Food

International study links ultra-processed foods to greater risk of head and neck cancer

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Unfortunately, too many people regularly indulge in processed foods without much consideration.  Growing up, the average person often found these foods omnipresent in their households due to their affordability and appealing taste.

However, a recent international study has uncovered a concerning aspect of ultra-processed foods.  This research highlights a connection between the consumption of highly processed foods and an elevated risk of both head and neck cancer.  The findings shed light on the potential health implications associated with our common dietary choices.

Insights from a recent study on ultra-processed foods and cancer development

In the study mentioned earlier, researchers discovered that ultra-processed foods contain substances associated with the development of mouth and throat cancer.  However, the noteworthy finding is that the risk of developing cancer in these areas significantly rises with increased consumption of such processed foods and beverages.

The research involved an analysis of the dietary habits and lifestyles of 450,111 individuals over a span of 14 years.  The results revealed that those with higher consumption of ultra-processed foods faced an elevated risk of developing cancer in the esophagus and upper digestive tract.

Specifically, a 10% increase in the intake of ultra-processed foods was correlated with a notable 23% increase in the risk of both neck and head cancer.  Additionally, a 10% rise in the consumption of ultra-processed foods heightened the likelihood of esophageal cancer by 24%.

Why do ultra-processed foods damage the human body?

While the researchers behind the study aren’t entirely certain about why ultra-processed foods pose a threat to people, the findings suggest that the increased risk may at least be partially attributed to contaminants from packaging materials.  Despite this potential harm, such products remain pervasive due to their affordability and convenience.

It’s essential to highlight that the mentioned study builds upon prior research that already established a connection between the consumption of ultra-processed foods and cancer.  An earlier European study delved into this relationship, examining more than 30 types of cancer.  The lingering question revolves around whether the packaging materials of these foods solely contribute to the heightened cancer risk or play a partial role in its causation.

Here are the top offenders and how to remove them from your diet

Open your pantry, refrigerator, or freezer, and you’ll likely find plenty of processed foods.  Breaking away from tasty processed treats and entrees requires planning and preparation.  Make a mental note to avoid these ultra-processed foods and beverages at the grocery store:

  • Sugary drinks
  • Baked goods such as cakes, cookies and doughnuts
  • Sugar-laden breakfast cereals
  • Frozen pizzas and other frozen meals
  • Instant noodles
  • Processed meats such as sausage, bacon, deli meat and hot dogs
  • Packaged snacks and sweets such as bars of chocolate, crackers, pretzels and chips
  • Reconstituted fish/meat products such as fish sticks and nuggets
  • Foods/beverages with artificial sweeteners, such as foods labeled as “light” or diet

The challenge lies in finding creative ways to replace the ultra-processed foods listed above with healthy alternatives.  Instead of buying baked goods loaded with unnecessarily high amounts of sugar and fat, bake your own at home.  DIY homemade baked items are fresh, delicious, and, most importantly, do not have packaging that contains harmful chemicals.

Instead of buying prepackaged meat or deli meat, make a trip to the local butcher for 100% grass fed meat that is much safer, healthier, and presented in packaging that doesn’t subject you to nasty additives.

Resist the temptation to pop a frozen pizza or other frozen dinner into the oven.  Invest 15 minutes of time in making your own DIY pizza at home, and you’ll find it tastes better and is significantly healthier for your body.  Of course, for those people looking to be more “advanced,” developing your own organic food garden at home is a very smart choice.

How a simple dietary choice may alter your cardiovascular destiny

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The benefits of omega-3 fatty acids have been widely researched, and are one of the most important nutrients to get into your diet.  They affect brain development in children, contribute to mood regulation, decrease inflammation, and have been supported by studies suggesting their positive impact on heart health.

A new study from the Karolinska Institute, however, suggests that consuming oily fish is even more important for the cardiovascular health of those who have a family history of coronary artery disease.  The findings were not only consistent with the understanding that polyunsaturated fatty acids (PUFAs) are important for heart health but even more so for those with increased genetic risk factors.

Let’s take a look at the study and see if a simple dietary choice can change your genetically inclined cardiovascular destiny.

Does our genetic destiny defy common beliefs?

Many people believe that our genes determine everything from weight to cancer risk, but this oversimplification doesn’t hold true.  While we currently cannot alter our genes to change our hair color or our height, gene expression for disease risk is more complicated.

Recent studies indicate that numerous genes linked to diseases such as Parkinson’s or cancer must be turned on, oftentimes by factors that cause rampant inflammation, like smoking or a high-sugar diet, for example.

Have you ever wondered why a person who chain-smokes cigarettes for decades may never get lung cancer?  Science suggests it might be because their genes lack the catalyst that would be required to trigger such an opportunity.

Sometimes something as simple as a dietary change can protect our body from the inherent damage that genetic predispositions can prime us for.  Likewise, similar dietary changes can prevent the genes from ever “switching on.”

Diet might be the most important part of good health

The scientists at the Karolinska Institute wanted to determine if there was additional cardiovascular risk mediation from eating oily fish in patients who had a family history of cardiovascular disease.  Studies already exist showing that fish oil and omega-3s – particularly EPA and DHA – reduce the risk factors for cardiovascular disease, so the research was built on that premise.

They observed 40,885 patients who had no indications or history of cardiovascular health at the time of the study.  Tissue and blood samples were taken from the patients to evaluate biomarkers for polyunsaturated fatty acid dietary intake.  The individuals were then observed for the duration of the study and were reassessed at the time of a cardiovascular event or at the conclusion of the study.

