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The sugar industry paid for and was closely involved in development of an influential literature review, published by the New England Journal of Medicine in 1967[1,2], that downplayed dietary sugar…
Source: Sugar is linked to heart disease, was hidden in the report
Dairy foods (organic) contain tryptophan, which is a sleep-promoting substance. Other foods that are high in tryptophan include nuts and seeds, bananas, honey, and eggs.
Carbohydrate-rich foods complement dairy foods by increasing the level of sleep-inducing tryptophan in the blood.
If you struggle with insomnia, a little food in your stomach may help you sleep. But don’t use this as an open invitation to pig out. Keep the snack small. A heavy meal will tax your digestive system, making you uncomfortable and unable to get soothing ZZZs.
Tip: Eat a spoon of peanut butter to go back to sleep.
No Burger: As if you needed another reason to avoid high-fat foods, research shows that people who often eat high-fat foods not only gain weight, they also experience a disruption of their sleep cycles. A heavy meal activates digestion, which can lead to nighttime trips to the bathroom.
Avoid meds, nicotine, coffee, alcohol and spice. Cut fluids by 8pm.
Objectives: To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chr…
Source: Higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans
The sugar industry paid for and was closely involved in development of an influential literature review, published by the New England Journal of Medicine in 1967[1,2], that downplayed dietary sugar’s links to coronary heart disease while pointing the finger at fat and cholesterol intake, according to a report published September 12, 2016 in JAMA Internal Medicine[3].
The sugar industry’s funding and other participation were not disclosed in the 1967 articles, which had a major influence on dietary recommendations for sugar in the following decades, notes the new analysis from Dr Cristin E Kearns (University of California, San Francisco) and colleagues.
The literature review from almost 50 years ago served as a lobbying tool for the industry and likely influenced the first dietary guidelines of the 1980s, Kearns told heartwire from Medscape. It put the focus on dietary cholesterol and took the focus off sugar intake as a risk factor for heart disease, she said; if the evidence had been fairly presented, the recommendations would have been to reduce both fat and sugar, not just saturated fat.
“That was the message that guidelines hammered home for decades…that it’s the fat you really need to worry about,” she said. “The conversation about sugar was left out.” Kearns is with her institution’s Philip R Lee Institute for Health Policy Studies and Department of Orofacial Sciences.
What is clear, she and her colleagues write, is that today, “the sugar industry, led by the Sugar Association, the sucrose industry’s Washington, DC–based trade association, steadfastly denies that there is a relationship between added sugar consumption and CVD risk.”
The group analyzed internal documents from the Sugar Research Foundation (SRF), the precursor to the Sugar Association, that had become available in academic libraries and other publicly accessible locations. They also reviewed historical reports and statements made in early debates about health effects of sugar. According to those documents, the group reports, the SRF set the journal’s review’s objective, contributed articles for inclusion, and received drafts.
Kearns and colleagues describe finding documentation that the SRF paid two nutrition researchers, Dr D Mark Hegsted and Dr Robert McGandy (Harvard School of Public Health, Boston, MA), to conduct the literature review; the payments amounted to about $48,900 in 2016 dollars.
Also among the evidence of influence, they write, is correspondence from July 30, 1965, to Hegsted from SRF vice president John Hickson. In it, they report, Hickson emphasized the SRF’s objective for funding the review: “Our particular interest had to do with that part of nutrition in which there are claims that carbohydrates in the form of sucrose make an inordinate contribution to the metabolic condition, hitherto ascribed to aberrations called fat metabolism. I will be disappointed if this aspect is drowned out in a cascade of review and general interpretation.”
Hegsted, the current report states, responded “We are well aware of your particular interest in carbohydrate and will cover this as well as we can.”
Smoking Gun?
In an invited commentary to the current report[4], Dr Marion Nestle (New York University, NY) notes that typically, when industry sponsors nutrition studies, disclosures state that the funder had no role in designing, conducting, interpreting, writing, or publishing the study and “without a smoking gun it is difficult to prove otherwise.”
“Kearns and colleagues report on having found that smoking gun,” she writes. “They have produced compelling evidence that a sugar trade association not only paid for but also initiated and influenced research expressly to exonerate sugar as a major risk factor for coronary heart disease.”
She said the analysis shows the industry-funded review reached a foregone conclusion: “The investigators knew what the funder expected and produced it. Whether they did this deliberately, unconsciously, or because they genuinely believed saturated fat to be the greater threat is unknown. But science is not supposed to work this way.”
