts say that would reduce the incidence of high blood pressure and should help prevent some of the strokes and heart attacks associated with that condition. The plan is voluntary for food companies and involves no legislation. It allows companies to cut salt gradually over five years so the change is not so noticeable to consumers.
“We all consume way too much salt, and most of the salt we consume is in the food when we buy it,” said Dr. Thomas Farley, the city health commissioner, whose department is leading the effort. Eighty percent of the salt in Americans’ diets comes from packaged or restaurant food. Dr. Farley said reducing salt from those sources would save lives.
Since taking office, Mayor Michael R. Bloomberg, who just began his third term, has gained a reputation as an advocate for healthy living, initiating prominent campaigns against smoking and harmful trans fats. To combat obesity, he has campaigned for calorie labeling on restaurant menus and warned consumers about sugary soft drinks.
The city’s salt campaign is in some ways more ambitious and less certain of success than the ones it waged against smoking and obesity. For one thing, the changes it prescribes require cooperation on a national scale, city officials said, because major food companies cannot be expected to alter their products for just the New York market.
And removing salt from many products can be complicated. Salt plays many roles in food, enhancing flavor, preventing spoilage and improving shelf life. It helps bread to rise and brown.
The city’s campaign against salt resembles its push to cut trans fat from restaurant foods, which began with a call for voluntary compliance. When that did not work, the city passed a law to force restaurants to eliminate trans fat.
But city officials said it would be difficult to legislate sodium reduction.
“There’s not an easy regulatory fix,” said Geoffrey Cowley, an associate health commissioner. “You would have to micromanage so many targets for so many different products.”
He said officials hoped the campaign would work through public pressure. Companies that complied would benefit from good publicity.
The city has been discussing the program with the food industry since late 2008, yet only a few companies appear ready to jump on board. One of those is A.& P., the supermarket chain.
“We think it’s a very realistic set of criteria that our suppliers can adhere to,” said Douglas A. Palmer, vice president for store brands at A.& P.
He said the company expected to embrace the city’s salt reduction goals for the hundreds of store brand products it sells under labels like America’s Choice and Smart Price in 435 supermarkets throughout the Northeast and Mid-Atlantic regions. In Manhattan, the chain operates under the name Food Emporium.
Subway, the fast food sandwich chain, also said it expected to commit to the city’s salt guidelines at its nearly 23,000 stores across the country.
Lanette R. Kovachi, Subway’s corporate dietitian, said the company has reduced salt in stores in several other countries, including Britain and Australia, in response to government programs there.
“We view these as achievable goals,” she said.
The company’s best-selling item, a six-inch turkey sandwich, is already below the city’s five-year average target for lunch meat sandwiches in restaurants. But the chain also has a six-inch spicy Italian sub whose salt content is well above the city’s goals.
On Monday, after a year of consultations with industry, the city will release preliminary targets for sodium content. After a review, the city will unveil final targets in the spring and ask companies to commit to the program.
The system proposed by the city is complex, with reductions ranging from 10 to 40 percent for 61 classes of packaged foods and 25 classes of restaurant foods.
It would measure the average salt content of a company’s entire line of a particular type of product, like canned vegetables, breakfast cereals or frozen dinners, adjusted to give greater weight to products with the highest sales. That would allow companies to maintain a range of sodium levels but would create incentive to cut back on salt in the most popular items.
To continue reading the report, click here.
Strengthen and Protect Arteries with Broccoli
January 06, 2010
Natural News
By David Gutierrez
The health benefits of broccoli and related vegetables may come in part from a chemical known as sulforaphane, which appears to activate a specific heart-protecting protein, according to a study conducted by researchers from Imperial College London and published in the journal Arteriosclerosis, Thrombosis and Vascular Biology.
“We know that vegetables are clearly good for you, but surprisingly the molecular mechanisms of why they are good for you have remained unknown for many years,” said researcher Paul Evans of the United Kingdom’s National Heart and Lung Institute. “This study provides a possible explanation for how green vegetable consumption can promote a healthy heart.”
