Health Outcomes in USA vs other Countries

June 11 2014

by alex

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Interesting and informative infographic comparing health care and health outcomes in various countries. Note that Japan seems to be doing something right.

For all of the research bestowed upon the Mediterranean diet, the Japanese diet is very likely responsible for much of the superior health outcomes. Omnivorous diet, abundant produce, abundant seafood and modest animal proteins.


America's Health Disadvantage

Mediterranean Diet affects BP, glucose and lipids

June 9 2014

by alex

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The most studied dietary pattern continues to be studied further. Of course, outcomes such as heart attacks, strokes and death matter most, but this study helps to explain some of the ways that the cardiovascular benefits are mediated.


Mediterranean Diet Reduces 24-Hour Ambulatory Blood Pressure, Blood Glucose, and Lipids: One-Year Randomized, Clinical Trial

M Doménech, P Roman, J Lapetra, FJ García de la Corte, A Sala-Vila, R de la Torre, D Corella, J Salas-Salvadó, V Ruiz-Gutiérrez, RM Lamuela-Raventós, E Toledo, R Estruch, A Coca, E Ros

Hypertension 2014 May 05 [epub ahead of print]


The PREvención con DIeta MEDiterránea (PREDIMED) trial showed that Mediterranean diets (MedDiets) supplemented with either extravirgin olive oil or nuts reduced cardiovascular events, particularly stroke, compared with a control, lower fat diet. The mechanisms of cardiovascular protection remain unclear. We evaluated the 1-year effects of supplemented MedDiets on 24-hour ambulatory blood pressure (BP), blood glucose, and lipids. Randomized, parallel-design, controlled trial was conducted in 2 PREDIMED sites. Diets were ad libitum, and no advice on increasing physical activity or reducing sodium intake was given. Participants were 235 subjects (56.5% women; mean age, 66.5 years) at high cardiovascular risk (85.4% with hypertension). Adjusted changes from baseline in mean systolic BP were -2.3 (95% confidence interval [CI], -4.0 to -0.5) mm Hg and -2.6 (95% CI, -4.3 to -0.9) mm Hg in the MedDiets with olive oil and the MedDiets with nuts, respectively, and 1.7 (95% CI, -0.1 to 3.5) mm Hg in the control group (P<0.001). Respective changes in mean diastolic BP were -1.2 (95% CI, -2.2 to -0.2), -1.2 (95% CI, -2.2 to -0.2), and 0.7 (95% CI, -0.4 to 1.7) mm Hg (P=0.017). Daytime and nighttime BP followed similar patterns. Mean changes from baseline in fasting blood glucose were -6.1, -4.6, and 3.5 mg/dL (P=0.016) in the MedDiets with olive oil, MedDiets with nuts, and control diet, respectively; those of total cholesterol were -11.3, -13.6, and -4.4 mg/dL (P=0.043), respectively. In high-risk individuals, most with treated hypertension, MedDiets supplemented with extravirgin olive oil or nuts reduced 24-hour ambulatory BP, total cholesterol, and fasting glucose.


Link to abstract:hyper.ahajournals.org/content/early/2014/05/05/HYPERTENSIONAHA.113.03353.abstract

Baked Halibut with Mango Pepper Salsa

June 4 2014

by alex

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Baked Halibut with Mango Pepper Salsa
Serves: 4
This mango with red pepper salsa works well with fish or chicken.
  • 4 halibut filets
  • 1 mango, diced, about 1½ cups
  • ½ cup diced red bell pepper
  • ⅓ cup finely diced red onion
  • ½ – 1 jalapeno, finely diced
  • 3 tbsp. lime juice
  • 2 tbsp. fresh cilantro
  • ¼ tsp ground cumin
  • salt to taste
  1. Bake halibut at 350 degrees F for 10-14 minutes, depending on thickness and your oven.
  2. Meanwhile, prepare salsa with all other ingredients.
  3. Serve salsa with halibut and other side dishes of your choice.