Nestle says the findings should not be viewed as ancient history and that industry influence continues today in the food industry. She points out that in 2015 the New York Times obtained emails that revealed Coca-Cola’s relationships with sponsored researchers conducting studies aimed at limiting effects of sugary drinks on obesity[5].
The findings from Kearns and colleagues are “appalling,” according to Dr James J DiNicolantonio (Saint Luke’s Mid America Heart Institute, Kansas City, MO). He told heartwire that while their findings show “probably the earliest evidence we have that this has been going on,” sugar industry conflicts of interest continue today.
Some meta-analyses have favored short-term studies in looking at effects of sugar, he said, but because people have been consuming sugar in large quantities for so long, those short-term studies aren’t going to show harm. “If you actually look at the studies that restrict sugar, so they limit sugar to only 5% of calories, then you’ll see a reduction in prediabetes and diabetes by 50%. We’ve known this since the early 1980s, but the dietary guidelines during that time specifically said sugar does not cause diabetes,” despite evidence to the contrary.
“Basically, the dietary guidelines were lying to us,” DiNicolantonio said.
At the time of the NEJM review, Mark Hegsted was one of the nation’s top nutritional scientists, he noted. “If someone with that much clout said sugar wasn’t harmful, a lot of people are going to believe that person, at least until the ’90s when we started demanding systematic reviews and meta-analyses.”
Given the evidence, DiNicolantonio said, the NEJM should retract the original article. “These authors were literally paid. . . . It wasn’t acknowledged that they were directly paid to write this paper,” but what they wrote was “clearly influenced by who they were paid by,” he said.
This study was supported by the UCSF Philip R Lee Institute for Health Policy Studies; a donation by the Hellmann Family Fund to the UCSF Center for Tobacco Control Research and Education; the UCSF School of Dentistry Department of Orofacial Sciences and Global Oral Health Program; the National Institute of Dental and Craniofacial Research; and the National Cancer Institute. The authors report no relevant financial relationships. Di Nicolantonio reports being the author of an upcoming book with bearing on dietary sugar and policy, serving as a frequent reviewer for several medical journals, and being on the editorial advisory board of several medical journals including the International Journal of Clinical Pharmacology & Toxicology,CIP Journal of Cardiology, and Progress in Cardiovascular Diseases. Nestle’s salary from New York University supports her research, manuscript preparation, and website. She also earns royalties from books and honoraria and travel from lectures on subjects relevant to her commentary, she reports.
Objectives: To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chr…
Source: Higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans
Disparities in Heart Disease Among Women Heart disease is the leading cause of death in women in the United States, accounting for more deaths than stroke, lung cancer, and breast cancer.[1,2] Card…
Source: More acculturated Asians Americans, more fat in their diet
Disparities in Heart Disease Among Women Heart disease is the leading cause of death in women in the United States, accounting for more deaths than stroke, lung cancer, and breast cancer.[1,2] Card…
Heart disease is the leading cause of death in women in the United States, accounting for more deaths than stroke, lung cancer, and breast cancer.[1,2] Cardiovascular diseases account for one third of all deaths in women worldwide.[3] This third essay on “Nutrition, Culture, and Women’s Health” focuses on the influence of acculturation on dietary habits of women.
Within the United States, heart disease prevalence is highest among black women, followed by Mexican-American and Caucasian women.[2] Data specifically detailing the prevalence of heart disease among Asian-American women is lacking, although heart disease is the leading cause of death among women of Asian/Pacific Island descent. Women of South Asian descent are at greater risk of heart disease than those of Japanese descent.
Internationally, coronary events among women occur most often in the United Kingdom and least often in Spain and China.[3] Mortality attributed to heart disease, however, is highest for women in the Ukraine and lowest in women living in Japan.[4] In developing countries, heart disease morbidity and mortality are steadily increasing, and this has been attributed to the adoption of a Western lifestyle.[3,5] It has been predicted that within the next 10 to 20 years, developing countries will list heart disease as the most common cause of death.
The impact of diet on heart health is well established, with the American Heart Association recommending a heart-healthy diet focused on limiting foods high in saturated fats and cholesterol and emphasizing whole grains, fruits, and vegetables.[6-8] However, a woman’s cultural beliefs, traditions, and ethnic preferences exert a strong influence on her diet.[9] In addition, availability, cost, and convenience, as well as role responsibilities, time constraints, and dietary knowledge, influence food selection and preparation. For women immigrating to the United States, acculturation is a major influence on their diet.
