Metformin, Diabetes and Death
December 13, 2010 by admin
Filed under Cancer, Kidney Disease, Metformin, Weekly Health Update, cardiovascular disease, death, diabetes, health, mortality
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
METFORMIN, DIABETES AND DEATH Metformin is a diabetes medication that is of great interest to me, and to other cancer specialists, because of intriguing research data suggesting that it may reduce the risk of cancer occurrence and cancer recurrence in people with diabetes. (Diabetes is, itself, a risk factor for certain types of cancer, including one of the most lethal of all cancers, pancreatic cancer.) Metformin has been shown to be particularly beneficial in reducing the risk of death due to the complications of diabetes in overweight and obese patients, who are especially prone to developing diabetes. However, there has been some concern regarding the potential safety of metformin in patients with preexisting cardiovascular disease and kidney disease, and so this first-line diabetes medication has not been extensively prescribed to diabetic patients with these diseases. (Somewhat ironically, cardiovascular disease and kidney disease are, themselves, known complications of diabetes.) For this reason, the clinical research study that I will be discussing in today’s column is especially important to the estimated 24 million patients in the United States, alone, who have diabetes, and to the hundreds of thousands of diabetic patients who have already developed cardiovascular disease and kidney disease in the US. This newly published study, which appears in the current issue of the Archives of Internal Medicine, reports on the results of the massive Reduction of Atherothrombosis for Continued Health (REACH) Study, which included 19,691 patients with documented diabetes. (The researchers involved in the REACH Study have been following this huge number of patient volunteers since they enlisted in the study between December 2003 and December 2004.) The findings of this very large prospective public health study validate the findings of smaller prior clinical studies. In this study, diabetic patients with cardiovascular disease were significantly less likely to die during the course of this study if they took metformin instead of other diabetes medications (or no diabetes medication at all). The patients in this study who took metformin were 24 percent less likely to die when compared to the diabetic patients who did not take metformin. Among patients with congestive heart failure, which has until recently has been considered a contraindication to taking metformin, the use of metformin was associated with a 31 percent reduction in death due to all causes. Moreover, patients with other health conditions that have previously thought to preclude diabetes treatment with metformin also appeared to benefit from metformin in this study. Diabetic patients with cardiovascular disease who were older than 65 years were 23 percent less likely to die if they took metformin, while patients with decreased kidney function (estimated creatinine clearance of 30 to 60 ml/minute) experienced a whopping 36 percent decrease in the risk of death if they took metformin. As this was an observational study (i.e., there were no randomized groups of patients, and there was no placebo-control group), it should be urgently followed with a prospective, randomized, placebo-controlled clinical research study to confirm these highly important clinical findings. Taken together, however, the findings of this pivotal public health study are certain to eventually expand the number of patients with diabetes who will be considered eligible to receive metformin!
For a complete discussion of metformin as a potential cancer prevention agent, as well as other important evidence-based approaches to cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race, now! For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, and begin living an evidence-based cancer prevention lifestyle today!
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GIVE THE GIFT OF HEALTH THIS HOLIDAY SEASON! For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores! On Thanksgiving Day, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com Top 100 Bestseller’s List for Kindle e-books! Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!) As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Mammograms Between 40 and 49 Years of Age
October 9, 2010 by admin
Filed under Breast Cancer, Cancer, Cancer Prevention, Mammograms, Weekly Health Update
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
OCTOBER IS NATIONAL BREAST CANCER
AWARENESS MONTH
MAMMOGRAMS BETWEEN 40 AND 49 YEARS OF AGE Both patients and their physicians were stunned last year when the U.S. Department of Health and Human Services’ U.S. Preventive Services Task Force (USPSTF) recommended against routine annual screening mammograms in women between the age of40 and 49 years (as has been the standard recommendation in the United States, and in most countries around the world, for many years). The USPSTF’s recommendations quickly set off a firestorm of debate regarding the calculations and public health considerations used by the USPSTF to arrive at this surprising recommendation. Since the USPSTF released its recommendations in the fall of 2009, most breast cancer specialists and breast cancer advocacy groups have continued to recommend that women who are at average risk of developing breast cancer begin routine annual screening mammograms at age 40. As I extensively discuss in my new book, A Cancer Prevention Guide for the Human Race, there is ample available clinical research data showing that screening mammograms detect breast cancer at an earlier stage than other commonly available screening methods, and that survival is improved in women in whom breast cancer is first detected by a mammogram (as opposed to the detection of a palpable or visible breast mass). Now, a newly published large-scale public health study from Sweden, which appears in the current issue of the journal Cancer, offers further important evidence that the routine use of annual screening mammograms among women between 40 and 49 years of age significantly reduces the risk of dying from breast cancer. In this enormous study, women between the ages of 40 and 49 years were separated into two groups, depending upon whether or not they underwent annual screening mammograms between 1986 and 2005 (the average duration of patient follow-up in this study was a very impressive 16 years). In this very powerful research study, young women who underwent annual mammograms accounted for 7.3 million “person-years” of observation, while the young women who did not undergo mammograms accounted for a similarly astonishing 8.8 million “person-years” of observation within this landmark public health study. When the number of breast cancer deaths were assessed in both of these huge groups of young women, the women who underwent routine annual mammograms were found to be 29 percent less likely to die of breast cancer when compared to the young women who did not undergo annual mammograms! (In public health terms, this 29 percent observed reduction in the death rate due to breast cancer is highly clinically significant!)
