PURE Headline 2: Don’t Bother with More Veggies?

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Using the same data base of subjects in the PURE Study, researchers examined the vegetable, fruit, and legume intake on total mortality, mortality, and major cardiac events such as heart attacks.

The most important finding was that higher vegetable, fruit, and legume intake was associated with a reduced risk of mortality and morbidity. Simply put, the more plant-based the diet, the better off you are from an overall health perspective.

But that’s not what the headline messages said. They focused on the part of the study that said there appeared to be no additional benefits if subjects ate more than a few servings of vegetables, fruits, and legumes. That seems to fly in the face of the “more is better” results that previous research has shown.

Have all the prior studies been wrong? Have you been eating kale for no good reason? No, and I’ll explain why the headlines are wrong on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/S0140-6736(17)32253-5.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8

 

The Bottom Line on E-Cigarettes

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Vaping e-cigarettes is supposed to be better than smoking cigarettes because the toxic chemicals will be gone. That may be true for the chemicals released from tobacco and paper, but the third area of concern is the e-liquids that make up the flavor component of e-cigarettes. The marketing tactic often focuses on the variety of flavors available. The question is this: are they safe or do they contain chemicals that could negatively impact the lungs?

Researchers obtained a random sample of e-cigarette liquids from the most popular brands on sale in Greece, Spain, Germany, the Netherlands, the UK, Hungary, Romania, Poland, and France. The samples included a variety of different flavors and nicotine strengths. They analyzed each sample to find out exactly which chemicals were present and in what quantities.

Every liquid container that they tested contained at least one substance that has some level of health risk according to the United Nations classification system. The chemicals, with long complex names, can cause respiratory irritation, allergy or asthma symptoms, or breathing difficulties if inhaled. What they might do when heated is still to be determined.

There were several more research papers presented that also illustrated that e-cigarettes are not problem free. The belief is that they are not as harmful as conventional cigarettes, but the fact is we really don’t know because the components haven’t been tested.
 

Meanwhile There’s the FDA

And they probably never will be tested, at least in the U.S. This past July, the new head of the FDA Dr. Scott Gottlieb announced that he was suspending laws that govern e-cigarettes for five years. In the last administration, the governance over e-cigarettes was turned over to the FDA where they enacted restrictions that insisted the products be tested for safety before being brought to market. Those rules have been suspended so the industry could have time to set standards and comply with tobacco regulations.

I read Dr. Gottlieb’s ruling. As a physician who has treated cancer patients, he has seen what cigarettes do first hand. His belief is that nicotine addiction is the primary issue and that vaping, while not as good as not smoking, may help people quit smoking by using these products to help reduce reliance on nicotine. Gottlieb seems to believe that nicotine, while still addictive, does not kill people; it’s the 5,000 other chemicals in cigarettes that do.

I simply do not understand his reasoning. There are hazards to nicotine, as the research this week has shown. There are chemicals in the e-liquids that have not been identified, have not been tested, and we have no history with their use to investigate. How do we know what health issues we’re facing without finding answers to those questions?

One more thing. Dr. Gottlieb is an investor in a vaping products company called Kure. He has said that he will divest his interest and recuse himself from decisions on vaping for one year. I guess physician years are like dog years; he seems to have made a big decision on vaping after being in office just a few months.
 

The Bottom Line

As a former smoker, I understand the addiction. If vaping products had been available when I quit, maybe I would have used them. As a healthcare professional today, there is not a chance. We’re talking about inhaling substances that have never been subjected to any form of safety or toxicity testing. It’s unreasonable to do that. The studies I reviewed this week clearly show there is doubt. We know how long it took the tobacco industry to finally admit that tobacco was addictive when they had the data all along. The e-cigarette industry has no data at all.

You are a free-living human being. It’s your body, and what you choose to put in it is your choice. I just hope none of it comes from tobacco or e-cigarette products.

What are you prepared to do today?

Dr. Chet

 

Reference: European Respiratory Society. 2017. Abstract OA1978.

 

Update: E-Cigarettes Put Lungs at Risk

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The second study presented at the European Respiratory Conference on e-cigarettes that caught my attention was a study done in Sweden. Researchers questioned over 30,000 people, randomly selected from the Swedish population. The purpose was to ask the subjects about smoking: did they smoke, what did they smoke, and what type of respiratory symptoms did they have? Here’s what they found.

Only 12.6% of those surveyed said they smoked, and the numbers broke down this way: 11% smoked only conventional cigarettes, 0.6% vaped only, and 1.2% said they used both. Researchers speculated they smoked cigarettes when allowed and vaped in public or other settings.

What about respiratory conditions? As you might expect, the highest percentage of respiratory issues came from those subjects who smoked both conventional and e-cigarettes at 56%; 46% of those who smoked only cigarettes had respiratory issues, and 34% of those who exclusively used e-cigarettes. How many non-smokers had respiratory conditions? Only 24%. The results clearly show that vaping causes the same respiratory issues such as wheezing or productive coughs as might be found in tobacco cigarettes.