Roasted Chickpea and Kale Salad With Sun-Dried Tomato Vinaigrette

May 30 2014

by alex

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Roasted Chickpea and Kale Salad With Sun-Dried Tomato Vinaigrette
Serves: 4-6
  • 1 (28 ounce) can chickpeas, rinsed and drained
  • 5 tablespoons extra-virgin olive oil
  • ½ teaspoon ground cumin
  • ½ teaspoon paprika
  • Kosher salt and freshly ground black pepper
  • 1 small bunch curly kale, trimmed and thinly sliced (about 1 quart of greens)
  • ½ cup pine nuts
  • ½ cup sun-dried tomatoes, thinly sliced
  • 4 scallions, white and light green parts only, thinly sliced
  • 1 medium clove garlic, grated (about 1 teaspoon)
  • 2 tablespoons juice and 1 teaspoon zest from 1 lemon, plus more juice as desired
  • ½ teaspoon hot sauce, such as Frank’s
  • 2 teaspoons sherry or red wine vinegar
  • 1 cup fresh cilantro leaves, roughly chopped
  • 1 cup fresh mint leaves, roughly chopped
  1. Adjust oven racks to upper and lower middle positions and preheat oven to 350°F. Line a rimmed baking sheet with paper towels. Spread chickpeas on top and roll around under your hands to thoroughly dry. Transfer chickpeas to a large bowl. Add 1 tablespoon olive oil, cumin, and paprika. Season to taste with salt and pepper. Discard paper towels and line baking sheet with aluminum foil. Spread chickpeas over foil and transfer to oven. Roast on upper rack, shaking pan occasionally, until chickpeas are about ¾ their original size with a dense, nutty texture, about 1 hour. Remove from oven and let cool slightly.
  2. Meanwhile, add kale to now-empty chickpea bowl. Add 1 tablespoon olive oil, season with salt and pepper, and massage kale until well-coated in oil. Set aside at room temperature.
  3. Place pine nuts in a skillet and transfer to lower rack of oven. Toast, stirring occasionally, until pine nuts are deep golden brown, about 15 minutes. Remove from oven and transfer to a bowl. Set aside.
  4. In a medium bowl, combine sun-dried tomatoes, scallions, garlic, lemon juice, zest, hot sauce, vinegar, and remaining 3 tablespoons oil. Season with salt and pepper and stir well with a fork.
  5. When chickpeas are cooked and slightly cooled, add to bowl with kale. Add pine nuts, sun-dried tomato dressing, cilantro, and mint. Toss with hands until well-combined. Adjust seasoning with more salt, pepper, and/or lemon juice as necessary.


Asparagus Mushroom Risotto

May 27 2014

by alex

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Asparagus Mushroom Risotto
Prep time: 
Cook time: 
Total time: 
Serves: 6
The cooking method used here is not the traditional way to make risotto, but is simplifies it and turns out well. Vegetarians can use vegetable stock and vegans and those sensitive to dairy can omit the cheese but increase the salt to taste.
  • 1 Tbs olive oil
  • 2 cups mushrooms, sliced
  • 2 cloves garlic, minced
  • 1 onion, chopped
  • ½ tsp pepper
  • salt
  • 1½ cups arborio rice
  • 3½ cups chicken broth
  • ½ cup white wine
  • 1 lb asparagus
  • ½ tsp lemon zest
  • ½ cup asiago or parmesan cheese, grated
  1. In a large heavy saucepan, heat oil over medium-high heat. Cook mushrooms, garlic, onion, and pepper; stirring until mushrooms are browned and moisture is evaporated.
  2. Stir in 3½ cups of the stock and wine, along with the rice; bring to a boil. Cover and simmer over low heat for 10 minutes. Meanwhile, trim asparagus, cutting diagonally into 1 inch pieces.
  3. Add asparagus to pan along with lemon zest. Cook, covered, for 10 minutes or until liquid is almost absorbed, asparagus is tender-crisp and rice is still slightly firm to the bite. Stir in remaining stock and wine, along with the cheese until mixture is creamy. Serve immediately.


Exercise and Aging

May 23 2014

by alex

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An interesting new study has shown that plasma irisin, a hormone released from muscle after exercise, is associated with telomere length which is a marker of aging. Irisin is known to signal your body to shift to fat-burning instead of fat storage. This may be the molecular link between exercise and healthier aging.