This public health study, which encompassed the entire country of Sweden, is the largest mammography study of its kind, and its findings are both powerful and persuasive in defense of beginning routine annual screening mammograms at the age of 40 in women who are at average risk of developing breast cancer. It is my hope that the dramatic findings of this huge clinical study will now lay to rest any lingering doubts regarding the effectiveness of screening mammograms, beginning at 40 years of age, in reducing the risk of death due to breast cancer.
In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer. There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure. Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition! There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in!
For an evidence-based discussion of the critical importance of breast cancer screening, including mammograms, in a cancer prevention lifestyle, order your copy of my new landmark book, “A Cancer Prevention Guide for the Human Race,” from Amazon or Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!) As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Vitamin D, Cardiovascular Disease, Cancer, and Death
October 2, 2010 by admin
Filed under Cancer, Cancer Prevention, Nutrition, Vitamin D, Weekly Health Update, diet, fractures, health, heart disease
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers” VITAMIN D, CARDIOVASCULAR DISEASE, CANCER AND DEATH Among all of the vitamins, only Vitamin D appears to have clinically significant health benefits in reducing the risk of death associated with cardiovascular disease, fractures, and cancer, based upon numerous recent clinical research study findings (for a comprehensive update on the role of Vitamin D as part of a cancer prevention lifestyle, please see my new book, A Cancer Prevention Guide for the Human Race, which is now available from Amazon and Barnes & Noble). A newly-published clinical research study, which appears in the current issue of the American Journal of Clinical Nutrition, prospectively evaluated 1,194 elderly men (average age was 71 years) over a period of nearly 13 years. Blood levels of Vitamin D were measured in these elderly male men, and the results of these blood tests were then correlated with subsequent health outcomes. In this prospective public health study, with extensive long-term follow-up, very low and very high blood levels of Vitamin D were associated with a significantly increased risk of death. In fact, a whopping 50 percent increase in the risk of death was associated with both very low (<46 nmol/L) and very high (>98 nmol/L) concentrations of Vitamin D in the blood. Death due to cancer was two times more common with very low Vitamin D levels, while very high levels of Vitamin D increased the risk of death due to cancer by almost three-fold. At the same time, death due to cardiovascular disease was nearly twice as likely in elderly men with very low Vitamin D levels, but not in men with very high levels of this hormone-like vitamin. The findings of this prospective public health study add to the enormous volume of previously published clinical research data on the health effects of Vitamin D. As this study suggests, there may be an optimal concentration of Vitamin D in the blood that is associated with a decreased risk of death from both cardiovascular disease and cancer. Meanwhile, a healthy diet that emphasizes fresh fruits, brightly-colored fresh vegetables, whole grains, and fatty fish (and minimal red meat and other animal-based foods) is your best bet for a long and healthy life!
For a comprehensive, evidence-based review of the importance of Vitamin D and diet in a cancer prevention lifestyle, order your copy of my new landmark book, A Cancer Prevention Guide for the Human Race, from Amazon or Barnes & Noble!
