Research news on nutrition, environmental medicine and health
Consuming pomegranate juice regularly improves heart health(NaturalNews) Pomegranate juice is rich in antioxidants such as polyphenols, tannins, and anthocyanins. The health benefits of pomegranate juice have been compared to that of red wine, purple grape juice, and black tea. The only potential downside of fresh pomegranate juice is that it is very high in natural sugar.
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The recommended dietary allowance, or RDA, of vitamin C is less than half what it should be, scientists argue in a recent report, because medical experts insist on evaluating this natural, but critical nutrient in the same way they do pharmaceutical drugs and reach faulty conclusions as a result.
The researchers, in Critical Reviews in Food Science and Nutrition, say there’s compelling evidence that the RDA of vitamin C should be raised to 200 milligrams per day for adults, up from its current levels in the United States of 75 milligrams for women and 90 for men.
Rather than just prevent the vitamin C deficiency disease of scurvy, they say, it’s appropriate to seek optimum levels that will saturate cells and tissues, pose no risk, and may have significant effects on public health at almost no expense – about a penny a day if taken as a dietary supplement.
“It’s time to bring some common sense to this issue, look at the totality of the scientific evidence, and go beyond some clinical trials that are inherently flawed,” said Balz Frei, professor and director of the Linus Pauling Institute at Oregon State University, and one of the world’s leading experts on the role of vitamin C in optimum health.
“Significant numbers of people in the U.S. and around the world are deficient in vitamin C, and there’s growing evidence that more of this vitamin could help prevent chronic disease,” Frei said. “The way clinical researchers study micronutrients right now, with the same type of so-called ‘phase three randomized placebo-controlled trials’ used to test pharmaceutical drugs, almost ensures they will find no beneficial effect. We need to get past that.”
Unlike testing the safety or function of a prescription drug, the researchers said, such trials are ill suited to demonstrate the disease prevention capabilities of substances that are already present in the human body and required for normal metabolism. Some benefits of micronutrients in lowering chronic disease risk also show up only after many years or even decades of optimal consumption of vitamin C – a factor often not captured in shorter-term clinical studies.
A wider body of metabolic, pharmacokinetic, laboratory and demographic studies suggests just the opposite, that higher levels of vitamin C could help reduce the chronic diseases that today kill most people in the developed world – heart disease, stroke, cancer, and the underlying issues that lead to them, such as high blood pressure, chronic inflammation, poor immune response and atherosclerosis.
“We believe solid research shows the RDA should be increased,” Frei said. “And the benefit-to-risk ratio is very high. A 200 milligram intake of vitamin C on a daily basis poses absolutely no risk, but there is strong evidence it would provide multiple, substantial health benefits.”
An excellent diet with the recommended five to nine daily servings of fruits and raw or steam-cooked vegetables, together with a six-ounce glass of orange juice, could provide 200 milligrams of vitamin C a day. But most Americans and people around the world do not have an excellent diet.
Even at the current low RDAs, various studies in the U.S. and Canada have found that about a quarter to a third of people are marginally deficient in vitamin C, and up to 20 percent in some populations are severely deficient – including college students, who often have less-than-perfect diets. Smokers and older adults are also at significant risk.
Even marginal deficiency can lead to malaise, fatigue, and lethargy, researchers note. Healthier levels of vitamin C can enhance immune function, reduce inflammatory conditions such as atherosclerosis, and significantly lower blood pressure.
Laboratory studies with animals – which may be more accurate than human studies because they can be done in controlled conditions and with animals of identical genetic makeup – can document reasons that could explain all of these findings, Frei said.
Critics have suggested that some of these differences are simply due to better overall diet, not vitamin C levels, but the scientists noted in this report that some health benefits correlate even more strongly to vitamin C plasma levels than fruit and vegetable consumption.
Scientists in France and Denmark collaborated on this report. Research at OSU on these issues has been supported by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health.
Reference
Frei B, Birlouez-Aragon I, Lykkesfeldt J. Authors’ Perspective: What is the Optimum Intake of Vitamin C in Humans? Crit Rev Food Sci Nutr 2012; 52 (9): 815-29.
Robert H. Lustig, MD, and a team of the University of California, San Francisco (UCSF) researchers argue that sugar should be controlled like alcohol and tobacco to protect public health. In a new report, they maintain that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer.
Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.
Robert Lustig, MD
In the Feb. 2 issue of Nature, Robert Lustig, MD, Laura Schmidt, PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at UCSF, argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet, make it a primary culprit of this worldwide health crisis.
This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.
Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver – the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.
Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome — the key metabolic changes that lead to diabetes, heart disease and cancer — are not clinically obese.
“As long as the public thinks that sugar is just ‘empty calories,’ we have no chance in solving this,” said Lustig, a professor of pediatrics, in the division of endocrinology at the UCSF Benioff Children’s Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.
“There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,” Lustig said. “But sugar is toxic beyond its calories.”
Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. “We recognize that there are cultural and celebratory aspects of sugar,” said Brindis, director of UCSF’s Philip R. Lee Institute for Health Policy Studies (IHPS). “Changing these patterns is very complicated.”
According to Brindis, effective interventions can’t rely solely on individual change, but instead on environmental and community-wide solutions, similar to what has occurred with alcohol and tobacco, that increase the likelihood of success.
Laura Schmidt, PhD, MSW, MPH
The authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar.
“There is an enormous gap between what we know from science and what we practice in reality,” said Schmidt, professor of health policy at UCSF’s IHPS and co-chair of UCSF’s Clinical and Translational Science Institute’s (CTSI) Community Engagement and Health Policy Program, which focuses on bridging academic research, health policy, and community practice to improve public health. In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level,” she said.
The paper was made possible with funding from UCSF’s CTSI, UCSF’s National Institutes of Health-funded program that helps accelerate clinical and translational research through interdisciplinary, interprofessional and transdisciplinary work.
Claire Brindis, DPH
Many of the interventions that have reduced alcohol and tobacco consumption can be models for addressing the sugar problem, such as levying special sales taxes, controlling access, and tightening licensing requirements on vending machines and snack bars that sell high sugar products in schools and workplaces.
“We’re not talking prohibition,” Schmidt said. “We’re not advocating a major imposition of the government into people’s lives. We’re talking about gentle ways to make sugar consumption slightly less convenient, thereby moving people away from the concentrated dose. What we want is to actually increase people’s choices by making foods that aren’t loaded with sugar comparatively easier and cheaper to get.”
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For more information, please visit http://www.ucsf.edu.
Photos by Susan Merrell
Reference
Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature 2012; 482 (7383): 27-9.
New study presented at the World Congress of Cardiology organized by the World Heart Federation
Omega-3 fatty acids may help to reduce the physical harm caused by smoking, according to a new study presented yesterday (20 April 2012) at the World Congress of Cardiology in Dubai, United Arab Emirates.
The study, carried out in Greece, assessed the effect of four-week oral treatment with 2 g/day of omega-3 fatty acids on the arterial wall properties of cigarette smokers. The results showed that short-term treatment with omega-3 fatty acids improves arterial stiffness and moderates the acute smoking-induced impairment of vascular elastic properties in smokers.
“These findings suggest that omega-3 fatty acids inhibit the detrimental effects of smoking on arterial function, which is an independent prognostic marker of cardiovascular risk,” said Dr. Gerasimos Siasos, University of Athens Medical School, 1st Department of Cardiology, “Hippokration” Hospital. “The cardioprotective effects of omega-3 fatty acids appear to be due to a synergism between multiple, intricate mechanisms involving anti-inflammatory and anti-atherosclerotic effects. Furthermore, AHA recommends that people without documented history of coronary heart disease should consume a variety of fish (preferably oily – rich in omega-3 fatty acids) at least twice per week.”
“The World Heart Federation strongly encourages all smokers to quit,” said Dr Kathryn Taubert, Chief Science Officer at the World Heart Federation. “The only way to protect your body from the harmful effects of tobacco is to stop smoking. We encourage all people, both smokers and non-smokers, to eat healthy diets, which includes foods rich in omega-3 fatty acids.”
Taking large doses of vitamin C may moderately reduce blood pressure, according to an analysis of years of research by Johns Hopkins scientists. But the researchers stopped short of suggesting people load up on supplements.
“Our research suggests a modest blood pressure lowering effect with vitamin C supplementation, but before we can recommend supplements as a treatment for high blood pressure, we really need more research to understand the implications of taking them,” says Edgar “Pete” R. Miller III, M.D., Ph.D., an associate professor in the division of general internal medicine at the Johns Hopkins University School of Medicine and leader of the study published in the American Journal of Clinical Nutrition.
Roughly 30 percent of adults in the United States have high blood pressure, or hypertension, an important risk factor for heart disease and stroke. Successful treatment may include drugs, exercise, weight loss, and dietary changes such as reducing salt intake. Some experts believe that large amounts of vitamin C, an essential micronutrient found primarily in fruits and vegetables, could lower pressure as well, but randomized, controlled dietary intervention studies — the gold standard of nutrition research — have produced mixed results.