Parameters of the study indicated that they considered a low PUFA intake as lower than or equal to the 25th percentile of PUFA biomarker saturation in giving samples within the studied population.  With that information in mind, the study found that people who had a low PUFA dietary intake, along with a family history of cardiovascular disease, were 1.41% more likely to have a cardiovascular event than the rest of the group.  People with just a family history but a moderate intake of PUFA had a 1.26 percent increased risk, and those without a family history and a moderate PUFA intake had a 1.06% risk.

While the differences in risks may seem small – 1.41%, 1.26%, and 1.06% for various scenarios involving PUFA intake and family history – it’s important to note their significance in the study.  In simpler terms, what you eat and your family history might play a role in your heart health.

Where do I find PUFAs?

Polyunsaturated fatty acids are in their highest concentration in oily fish, so increasing your intake of seafood is a great place to start.  In particular, fish like wild-caught salmon are full of omega-3s and one of the healthiest proteins you can eat.

With that said, however, eating fish in this day and age can be a risky prospect.  The days of pulling healthy, unspoiled salmon from rivers and having them cooked and brought to your plate are fast dwindling.  Most fish you get in a supermarket is farm-raised, and that raises a series of concerns.

Farm-raised fish in the U.S. are often fed diets that are not comparable to wild-caught fish and therefore have an abundance of omega-6 fatty acids.  Studies indicate that, if we overeat foods loaded with omega-6 fatty acids, we will tend to increase inflammatory markers in the body.  Farm-raised fish from other countries are even worse, typically not having anywhere near the levels of quality control that the U.S. or Europe has, and are therefore exposed to plastic, toxic chemicals, waste products from other livestock, and about a thousand other things that you should never eat.

Wild-caught fish are almost always the best choice, but they are often more expensive compared to their farm-raised counterparts.  Having said that, most people would benefit by only eating wild-caught fish 2x / week, a few ounces per serving.

“Fin-tastic” fish picks: Swimming towards better choices

One of the cheapest, most environmentally friendly, and easily accessible fish for your health is sardines.  Little canned fish like sardines, mackerel, bristling, and anchovies are cheap, sustainably caught, and have a micronutrient profile full of omega-3s that are perfect for heart health.

You can also opt for wild-caught frozen fish, which are not subject to seasonality and are, therefore, often cheaper.  Most fish undergo a freezing process anyway to kill parasites, so unless you live near an ocean, it is unlikely that any “fresh” fish you eat wasn’t frozen at some point and then thawed.  This means there is no loss of quality with frozen fish.

When it comes to choosing fish, steer clear of the farm-raised options altogether.  If you’re still tempted, make sure to scrutinize their aquaponic methods and feeding practices.  Stick to fish from regions like Europe, particularly Scandinavian countries or the U.S., where stringent regulations ensure higher standards.

Simply put, increasing your intake of omega-3s from oily fish is relatively easy.  It’s a delicious way to improve your health and is critically important if you have a family history of cardiovascular disease.

Ancient diet, modern benefits: Exploring the Mediterranean connection to cognitive health

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Dementia, a pervasive threat to the elderly, stealing their cherished golden years, is now seen through a lens that connects it to metabolic health issues like type 2 diabetes.  The role of diet in safeguarding against cognitive decline, Alzheimer’s, and other forms of dementia has become increasingly evident.

For example, the Mediterranean diet stands out as a beacon of health, renowned for its protective qualities against cancer and diabetes and for promoting weight management.  In fact, a recent study from France aimed to further elucidate the positive impact of this diet on cognitive health as individuals age.

Given the well-documented advantages of the Mediterranean diet, any additional evidence reinforcing its benefits is of immense significance.  Let’s delve into the study’s findings and explore some insights on embracing a Mediterranean lifestyle.

A deep dive into the Mediterranean diet and longevity

Cultures around the Mediterranean Sea are largely in what is considered a blue zone – areas where the population lives long, healthy lives.  Places like Sardinia, Greece, Italy, Crete, and others that follow similar lifestyles and diets have significantly more people within their population living healthfully into their 80s, 90s, and beyond.  This longevity is at least partially attributed to the way that they eat and live their lives.

The diet itself is exceedingly simple, filled mostly with whole foods, healthy protein from fish, sheep, and poultry, and lots of plants, like beans, greens, and squash.  People in these regions enjoy some red wine and vinegar and oil-based salad dressing and certainly avoid highly processed foods filled with industrial seed oils, high fructose corn syrup, and the preservatives that are rife within foods in western nations.

Blood biomarkers: A scientific window into dietary efficacy

It turns out that you can measure the efficacy of your diet within your blood.  There are certain biomarkers that can be gathered as data points from blood samples, like docosahexaenoic acid from fish, enterolactone and nitric oxide from plants, and oleic acid from healthy fats.  We know that these biomarkers, among dozens of others, benefit us by reducing inflammation, dilating blood vessels, and protecting us from free radical damage.

Because we can measure these biomarkers, the study did not simply rely on self-reported dietary data from the participants – the researchers actually drew blood samples to determine what the diets of these participants principally were.

Mediterranean diet’s impact on cognitive health: A 12-year study

In a study conducted across three French cities, researchers examined the cognitive health of participants around the age of 75.  Upon enrollment, participants underwent evaluations for cognitive decline and potential signs of dementia.  They also provided insights into their health status, encompassing conditions like diabetes, hypertension, and familial metabolic predispositions.  Blood samples were collected to assess relevant biomarkers and cognitive assessments were conducted.