Researchers carried out their tests directly on the chemical sulforaphane, which occurs naturally in vegetables in the family Brassicaceae, also known as cruciferous vegetables. In addition to broccoli, the cruciferous vegetables include cabbage, cauliflower, rapeseed (canola), radish, turnip, mustard greens and watercress.
Sulforaphane was found to increase the activity of the protein Nrf2, which is known to be inactive in areas of the cardiovascular system that are predisposed to plaque buildup. In these areas, which include bends and branches in blood vessels, blood flow is slowed or even disrupted entirely.
“What our study showed was that sulforaphane can protect those regions by switching on the Nrf2,” Evans said.
“These fascinating findings provide a possible mechanism by which eating vegetables protects against heart disease,” said Peter Weissberg of the British Heart Foundation, which funded the study. “As well as adding evidence to support the importance of eating ‘five-a-day’, the biochemistry revealed in this research could lead to more targeted dietary or medical approaches to prevent or lessen disease that leads to heart attacks and strokes.”
Because the study was carried out using pure sulforaphane, the researchers plan to repeat it in a way that closer approximates consumption of actual broccoli.
“We now need to go and test this with broccoli smoothies, as it were, and compare that with the effect of purified sulforaphane,” Evans said.
Women Weighing Breast Cancer Screening Benefits/Risks
December 23, 2009
DailyMail.co.uk
By Nigel Hawkes
Here’s a little test. Breast cancer screening reduces deaths by 25 per cent. If we assume that 1,000 women dutifully turn up to all their screening appointments, how many lives will be saved?
Remarkably, the answer is one. Not 250, or 100, or even 25 - the figures picked by a substantial proportion of gynaecologists who were asked this question.
As a recent study showed, if 1,000 women began screening at the age of 50, and had a mammogram every year, only one would have her life saved through early detection and treatment of cancer by the time screening stops at the age of 70.
Without screening, four women would have died from breast cancer. With it, three would have done so.
But in the same group, between two and ten women would also be treated needlessly - possibly with surgery, radiotherapy and chemotherapy.
And between 100 and 500 would have a false alarm, suffer worry, and need further tests before getting the all-clear. About half would undergo an unnecessary biopsy.
Here’s another example. The drug giant Pfizer claims, on the basis of a clinical trial, that its statin drug Lipitor reduces the risk of heart attacks in people with multiple risk factors - high blood pressure, high cholesterol or angina - by 36 per cent.
Assume 100 people take Lipitor for three-and-a-half years. How many heart attacks will be prevented?
The answer, once again, is one.
Without Lipitor, there would have been three heart attacks. With it, there were two.
More…
* Thousands of women still waiting months for breast cancer diagnosis despite Labour pledge
This is, indeed, close to the 36 per cent reduction claimed: Pfizer is not lying. But the bottom line is that 100 high-risk people had to take Lipitor for more than three years to prevent one of them having a heart attack. The other 99 got no benefit.
Benefits are easy to exaggerate when they are expressed in this way - and medicine is riddled with examples of inflated benefits and understated risks, misleading the unwell into unrealistic expectations and causing healthy people to worry needlessly.
The problem is called mismatched framing. Benefits are framed in one way; side-effects in another.
Expressing benefits as a relative risk - 25 per cent fewer breast cancer deaths, 36 per cent fewer heart attacks - produces a nice big number that looks impressive. But unless we know what the real underlying risk is, a percentage reduction is meaningless.
Let’s suppose that the risk to women of dangerous blood clots from a contraceptive pill is one in 7,000. A new pill is introduced and the risk doubles. Letters are sent to GPs across the country saying that the risks of the new pill are 100 per cent greater, and panic ensues.
Women give up the new pill in droves, abortions rise, and so does the risk of blood clots, since pregnancy carries a greater risk of thrombosis than the new pill.
This, of course, actually happened in 1995. If women had been told not that the risk had doubled, but it had increased by one in 7,000, would the same panic have occurred? Almost certainly not. One in 7,000 is an absolute risk increase; 100 per cent is a relative risk increase.