What might be contributing to the issues with e-cigarettes? I’ll cover that on Saturday. One thing is clear so far: vaping is not innocuous as has been sold to consumers.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017. Abstract PA4485

 

Update: E-Cigarette Safety

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As the European Respiratory Society held their annual convention, several research studies made the health news, including e-cigarettes and vaping. The appeal of e-cigarettes is that they seem to be safe–you’re not actually burning tobacco with its associated chemicals and inhaling that into your lungs. E-cigarettes remove all that bad stuff and associated negative health effects. Or do they?

In the first study, researchers recruited 15 subjects who had smoked cigarettes occasionally, fewer then 10 per month; subjects had also never used e-cigarettes. They were asked to smoke e-cigarettes for 30 minutes in a random order on different days; once with nicotine, the other without. The researchers measured blood pressure, heart rate, and arterial stiffness immediately after smoking the e-cigarettes and then two and four hours later.

In the first 30 minutes after smoking e-cigarettes with nicotine, there was a significant increase in blood pressure, heart rate, and arterial stiffness. That didn’t happen after the e-cigarettes without nicotine. While this is a small pilot study, it seems that vaping nicotine can impact the cardiovascular system in the same way regular cigarettes do.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017; Abstract OA1979.

 

B6, B12, and Lung Cancer

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The overwhelming message from the study I’ve been reviewing this week: don’t smoke cigarettes. Period. That’s the true cause of most cases of lung cancer. There was no increase in lung cancer in subjects taking high doses of B6 or B12 who never smoked or in those who quit more than 10 years before the study began. While the increased risk applied only to men, women shouldn’t smoke either: 44% of those who got lung cancer were women.

For those men who still insist on smoking or quit less than ten years ago, is there anything to be concerned about if you megadose on B6 or B12? It’s hard to know for sure.

I spoke with the primary author via email. Dr. Ted Brasky and I have battled over omega-3s in the past but minor disagreements in methodologies aside, he is a top-notch researcher. He doesn’t think the B vitamins cause cancer. What he thinks may be happening is that the carcinogens in cigarette smoke cause damage to lung cell DNA, and the excess B vitamins may be enhancing the initiation of cancer. I agree with him.

The question is why might this be happening? The lack of B vitamins seems to reduce the DNA repair process, so increasing to normal levels seems to help. But overdoing it may not be beneficial. Some smokers are taking high-stress B supplements with hundreds or thousands of micrograms of B12. Those are the smokers who could be at risk.

There are two explanations that make sense to me. First, there may be a mutation in the gene that manufactures the enzyme methylenetetrahydrofolate reductase, the enzyme that helps convert homocysteine to methionine. That enzyme requires B12, but perhaps it malfunctions and the B12 becomes toxic to the cells damaged by smoking.

The second explanation comes from the article itself. When trying to explain the factors that could impact this relationship between smoking and vitamin intake, researchers suggest there may be a difference in the absorption, utilization, or distribution of the vitamins. In other words, some people may absorb more vitamin B6 or B12 than others, resulting in a higher circulating amount and thus more available for cells to use. In normal conditions that may be fine but with smoking-induced damage, it may not. The fact is we just don’t know at this time.

 

The Bottom Line

Back to addressing those headlines. If you don’t smoke, there is no problem based on this study. If you do smoke, taking a multivitamin, a B-complex with reasonable amounts of B vitamins, or using energy drinks should present no problem: the study showed no increases with the amounts found in those types of products. If you do smoke, until there is research to clarify the actual cause, limit your intake of high-stress Bs or megadoses of vitamins B6 and B12.

Or maybe the best idea is to just quit smoking. I know it’s hard; I smoked back when I was young and thought myself immortal. You have my sympathy, but my advice is to quit any way you can.

What are you prepared to do today?

Dr. Chet

 

Reference: J Clin Oncol. DOI: https://doi.org/10.1200/JCO.2017. 72.7735

Behind the Misleading B Vitamin Headlines

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Headlines are designed to be provocative. With so many sources of news to choose from, something must get you to click on that link. The problem is when the articles and posts are misleading and, in some cases, just wrong. There were primarily two things wrong about the two online articles I cited in Tuesday’s Memo. I could have picked just about any articles about the study but these were the highest profile.

First, the headlines and the body of the text in both articles implied that the increased risk applies to everyone who uses high doses of vitamins B6 and B12. That’s false. There were so few cases of lung cancer in non-smokers, they saw no reason to analyze that data. Either that’s outright deception or the reporters didn’t read the study.

Second, the word “cause” was used in some headlines, and that’s just false. This was an observational study; the original data on supplement use was collected at the beginning, and then the researchers observed the health of the subjects via a centralized medical database. That type of study shows there’s a link of some kind but cannot show cause and effect.

What did the study actually say and what did the study author say about the results? I’ll let you know on Saturday.