The study juxtaposed two groups: a control group comprising individuals with diverse dietary habits and another group committed to the Mediterranean diet.  Over 12 years, participants adhered to their dietary patterns and returned periodically for health evaluations and blood analyses.

The findings were striking.  Those adhering to the Mediterranean diet exhibited notably reduced cognitive decline compared to their counterparts.  Additionally, they showcased a diminished prevalence of diabetes, alongside fewer instances of metabolic ailments such as cardiovascular issues, hypertension, and weight fluctuations.

How to make the Mediterranean diet work for you

At its core, the Mediterranean diet champions simplicity: prioritizing organic whole foods, predominantly from plant sources and cold-water fish, while sidestepping processed foods.  Yet, the secret behind the longevity observed in blue zones isn’t solely diet-centric.  Factors like regular walking, reduced stress levels, and restrained consumption of alcohol, sugar, and tobacco play pivotal roles.

For those considering a dietary shift, a simple adjustment could involve occasionally substituting common protein sources like factory-farmed beef with sheep, goat, or lamb – creatures that naturally graze on grass, resulting in meat rich in beneficial fats.  In contrast, conventionally raised livestock, fed on corn and other grains produce meat with elevated levels of inflammatory polyunsaturated fatty acids.  Incorporating cold-water fish, especially sardines, further enhances the intake of essential fats without exposing oneself to the mercury risks associated with larger (deep water) marine species.

Enjoy meatless meals by eating organic (non-GMO) tofu and beans as a source of protein, and eat far more organic plants in general.  Eating seasonally will help you cover your nutritional needs, too – most humans only eat within a very small group of fruits and vegetables when we were designed to thrive on a variety of nuts, seeds, sprouts, plants, meats, fruit, and legumes.

The Mediterranean diet has many benefits, especially when paired with these cultures’ lifestyles.  Keep your stress low, walk and exercise more, and eat organic whole foods as much as possible, and you can enjoy years of great brain function and overall wellbeing.

Metabolic syndrome tied to a vitamin deficiency, increasing disease risk for nearly 40% of Americans

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 Metabolic syndrome refers to a group of risk factors that increase your risk of developing heart disease, stroke, and diabetes. These risk factors include high blood sugar levels, high blood pressure, high triglycerides, extra fat around the waist, and low levels of HDL (good) cholesterol.

Once you have three or more of these risk factors, it results in a metabolic syndrome risk and means you’re at risk for serious health complications.

It’s currently estimated that nearly 40% of Americans have metabolic syndrome, and beyond increasing the risk of heart problems and diabetes, one recent study found a link between metabolic syndrome and vitamin C deficiency. And for those with metabolic syndrome, getting the normal recommended amount of vitamin C may not be enough.

Editor’s Note: Click here to register for the Fatty Liver Docu-Class … because a fatty liver is a precursor to metabolic syndrome and on “Day 9” of the Fatty Liver Docu-Class, you’ll see the “Best of the Metabolic Syndrome Docu-Class,” hosted by yours truly, Jonathan Landsman.

Poor eating habits create a cycle of depleted antioxidant protection

Poor eating habits – specifically a diet high in processed sugars and toxic fats – cause chronic low-grade inflammation that can result in the development of metabolic syndrome. This recent study published in Redox Biology also suggests that the same eating habits that may lead to metabolic syndrome cause imbalances within the gut microbiome.

Impaired gut function contributes to additional toxins in the blood. This, in turn, results in the depletion of vitamin C, subsequently impairing vitamin E trafficking in the body.

Since vitamin C protects vitamin E, if you don’t have enough vitamin C, then your vitamin E also gets lost – which means you end up without both of these essential antioxidants. And this only makes a bad situation worse, since vitamins E and C both help defend the body from oxidative stress caused by inflammation and free radicals, which may cause damage to the body’s cells.

In other words, without intervention, this cycle continues to repeat itself – resulting in a severe increase in disease risk for these individuals.

Vitamin C does the heavy lifting for the immune system

Science backs up the fact that vitamin C is a ‘powerhouse’ antioxidant that does a lot of the heavy lifting for the immune system. In fact, evidence shows that healthy levels of vitamin C in the body can eradicate most acute infections and even neutralize many toxin exposures, including many serious health issues.

Vitamin C is far more than just the premier antioxidant circulating through your body – it also stimulates and promotes many of the essential functions of your immune system.

For those with metabolic syndrome, the link to vitamin C deficiency is serious, since it leaves these individuals with a weaker immune system that’s more susceptible to disease. And individuals with metabolic syndrome may eat the same amount of this vitamin as others but continue to have lower levels of vitamin C in the body.

The takeaway: if you have metabolic syndrome, you’ll need even more vitamin C than most people do.

Increase vitamin C levels by eating more fresh fruits and vegetables. You may also want to consider adding a vitamin C supplement to your diet to ensure you’re getting enough vitamin C.  Keep in mind a simple rule, the sicker you are … the more you need vitamin C, on a daily basis.

Vitamin C shown to improve blood sugar levels and reduce blood pressure in patients with type 2 diabetes

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The Centers for Disease Control and Prevention (CDC) recently reported that fully one third of the American population is prediabetic, with elevated blood sugar (glucose) levels that can – if untreated – lead to full-blown type 2 diabetes.  Diabetes, which currently affects over 30 million Americans, causes the risk of heart disease to skyrocket – and can feature serious complications such as nerve damage, kidney disease and retinal damage.

