Now palm oil is in the gun

It started out that ordinary animal fats --  saturated fats -- were widely used in processed food -- cakes, cookies etc.  But then we were all told that saturated fats were bad for you.  So manufacturers were told to switch to trans fats, which they did.

But some evidence soon emerged that trans fats were also bad for you.  So everybody was told to switch to palm oil in food preparation, which many did.

But now palm oil also appears to be bad for you!  You can't win against the food freaks, it appears.  

What next?  It can't be butter because that was condemned long ago.  The obvious move is to switch back to animal fats -- tallow, dripping etc -- and damn the food freaks.  When everything is bad for you, nothing is


New studies have discovered how a fatty acid found in palm oil affects the cancer genome, increasing the likelihood the disease will spread in human beings.

The spread of cancer, known as metastasis, is the main cause of death in patients with the disease. Researchers in the field say the vast majority of people with metastatic cancer can only be treated, but not cured.

The Institute for Research in Biomedicine (IRB) in Barcelona conducted a study on mice, finding that palmitic acid promoted metastasis in mouth and skin cancers.

Scientists suggest this process could be targeted with drugs or carefully designed eating plans in the future, but the team behind the work has put out a warning for patients putting themselves on diets in the absence of clinical trials.

According to the research, other fatty acids called oleic acid and linoleic acid found in foods such as olive oil and flaxseeds did not show the same effect.

“There is something very special about palmitic acid that makes it an extremely potent promoter of metastasis,” Professor Salvador Aznar-Benitah said via The Guardian.

The research found that when palmitic acid was supplemented into the diet of mice, it not only contributed to metastasis but also exerted long-term effects on the genome.

However, the professor also claimed it was too early to tell what diet should be taken for patients with metastatic cancers.

“I think it is too early to determine which type of diet could be consumed by patients with metastatic cancer that would slow down the metastatic process,” he said.

“That is a much more realistic approach in terms of a real therapy, that doesn’t depend on whether a patient likes Nutella or pizza. Playing with diets is so complicated.”

Prof Greg Hannon, director of the Cancer Research UK Cambridge Institute, praised the “rigorous and comprehensive” study into one of the most commonly used oils around the world.

“This is a rigorous and comprehensive study that suggests that exposure to a major constituent of palm oil durably changes the behaviour of cancer cells, making them more prone to progress from local to potentially lethal metastatic disease,” he said.

“Given the prevalence of palm oil as an ingredient in processed foods, this study provides strong motivation for further study on how dietary choices influence the risk of tumour progression.”

Made from the fruit pulp of the oil palm tree, palm oil plantations are grown in tropical regions in Indonesia, Malaysia, Colombia, New Guinea and Ghana.

According to Ethical Consumer, it is the most consumed vegetable oil on the planet, with 72 per cent of worldwide production being used in the food industry. A 2015 report by the Roundtable on Sustainable Palm Oil estimated worldwide use would more than double by 2030 and triple by 2050.

Palm oil is a cheap substitute for butter, meaning it is especially common in dough and baked foods. It is commonly found in everyday pantry items, such as margarine, Nutella and biscuits.

Helen Rippon, chief executive at Worldwide Cancer Research, said the discovery is “a huge breakthrough in our understanding of how diet and cancer are linked”.

“Perhaps more importantly,” she said. “Is how we can use this knowledge to start new cures for cancer. Metastasis is estimated to be responsible for 90 per cent of all cancer deaths – that’s around 9 million deaths a year globally.

“Learning more about what makes cancer spread and – importantly – how to stop it is the way forward to reduce these numbers.”

The environmentally unsustainable nature of palm oil production, which has led to mass pollution and loss of native species, has long been a topic of pursuit for activists worldwide.

According to The Orangutan Project, palm oil plantations have been a major factor in deforestation in Malaysia and Indonesia, where 85 per cent of the world’s palm oil is produced.

Palm oil plantations are the biggest cause of rainforest destruction in these countries, where the United Nations reports an area of forest the size of 300 soccer fields is lost every hour.

This loss of rainforest displaces animals such as the orangutan and causes air pollution.