Immigrants to the United States experience greater risks of chronic diseases, such as heart disease, than their counterparts in their countries of origin.[10] One explanation for the increased risk is dietary change. As a result, “dietary acculturation”[10] has received considerable attention in recent research examining ethnic groups’ dietary habits. Acculturation refers to the adoption of a majority culture’s attitudes, beliefs, values, and behavior. The process of acculturation is complex and nonlinear and is influenced by many factors. Satia-Abouta and colleagues[10] propose a model for understanding the complexity of the acculturation process: Socioeconomic/demographic and cultural factors are influenced by the new culture that result in changes in knowledge, attitudes, beliefs, values, and preferences, which affect food purchasing and preparation. The result of these changes can be the adoption of some majority culture dietary practices and the maintenance of some traditional practices. For example, an immigrant may adopt a Western-style breakfast and continue eating a traditional evening meal or may replace portions of meals with Western foods. Some of the adopted practices may be healthful, such as reducing dietary saturated fats. Other adopted practices may not promote a healthy diet, such as increasing consumption of soft-drink beverages and fast food.
Results of a recent study showed that the measure used to define acculturation influenced the outcome.[11]This study of 119 Hispanic women in the San Francisco Bay Area showed that language and birthplace combined were most discriminating in identifying dietary changes as compared with language preference alone or number of years living in the United States. The number of years of residence in the United States was not associated with changes in diet, and language alone identified fewer dietary changes than birthplace and language preference combined. The most highly acculturated Hispanic women — defined as born in the United States with English as the preferred language — consumed more convenience foods, salty snacks, and fatty foods than the less-acculturated women who were born outside the United States and preferred speaking Spanish. Less-acculturated women consumed more beans in their diet.
Another study using preferred language, birthplace, and ethnic self-identification as determinants of acculturation examined dietary habits of Hispanics and non-Hispanic whites from the Yakima Valley in central Washington.[12] Most of the Hispanics in this region immigrated from Michoacan, Mexico, thus constituting a predominantly homogenous group. More than half of the sample was female. The results showed that of the 1689 interviews analyzed, Hispanics who were less acculturated ate more fruit and vegetables daily than the highly acculturated Hispanics. More highly acculturated Hispanics reported using more oil when cooking. However, the difference in total fat consumption between highly acculturated and low-acculturated Hispanics was not statistically significant. Interestingly, low-acculturated Hispanics used no added fat when eating potatoes and bread. All of the Hispanic subjects seldom chose low-fat items when eating in fast-food restaurants and consumed more fruits and vegetables than the non-Hispanic white subjects. The results of this study suggest that maintenance of traditional dietary practices of eating fruits and vegetables and eating potatoes and bread without adding margarine at the table is important and should be encouraged.
Heterogeneity within immigrant groups may lead to differences in acculturation levels and subsequent changes in diet. A study of Hispanic elders in Massachusetts illustrates the effect of diversity within an ethnic group.[13] Subjects were 61 to 80 years old, and more than half were female. Of the 937 subjects interviewed, 436 were Puerto Rican, 128 Dominican, 147 other Hispanic, and 226 non-Hispanic whites. Results of this study showed that on the basis of language preference and familiarity, Puerto Ricans were more highly acculturated than Dominicans, although both were less acculturated than other Hispanic groups. Overall, the majority of these Hispanic subjects were not highly acculturated. Dietary differences were found between the groups: Dominicans ate more complex carbohydrates and less monounsaturated fats than the other 2 Hispanic groups. Puerto Rican and Dominican women reported lower total energy intake and lower saturated fat and higher polyunsaturated fat consumption than non-Hispanic white women. The more acculturated Hispanics residing in the United States for more than 20 years had diets similar to non-Hispanic white subjects who obtained most of their energy from sweet baked foods and breads. The main source of complex carbohydrates for all Hispanic groups was beans and plantains, with rice as the main contributor of total energy.