Now, a brand-new Australian study shows that vitamin C can lower elevated blood glucose in type 2 diabetics, helping to control dangerous after-meal surges and “spikes.”

The misunderstood health benefits of vitamin C

Vitamin C, or ascorbic acid, is a potent natural antioxidant, anti-inflammatory and immune system booster.  Thankfully, a handful of forward-thinking doctors – early vitamin C pioneers such as Dr. Frederick Klenner, Linus Pauling, Dr. Mathias Rath and Thomas E. Levy, MD, JD – have long spoken out about the ability of vitamin C to treat, and even reverse, a host of serious conditions.

In the 1940s, Dr. Klenner reported curing a variety of diseases, including polio and hepatitis, with high-dose vitamin C – while in the present day, Dr. Paul Marik, Professor of Medicine of Eastern Virginia Medical School, administers a vitamin C protocol that drastically improves survival rates for patients suffering from sepsis, a life-threatening systemic infection.

But the therapeutic value of this non-toxic, inexpensive natural nutrient has been consistently downplayed by the medical powers-that-be. Time and again, the mainstream medical community seems to have greeted even the most impressive vitamin C studies with indifference, suspicion and even scorn.

Fortunately, well-designed scientific studies on vitamin C’s benefit are accumulating – as manifested by this latest study, conducted by an international team of researchers and published in a peer-reviewed medical journal.

Study: Vitamin C can reduce blood sugar spikes by a substantial 36 percent

In a double-blind, placebo-controlled study published in 2019 in Diabetes, Obesity and Metabolism, adult participants with type 2 diabetes were randomly divided into two groups. One group took 1,000 mg of ascorbic acid in divided doses every day for four months, while the other group received a placebo.

Participants were given standardized meals, and their glucose levels were monitored continuously for 48 hours.  The results were clear-cut.

The vitamin C group experienced significantly lower after-meal blood sugar levels – reducing by roughly three hours the time spent every day in hyperglycemia – a state of elevated blood glucose.

Why is this important?

Research has shown that blood sugar “spikes” damage cells in multiple ways, and are linked to heart disease, cancer, Alzheimer’s disease, peripheral neuropathy, kidney failure, cognitive dysfunction and retinal damage.

Clearly, the less time spent in hyperglycemia – the better.  However, better glucose control wasn’t the only benefit for the participants in the vitamin C group.

The ascorbic acid also lowered elevated blood pressure – a primary risk factor for heart disease.

The team reported that participants’ blood pressure readings dropped by an average of 7 mmHg in the systolic number (which measures the pressure exerted by heartbeats) and by 5 mmHg in the diastolic (which measures the pressure in between beats).

Incidentally, the vitamin C group also experienced a significant lessening of disease-promoting oxidative stress.  The researchers concluded that the study provided evidence for use of vitamin C as an adjunct therapy to improve control of blood sugar and blood pressure in people with type 2 diabetes.

Vitamin C drastically lowers the risk of developing cardiovascular disease

People with type 2 diabetes suffer from increased risk of heart disease – in fact, the Cleveland Clinic reports that 75 to 85 percent of patients with diabetes die from heart attack or stroke.

This makes the findings of recent studies on vitamin C and heart disease particularly significant.  In one study, which was published in Journal of the American College of Nutrition, researchers evaluated the daily vitamin C intake of 108 men.

They found that men in the group with the highest levels of vitamin C intake had a 66 percent less chance of developing coronary heart disease – the number one killer in the United States – than men in the lowest-intake group.  In other words, men who consumed higher levels of vitamin C were two-thirds more likely to avoid developing heart disease.

Researchers believe that this beneficial effect is due to vitamin C’s ability to prevent and alleviate endothelial dysfunction – the stiffening of arterial walls that interferes with the healthy flow of oxygen-rich blood.

And, in a 2003 observational study conducted by researchers at Harvard Medical School and published in the Journal of the American College of Cardiology, 85,000 female nurses were followed for 16 years.

Women who took supplemental vitamin C reduced their risk of heart disease by a hefty 28 percent.

Alert: Vitamin C also improves post-heart attack prognosis

Vitamin C can help reduce the damage to heart tissue from ischemia-reperfusion injury (a type of post-heart attack damage in which blood previously cut off by the attack suddenly floods back into the area).

Researchers credit vitamin C with improving electrical conduction throughout the heart muscle, reducing inflammation and decreasing clotting factors – which contribute to stroke risk.  Vitamin C also appears to help protect against two other heart problems: atrial fibrillation – a type of irregular heartbeat – and dilated cardiomyopathy, a harmful enlargement and weakening of the heart.

How much vitamin C do I need a day?

According to natural health experts, the current vitamin C RDAs advised by the Office of Dietary Supplements are good for a laugh – and not much else.

Vitamin C proponents note that the ODS recommendations – a paltry 75 to 90 mg of vitamin C a day – are enough to prevent the severe form of vitamin C deficiency known as scurvy, but not enough to maintain optimal health or combat disease.

Knowledgeable integrative and functional doctors usually advise taking anywhere from 1,000 to 6,000 mg of vitamin C a day, in divided doses – with even higher levels recommended for serious chronic conditions.

Naturally, you should consult with your own physician before supplementing with vitamin C.  And, of course, do not stop or reduce prescribed blood sugar-lowering medications – unless specifically advised to do so by your doctor.

Health tip: various fiber-rich foods and nutritional supplements – including citrus fruits, cruciferous vegetables, oat bran and psyllium husks – can also help to promote healthy glycemic control.