Plasma irisin levels predict telomere length in healthy adults

Karan S. Rana, Muhammad Arif, Eric J. Hill, Sarah Aldred, David A. Nagel, Alan Nevill, Harpal S. Randeva, Clifford J. Bailey, Srikanth Bellary, James E. Brown
AGE, 2014; DOI: 10.1007/s11357-014-9620-9


The ageing process is strongly influenced by nutrient balance, such that modest calorie restriction (CR) extends lifespan in mammals. Irisin, a newly described hormone released from skeletal muscles after exercise, may induce CR-like effects by increasing adipose tissue energy expenditure. Using telomere length as a marker of ageing, this study investigates associations between body composition, plasma irisin levels and peripheral blood mononuclear cell telomere length in healthy, non-obese individuals. Segmental body composition (by bioimpedance), telomere length and plasma irisin levels were assessed in 81 healthy individuals (age 43 ± 15.8 years, BMI 24.3 ± 2.9 kg/m2). Data showed significant correlations between log-transformed relative telomere length and the following: age (p < 0.001), height (p = 0.045), total body fat percentage (p = 0.031), abdominal fat percentage (p = 0.038), visceral fat level (p < 0.001), plasma leptin (p = 0.029) and plasma irisin (p = 0.011), respectively. Multiple regression analysis using backward elimination revealed that relative telomere length can be predicted by age (b = −0.00735, p = 0.001) and plasma irisin levels (b = 0.04527, p = 0.021). These data support the view that irisin may have a role in the modulation of both energy balance and the ageing process.

Full text link:


May 21 2014

by alex

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Read about this food additive on Cornucopia.
It is found in many of your foods as well as in canned pet foods.
You may wish to avoid it.


Higher Sugar Intake Associated with Higher CV Mortality

May 16 2014

by alex

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This prospective cohort study confirms what epidemiologic studies have shown: that higher intakes of sugar correlate with a higher risk of death from cardiovascular causes. In this study they found a clear dose-response curve, with higher intakes being associated with higher risk of cardiovascular death.
This study emphasizes the need to reduce sugar intake more aggressively.


Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults

Quanhe Yang, Zefeng Zhang, Edward W. Gregg, W. Dana Flanders, Robert Merritt, Frank B. Hu

JAMA Intern Med. Published online February 03, 2014. doi:10.1001/jamainternmed.2013.13563

Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors. Few prospective studies have examined the association of added sugar intake with CVD mortality.

To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality.

Design, Setting, and Participants:
National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III], 1999-2004, and 2005-2010 [n = 31 147]) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006 [n = 11 733]), a prospective cohort of a nationally representative sample of US adults for the association study.

Main Outcomes and Measures:
Cardiovascular disease mortality.

Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% (95% CI, 15.0%-16.4%) in 1988-1994 to 16.8% (16.0%-17.7%; P = .02) in 1999-2004 and decreased to 14.9% (14.2%-15.5%; P < .001) in 2005-2010. Most adults consumed 10% or more of calories from added sugar (71.4%) and approximately 10% consumed 25% or more in 2005-2010. During a median follow-up period of 14.6 years, we documented 831 CVD deaths during 163 039 person-years. Age-, sex-, and race/ethnicity–adjusted hazard ratios (HRs) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 (reference), 1.09 (95% CI, 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P < .001), respectively. After additional adjustment for sociodemographic, behavioral, and clinical characteristics, HRs were 1.00 (reference), 1.07 (1.02-1.12), 1.18 (1.06-1.31), 1.38 (1.11-1.70), and 2.03 (1.26-3.27; P = .004), respectively. Adjusted HRs were 1.30 (95% CI, 1.09-1.55) and 2.75 (1.40-5.42; P = .004), respectively, comparing participants who consumed 10.0% to 24.9% or 25.0% or more calories from added sugar with those who consumed less than 10.0% of calories from added sugar. These findings were largely consistent across age group, sex, race/ethnicity (except among non-Hispanic blacks), educational attainment, physical activity, health eating index, and body mass index.

Conclusions and Relevance:
Most US adults consume more added sugar than is recommended for a healthy diet. We observed a significant relationship between added sugar consumption and increased risk for CVD mortality.