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!) As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Low-Carb Diet and Risk of Death
September 12, 2010 by admin
Filed under Atkins diet, Weekly Health Update, diet, health, heart disease
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
LOW-CARB DIET AND RISK OF DEATH The debate regarding the potential health benefits of low-carbohydrate diets has gone on for over four decades now. During this period, the pendulum has swung, repeatedly, back and forth between “low-carb” and “high-carb” diets, combined with controversies regarding low-fat versus high-fat diets, as various diet and health gurus have weighed in with their recommendations. (Witness one of the more popular and enduring of these “have it your way” dietary fads, the now discredited Atkins Diet, which advocated a reduction in carbohydrate intake combined with a free pass on meat consumption, and other animal-based sources of fat and protein.) Currently, there is really no meaningful controversy regarding the linkage between meat consumption and an increased risk of cardiovascular disease and cancer. However, the impact of dietary carbohydrate intake on health continues to be the subject of some debate. Unfortunately, as is often the case regarding debates about lifestyle- and diet-related health factors, there is very little high-level clinical research data evidence available to support the more ambitious claims made by “experts” at either spectrum of the carbohydrate debate. Now, a newly published study, which appears in the current issue of the Annals of Internal Medicine, offers a fresh, evidence-based assessment of the impact of carbohydrate and meat intake on the risk of early death. In this prospectively conducted cohort study, which was funded by the National Institutes of Health, the results of two very large prospective public health studies were combined. More than 85,000 women who participated in the vast Nurses’ Health Study, and nearly 46,000 male physicians who participated in the Health Professionals Follow-up Study, were included in this analysis. These healthy female and male volunteers were without clinical evidence of cardiovascular disease, diabetes, or cancer when they entered into these studies. An almost unprecedented duration of clinical follow-up was available for these two enormous groups of research volunteers, which makes this combined cohort study extremely powerful. On average, the male study volunteers have already been followed for 20 years, while the women volunteers have been followed for an average of 26 years. All of these 129,716 men and women completed multiple validated diet questionnaires at various time points in these two clinical studies, and the data collected from these questionnaires was then used to analyze the impact of diet on mortality (death) risk among this huge group of nurses and physicians. Two sub-groups of volunteers were assessed, based upon their dietary preferences, and these two sub-groups of men and women were then compared with the remaining study volunteers. The first dietary preference sub-group consisted of men and women who preferred a low-carbohydrate diet associated with the frequent intake of meat and other animal-based foods (along the lines of the Atkins Diet), while the second sub-group consisted of men and women who routinely consumed a low-carbohydrate diet that emphasized vegetable and fruit sources of protein (instead of animal sources of protein). Over the very long duration of the two combined studies, 12,555 deaths occurred among the women (including 2,458 deaths due to cardiovascular disease). Among the men, there were 8,678 deaths (including 2,746 deaths due to cardiovascular disease). In the group of men and women who favored an Atkins-like diet, emphasizing a low carbohydrate intake but liberal meat consumption (and other animal-based foods, as well), the risk of premature death from any cause (when compared to a low-carb, low-meat diet) was elevated by 23 percent. This same dietary preference was also associated with a 14 percent increase in the risk of death due to, specifically, cardiovascular disease. In contrast, the men and women who consumed a diet low in both carbohydrates and animal products appeared to significantly reduce their risk of death due to all causes, as well as their mortality due to cardiovascular disease, specifically. In this group of research volunteers, mortality due to any cause was reduced by 20 percent, while death due to cardiovascular disease, specifically, was reduced by 23 percent. The findings of this very large prospective public health study, with its extremely long duration of clinical follow-up, confirms the findings of other recent (and less powerful) small clinical studies that a diet rich in vegetables, but low in both carbohydrates and animal-derived foods, confers a very significant benefit in terms of the overall risk of death, and the risk of death from cardiovascular disease, in particular. Excessive carbohydrate intake has been previously shown to increase the risk of diabetes, obesity, cardiovascular disease, cancer, and other serious illnesses. At the same time, increased meat intake has also been clearly shown to raise the risk of many of these same life-threatening illnesses, as well. From this huge prospective cohort clinical study, we can see highly significant health benefits associated with long-term adherence to a healthy diet rich in vegetables and low in carbohydrates and animal-derived foods. (And there are not many health benefits that can trump a significant reduction in your risk of premature death!)