Miller and his colleagues reviewed and analyzed data from 29 randomized, controlled, previously published clinical trials that reported systolic and/or diastolic blood pressure values and also compared vitamin C intake to a placebo. What they found is that taking an average of 500 milligrams of vitamin C daily — about five times the recommended daily requirement — reduced blood pressure by 3.84 millimeters of mercury in the short term. Among those diagnosed with hypertension, the drop was nearly 5 millimeters of mercury.
By comparison, Miller says, patients who take blood pressure medication such as ACE inhibitors or diuretics (so-called “water pills”) can expect a roughly 10 millimeter of mercury reduction in blood pressure.
Five hundred milligrams of vitamin C is the amount in about six cups of orange juice. The recommended daily intake of vitamin C for adults is 90 milligrams.
“Although our review found only a moderate impact on blood pressure, if the entire U.S. population lowered blood pressure by 3 milliliters of mercury, there would be a lot fewer strokes,” Miller says. Miller cautions, however, that none of the studies his team reviewed show that vitamin C directly prevents or reduces rates of cardiovascular disease, including stroke.
Scientists have focused on vitamin C’s potential role in blood pressure reduction because of the nutrient’s biological and physiological effects. For example, vitamin C may act as a diuretic, causing the kidneys to remove more sodium and water from the body, which helps to relax the blood vessel walls, thereby lowering blood pressure.
Nutritional supplements are a USD 28 billion-a-year industry, and marketing claims, newspaper stories and testimonials often make them hard to resist, Miller says. People often view supplements as a “natural alternative” and preferable to drugs for high blood pressure or other ailments, he adds, despite mounting evidence that many supplements don’t work and in some cases may cause harm.
“People love to take vitamins regardless of the evidence or lack of it,” Miller says. “We’re trying to raise the bar and provide evidence-based guidance about whether supplements help or actually do harm.” With respect to vitamin C, he says, the jury is still out.
Other study authors from Johns Hopkins include Stephen P. Juraschek, an M.D., Ph.D. candidate; Eliseo Guallar, M.D., Dr.Ph.; and Lawrence J. Appel, M.D., M.P.H.
Reference
Juraschek SP, Guallar E, Appel LJ, Miller ER 3rd. Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012 Apr 4. [Epub ahead of print]
If you are what you eat, then what does it mean that the average American consumes 130 pounds of sugar a year? Dr. Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. Some physicians go so far as to call sugar a toxin (CBS News, 2012).
Millions of people around the world are currently taking medications to lower their cholesterol. In England alone, around 7 million people are taking cholesterol-lowering statins in the hope of reducing their risk of a heart attack. But an increasing number of doctors and researchers are questioning the supposed link between cholesterol and heart disease.
At the same time, many people are concerned about the mass prescription of medications. In particular, prescribing medications to people who are, for the most part, perfectly healthy.
A team is now working on a documentary about the cholesterol hypothesis. The documentary will address several key issues: Have the facts about cholesterol and heart disease been distorted by pharmaceutical companies keen to increase their profits? Have our health authorities done their job to protect us from these commercial interests?
29 billion dollars is a conservative estimate of the current value of the cholesterol-lowering industry.
29 billion pounds is what cardiovascular disease costs the UK economy each year.
If the focus on cholesterol has been a mistake, then the greatest cost is associated with the lost opportunity to tackle heart disease.
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Ascorbate Supplementation Reduces Heart Failure
New research has reported that risk of heart failure decreases with increasing blood levels of vitamin C [1]. Persons with the lowest plasma levels of ascorbate had the highest risk of heart failure, and persons with the highest levels of vitamin C had the lowest risk of heart failure.
According to the US Centers for Disease Control (CDC) there are about 600,000 deaths from heart disease each year. [2] This is an enormous number. The definition of heart failure used by the study authors was on the basis of drugs prescribed, which would include all forms of heart disease that cause death. This agrees well with the CDC definition.
Specifically, the study found that each 20 micromole/liter (μmol/L) increase in plasma vitamin C was associated with a 9% reduction in death from heart failure. That works out to 54,000 fewer deaths from heart failure for each increase in 20 μmol/L plasma vitamin C. If everyone took high enough doses of vitamin C to reach the highest quartile (80 μmol/L), that would work out to approximately 216,000 fewer deaths per year. Just from taking vitamin C.