Less n-6 fat and more n-3 fat improves chronic headache

May 14 2014

by alex

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In general, the lipid mediators derived from the n-6 PUFA (polyunsaturated fatty acid) arachidonic acid are pro-inflammatory and pronociceptive (increase pain), while those from n-3 LC-PUFAs are less inflammatory. DHA and EPA (found in fish oil) also give rise to several compounds (resolvins, protectins and maresins) that are anti-inflammatory, pro-resolving and pain-reducing. These distinctions suggest that dietary manipulations to reduce n-6 PUFAs and increase n-3 LC-PUFAs might contribute to the effective management of pain.

This study was designed to explore this in patients with chronic daily headache. The patients were assigned to either:
diet high in n-3 LC-PUFAs (long chain poly-unsaturated fatty acids) and low in linoleic acid (n-6 fatty acid)
diet only low in linoleic acid.
The investigators examined headache-related clinical outcomes, red blood cell fatty acids and pro- and anti-nociceptive derivatives of these PUFA families. The primary outcome was headache hours per day.

Sixty-seven participants were recruited who had headaches ≥ 4 hours per day for ≥ 15 days per month for at least 3 months and a headache history of ≥ 2 years under physician headache management. Participants with headaches secondary to head or neck trauma, cranial or cervical vascular disorder, substance use or withdrawal and certain other conditions were ineligible. A neurologist classified the type of headache as chronic migraine, chronic daily headache with migraine features or chronic daily headache without migraine. Approximately 87% of participants were female, with an average age of 42 years.

After a 4-week run-in phase, participants were randomly allocated to consume either the low n-6 PUFA/high n-3 LC-PUFA diet or the low n-6 PUFA diet for 12 weeks.

The investigators calculated the total highly unsaturated fatty acids (HUFA, unsaturated fatty acids with ≥ 4 double bonds) in the red blood cells and the proportion of n-6 PUFA in the total HUFA, as well as the n-3 index, the sum of EPA and DHA. They measured anti-nociceptive mediators derived from EPA and DHA, pro-nociceptive mediators derived from linoleic and arachidonic acids.

To assess headache-related disability, participants completed the Headache Impact Test (HIT-6) at randomization and on the final day of the 12-week intervention and completed a daily headache diary for the run-in and experimental periods to determine the number of headache days. The HIT-6 test covers six categories of the effects of headache. The investigators monitored the number and type of medications used at the beginning and end of the study.

At 12 weeks, both groups had significant improvements in all clinical outcomes, but the improvements were significantly greater in those on the low n-6/high n-3 LC-PUFA diet. There were also significantly fewer patients on the low n-6/high n-3 LC-PUFA diet who used any pain-related acute or adjunctive medication at the end of the study compared with baseline.

Both groups achieved significant reductions in red blood cell n-6 HUFA score and significant increases in the omega-3 index, with changes substantially greater in the low n-6/high n-3 LC-PUFA group. It is worth noting that simply reducing the consumption of n-6 PUFAs without adding n-3 LC-PUFAs was associated with a significant increase in red blood cell EPA and DHA. Only the low n-6/high n-3 LC-PUFA group had significantly reduced red blood cell arachidonic acid levels (change, 14.3 to 12.3, P = 0.001 vs 14.2 to 13.2, NS), even though the low n-6 PUFA group reduced their dietary intake of arachidonic acid by half. This observation suggests that red blood cell concentrations of arachidonic acid are tightly regulated.

The low-n-6/high n-3 LC-PUFA diet was also associated with significant increases in the precursors of EPA- and DHA-derived resolvins, which have anti-nociceptive properties, and decreases in several pro-nociceptive eicosanoid derivatives of linoleic acid and arachidonic acid. Interestingly, the low n-6 PUFA diet was associated with lower levels of some pro-nociceptive derivative HETEs, even though their precursor levels did not change. This group also had increased anti-nociceptive precursors, which was probably related to the higher EPA and DHA levels observed in their red blood cells. The authors suggest that these changes might have resulted from reduced metabolic competition between n-6 and n-3 LC-PUFAs.