As the studies suggest, daily supplementation with inexpensive, non-toxic vitamin C can provide major protective dividends to the heart – while helping to regulate blood sugar levels. Clearly, having optimal levels of this essential micronutrient is a “win/win” scenario.

Unlock the power of meal timing to reduce your cardiovascular risk

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Starting your day with a nutritious breakfast is widely emphasized, but here’s a groundbreaking revelation: the timing of your meals, including lunch and dinner, could significantly influence your cardiovascular health.

A recent analysis in Nature Communications underscores this, highlighting that when you eat might be as crucial as what you eat in mitigating cardiovascular risks.

Why “chrononutrition” may soon become the health industry’s new buzzword

Chrononutrition, meaning the strategic timing of meals, will likely be one of the hottest health and nutrition trends in the new year.  We have transitioned from meals at the family dinner table to grabbing unhealthy fast food on the go in less than half a century.  The decline of the family unit combined with the ever-competitive rat race has led to harmful outcomes for too many people throughout the modern world.

The analysis linked above delves into the time at which food is consumed.  The examination aimed to determine if the strategic timing of meals improves human health.  Though it was already known that exposure to light plays a part in circadian rhythms, there was still some debate as to whether chrononutrition had merit.

The scientists who conducted the chrononutrition study analyzed data from 103,389 individuals.  Precisely 79% of the women in the study were women.  The average age of participants was 42.  The research team also accounted for numerous confounding factors ranging from participant sleep cycle to lifestyle, diet quality, and even nuanced demographics such as age.

The data makes the case for timing every meal

The results show timing one’s first meal of the day is especially important.  Consuming breakfast late in the morning or skipping it in favor of lunch is linked to an elevated risk of heart disease.  The researchers determined there was a 6% hike in the risk of cardiovascular disease for each hour that the initial meal was delayed.

For example, an individual who waits until 11 a.m. to eat breakfast has a 6% greater increase in developing cardiovascular disease than someone who consumes breakfast at 10 a.m.

The data shows the timing of the day’s first meal and fasting periods synch the body’s circadian rhythms, affecting cardiometabolic functionality including blood pressure.  Moreover, the study results also provide insight into the importance of the day’s last meal.

Eating food late at night, meaning after 9 in the evening, is linked to a 28% hike in the development of cerebrovascular disease compared to taking the last bite of the evening before 8.  Stroke is a typical example of cerebrovascular disease.  The risk of cerebrovascular disease was higher in female study participants.

The researchers also found the longer one waits when fasting at night, meaning the time difference between the final meal of the day and the first bite in the morning, influences the risk of cerebrovascular disease.

In short, it is in your interest to resist the temptation to enjoy a “fourth meal” late at night.  Instead, build up your hunger after dinner or dessert so you can kick off the next day with a nutritious and fulfilling breakfast.

Tips to strategically time your food intake

Kickstart your metabolism early by eating a balanced breakfast within an hour of waking up.  This sets the tone for your body’s energy utilization throughout the day.

Establish regular meal times and stick to them.  This helps regulate your body’s internal clock, optimizing digestion and nutrient absorption.

Try to finish your dinner at least 2-3 hours before bedtime.  Late-night meals can disrupt sleep patterns and slow down metabolism.

Be mindful of when you consume caffeinated drinks.  Late afternoon or evening consumption can interfere with sleep quality and affect meal timing the next day.

Prepare meals and snacks in advance to ensure you have nutritious options readily available.  This can help prevent impulsive eating and ensure you consume balanced meals at the right times.

If your appetite is lacking early in the morning or afternoon, engage in a light workout before eating.  Use your scheduled meals as positive reinforcement for exercising, and you’ll find eating at designated intervals much easier.

Low-Sodium Diet Did Not Cut Clinical Events in Heart Failure Trial

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A low-sodium diet was not associated with a reduction in future clinical events in a new study in ambulatory patients with heart failure. But there was a moderate benefit on quality of life and New York Heart Association (NYHA) functional class.

The results of the SODIUM-HF trial were presented today at the American College of Cardiology (ACC) 2022 Scientific Session, conducted virtually and in-person in Washington, DC. They were also simultaneously published online in The Lancet.

The study found that a strategy to reduce dietary sodium intake to less than 1500 mg daily was not more effective than usual care in reducing the primary endpoint of risk for hospitalization or emergency department visits due to cardiovascular causes or all-cause death at 12 months.

“This is the largest and longest trial to look at the question of reducing dietary sodium in heart failure patients,” lead author, Justin Ezekowitz, MBBCh, from the Canadian VIGOUR Center at the University of Alberta, Edmonton, Canada, told theheart.org |Medscape Cardiology.

But he pointed out that there were fewer events than expected in the study, which was stopped early because of a combination of futility and practical difficulties caused by the COVID pandemic, so it could have been underpowered. Ezekowitz also suggested that a greater reduction in sodium than achieved in this study or a longer follow-up may be required to show an effect on clinical events.

“We hope others will do additional studies of sodium as well as other dietary recommendations as part of a comprehensive diet for heart failure patients,” he commented.

Ezekowitz said that the study results did not allow blanket recommendations to be made on reducing sodium intake in heart failure.

But he added: “I don’t think we should write off sodium reduction in this population. I think we can tell patients that reducing dietary sodium may potentially improve symptoms and quality of life, and I will continue to recommend reducing sodium as part of an overall healthy diet. We don’t want to throw the baby out with the bathwater.”