For an evidence-based review of the critical importance of diet in a cancer prevention lifestyle, watch for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” later this month.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Non-Compliance with Hormonal Therapy for Breast Cancer and Risk of Death
September 5, 2010 by admin
Filed under Breast Cancer, Hormonal Therapy, Weekly Health Update
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
NON-COMPLIANCE WITH HORMONAL THERAPY FOR BREAST CANCER AND RISK OF DEATH The management of breast cancer today bears little resemblance to the way that we managed this most common cancer among women when I entered medical school in the early 1980s. Back then, both early-stage and advanced breast cancers were managed with a standard “one-size-fits-all” approach that included removal of the entire breast (mastectomy) and most of the lymph nodes in the armpit area (axillary lymph node dissection). Twenty-five years ago, most women with breast cancer also received chemotherapy, while “hormonal therapy” for many premenopausal women with breast cancer consisted of the surgical removal of both ovaries (oopherectomy). In 2010, 85 to 90 percent of women are eligible to undergo breast-conserving surgery (“lumpectomy”). Radical removal of the armpit lymph nodes has also become unnecessary for the majority of women with newly diagnosed breast cancer, as approximately two-thirds of women will be found to have normal armpit lymph nodes using a high-tech lymph node mapping procedure known as sentinel lymph node biopsy. (Sentinel lymph node biopsy is associated with one-tenth the incidence of the risks associated with more radical lymph node dissections.) Using a recently validated genetic test (Oncotype DX), many women with early-stage, favorable breast cancers can also safely choose to avoid chemotherapy, based upon the results of individualized “molecular” testing of their breast tumors. Instead of undergoing surgery to remove their ovaries, premenopausal women with hormone-sensitive breast cancers can now opt to take one of several different hormone-blocking medications (selective estrogen receptor modulators, or “SERMs”) for 5 years, to further reduce their risk of developing either a recurrence of their breast cancer or a new breast cancer. For postmenopausal women with hormone-sensitive cancers, a different class of hormone blocking medications, the aromatase inhibitors (“AIs”), are often prescribed, also for 5 years. These medications have been shown to reduce the risk of both recurrent breast cancer and new breast cancers by as much as 50 percent, and so they have become powerful clinical tools in our breast cancer prevention and treatment armamentarium. However, as with almost all medications, SERMs and AIs are associated with some rather significant side effects. In the case of SERMs, these side effects can include bone pain, hot flashes, nausea, mood swings, decreased libido, and constipation, among others. Tamoxifen, the most commonly prescribed SERM, is also associated with a small but significant increase in the risk of uterine cancer. (Raloxifene, the newest SERM to be approved for breast cancer prevention and treatment, appears not to significantly increase the risk of uterine cancer.) Both of these SERMS are also associated with an increased risk of blood clots in the body, as well. On the other hand, in addition to their potent ability to reduce the risk of both recurrent and new breast cancers, tamoxifen and raloxifene also decrease the risk of osteoporosis and osteoporosis-related bone fractures. AIs are also associated with significant side effects in some patients, including hot flashes, bone and joint pain, mood changes, rash, headache, insomnia, and a small but significant increase in the risk of osteoporosis and osteoporosis-related bone fractures, among other symptoms and complications. In view of the side effects profiles of SERMs and AIs, it is not surprising that patient compliance with these medications is an ongoing problem in the management of breast cancer (and, especially, among premenopausal women). A newly published clinical research study in the journal Breast Cancer Research & Treatment reveals just how serious the issue of patient compliance with hormonal therapy is among breast cancer patients, as well as the significant impact of such noncompliance on the subsequent risk of death. In this clinical study, performed by my Northern California Kaiser Permanente colleagues, 8,769 women diagnosed with hormone-sensitive breast cancer between 1996 and 2007 were evaluated. One of the most powerful clinical assets of Kaiser Permanente is its comprehensive electronic health records system (“Health Connect”), which allows any Kaiser Permanente health care provider to access any individual patient’s detailed medical history, including diagnoses, past and current treatments (including surgeries and medications), lab results, radiology results, and other important clinical information. This rich source of clinical information not only improves the quality and efficiency of care provided to patients, but it also serves as a powerful tool to conduct meaningful clinical research on large numbers of patients in an effort to further improve the delivery of high-quality health care. (Indeed, Kaiser Permanente’s computerized medical records system is often held up as an example of what the future of electronic medical records should look like in the United States.) The results of this study revealed the true potential costs of noncompliance with hormonal therapy among patients diagnosed with relatively early-stage hormone-sensitive breast cancers. Among the nearly 9,000 women who filled at least an initial prescription for their breast cancer hormonal therapy medications, 31 percent subsequently discontinued their SERMs or AIs, and an additional 28 percent continued with hormonal therapy, but were not fully compliant in taking their SERMs or AIs. (This combined 59 percent incidence of overall noncompliance is consistent with the 50 to 60 percent incidence of noncompliance with hormonal therapy that has been identified in previous clinical research studies.) During an average follow-up period of 4.4 years, 831 of these 8,769 patients died. Based upon the observed survival data collected in this study, the women who were compliant with their SERMs or AIs had