The heart muscle fails for many reasons. As we get older, it weakens and may not get enough nutrients to keep it healthy. A severe heart attack, that does not kill the patient but has caused significant damage to the heart muscle, may leave the heart in a very weakened state. Long standing or acute high blood pressure can put a massive strain on the heart and cause it to fail. An abnormal beating of the heart such as a very fast heart rate, an irregular beat or a lot of missed beats will result in a less effective pumping and eventual failure. Anemia will make the heart pump harder and faster in an attempt to deliver enough oxygen to the organs. The valves in the heart which direct blood flow are made up of an important fibrous strengthening tissue called collagen. Weakness or tearing of these valves can cause the blood to flow backwards, making the heart pump very inefficiently and eventually causing it to fail. When the heart muscle begins to fail, there is a buildup of carbon dioxide and waste products, resulting in weakening of the kidneys and liver. Eventually, fluid builds up in all the organs and the person presents with severe fatigue, shortness of breath (from fluid in the lungs) and swelling of the ankles.
Viruses and other microorganisms can attack the heart and weaken the heart muscle cells permanently by causing viral myocarditis. As the heart muscle cells get older they may require more energy to work and a greater level of protection from free radical damage. Nutrients such as magnesium, orotic acid, coenzyme Q10, acetyl L-Carnitine, and others may be required. Toxins, chemotherapeutic drugs, alcohol and deficiencies of some nutrients such as selenium may cause the heart to increase the size of its cells to compensate for the weakness. An enlargement of the heart muscle is called cardiomyopathy. These hearts are much more likely to fail.
Medical treatment of cardiac failure uses drugs that open the arteries, reduce blood pressure, and force the excessive fluid out of the body (diuretics). Drugs known as ACE Inhibitors improve quality of life and survival. Diet, fluid and salt restriction, and tolerable exercise are essential. For the most severe cases, a heart transplant may be required. However, many of these treatments have significant side effects. For example, treatment with diuretics to remove excess fluid will tend to lower the plasma vitamin C level and exacerbate the causes of cardiac failure.
It takes less vitamin C than you may have thought. To achieve a plasma level of 80 μmol/L, and thereby reduce deaths by 216,000 per year, requires a daily dosage of about 500 mg of vitamin C. This is only one or two tablets per day, costing less than ten cents.
3,000 to 8,000 mg/day, in continued divided doses, can achieve a plasma level twice as high (160 μmol/L). This much C could save an additional 216,000 lives as it is an additional 80 μmol/L, assuming the relationship holds.
We can go still higher, and without intravenous administration. 1,000 mg of oral vitamin C per hour for 12 hours (12,000 mg/day) will result in a plasma level of about 240 μmol/L. A single 5,000 milligram dose might take you to a peak of 240 μmol/L, but only for about 2-4 hours after the intake. That is why the dosage needs to be spread out: better absorption, gradual excretion, higher plasma levels . . . and better results.
Optimizing vitamin C intake optimizes the health of a person taking it. This includes persons with potentially life-threatening disorders. It is a simple, cheap, effective, and safe therapy. Vitamin C is no longer a “controversial” therapy. It is an ignored therapy. It is time for the medical profession to fully awaken to what this recent study confirms: higher vitamin C intakes mean less heart failure. That means that higher vitamin C intakes mean fewer deaths. 200,000 per year fewer.
With just two vitamin C tablets per day.
(Orthomolecular Medicine News Service, November 22, 2011)
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Low Vitamin C Levels May Raise Heart Failure Patients’ Risk
1. Pfister R, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study. Am Heart J 2011; 162: 246-253.
2. http://www.cdc.gov/nchs/fastats/lcod.htm
Low levels of vitamin C were associated with higher levels of high sensitivity C-Reactive protein (hsCRP) and shorter intervals without major cardiac issues or death for heart failure patients, in research presented at the American Heart Association’s Scientific Sessions 2011.
Compared to those with high vitamin C intake from food, heart failure patients in the study who had low vitamin C intake were 2.4 times more likely to have higher levels of hsCRP, a marker for inflammation and a risk factor for heart disease.
The study is the first to demonstrate that low vitamin C intake is associated with worse outcomes for heart failure patients.
Study participants with low vitamin C intake and hsCRP over 3 milligrams per liter (mg/L) were also nearly twice as likely to die from cardiovascular disease within one year of follow-up.
“We found that adequate intake of vitamin C was associated with longer survival in patients with heart failure,” said Eun Kyeung Song, Ph.D., R.N., lead author of the study and assistant professor at the Department of Nursing, College of Medicine, in the University of Ulsan in Korea.
The average age among the 212 patients in the study was 61, and about one-third were women. Approximately 45 percent of the participants had moderate to severe heart failure.