Ezekowitz noted that heart failure is associated with neurohormonal activation and abnormalities in autonomic control that lead to sodium and water retention; thus, dietary restriction of sodium has been historically endorsed as a mechanism to prevent fluid overload and subsequent clinical outcomes; however, clinical trials so far have shown mixed results.

“The guidelines used to strongly recommend a reduction in sodium intake in heart failure patients, but this advice has backed off in recent years because of the lack of data. Most heart failure guidelines now do not make any recommendations on dietary sodium,” he said.

SODIUM-HF was a pragmatic, multinational, open-label, randomized trial conducted in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand), which included 809 patients (median age, 67 years) with chronic heart failure (NYHA functional class II–III) who were receiving optimally tolerated guideline-directed medical treatment. They were randomly assigned to usual care according to local guidelines or a low-sodium diet of less than 100 mmol (<1500 mg/day). Patients with a baseline sodium intake of less than 1500 mg/day were excluded.

In the intervention group, patients were asked to follow low-sodium menus developed by dietitians localized to each region. They also received behavioral counseling by trained dietitians or physicians or nurses.

Dietary sodium intake was assessed by using a 3-day food record (including 1 weekend day) at baseline, 6 months, and 12 months in both groups and, for the intervention group, also at 3 and 9 months to monitor and support dietary adherence.

Ezekowitz explained that although the best method for measuring sodium levels would normally be a 24-hour urine sodium, this would be impractical in a large clinical trial. In addition, he pointed out that urinary sodium is not an accurate measure of actual sodium levels in patients taking diuretics, so it is not a good measure to use in a heart failure population.

“The food record method of assessing sodium levels has been well validated; I think we measured it as accurately as we could have done,” he added.

Results showed that between baseline and 12 months, the median sodium intake decreased from 2286 mg/day to 1658 mg/day in the low-sodium group and from 2119 mg/day to 2073 mg/day in the usual care group. The median difference between groups was 415 mg/day at 12 months.

By 12 months, events comprising the primary outcome (hospitalization or emergency department visits due to cardiovascular causes or all-cause death) had occurred in 15% of patients in the low-sodium diet group and 17% of those in the usual care group (hazard ratio [HR], 0.89 [95% CI, 0.63 – 1.26]; P = .53).

All-cause death occurred in 6% of patients in the low-sodium diet group and 4% of those in the usual care group (HR, 1.38; P = .32). Cardiovascular-related hospitalization occurred in 10% of the low-sodium group and 12% of the usual care group (HR, 0.82; P = .36), and cardiovascular-related emergency department visits occurred in 4% of both groups (HR, 1.21; P = .60).

The absence of treatment effect for the primary outcome was consistent across most prespecified subgroups, including those with higher vs lower baseline sodium intake. But there was a suggestion of a greater reduction in the primary outcome in individuals younger than age 65 years than in those age 65 years and older.

Quality-of-life measures on the Kansas City Cardiomyopathy Questionnaire (KCCQ) suggested a benefit in the low-sodium group, with mean between-group differences in the change from baseline to 12 months of 3.38 points in the overall summary score, 3.29 points in the clinical summary score, and 3.77 points in the physical limitation score (all differences were statistically significant).

There was no significant difference in 6-minute-walk distance at 12 months between the low-sodium diet group and the usual care group.

NYHA functional class at 12 months differed significantly between groups; the low-sodium diet group had a greater likelihood of improving by one NYHA class than the usual care group (odds ratio, 0.59; P = .0061).

No safety events related to the study treatment were reported in either group.

Ezekowitz said that to investigate whether longer follow-up may show a difference in events, further analyses are planned at 2 years and 5 years.

Questions on Food Recall and Blinding

Commenting on the findings at the late-breaking clinical trials session at the ACC meeting, Biykem Bozkurt, MD, professor of medicine at Baylor College of Medicine, Houston, Texas, congratulated Ezekowitz on conducting this trial.

“We have been chasing the holy grail of sodium reduction in heart failure for a very long time, so I have to commend you and your team for taking on this challenge, especially during the pandemic,” she said.

But Bozkurt questioned whether the intervention group actually had a meaningful sodium reduction given that this was measured by food recall and this may have been accounted for by under-reporting of certain food intakes.

Ezekowitz responded that patients acted as their own controls in that calorie intake, fluid intake, and weight were also assessed and did not change. “So I think we did have a meaningful reduction in sodium,” he said.         

Bozkurt also queried whether the improvements in quality of life and functional status were reliable given that this was an unblinded study.

To this point, Ezekowitz pointed out that the KCCQ quality-of-life measure was a highly validated instrument and that improvements were seen in these measures at 3, 6, and 12 months. “It is not like these were spurious findings, so I think we have to look at this as a real result,” he argued.

Commenting on the study at an ACC press conference, Mary Norine Walsh, MD, director of the heart failure and cardiac transplantation programs at St Vincent Heart Center in Indianapolis, Indiana, said the trial had answered two important questions: that sodium reduction in heart failure may not reduce heart failure hospitalization/death but that patients feel better.

 “I think we can safety tell patients that if they slip up a bit they may not end up in hospital,” she added.

Supermarket Diet Advice Improves DASH Adherence: SuperWIN

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People who received personalized nutrition education in a series of sessions at their regular grocery store significantly improved adherence to a healthy diet, in a new “first-of-its-kind” study in which scientific researchers partnered with a large supermarket company.