a statistically predicted 10-year survival rate of 81 percent, while the women who prematurely discontinued their hormonal therapy had a predicted 10-year survival rate of 74 percent. (The women who continued with their hormonal therapy, but who were not compliant with their daily doses, were projected to have an intermediate 10-year survival rate of 78 percent.) In the final analysis of their data, the authors of this study found that early discontinuation of hormonal therapy or continuing with hormonal therapy in a noncompliant manner were associated with a significant reduction in survival among patients with hormone-sensitive breast cancers. The results of this study say two important things, in my mind. The first is that SERMs and AIs significantly reduce the risk of death in patients with hormone-sensitive breast cancer (as has already clearly been shown by multiple prospective, randomized, blinded, placebo-controlled clinical research studies). As with all medications, discontinuing hormonal therapies prematurely, or taking these important breast cancer medications in a haphazard manner, deprives breast cancer patients of the full potential benefits of SERMs and AIs. The second important observation to be derived from this study is that we need to continue to search for new hormonal therapies with improved side effect profiles, to encourage better patient compliance with this important aspect of breast cancer prevention and treatment. If you are a breast cancer survivor who has been prescribed hormonal therapy (or a woman who is at very high risk of developing breast cancer, and who been prescribed a SERM or AI for breast cancer prevention purposes), then you should make every effort to work together with your Oncologist to help you to remain compliant with your SERM or AI prescription, including the aggressive management of any unpleasant treatment side effects that you might be experiencing.
To learn more about an evidence-based approach to breast cancer prevention, watch for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” in September of this year.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link:
I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Coffee & the Risk of Death from Heart Disease & Cancer
May 15, 2010 by admin
Filed under Weekly Health Update
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
COFFEE & THE RISK OF DEATH FROM HEART DISEASE & CANCER Last month, I reviewed research showing that increased coffee consumption was associated with a decrease in inflammation and an increase in HDL cholesterol (the “good cholesterol”). However, as I noted in that column, this small study did not address any long-term health outcomes of frequent coffee consumption (Coffee Improves HDL Cholesterol Levels). Now, a newly published prospective public health study, from Japan, suggests that regular coffee consumption may, indeed, have long-term health benefits (at least for half of the population…). (I should also note that, as a disclaimer, I am not a coffee drinker, despite reviewing two coffee-related health research studies in as many months!) The results of this large Japanese research study appear in the current issue of the Journal of Nutrition. In this prospective epidemiological study, 18,287 men and 19,455 women (between the ages of 40 and 64 years) were prospectively included in the Miyagi Cohort Study, which began in 1990. All of these study volunteers were without any clinical history of cancer, heart disease, or stroke when they entered into the Study. After an average of more than 10 years of follow-up, 2,454 of the volunteers died from various causes, including 426 cases of fatal cardiovascular disease and 724 fatal cases of cancer. These volunteers were categorized and analyzed according to their self-reported daily consumption of coffee: “never-drinkers,” “occasional-drinkers,” 1 to 2 cups per day, and 3 or more cups per day. Other known risk factors for cardiovascular disease (including heart disease and stroke) and cancer were also factored into the analysis of the risk of death associated with coffee consumption for each volunteer. Among the women in this study, increasing levels of daily coffee consumption were associated a decreasing risk of death, due to any cause. (This “dose-dependent” relationship between daily coffee consumption and risk of death strongly suggests a direct clinical relationship between increased coffee consumption and a decreased risk of death.) When compared to the women who did not drink coffee at all, the women who drank 3 or more cups of java per day were 25 percent less likely to die, from any cause, during this decade-long public health study. The coffee-associated reduction in the risk of death from cardiovascular disease was even more powerful (and also appeared to be “dose-dependent”), as the women who downed 3 or more cups of coffee per day experienced a whopping 55 percent decrease in the risk of death due to cardiovascular causes! Finally, there was an apparent modest decrease in the risk of dying from colorectal cancer among the female coffee drinkers, but no other reduction in the risk of dying from cancer was observed in association with regular coffee consumption among these women volunteers. Well, I have just shared with you the good news regarding reduced death rates associated with regular coffee consumption from this large, prospective, long-term public health study; and many of you will notice that I have not yet mentioned the health impact of coffee on men! This is because, unfortunately, this study did not identify any apparent beneficial health effects of regular coffee consumption in men. The reason, or reasons, for this gender-related disparity is not clear, although it is well known that there are major differences in both the incidence of cardiovascular disease between men and women, and differences in the way that cardiovascular diseases (and heart disease, in particular) manifest themselves in women versus men. It is, therefore, possible, that cardiovascular disease factors that are more unique to women are directly impacted upon by regular coffee consumption. (At least no adverse effects of regular coffee consumption on male mortality were observed in this large public health study!) So, ladies, keep the favorable results of this clinical research study in mind whenever you order that next cuppa Joe!