The key finding from this study was the significant marked reduction in chronic headache pain, as observed in fewer headache hours per day, fewer headache days per month and clinically improved quality of life among chronic headache patients consuming a diet low in n-6 PUFA and high in n-3 LC-PUFAs. There were modest improvements in headache pain with the low n-6 PUFA diet (Table), but none were comparable to the changes with the combined dietary PUFA alterations. The combined dietary changes were also associated with a significant reduction in the consumption of acute and chronic pain medications and red blood cell arachidonic acid concentrations. Changes in the concentrations of the PUFA-derived anti- and pro-nociceptive mediators, such as resolvins and prostaglandins suggest that these substances might contribute to the clinical improvements observed. More detailed studies could confirm and extend these observations.

These results were superior to other studies that simply supplemented with EPA and DHA without restricting n-6 fats.

This study adds to the growing body of evidence showing clinical usefulness of fish oil supplementation in the context of other dietary fatty acid intake.


Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial

Ramsden CE, Faurot KR, Zamora D, Suchindran CM, Macintosh BA, Gaylord S, Ringel A, Hibbeln JR, Feldstein AE, Mori TA, Barden A, Lynch C, Coble R, Mas E, Palsson O, Barrow DA, Mann JD.
Pain. 2013 Nov;154(11):2441-51. doi: 10.1016/j.pain.2013.07.028. Epub 2013 Jul 22.


Omega-3 and n-6 fatty acids are biosynthetic precursors to lipid mediators with antinociceptive and pronociceptive properties. We conducted a randomized, single-blinded, parallel-group clinical trial to assess clinical and biochemical effects of targeted alteration in dietary n-3 and n-6 fatty acids for treatment of chronic headaches. After a 4-week preintervention phase, ambulatory patients with chronic daily headache undergoing usual care were randomized to 1 of 2 intensive, food-based 12-week dietary interventions: a high n-3 plus low n-6 (H3-L6) intervention, or a low n-6 (L6) intervention. Clinical outcomes included the Headache Impact Test (HIT-6, primary clinical outcome), Headache Days per month, and Headache Hours per day. Biochemical outcomes included the erythrocyte n-6 in highly unsaturated fatty acids (HUFA) score (primary biochemical outcome) and bioactive n-3 and n-6 derivatives. Fifty-six of 67 patients completed the intervention. Both groups achieved targeted intakes of n-3 and n-6 fatty acids. In intention-to-treat analysis, the H3-L6 intervention produced significantly greater improvement in the HIT-6 score (-7.5 vs -2.1; P<0.001) and the number of Headache Days per month (-8.8 vs -4.0; P=0.02), compared to the L6 group. The H3-L6 intervention also produced significantly greater reductions in Headache Hours per day (-4.6 vs -1.2; P=0.01) and the n-6 in HUFA score (-21.0 vs -4.0%; P<0.001), and greater increases in antinociceptive n-3 pathway markers 18-hydroxy-eicosapentaenoic acid (+118.4 vs +61.1%; P<0.001) and 17-hydroxy-docosahexaenoic acid (+170.2 vs +27.2; P<0.001). A dietary intervention increasing n-3 and reducing n-6 fatty acids reduced headache pain, altered antinociceptive lipid mediators, and improved quality-of-life in this population.

Fish Oil Helps Rheumatoid Arthritis

May 6 2014

by alex

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There have been a number of clinical trials evaluating fish oil in the treatment of rheumatoid arthritis, with most of the studies showing benefit in reduction of pain and swelling. This study looked at the use of fish oil in recently diagnosed RA patients. They compared low dose and high dose fish oil as adjunctive treatment along with conventional medications. The results were positive. Fish oil is underutilized by rheumatologists in the treatment of their RA patients, but more studies such as this one should change this.


Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use

Proudman SM, James MJ, Spargo LD, Metcalf RG, Sullivan TR, Rischmueller M, Flabouris K, Wechalekar MD, Lee AT, Cleland LG.
Ann Rheum Dis. 2013 Sep 30. doi: 10.1136/annrheumdis-2013-204145. [Epub ahead of print]


The effects of fish oil (FO) in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA. This study examined the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).

Patients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy.

In the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti-cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events.

FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.