One more thing: we try to make our Memo headlines grab your attention by using key words or asking an intriguing question. That’s part of the business of online information. But if we ever have a headline that’s truly misleading, I expect you to call me on it. Being reliable, trustworthy, and factual are our goals.

What are you prepared to do today?

Dr. Chet

 

Reference: J Clin Oncol. DOI: https://doi.org/10.1200/JCO.2017. 72.7735

 

Do Vitamins B6 and B12 Cause Cancer in Men?

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The headline in The Atlantic said: “Vitamin B6 and B12 Supplements Appear to Cause Cancer in Men.” The Huffington Post said: “Men: Taking Vitamins B6 and B12 Could Increase Your Risk of Lung Cancer.” There were few news sources that didn’t pick up this provocative headline. As you might expect, I started to get questions about the study almost immediately from people who take B vitamins and who drink energy drinks. Exactly what is going on? That’s what we’ll examine in this week’s Memos. Today we’ll take a look at the study.

The Vitamin and Lifestyle study (VITAL) collected information from over 77,000 men and women in western Washington State. The subjects were 50 to 76 when data collection began in 2000–2002. Participants completed a detailed questionnaire on supplement use, a food frequency questionnaire for diet, and a lifestyle questionnaire focusing on risk factors for cancer. The focus was to recruit supplement users.

In an analysis of the data on smoking patterns and the use of folic acid and vitamins B6 and B12, researchers found that men who smoked while taking high amounts of vitamin B6 and B12 had a significantly increased risk of lung cancer. The same results were not found in women.

Those are the results. We’ll take a closer look at the accuracy of the headlines on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: J Clin Oncol. DOI: https://doi.org/10.1200/JCO.2017. 72.7735

 

How Does Alternative Medicine Affect Cancer?

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The final study this week is an analysis of survival data on people who selected only alternative medicine as treatment after being diagnosed with a non-metastatic cancer. The subjects declined any conventional cancer treatment defined as surgery, chemotherapy, radiation, and hormone therapy. Let’s take a look at this observational study.

Researchers used the National Cancer Database to identify people who selected “other unproven cancer treatments administered by non-medical personnel”; 281 were identified over a 10-year time span. They were compared with 560 randomly selected subjects who chose conventional treatment. All were tracked for an average of 5.5 years.

The results were dismal. Over the 5.5 years, those who chose alternative medicine were 2.5 times more likely to die than those who chose conventional treatment. The rates were worse for individual forms of cancer such as breast, lung, and colorectal cancer. The only type of cancer for which had no significant differences in mortality was prostate cancer; that’s to be expected as most prostate cancers are slow growing and rarely cause death quickly.

This was simply an observational study. We don’t know the types of alternative medicine used nor whether any people returned for conventional treatment when the alternative medicine wasn’t working. However, I still think it speaks volumes: If you’re diagnosed with cancer, don’t play games. Get the strongest treatment possible; if you don’t, it could cost you your life sooner rather than later.

If you want more information about the study and the place of complementary and integrative treatments if you have cancer, listen to the newest Straight Talk on Health MP3, Alternative Medicine and Cancer. Normally you’d have to be a Member or Insider to listen to Straight Talk on Health, but because this topic is so important to your health, I’m making it available to everyone if you click on the link in this memo (I’m asking you to share it only when appropriate). If you like it, that’s one more reason to join DrChet.com.

What are you prepared to do today?

Dr. Chet

 

Reference: JNCI: doi.org/10.1093/jnci/djx145.

 

A Cancer Blood Test Gets Closer to Reality

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Noninvasive detection of early stage cancers has long been a goal for researchers because earlier detection means earlier treatment. For some cancers such as ovarian and lung cancer, that can increase the five-year survival rate, the benchmark used to determine whether someone is cancer free.

Here’s what researchers did: they developed a blood test that examined the genetic mutations in pieces of DNA floating in the bloodstream. Specifically they looked at 58 different cancer-driver genes to see if there were mutations in the DNA fragments. If they found mutated DNA pieces floating in the blood stream, they knew there were tumors somewhere.

They first examined blood from 44 healthy individuals and found no changes in those genes related to cancer. Then they examined the blood of 200 people who were diagnosed with stage I or II cancers. They were able to correctly identify cancer-driver gene mutations for several types of cancer: 71% of colorectal cancer, 59% of both breast and lung cancer, and 68% of ovarian cancer. There’s more refinement needed to get the detection to 100% while maintaining no false-positives, but this is a major first step in noninvasive early detection of cancers. Developing a blood test for cancer could save lives by getting treatment even before symptoms occur.

If you want more information on this study and the implications this study has on treatment and ethical concerns, become a Member or Insider at DrChet.com to get access to the Straight Talk on Health audios. Gene Test to Diagnose Cancer has just been posted, as well as a new one on The Cholesterol Myth.

What are you prepared to do today?

Dr. Chet

 

Reference: Science Translational Medicine. DOI: 10.1126/scitranslmed.aan2415.