To learn more about the role of coffee, and other sources of dietary tannins, as potential cancer prevention nutrients, look for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: http://www.youtube.com/watch?v=7-Tdv7XW0qg I and the staff of Weekly Health Update would like to take this opportunity to thank the nearly 120,000 new and returning readers who visited our premier global health information website last month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Aspirin & Breast Cancer Survival
March 28, 2010 by admin
Filed under Weekly Health Update
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
ASPIRIN & BREAST CANCER SURVIVAL
Breast cancer tumors, like many other types of cancer, produce increased amounts of chemicals called prostaglandins. As with many other types of cancer, prostaglandins are thought to play an important role in the growth and spread of breast cancer. Aspirin belongs to a class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs). Like other NSAIDs, aspirin is able to block the activity of the prostaglandin-producing enzyme cyclooxygenase (COX). Moreover, previous research has indicated that, in addition to decreasing prostaglandin production in the body, aspirin also reduces the levels of estrogen in the body (approximately 90 percent of breast cancers are stimulated to grow in the presence of estrogen). Previous research on aspirin as a breast cancer prevention drug has resulted in contradictory findings (although aspirin and other NSAIDs have clearly been shown to reduce the incidence of colorectal polyps and colorectal cancer, and other cancers as well). However, a newly published study, in the Journal of Clinical Oncology, adds weight to prior evidence that the regular intake of aspirin may significantly decrease the risk of breast cancer recurrence, and the risk of death due to recurrent breast cancer. The enormous Nurses’ Health Study is a prospective public health research study that began in 1976 with more than 120,000 female nurses in the United States. Every 2 years, this huge cohort of women completes detailed personal questionnaires regarding diet and lifestyle factors related to cardiovascular disease and cancer. Between 1976 and 2002, more than 4,000 nurses participating in this study were newly diagnosed with breast cancer. The researchers conducting this landmark study then analyzed the incidence of breast cancer recurrence, and the risk of death, among these 4,164 breast cancer patients as a function of their aspirin intake. (Other cancer-associated diet and lifestyle risk factors were also analyzed, as well.) In this huge prospective public health trial, regular aspirin intake was found to significantly reduce the risk of death due to breast cancer. Taking aspirin 2 to 5 times per week was associated with a 71 percent reduction in the relative risk of death due to breast cancer, while 6 to 7 days of aspirin use per week was associated with a 64 percent reduction in the relative risk of cancer-associated death. Importantly, this apparent aspirin-associated reduction in the risk of death due to breast cancer recurrence was observed in women with both early-stage and more advanced breast cancers, in both premenopausal and postmenopausal women, in both obese and non-obese women, and in women with estrogen-sensitive and estrogen-resistant tumors. While this study’s primary weakness is that (like most epidemiological studies) the collected data was primarily based upon patient questionnaires, the Nurses’ Health Study continues to be a carefully conducted prospective study with very stringent data quality controls in place. To summarize the important findings of this study: Among women previously diagnosed with breast cancer, taking aspirin for 2 or more days per week was associated with a significant reduction in the risk of both breast cancer recurrence and death due to breast cancer. (As always, I recommend that you discuss the potential risks and benefits of regularly taking aspirin, or any other new medication, with your doctor before making such changes.)