In medical journals, it is commonplace for benefits to be expressed in relative terms, while side-effects are given in absolute terms.
One recent study of the BMJ, the Journal of the American Medical Association and The Lancet found that a third of papers that included both benefits and harms failed to express them in the same metric.
The Academy of Medical Sciences has postponed a report on the issue until later in 2010.
In February, misleading leaflets urging women to get screened for breast cancer were withdrawn by the NHS because they failed to mention risks - false positives, invasive tests, misleading results, unnecessary operations and anxiety - and did not express benefits straightforwardly.
Public health specialists are in a bind over this. Their job is to get as many participants as possible screened, or vaccinated against flu, or whatever the latest wheeze is. So they focus on big numbers in order to make <em>not </em>participating seem like a dereliction of duty.
But what matters to the individual making a decision about whether to participate is not how it affects national statistics, but what it means to him or her.
The best way to express that is as a ‘number needed to treat’ (NNT) - that is, how many people have to take the treatment to save one event. In the case of the statin trial, the NNT would be 100. With breast cancer screening, it is 1,000.
So the chances that an individual will personally benefit are quite small: one in 100 for statins, one in 1,000 for mammography.
Some doctors argue that any treatment with an NNT of over 50 is no better than buying a lottery ticket. If women were told this, some would decide to get screened anyway. Others may prefer to opt out.
Screening is not worthless, but nor is it quite as wonderful as women have been led to believe.
Can public health doctors afford to be honest about risks and benefits? I wouldn’t bet on it. If drug companies, journals, public health campaigners and journalists are allowed to exaggerate without actually lying, who’s to stop them?
Meanwhile, the public struggle to understand what’s really best for them. Much greater transparency is needed, and fast.
Click here for the full report.
Medical Imaging Scans Equalivalant to 725 Chest X-rays
December 15, 2009
NaturalNews
by E. Huff
Researchers from Duke University Medical Center in North Carolina have discovered that the tests administered to a person undergoing a heart attack emit radioactive elements at levels equivalent to 725 chest X-rays. The aggregate average of radiation administered is about a third of what nuclear power plant workers are allowed to be exposed to annually.
Dr. Prashant Kaul, author of the research study, indicated that doctors typically fail to identify any other tests a heart attack victim may have already received when administering their own. As a result, patients are being exposed to high levels of radiation that far exceed safe maximum levels.
The research team accumulated and analyzed data from over 64,000 patients who had undergone treatment for heart attacks between 2006 and 2009. The team discovered that patients underwent an average of seven tests utilizing ionizing radiation, the kind that is capable of penetrating tissue and damaging DNA cells. The vast majority of the tests were chest X-rays, followed by catheter procedures and computed tomography, also known as CT scans.
According to the American Heart Association, the aggregate number of medical tests given each year that involve some sort of radioactive exposure has skyrocketed, increasing 700 percent between 1980 and 2006. Most of these tests deal in some way with heart disease as it is one of the fastest growing disease epidemics in America.
Improvements in scanning technology have resulted in a sevenfold increase in radiation exposure compared to diagnostic scans performed in 1980. The New England Journal of Medicine reported in August that roughly 4 million Americans are exposed to dangerously high levels of radiation each year due to such medical testing procedures.
The obvious threat from radioactive testing procedures is the potential for increased rates of cancer. The U.S. Food and Drug Administration (FDA) has indicated that a person subjected to a CT scan may develop cancer at some point in his or her life due to the amount of radiation emitted from the test. For this reason, doctors should be cautious in advising patients to undergo such tests unless absolutely necessary.
Magnetic resonance imaging (MRI) is an alternative technology that involves no ionizing radiation. MRIs utilize magnetic fields to generate images that are typically clearer than those produced by a CT scan. Ultrasound is another option that uses sound waves to form images. Heart ultrasounds work especially well at assessing the heart for possible risk factors before a heart attack occurs.