In the SuperWIN study, participants were given individualized advice from supermarket-based dieticians using data on their own buying habits recorded on their supermarket loyalty cards. This was associated with an increased adherence to the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes vegetables, fruits and whole grains while limiting foods that are high in saturated fat, sugar, and sodium and has been shown to lower blood pressure and low-density lipoprotein cholesterol.

One group of patients also received additional education about healthy eating and meal planning through online technologies, and this group showed even better adherence to the DASH diet.

The study was presented at American College of Cardiology (ACC) 2022 Scientific Session by Dylan Steen, MD, adjunct associate professor of medicine at the University of Cincinnati College of Medicine in Ohio.

“The SuperWIN study provides evidence for the benefit of delivering healthy-eating interventions at modern supermarkets and retail-based clinics,” Steen said. “It demonstrates the efficacy of dietary interventions harnessing the physical environment of the supermarket, the retail-based dietitians working within the store, and the purchasing data captured on the store’s loyalty cards,” he added.

The study was conducted in partnership with Kroger, the largest supermarket chain in the United States, which also operates a large chain of pharmacies and health clinics.

Steen said the study was addressing one of the biggest public health problems — unhealthy eating — with an innovative approach. “We need to think about how we can extend the reach of modern healthcare systems into communities and better deliver services right where people are; meet them where they live,” he said at an ACC press conference.

Commenting on the study ay the press conference, Eileen Handberg, PhD, professor of medicine at University of Florida, Gainesville, and immediate past chair of the ACC Cardiovascular Care Team Council, said, “I am amazingly excited about this. There is so much potential here. We have never really taken advantage of the current explosion in retail-based healthcare before.”

Handberg suggested the study had major implications for the primary prevention of cardiovascular disease. “Little kids go shopping with their parents, so you have the ability here to change behavior from children on up if you can change the dynamic of the choices they make in the grocery store,” she said.

In his presentation, Steen noted that despite many longstanding guidelines on healthy eating, about 75% of Americans still have a poor-quality diet. This trial was conducted to see if a new approach could improve that situation. “If we change the environment in which we deliver dietary education, we can make a difference,” he said.  

The SuperWIN trial was conducted in 13 Kroger stores in Ohio and Kentucky. The study enrolled 267 people with at least one cardiovascular risk factor from a primary care network who regularly shopped at one of the study stores. All participants also had to be willing to follow the DASH diet, which was taught at each educational session in the trial.

All participants received one “enhanced” medical nutrition therapy that was guided by the individual’s own dietary intake analytics.

They were then randomly assigned to one of three arms. The control group received no further education. The strategy 1 group received six additional teaching sessions in the supermarket aisles over a 3-month period. Each session was guided by updated individualized purchasing data provided to the dietitian and the participant. 

The strategy 2 group received the same six additional teaching sessions as strategy 1, but they also had some additional teaching on healthy eating and meal planning from a variety of online shopping tools, and nutrition and healthcare apps.  

“The supermarket analytics were automatically collected so the dietitians could tell what each person liked to eat, how much of each product they were buying and how much they were spending,” Steen explained.

COVID hit halfway through the trial, and 20 participants were withdrawn for their own safety as they could no longer visit the stores, but the trial continued with the rest of the participants with enhanced safety precautions. The overall analysis cohort was 247 participants.

The average age of the participants was mid-50s, around 70% were female, and most did not have a history of cardiovascular disease.

Eating habits were assessed by three 24-hour dietary recalls assessed at the start of the study and at 3 and 6 months. The DASH score, which is a measure of adherence to the DASH diet, was calculated from this information. The score can range from 0 to 90, with an increased score showing increased adherence.

In one analysis, the researchers compared the DASH scores from the two intervention groups together with the control group, and in a second analysis they compared the scores in the strategy 2 group with those in the strategy 1 group.

Before the pandemic there was “near 100%” attendance for the six visits over the 3-month study period, which Steen said he thought was “remarkable.” During the pandemic, attendance came down to around 80%.

Results showed that the DASH score increased in all three groups at 3 months, with stepwise increases corresponding to the intensity of the intervention. DASH scores increased by 5.8 points in the control group, by 8.6 points in the strategy 1 group, and by 12.4 points in the strategy 2 group.    

DASH scores significantly differed between the two intervention groups and the control group (P = .02). “This shows that purchasing data–guided in-store tours do increase the efficacy of dietary education,” Steen said.  

The difference in scores between the strategy 1 and strategy 2 groups was also significant (P = .01). “This shows online enhancements increase adherence to the DASH diet even further,” Steen commented

By 6 months, the scores had dropped off a little but were still increased from baseline: by 4.4 points in the control group, 6.6 points in the strategy 1 group, and 8.4 points in the strategy 2 group. “There was again a stepwise increase as the intervention intensified, but there was no longer a significant difference between the interventions and control,” Steen noted.

Secondary endpoints included blood pressure and body mass index. Systolic blood pressure decreased slightly in all three groups: by 2.8 mm Hg in the control group, 6.6 mm Hg in the strategy 1 group, and 5.7 mm Hg in the strategy 2 group. BMI was reduced by 0.2, 0.4 and 0.8, respectively, but the between-group differences were not significant.

Steen noted that this is the first study of its kind to date in which  scientific researchers collaborated with a large supermarket chain. He explained they also involved a primary care network so that healthcare utilization information will be available.

“We can the integrate retail-based healthcare information with traditional healthcare information. And we can start to look at downstream healthcare utilization and cost outcomes as well, which will be important as we start to think how to evolve the healthcare system,” he commented.