Participants completed a four-day food diary verified by a registered dietitian and a software program calculated their vitamin C intake. Bloods tests measured hsCRP.
Researchers divided participants into one group with levels over 3 mg/L of hsCRP and another with lower levels. Patients were followed for one year to determine the length of time to their first visit to the emergency department due to cardiac problems or death.
Researchers found that 82 patients (39 percent) had inadequate vitamin C intake, according to criteria set by the Institute of Medicine. These criteria allowed the researchers to estimate the likelihood that the patient’s diet was habitually deficient in vitamin C based on a four day food diary. After a year follow-up, 61 patients (29 percent) had cardiac events, which included an emergency department visit or hospitalization due to cardiac problems, or cardiac death.
The researchers found that 98 patients (46 percent) had hsCRP over 3 mg/L, according to Song.
Inflammatory pathways in heart failure patients may be why vitamin C deficiency contributed to poor health outcomes, the data suggests.
“Increased levels of high-sensitivity C-reactive protein means a worsening of heart failure,” Song said. “An adequate level of vitamin C is associated with lower levels of high-sensitivity C-reactive protein. This results in a longer cardiac event-free survival in patients.”
The use of diuretics may also play a role because vitamin C is water soluble and diuretics increase the amount of water excreted from the kidneys, said Terry Lennie, Ph.D., R.N., study author and associate dean of Ph.D. studies in the College of Nursing at the University of Kentucky in Lexington, Kentucky.
“Diet is the best source of vitamin C,” Lennie said. “Eating the recommended five servings of fruits and vegetables a day provides an adequate amount.”
More randomized controlled trials and longitudinal prospective studies are needed to determine the impact of other micronutrients on survival or rehospitalization, Song said.
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Two Vitamin C Tablets Every Day Could Save 200,000 American Lives Every Year
Your Heart Loves Vitamin C
Dr. Benjamin Weeks explains in this video from 2008 how vitamin C impacts the heath of the cardiovascular system.
Research: Calcium supplements with or without vitamin D and risk of cardiovascular events: Reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis
Research published in BMJ (British Medical Journal) in April 2011 adds to mounting evidence that calcium supplements increase the risk of cardiovascular events, particularly heart attacks, in older women. The findings suggest that their use in managing osteoporosis should be re-assessed.
Calcium supplements are often prescribed to older (postmenopausal) women to maintain bone health. Sometimes they are combined with vitamin D, but it’s still unclear whether taking calcium supplements, with or without vitamin D, can affect the heart.
The Women’s Health Initiative (WHI) study – a seven-year trial of over 36,000 women – found no cardiovascular effect of taking combined calcium and vitamin D supplements, but the majority of participants were already taking personal calcium supplements, which may have obscured any adverse effects.
So a team of researchers, led by Professor Ian Reid at the University of Auckland, re-analysed the WHI results to provide the best current estimate of the effects of calcium supplements, with or without vitamin D, on the risk of cardiovascular events.
They analysed data from 16,718 women who were not taking personal calcium supplements at the start of the trial and found that those allocated to combined calcium and vitamin D supplements were at an increased risk of cardiovascular events, especially heart attack.
By contrast, in women who were taking personal calcium supplements at the start of the trial, combined calcium and vitamin D supplements did not alter their cardiovascular risk.
The authors suspect that the abrupt change in blood calcium levels after taking a supplement causes the adverse effect, rather than it being related to the total amount of calcium consumed. High blood calcium levels are linked to calcification (hardening) of the arteries, which may also help to explain these results.
Further analyses – adding data from 13 other trials, involving 29,000 people altogether – also found consistent increases in the risk of heart attack and stroke associated with taking calcium supplements, with or without vitamin D, leading the authors to conclude that these data justify a reassessment of the use of calcium supplements in older people.
But in an accompanying editorial, Professors Bo Abrahamsen and Opinder Sahota argue that there is insufficient evidence available to support or refute the association.
Because of study limitations, they say “it is not possible to provide reassurance that calcium supplements given with vitamin D do not cause adverse cardiovascular events or to link them with certainty to increased cardiovascular risk. Clearly further studies are needed and the debate remains ongoing.”
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Medical News: Calcium Builds Bones But May Weaken Heart – in Cardiovascular, Myocardial Infarction from MedPage TodayThe findings suggest the use of these supplements in managing osteoporosis should be re-assessed, researchers reported online today in the BMJ. In the new study, researchers analyzed data from 16,718 women who were not taking personal calcium supplements at the start of the trial and found that those allocated to combined calcium and vitamin D supplements were at an increased risk of cardiovascular events, especially MI.
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