Palm oil is a common ingredient in food and cosmetic products, with alternate names such as palm oil kernel, palmitate, palmate, palmitic acid, elaeis guineensis and hydrated palm glycerides hexadecanoic.

https://www.news.com.au/lifestyle/health/diet/institute-for-research-in-biomedicine-study-links-palm-oil-to-increased-cancer-risk/news-story/500b5cf5f3bc1c0ebe71802f0e55c643

Personal trainer says a McDonald's cheeseburger is 'healthier' than a protein cookie

A personal trainer and fitness infuencer swears a McDonald's cheeseburger will really not set your progress back as much as you think, especially when compared to a protein cookie.

TikTok user Laura Ghiacy listed the nutritional value of a McDonald's cheeseburger and a protein cookie and highlighted the differences between them, coming to the conclusion the burger is, ultimately, healthier.

"I'm going to get so much hate for this," Ghiacy says in the beginning of her video, before asking the question of the hour: "Is a protein cookie healthier than a McDonald's cheeseburger?"

Ghiacy found that in a protein cookie, there are 420 calories, while in a McDonald's cheeseburger, there are 300 calories.

Between the pair, the fast food item is slightly higher when it comes to fat levels, containing 13g compared to the protein cookie's 12g.

When it comes to sugar levels, however, the difference between the two was stark — the protein cookie, which is plant-based, has 25g of sugar, whereas the McDonald's cheeseburger only has 7g.

Ghiacy listed other nutritional comparisons between the pair, but then said the most "important" issue between them was the taste — ultimately declaring the cheeseburger as the winner on the flavour front as the burger tastes "a thousand times better."

TikTok users flocked to Ghiacy's comments to let her know what they thought about the revelation.

"As a Dietitian, I freaking love this! We love putting labels on everything but in the end food is food," registered dietitian Tia Glover commented.

Meanwhile, another TikTok user wrote: "All I heard was I can eat cheeseburgers without feeling guilty now."

Other users simply took Ghiacy's nutritional breakdown as the signal they needed to order McDonald's.

"She just gave us the green light to have a cheeseburger," one user commented, as another noted, "Now I'm craving a cheeseburger!"

Other commenters were more balanced, with one writing, "This is not about saying the cookie is bad. It's that a small cheeseburger is not actually the villain that many make it out to be."

https://www.msn.com/en-au/health/nutrition/personal-trainer-says-a-mcdonalds-cheeseburger-is-healthier-than-a-protein-cookie/ar-AAQvWtd

Drinking a beer or glass of wine a day could PROTECT you from getting heart disease

Drinking a wine or beer every day could be the key to preventing heart disease in the elderly, a study has revealed.

Monash University researchers observed the effects of alcohol consumption in 18,000 people aged 70 and above in the US and Australia.

They discovered that drinking between five and 10 beverages a week led to a much smaller chance of dying from heart problems.

School of Public Health and Preventive Medicine associate professor Robyn Woods said the research was insightful.

'It's that range of five to 10 standard drinks a week where we saw real benefit for reducing the mortality risk, but also on cardiovascular disease,' Prof Woods told The Daily Telegraph.

'We are very confident to say that moderate alcohol intake does not appear to do harm in older people regarding cardiovascular disease and also for all-cause mortality.'

Researchers came to the conclusion after observing participants of the ASPREE trial - Aspirin in Reducing Events in the Elderly.

The study looks at the effects of lose-dose aspirin on healthy, elderly people and requires participants to self-report their alcohol consumption.

Fifty-seven per cent of participants were female, 43.3 per cent were male and most were aged in their mid-70s.

The participants were followed for around 4.7 years and researchers discovered the moderate alcohol drinkers fared better than their teetotaller counterparts.

Lead author Dr Neumann pointed out all the participants were considered to be healthy before they started the trial.

The effects of moderate alcohol consumption remain unknown for elderly people who are less healthy and physically active.

People should also not use the study as encouragement to drink more alcohol with excess consumption linked with increasing risks of cancers, heart disease, dementia, stroke and liver failure.

https://www.dailymail.co.uk/news/article-10175595/Wine-beer-day-reduces-cardiovascular-disease-Monash-University-study-shows.html

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Why that glass of wine with dinner isn't so bad after all: Experts say a tipple every other day is perfectly healthy

The 'occasional' glass of wine is perfectly safe, scientists have insisted in a bid to put to bed fears that a tipple with dinner could be detrimental to health.