To learn more about the potential role of NSAIDs in cancer risk reduction, look for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” in the spring/summer of this year. Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: http://www.youtube.com/watch?v=7-Tdv7XW0qg I and the staff of Weekly Health Update would like to take this opportunity to thank the nearly 120,000 new and returning readers who visited our premier global health information website last month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in those countries to assist the injured, the ill, and the homeless. There are many such legitimate charities, including the following two:
http://www.imcworldwide.org/haiti |
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Obesity, Alcohol & Liver Disease
March 21, 2010 by admin
Filed under Weekly Health Update
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
OBESITY, ALCOHOL & LIVER DISEASE
Chronic liver disease, including cirrhosis, is the 12th most common cause of death in the United States, alone, and causes nearly 30,000 deaths per year in America. Increased alcohol intake and obesity are both known risk factors for chronic liver disease. Moreover, recent research has suggested that the combination of alcohol intake and obesity may synergistically increase the risk of chronic liver disease above and beyond the sum of these two risk factors. Two newly published prospective, randomized clinical research studies from the United Kingdom further suggest that increased alcohol intake in the presence of obesity significantly increases the risk of chronic liver disease, and premature death related to chronic liver disease. Both of these studies appear in the current issue of the British Medical Journal. In the first study, more than 1.2 million women (average age was 56 years) were recruited between 1996 and 2001. In this Million Woman Study, after an average duration of follow-up of 6.2 years, 1,811 women were either admitted to a hospital with a new diagnosis of cirrhosis, or died of cirrhosis. Based upon the extensive health data collected from all of the participants in this enormous public health study, both obesity and alcohol intake were proportionally linked to an increased risk of cirrhosis, as well as death due to cirrhosis. (Note: a standard glass of wine, mixed drink, or beer contains about 0.6 ounces, or 14 grams, of alcohol.) For every 5 units of BMI above 22.5, the relative risk of cirrhosis increased by 28 percent (BMI is a standard measure of body fat content that is adjusted for height and weight). Among women who reported the consumption of less than 70 grams of alcohol per week (equivalent to 5 alcoholic drinks per week), the absolute risk of developing cirrhosis, over a period of 5 years, was 20 percent higher in women with a BMI of 30 or more, when compared to non-obese women with normal BMIs (“obesity” is defined as a BMI of 30, or greater; while being “overweight is defined as having a BMI of 25 or greater, but less than 30). Among the women who reported consuming 150 grams or more of alcohol per week (which is equivalent to 11 or more alcoholic drinks per week), a normal BMI was associated with a 170 percent increase in the absolute risk of developing cirrhosis, while obese women (with a BMI of 30 or greater) who consumed 150 grams or more of alcohol per week experienced a whopping 400 percent increase in the risk of developing cirrhosis! When this data was extrapolated to the population of the United Kingdom, as a whole, it was determined that alcohol consumption, particularly at higher levels, accounted for 42 percent of all cases of non-fatal and fatal cirrhosis in middle-aged women, while obesity caused an additional 17 percent of all non-fatal and fatal cases of cirrhosis of the liver.
In the second published study in the British Medical Journal, data from two prospective clinical studies was analyzed. A total of 9,559 men participated in these prospective public health studies, with a highly impressive median follow-up of 29 years. These nearly 10,000 male study participants were divided into separate study groups based upon their measured BMI and their self-reported alcohol intake. During nearly 3 decades of observation, 80 (0.8 percent) of these male research volunteers died directly due to chronic liver disease, while another 146 (1.5 percent) died of multiple causes, but with liver disease as a contributing cause of death. As with the previous study, there were significant interactions between alcohol intake, BMI, and chronic liver disease (after adjusting for other known risk factors for chronic liver disease). In this study, the consumption of 15 or more alcoholic drinks per week in volunteers with a normal BMI more than doubled the relative risk of dying of chronic liver disease when compared to other non-obese men who consumed less than 15 drinks per week. Among the overweight (but not obese) men who consumed 15 or more alcoholic drinks per week, the relative risk of death due to chronic liver disease was more than 7 times higher than was observed in overweight men who consumed significantly less than 15 drinks per week. Finally, and most disconcertingly, obese men who consumed 15 or more alcoholic drinks per week experienced nearly 18 times the relative risk of dying from chronic liver disease as compared to their obese counterparts who drank significantly less alcohol. (Even among obese men who consumed 14 or fewer alcoholic drinks per week, the relative risk of death due to chronic liver disease was still more than 4 times higher than what was observed in obese men who did not drink alcoholic drinks at all.) Based upon this data, the researchers conducting this study were able to determine that there was a synergistic, enhanced risk of dying from liver disease when alcohol intake was present in addition to being overweight or obese. This “relative excess risk” due to an interaction between alcohol intake and increasing BMI amounted to 4 times the relative risk of simply adding the individual liver disease risks of increased BMI and alcohol intake.
