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12 November 2010

Scan Ban

That’s a pretty disturbing statistic published in the Archives of Internal Medicine. It just adds to the controversy stirring around CT (computed tomography) scan use. A tipping point that led to more investigation of CT scan use was this: General Electric applying for approval of CT scans as tests for colon cancer. It’s a request made because, even though the practice of screening healthy patients with CT scans has become commonplace, many insurers are hesitant to pay for the scans.
The FDA moved to approve GE’s request—until agency scientists had objections. They said that the increased cancer risk from CT scans’ radiation would outweigh any potential benefits. Gastroenterologist and former FDA consultant Julian Nicholas—who trained at Oxford University and the Mayo Clinic—was one of those objecting. He wrote in an e-mail that approval would “expose a number of Americans to a risk of radiation that is unwarranted and may lead to instances of solid organ abdominal cancer.”
That didn’t set too well. Nicholas says, “I was first ignored, then pressured to change my scientific opinion, and when I refused to do that, I was intimidated and ultimately terminated.”

Nicholas wasn’t alone in questioning the safety of CT scans. FDA medical officer Dr. Robert Smith of Yale and Cornell Universities said, “The increased radiation exposure to the population could be substantial and would raise a serious public health/public policy issue.” Smith’s input was dismissed, too.
At present, approval for G.E.’s request is still pending.

9 November 2010

Even 1 Soda a Day Can Hike Your Diabetes Risk

A soda a day? That's not so bad—a 150-calorie blip, burned off with a brisk half-hour walk. But it's not only your waistline that's at stake. A study released today in the journal Diabetes Care found that people with a daily habit of just one or two sugar-sweetened beverages—anything from sodas and energy drinks to sweetened teas and vitamin water—were more than 25 percent likelier to develop type 2 diabetes than were similar individuals who had no more than one sugary drink per month. Since the overall rate of diabetes is roughly 1 in 10, an increase of 25 percent raises the risk to about 1 in 8. One-a-day guzzlers in the study also had a 20 percent higher rate of metabolic syndrome, a collection of indicators such as high triglyceride levels suggesting that diabetes is not far off.

"Previous studies have shown that sugar-sweetened beverages are strongly associated with weight gain," says lead author Vasanti Malik, a research fellow in the Harvard School of Public Health Department of Nutrition, who says the decision to examine the relationship between sugar-sweetened beverages and risk of diabetes was "the logical next step."

[To Cut Diabetes-Related Heart Risks, Diet and Exercise May Beat Drugs]

The researchers conducted a study of studies—a meta-analysis—to reach their conclusions. They identified eight studies with enough data to let them check for a link between sugary drinks and type 2 diabetes and three similar studies of metabolic syndrome. The largest diabetes study, which followed more than 91,000 American women ages 24 to 44 for eight years, made the strongest case for a relationship, and it wasn't just because higher consumption of sweetened drinks added excess calories that turned into pounds. While weight gain is a known diabetes risk factor, the diabetes-beverage link persisted even after adjusting for that. "Other factors independently put you at risk for developing diabetes," says Malik.

The main one is spikes in blood glucose and insulin because sweetened drinks are often consumed quickly and in large quantities and their sugar content is rapidly absorbed. Frequent spiking can lead to insulin resistance, inflammation, and hypertension—often precursors to diabetes. High-fructose corn syrup, the sugar in many sweetened drinks, is emerging as possibly riskier than other sugars because it seems to produce more belly fat. Fat that accumulates around the middle is closely tied to high blood pressure and other cardiovascular problems.

Americans love sweetened drinks. Consumption climbed to an average of 142 calories a day, or nearly one 12-ounce can of soda, in 2006, from 65 in the late 1970s. And many people down far more than that, notes Frank Hu, a senior author of the study and a professor of nutrition and epidemiology at Harvard, which puts them at a much greater risk of diabetes. A report from the Centers for Disease Control and Prevention released earlier this week projects that by 2050, 1 in 3 Americans will develop the disease. "Soft drink consumption has significant public health implications in terms of the diabetes epidemic," says Hu.