A landmark paper published in the Lancet in 2019 stoked fears that consuming even small amounts of alcohol is likely to cause changes in blood pressure and increase the risk of a stroke.

It overturned a mainstream theory that a regular glass of wine could actually be beneficial for heart health because of the protective antioxidants contained in the drink.  

But the new report, by scientists from University College London and the London School of Hygiene and Tropical Medicine claims the Lancet analysis was flawed.

Sir Nicholas Wald, an expert in epidemiology and preventative medicine at UCL, told The Times that while it is difficult to define what a safe amount of alcohol is, it is not true to say a single glass is harmful.

He said: 'One cannot now say any amount of alcohol is harmful in the same way as one can say any amount of smoking is harmful.

'The occasional glass of wine or no more than a glass of beer, say, every other day would be acceptable given our current state of knowledge. One need not feel that the only safe alcohol intake is zero.'

You should not feel guilty about drinking red wine in moderation during the week — in fact, it could give you health benefits, a study claimed in August.   

A team of experts in Germany and Northern Ireland looked at the link between consumption of flavonoids — found in red wine, among other food and drink — and blood pressure in a sample of nearly 1,000 German people.

They found drinking three standard-sized glasses (125ml) of red wine a week can lower blood pressure.

It's thought that flavonoids promote the relaxation of muscles in our arteries, allowing them to widen and therefore improving blood flow.  

However, the experts stress that if you don’t drink alcohol already, you shouldn’t start, and that boozers should always bare in mind official drinking guidelines.

The study, published in the journal Hypertension, was conducted by scientists at Queen’s University Belfast and Kiel University in Germany.

According to the team, flavonoids – the abundant nutrients in fruits, vegetables, tea and other plant-based foods – appear to have a positive effect on blood pressure levels.

Flavonoids are broken down by the trillion-strong community of microorganisms in our gut, known as the microbiota.

The new paper criticises the Lancet study's analytic techniques which were based on genetics.

In that study, Oxford scientists tracked half a million people in China from 2008 to 2017.

They compared one group who could not drink at all because they were allergic to alcohol and compared them to people who drank various levels of booze.

It focused on those who were genetically unable to drink as a reliable measure of abstinence to get around faulty self-reporting.   

The analysis found the two-thirds of participants who were able to drink were at far higher risk of high blood pressure and strokes.

But the new study, published in the International Journal of Epidemiology, found a flaw in the analysis techniques used by the Oxford researchers.

Most major research into alcohol's effect on strokes and blood pressure show a 'J-shaped' relationship between alcohol and stroke risk.

People who abstain from drinking normally have a slightly higher risk than those who have a tipple in low quantities. But heavy drinkers are always at the highest risk.

When these risks are plotted on a graph, the curve takes the shape of a letter J.

The UCL and LSHTM researchers took a hypothetical population where they knew accurate statistical analysis should reveal this J shaped curve.

When they ran the statistical analysis used in the Lancet study, it did not produce the correct shape.

This left the researchers believing there was a flaw in the previous paper's methodology.

Professor Chris Frost, a medical statistician at LSHTM and one of the study's co-authors, said the study showed that while 'a little alcohol is acceptable... a lot is harmful'.

He said the paper should not encourage drinking but it serves to highlight there was a flaw in the analysis of the Lancet study which suggested there is no safe limit to consumption.

The UK chief medical officer guidelines say it is not safer to drink more than 14 units — 6 pints or 1.6 bottles of wine — per week, spread over three days or more.

https://www.dailymail.co.uk/health/article-10063947/Major-analysis-sparked-alcohol-fears-flawed-experts-insist.html

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A leading Australian doctor has made a surprising finding regarding alcohol - and the best type of alcohol to drink for your health

Dr Paul Gow

Socially, when I say I’m a liver specialist, people imagine me to be a puritanical teetotaller. But I am actually quite the opposite. I enjoy a drink. I don’t enjoy all types of alcohol. Spirits remind me of bad hangovers as a younger man, beer makes me feel bloated, but wine? Wine, I thoroughly enjoy.

The fact that people are surprised that a liver specialist enjoys alcohol relates, of course, to the fact that alcohol causes liver disease and therefore people think I should know better.