Taken together, these two large prospective public health studies confirm previous observations that both rising levels of excess weight and increasing levels of regular alcohol intake are associated, both separately and together, with an increased risk of chronic liver disease, and death due to chronic liver disease. Moreover, the combination of obesity and increased alcohol intake appears to be a particularly severe risk factor for the development of chronic liver disease, and for death due to liver disease. Therefore, in addition to the multiple other health risks associated with obesity and excessive alcohol intake, the results of these two studies should cause all of us to reexamine our lifestyle and dietary habits in our pursuit of better health and greater longevity.
To learn more about the role of alcohol and obesity in cancer risk, look for the publication of my new book, “A Cancer Prevention Guide for the Human Race,” in the spring of this year. In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in those countries to assist the injured, the ill, and the homeless. There are many such legitimate charities, including the following two: http://www.imcworldwide.org/haiti Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a different perspective on Dr. Wascher, please click on the following YouTube link: http://www.youtube.com/watch?v=7-Tdv7XW0qg I and the staff of Weekly Health Update would like to take this opportunity to thank the nearly 120,000 new and returning readers who visited our premier global health information website last month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. |
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Vitamin D, Cardiovascular Disease & Death
February 7, 2010 by admin
Filed under Uncategorized
Welcome to Weekly Health Update“A critical weekly review of important new research findings for health-conscious readers”
VITAMIN D, CARDIOVASCULAR DISEASE & DEATH
There is mounting evidence that Vitamin D plays a much more complex role in maintaining health beyond its primary function in regulating calcium absorption. Increasingly, research data suggests that this hormone-like vitamin may also play important roles in the prevention of cardiovascular disease and cancer, as well. (A comprehensive update on Vitamin D’s cancer prevention properties will appear in my forthcoming book, “A Cancer Prevention Guide for the Human Race.”)
The vast majority of published research studies in disease prevention have relied upon low-level research methods, including surveys of patient volunteers and retrospective medical chart reviews. More recently, however, high-quality prospective, randomized cardiovascular disease prevention and cancer prevention clinical research trials have been performed. These high-level studies have the potential to significantly improve lifestyle-based approaches to preventing the diseases that, together, cause the majority of all premature deaths.
A newly published prospective clinical research study, from the Chianti region of Italy, enrolled more than 1,000 adults, aged 65 years and older. All patient volunteers were tested for the level of Vitamin D in their blood when they joined this study, and all of these older adults were then carefully followed for an average of nearly 7 years. During the course of this study, 228 study participants died. The researchers then compared the levels of Vitamin D in the blood of the participants who died during the study with those of the volunteers who survived. (This study is published in the current issue of the European Journal of Clinical Nutrition.)
The findings of this prospective clinical study were striking. The patient volunteers with the lowest levels of Vitamin D in their blood were more than 2 times as likely to die, from any cause, when compared with the patients who had the highest levels of Vitamin D in their blood. The patients with the lowest Vitamin D levels were also nearly 3 times as likely to die from heart attacks, and other complications related to cardiovascular disease, when compared to the patients with high levels of Vitamin D in their blood. These dramatic findings held up even after the researchers made statistical adjustments for differences in the age, gender, education level, exercise habits, and other health-related factors among these two groups of study participants.
As we age, our bodies become less efficient in converting sunlight into Vitamin D, and multiple research studies have shown that the majority of older adults are deficient in Vitamin D. A growing number of high-level clinical research studies, such as this Italian study, continue to suggest that Vitamin D deficiency is associated with an increased risk of cardiovascular disease, cancer, osteoporosis, bone fractures, and decreased muscle strength in older men and women. Therefore, the importance of this vitamin-hormone in maintaining optimal health is becoming increasingly apparent.
For additional Weekly Health Update articles on Vitamin D, please click the following links:
http://doctorwascher.com/Archives/2-3-08 http://doctorwascher.com/Archives/10-11-09.htm http://doctorwascher.com/Archives/11-8-09.html http://doctorwascher.com/Archives/9-20-09.htm http://doctorwascher.com/Archives/8-9-09.htm http://doctorwascher.com/Archives/12-28-08.htm http://doctorwascher.com/Archives/10-5-08.htm http://doctorwascher.com/Archives/6-29-08.htm
In view of the extreme devastation and human misery brought about in Haiti by the recent earthquake, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there. There are many such legitimate charities, including the following two: http://www.imcworldwide.org/haiti Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: http://www.youtube.com/watch?v=7-Tdv7XW0qg |
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