“The hope is that we can get more scientists working with more retailers to really drive the evidence to shape the evolution of our healthcare system,” he added.  

Challenges Ahead

Handberg pointed out there would be challenges in reaching the underserved population who do not shop at the major supermarkets. “We need to figure out how to get partnerships across the whole spectrum of grocery stores.”

She also noted that 3 months (the duration of the study intervention) was not much time to change the eating habits of a family. “Interventions may have to be a bit more intensive to get the change in blood pressure and weight that we would want to see.”

She added that she hoped the major grocery store companies will see the opportunities in this approach. “Changing behavior is very complicated, and the key will be how to make people stick with the changes. But grocery stores are smart. They have got us going to their pharmacies, so getting us to see a dietitian is not that much of a stretch.”   

Moderator of the ACC late breaker session at which the study was presented, Pamela Morris, MD, from the Medical University of South Carolina, who is also ACC Annual Scientific Session chair, asked whether the approach could be sustained.  

“I am thinking back to the barber shop study of blood pressure treatment and to my knowledge those PharmDs are no longer in those barbershops, taking blood pressures, counseling patients, and prescribing antihypertensives. So is Kroger maintaining a long-term commitment to providing this education, or how can this be financed over the long term?” she asked.

Steen replied that he believed sustainability to be one of the key strengths of this model. “Retail-based healthcare is exploding in the US. The number of retail outlets offering a comprehensive list of services is going up all the time. These programs exist regardless of whether this trial was conducted or not.”

But Steen stressed that having an evidence base will be critically important.

“Validation is an enormous part of this evolution in retail-based healthcare — not only to figure out what works but also to engage payors and others in the process of supporting these interventions. I think the sustainability is there — it is sort of baked into the model — but research will be a huge part of cementing this in and helping us to understand what we should do.”

Glycemic Control for Type 2 Diabetes Mellitus Patients: A Systematic Review

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Abstract

Diabetes mellitus is a chronic metabolic disorder resulting in hyperglycemia and microvascular and macrovascular complications in individuals globally. Type 2 diabetes mellitus (T2DM) is highly prevalent and accounts for 90% of patients. Maintaining blood glucose concentration is essential to avoid severe complications. Glycemic control is the optimal serum glucose concentration in diabetic patients. It is necessary to identify factors affecting the glycemic control of patients to prevent control and complications. We conducted this systematic review to assess the factors affecting glycemic control among type 2 diabetes mellitus patients. Published literature between the years 2020 to 2022 was retrieved from PubMed, Science Direct, and Google Scholar using different combinations of keywords: T2DM, Glycemic control, Poor, Good, Adequate, Inadequate, Factors, Association, and Determinants. All original articles written in the English language with full-text available and the value of glycemic control defined were included. A total of 1866 studies were retrieved. After the title, abstract, screening, and full-text screening, 12 studies were eligible. The prevalence of poor glycemic control was high, and it ranged between 45.2% and 93% among the studies. The factors associated with glycemic control were stratified into four categories: personal or body-related, clinical, medication-related, and behavioral factors. There was a high prevalence of poor glycemic control in all included studies. The glycemic control was associated with various factors; some were related to the patient or medical conditions while others were related to the behavior of the patients or the medication administrated.

Healthy Omega-3 Fatty Acids Could Slow a Deadly Lung Disease

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News Picture: Healthy Omega-3 Fatty Acids Could Slow a Deadly Lung DiseaseBy Ernie Mundell HealthDay Reporter

WEDNESDAY, Jan. 3, 2024 (HealthDay News)

A diet laden with omega-3 fatty acids found in nuts and oily fish might help slow the progression of pulmonary fibrosis, researchers report.

Pulmonary fibrosis is a relentless, potentially fatal disease where lung tissue scars and hardens over time. Often tied to smoking, the illness impairs lung function so that patients become short of breath, weak and disabled.

The new study was led by Dr. John Kim, a pulmonary and critical care expert at the University of Virginia School of Medicine and UVA Health, in Charlottesville.

His team tracked the health of 300 patients with interstitial lung disease — the class of respiratory ailments that includes pulmonary fibrosis. Most had “idiopathic” pulmonary fibrosis (meaning the exact cause of the illness is unknown) and most were men (males are more prone to the disease).

Blood tests were taken to gauge each patient’s dietary intake of omega-3 fatty acids.

The team found that “higher levels of omega-3 fatty acids were predictive of better clinical outcomes in pulmonary fibrosis,” Kim said in a university news release.

Specifically, people with higher levels of the nutrient had lungs that were better able to exchange carbon dioxide and oxygen — a process necessary to life. They also were better able to survive without needing a lung transplant, the study found.

“These findings were consistent whether [or not] you had a history of cardiovascular disease, which suggests this may be specific to pulmonary fibrosis,” Kim added.

It’s not yet clear how omega-3s are providing this benefit, or whether taking in more of the nutrient in food or supplements would help patients.

However, it’s not the first time omega-3s have been linked to better health: Other studies have shown that the fatty acids can improve outcomes for folks battling heart disease, blood clots and even some cancers.

As for pulmonary fibrosis, “we need further research to determine if there are specific omega-3 fatty acids that may be beneficial and, if so, what are their underlying mechanisms,” Kim said.

“Similar to other chronic diseases, we hope to determine whether nutrition-related interventions can have a positive impact on pulmonary fibrosis,” he said.

The study was published recently in the journal Chest.