[Why Diabetes May Triple by 2050]

Earlier this year the American Heart Association issued a recommendation advising consumers to set a limit on sweetened drinks of 450 calories a week, or three 12-ounce sodas, in a 2,000-calorie diet. Calorie-counting is a convenient way to keep track, but it can be misleading. "Consumers are overly focused on calories," says Constance Brown-Riggs, a spokesperson for the American Dietetic Association, who would like people also to understand that a 12-ounce can of soda contains the equivalent of 15 teaspoons of sugar. "They think it's not that bad, without taking into consideration the other components that are putting them at risk."

Type 2 diabetes and metabolic syndrome aren't the only risks of a one-a-day habit. In a 2004 study published in the Journal of the American Medical Association of 88,000 women followed for 24 years, those who guzzled two or more sugary drinks a day had a risk of coronary artery disease 35 percent higher than non-guzzlers, even after adjusting for other unhealthy lifestyle factors. "You receive no benefits out of drinking these beverages," says Malik, who lists additional hazards from dental cavities to gout. "It's a wake-up call for the American public."

Blood Pressure Treatment on Rise in Younger Adults, Says CDC Report

Kristen Pessalano just turned 23, but has been on blood pressure medication for more than two years. Pessalano, a New Yorker who works in public relations, found out she had high blood pressure while getting a physical before heading abroad for an internship.

"[I] got upset when I first found out because I automatically associated it with people who are overweight or old," said Pessalano. "I would have never associated high blood pressure with someone my age, especially when I appeared to be totally healthy."

Pessalano has a lot of company, according to a new report by the Centers for Disease Control and Prevention. The report finds that while the percentage of Americans who have high blood pressure has remained steady over the past decade at 30 percent, the number of younger adults -- ages 18 to 39 -- who have high blood pressure and take medication to treat it has significantly increased from 27.6 percent in 1999 to 2000 to 49.1 percent in 2007 to 2008.
Doctors say they're not surprised because of other health problems that plague younger adults.

"I'm not surprised that more and more young people are being treated for high blood pressure since the incidence of obesity, a contributing cause for high blood pressure, is increasing in this age group," said Dr. Randal Thomas, a cardiologist at the Mayo Clinic in Rochester, Minn.

"With increasing obesity and diabetes in younger populations, clinicians may be more aggressive about recognizing risk factors for cardiovascular disease, like hypertension, and treating it," said Dr. Carol Horowitz, associate professor of medicine at Mount Sinai School of Medicine.

Although the news that she had high blood pressure was unexpected to Pessalano, the CDC report found most people with high blood pressure have become more aware of the condition, which is something physicians say they've noticed in their own practices.

"[I]ndividuals are taking their own health issues more seriously and noticing the increased blood pressure readings," said Dr. R. Scott Wright, also a cardiologist at the Mayo Clinic.

Exercise Your Depression Away

Good news all you exercise fanatics.

Researchers have found that the more people engage in physical activity, even very light exercise, during their spare time, the less likely they are to be depressed.

Surprisingly, the study showed that people who exert themselves at work by doing lots of walking or lifting are no less likely to be depressed than people with sedentary jobs.

People who were inactive during their leisure time were almost twice as likely to have symptoms of depression, compared with the most active individuals.

lead author of the study, said the findings underlined the importance of the context in which exercise was taken.

“Our study shows that people who engage in regular leisure time activity of any intensity are less likely to have symptoms of depression,” he said.

“We also found that the context in which activity takes place is vital and that the social benefits associated with exercise, like increased numbers of friends, are more important in understanding how exercise may be linked to improved mental health than any biological markers of fitness.

“This may explain why leisure activity appears to have benefits not seen with physical activity undertaken as part of a working day.”