As is the case for Hispanic Americans, the adoption of Western dietary practices among Asian Americans varies with the country of origin. According to a recent study, first-generation Chinese immigrants from Mainland China increased their consumption of grain products, fruits, and meats to a greater degree than individuals from Taiwan, Hong Kong, and other locations.[14] Consumption of dairy products and a wider variety of foods increased for all immigrant subjects. Other dietary changes noted among more acculturated subjects included consumption of more bagels, pizza, fats and sweets, and sodas than those less acculturated (based on length of residency). Sixty-four percent of study participants reported skipping breakfast after moving to the United States, although 44.1% said they believed their diet was more healthful in the United States. Availability and convenience were the most prevalent reasons cited for changes in eating patterns.
Korean immigrants may change their traditional eating habits more slowly than other Asian immigrants.[15]Results of a study of predominantly South Korean immigrants showed overall low levels of acculturation; nevertheless, greater acculturation was associated with changes in diet.[15] Those immigrants who viewed themselves as American, spoke English, used American media, and had American friends were considered more acculturated. Subjects who were more acculturated consumed more bread, cereal, spaghetti, pizza, green salads, sweets, and soft drinks than those who were less acculturated. Greater acculturation was associated with higher levels of fat as a percent of total energy, although the total amount of fat consumed was still lower than that found in the typical US diet. The less-acculturated Koreans consumed significantly less fat, more fiber, and more salt than the more highly acculturated Koreans.
Although acculturation affects eating habits of all immigrants, there are important differences between and among immigrant groups.[10] Some immigrants may adopt new dietary patterns more quickly than others. For example, Koreans may be slower to change their eating habits than other Asian immigrants,[15] and Dominicans and Puerto Ricans may be more inclined to maintain traditional eating habits than other Hispanic groups.[13] English proficiency and birthplace have a significant influence on the extent of dietary change, as do food availability and accessibility,[10,12-14] and are important to assess when encouraging dietary changes to improve heart health. Because immigrants bring unique beliefs and strong family values with them to the United States, attention to health beliefs and household composition also can be important in identifying barriers to adopting heart-healthy eating habits.[10]
Dietary acculturation can include healthy and unhealthy change.[10] Some immigrants may maintain traditional consumption of fruits and vegetables and increase consumption of fast foods and sweets. The fusion of traditional eating habits with Western-style eating habits requires an individualized approach that assesses the dietary practices, language proficiency, level of nutrition knowledge, food availability and accessibility, and the individual’s level of affiliation with their ethnicity.
Objectives: To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States.
Methods: The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18–74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation.
Measurements and Main Results: The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6–39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3–4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration.
Conclusions: Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.
http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1211OC#.V-Fqa_krIUY
Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1211OC#.V-Fqa_krIUY
Worse, antidepressants, which can be lifesaving, are probably being underused in young people. Their use fell significantly after the Food and Drug Administration issued its so-called black-box war…
Worse, antidepressants, which can be lifesaving, are probably being underused in young people. Their use fell significantly after the Food and Drug Administration issued its so-called black-box warning in 2004, stating that all antidepressants were associated with a risk of increased suicidal feeling, thinking and behavior in adolescents. That warning was later extended to young adults.
One very large study, including 1.1 million adolescents and 1.4 million young adults, examined data for automated health care claims for 2000 to 2010 from 11 health plans in the United States Mental Health Research Network. Disturbingly, the study found that antidepressant use plunged 31 percent among adolescents and 24 percent among young adults within two years after the F.D.A. advisory was issued.
It’s not hard to understand why. The F.D.A.’s well-intended warning was alarming to the public and most likely discouraged many patients from taking antidepressants. Physicians, too, were anxious about the admittedly small possible risks posed by antidepressants and were probably more reluctant to prescribe them.
What the public and some in the medical community did not understand then — and perhaps still don’t know — is that the risk of antidepressant treatment is minuscule: In the F.D.A. meta-analysis of some 372 clinical trials involving nearly 100,000 subjects, the rate of suicidal thinking and behavior was 4 percent in people taking antidepressants, compared with 2 percent in people taking a placebo.
This very small risk of suicidal behavior posed by antidepressant treatment has always been dwarfed by the deadly risk of untreated depression: 2 to 15 percent of depressed people actually commit suicide.
The somewhat good news is that the downward trend in antidepressant use among adolescents following the F.D.A. advisory reversed a bit after 2008. Still, the rates of antidepressant use since the F.D.A. warning was issued have remained below the levels that would have been predicted based on pre-warning use patterns.
