Tuesday, September 21, 2010

Alcohol & Rheumatoid Arthritis

Health advisors often have differing views on alcohol. Is it a healthy drink to help avoid heart disease or is it an insidious and evil beverage that causes social turmoil? I agree with the words of Abraham Lincoln, or maybe his speech writer, who said: “It has long been recognised that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing.” Well, it was more interesting than saying “drink in moderation”.

1-2% population affected by RA

From UK researchers comes further indication that the occasional drink can be helpful and healthful. As alcohol has anti-inflammatory and a mild analgesic effect, they proposed that rheumatoid arthritis (RA) might be less likely or less severe in people who drank alcohol.

According to this [http://www.aihw.gov.au/publications/phe/phe-110-10524/phe-110-10524.pdf booklet] from the Australian Institute of Health and Welfare rheumatoid arthritis is an autoimmune disease in which the body attacks its own organs and joints, especially the joints on the knees, wrists, fingers and elbows. This debilitating condition affects around 400,000 Australians (about 1 in 50 people). It is more common in ladies and older folk.

Don’t smoke; drink frequently

The research compared 873 Caucasians with RA to 1004 without the condition, all from around Sheffield in England. Each one underwent clinical and radiological assessment as well as completing a survey. Those with RA were more likely to be older, smoke and female when compared to the control group. The more frequently someone drank, the less likely they were to have RA, and the less severe were the symptoms if they had RA.

Dr James Maxwell, the lead author of the paper, said: “Patients who had drunk alcohol most frequently had symptoms that were less severe than those who had never drunk alcohol or only drunk it infrequently. X-rays showed there was less damage to joints, blood tests showed lower levels of inflammation and there was less joint pain, swelling and disability”.

What does it all mean?

Note that only frequency of alcohol consumption was measured, not the amount of alcohol, and alcohol consumption was based on a questionnaire, always a problem as humans have lousy memories and like to give socially acceptable answers. Despite this, the protective effect of alcohol against RA was pretty persuasive and cannot be ignored. Like all good researchers, they did say: “Further research is needed to confirm the results.” If they are confirmed, health authorities will hope that only 1, maybe 2, standard drinks does the trick, because then we can keep giving out the same advice as we always do.

Reference: Rheumatology. 2010; doi:10.1093/rheumatology/keq202

Tuesday, September 7, 2010

Is weight loss good for overweight people ?

Sensible answer: of course it is. I mean, haven’t you seen all those public weight loss campaigns? When overweight folk lose weight, their health risks tend towards normal, that is, blood pressure drops, blood glucose lowers and blood cholesterol improves. A good thing, no? Not so fast, say a couple of American scientists who have crunched the numbers.

Intentional vs unintentional

Previous research has revealed that weight loss is linked to an increased chance of dying. Yes, that’s right, weight loss = early death. Clever readers will note that sick people usually unintentionally lose weight before they die, so such people will skew the statistics. There are other confounding factors too. Intentional weight loss is often via an unbalanced and low nutrient starvation diet (do you feel just too vibrant and joyful? Then try the Israeli Army diet) and semi-starvation has never been associated with longevity. These diets often mean a loss of muscle tissue and not just body fat. So, we have to be careful when we say that weight loss increases the chance of early death.

Too much weight loss unhealthy

Anyway, the statisticians looked at over 6000 men and women who were 50 years plus. They were followed for about 20 years and in that time 1600 died. Once they had adjusted for age, health and smoking and all the other things they adjust, guess what? If you lose more than 15% of your weight, whether you are male or female, obese or overweight, you die earlier than if you had lost only 5% of your weight. Women doubled their risk of early death and men increased their risk one and a half times by losing over 15% of their weight.

Let’s say you weigh 120 kg (265 lb) and lost 18 kg (40 lb) then you have probably brought your funeral forward. Are you listening at The Biggest Loser as you cheer Bob or Jane who has gone from 140 kg to 85 kg in a 12 week season?

What does it all mean?

Not every chunky person needs to lose weight. It is well regarded that people over 75 years do better and live longer with a little extra padding. The overweight unwell shouldn’t be placed on weight loss programs either. An otherwise healthy overweight person should lose weight slowly and not use televised “reality” weight loss programs as a guide.

This study is not saying that overweight people won’t benefit from weight loss, but it is making us ask whether encouraging a huge weight loss down to a supposed “ideal weight” is a good idea for everyone. Being very overweight is not healthy; promoting big weight loss doesn’t appear to be wise either. Right now we just don’t know what is a healthy rate or level of weight loss. The current advice for the overweight to lose around 0.5 kg (1.1 lb) a week and accept they probably won’t ever be super-lean is still the best advice.

Reference: International Journal of Obesity. 2010; 34: 1044-1050

Vitamin Supplements

Rod wrote to me and said: "Just returned from a stint in Samoa and have hopefully encouraged a group of people to sign up to your newsletter. I seem to be constantly faced with questions about taking vitamins. My response is usually that if you have a balanced diet, there is no need to take additional vitamins. Many are now responding with the statement that our food is so over fertilised and sprayed with pesticides that the vitamin levels are deficient and therefore we should take extra supplements. Can you clarify?"

Thanks for your note Rod.

If you want people to take more of your supplement, especially vitamin supplements, then you must constantly seed the idea that today's food supply is deficient in whatever nutrient supplement you are trying to convince people to purchase. This style of marketing has been very common over the last three decades. You must tell people that fruits and vegetables now have less vitamins than they did 100 years ago, despite the fact that we didn't even isolate the very first vitamin until 1912, or you tell them that fruits and vegetables are devoid of vitamins without appreciating that the vitamins are there for normal plant function and growth and not specifically for humans.

In this country, as far as we can determine, fruits and vegetables have just as much vitamins and minerals as they did decades ago. The greatest influence on the nutrient content of fruits and vegetables is actually the purchaser. It will depend upon how the produce is stored, how soon after purchasing the produce is consumed, and how the produce is prepared and cooked. But of course, people don't want to hear that. They much prefer to hear the conspiracy theory of food supply.

There are certain subgroups of people who do require additional nutrient supplementation, such as extra folate during pregnancy, additional iron in anaemic patients, vitamin D in those with vitamin D insufficiency. Most healthy people who eat well and are fit are those least likely to benefit from a multivitamin supplement.

In fact, I think, this is a sensible argument, but I do not have the funds to constantly pitch myself against high-profile cricketers flogging supplements to those who can afford them yet will get the least benefit. People find celebrities and athletes more credible than scientists. I live with that every day. Please hand me that box of tissues.