This pattern is very disturbing, since in the decade before this downturn in prescribing of antidepressants — 1990 to 2000 — there was a steady decline in adolescent suicide rates that coincided with an increase in the use of antidepressants in this age group.
One study found that a 1 percent increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicides per 100,000 adolescents per year. (Of course, correlation cannot prove causality; other factors, like reduced rates of alcohol and drug use and more stringent gun safety regulations during this period, may have played a role, too.)
Attention deficit disorder is the most common mental health diagnosis among children under 12 who die by suicide, a new study has found. Very few children aged 5 to 11 take their own lives, and lit…
Attention deficit disorder is the most common mental health diagnosis among children under 12 who die by suicide, a new study has found.
Very few children aged 5 to 11 take their own lives, and little is known about these deaths. The new study, which included deaths in 17 states from 2003 to 2012, compared 87 children aged 5 to 11 who died by suicide with 606 adolescents aged 12 to 14 who did, to see how they differed.
The research was published on Monday in the journal Pediatrics.
About a third of the children of each group had a known mental health problem. The very young who died by suicide were most likely to have had attention deficit disorder, or A.D.D., with or without accompanyinghyperactivity.
By contrast, nearly two-thirds of early adolescents who took their lives struggled with depression.
Suicide prevention has focused on identifying children struggling with depression; the new study provides an early hint that this strategy may not help the youngest suicide victims.
“Maybe in young children, we need to look at behavioral markers,” said Jeffrey Bridge, the paper’s senior author and an epidemiologist at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.
Jill Harkavy-Friedman, the vice president of research at the American Foundation for Suicide Prevention, agreed. “Not everybody who is at risk for suicide has depression,” even among adults, said Dr. Harkavy-Friedman, who was not involved in the new research.
Yet the new research does not definitively establish that attention deficit disorder and attention deficit hyperactivity disorder, or A.D.H.D., are causal risk factors for suicide in children, Dr. Bridge said. Instead, the findings suggest that “suicide is potentially a more impulsive act among children.”
Other experts cautioned that it was hard to draw definitive conclusions from such a small population.
David N. Miller, the president of the American Association of Suicidology, applauded the new research for insight into “an understudied population.” But he questioned whether impulsiveness was a large factor in child suicide. “There is a lot of evidence it isn’t,” he said.
Researchers used a database with detailed suicide reports from coroners and medical examiners. It was unclear whether mental health professionals had diagnosed attention deficit problems in each case.
Dr. Nancy Rappaport, a child psychiatrist and part-time associate professor at Harvard Medical School, said she suspected that children listed as having A.D.D. or A.D.H.D. often might not have had the conditions. Children withbipolar disorder “are often undiagnosed under 12,” she said, and their conditions are “often confused with A.D.H.D.”
Last year, researchers from Nationwide Children’s Hospital, among others,reported that the suicide rate among black 5- to 11-year-olds had almost doubled since 1993, while the rate for their white peers had declined.
The new report found that about 37 percent of elementary school-aged children who died by suicide were black, compared with just 12 percent of adolescents who did so.
Still, Dr. Rappaport said, “This study shouldn’t raise alarms for African-American families that have children diagnosed with A.D.D. that they need to worry that their child will impulsively kill themselves.”
“It’s usually a much more complicated picture,” she added.
The new study detailed a convergence of circumstances before suicide deaths in the very young.
The children most commonly had fought with a relative or peer before dying by suicide. About a third of the children and adolescents had experienced a problem at school. A similar percentage had gone through a recent crisis.
“Younger kids don’t necessarily have the words to negotiate the conflict, to talk about what they are feeling or seek a solution,” Dr. Harkavy-Friedman said.
“It’s O.K. to ask your child, ‘Are you feeling like you don’t want to be around anymore?’” she added. “It won’t put the idea in their head, but it opens the door for a conversation.”
About 30 percent of the nearly 700 children studied in the new research had told someone of their suicidal intentions.
Not only is it important to take seriously a declaration of suicidal intent, no matter the child’s age, Dr. Harkavy-Friedman said, but it is also crucial for pediatricians, parents and school personnel to broach the topic with children if the adults are concerned.
“We know that often kids don’t necessarily disclose that they are suicidal,” Dr. Miller said.
But, he added, “they will disclose if they are asked.”
The baby seemed fine when Dr. Thomas R. Frieden left for work that July morning in New York more than 20 years ago. But when he returned home several hours later, his son was pale and blazing hot, …
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