The truth though, is that for most individuals, alcohol can be beneficial – rather than detrimental.

For decades we have heard the message that alcohol causes cirrhosis, alcohol is a drug of addiction and alcohol ruins lives and, of course, all of these things are true. But it doesn’t have to be like that. Modest alcohol intake almost certainly does more good than harm.

Keep in mind, that when I talk about moderate alcohol intake, I mean up to 2 units of alcohol for women and up to 3 units for men on any given day, with a maximum of 7 units for women and 14 for men over a week.

A healthy liver can manage moderate alcohol intake. The job of a normal healthy liver is to filter bad chemicals from the blood and manufacture good chemicals.  Most of the bad chemicals the liver filters out are broken down remnants of what we’ve eaten. There’s nothing to worry about – this is, after all, the liver’s primary role.

All the blood from the gut (including chemicals we have eaten) drains through the liver – and the liver takes out the bad stuff, keeps the good stuff and manufactures essential chemicals. Alcohol therefore (in moderation), is metabolised by the healthy liver without any issue.

The French embrace.  Two decades ago, an article in the prestigious medical journal The Lancet coined the term ‘The French Paradox’. The paradox was that the French – despite a diet high in saturated fats – had a low incidence of death from cardiac disease.

The explanation for this apparent disparity was the moderate alcohol consumption typical of the French diet – and the premise that moderate alcohol intake protected the heart.

Ever since, there has been growing evidence moderate alcohol intake doesn’t just protect individuals from fatty liver disease and heart disease, but also against diabetes, dementia and numerous other conditions.

Although we still don’t know why, alcohol has been shown to be antioxidant, anti-inflammatory, blood pressure lowering and have anticoagulant properties. All these are good.

It is well recognised that heavy alcohol consumption can increase the risk of all sorts of cancer – the most common being liver cancer and throat (laryngeal) cancer.

What is less clear, but still crucially important, is whether moderate amounts of alcohol increase the risk of cancer. For most (but not all) cancers, there is no evidence that moderate alcohol has any effect on cancer risk.

However, there is evidence that moderate alcohol increases the risk of cancer of the mouth, throat (oral and pharyngeal cancer), breast, liver and oesophagus. Given the high rates of breast cancer in our population, this is certainly troubling.

On the other hand, moderate alcohol appears to be protective with respect to the risk of certain other cancers – including kidney cancer and lymphoma.

The Million Women Study reported no increase in the risk of breast cancers in women having 3 or fewer drinks/week.

But in women having 3–6 drinks per week, the rate of breast cancer increased slightly compared to non-drinkers, by about 8 per cent.

It is now well accepted that even small volumes of alcohol increase the risk of breast cancer in women. It also appears that there is a gradient of increasing risk with increasing alcohol intake.

Alcohol and longevity

Statistically, moderate drinkers live on average, 2 years longer than non-drinkers.  Some report a survival advantage of more than 3 years, while others report as little as 6 months.

All the studies however, report that moderate drinkers live longer than non-drinkers.

One other very important piece of information gained from these reports is that life-years gained by moderate drinkers are typically years of good health.

It’s also important to put the health benefits of moderate alcohol in context compared with other powerful public health messages such as exercise, stopping smoking and avoiding obesity.

Of these issues, the one that exerts the greatest effect in terms of life-years gained is to avoid or stop smoking.

Non-smokers live on average about 6 years longer than smokers. Regular exercise offers a survival benefit of about 3 years, while avoiding obesity adds an extra 12 months.

When considered like this, some data suggests that moderate alcohol intake is perhaps two- or three-fold more powerful as a lifestyle choice to increase longevity than avoiding obesity. The lifestyle measures discussed here are generally addictive in their effect on longevity.

For example, a non-smoking, regular exerciser who drinks moderately and isn’t obese lives between 8 and 15 years longer on average than their counterpart who smokes, doesn’t exercise, doesn’t drink and is obese.

Which type of alcoholic drink has the greatest health benefits?

From the existing data, all types of alcoholic drinks are associated with potentially positive health benefits, with the proviso that they are consumed in moderation. However, red wine appears to be associated with slightly greater health benefits.

The occasional binge

Don’t be tempted to binge drink. Drinking alcohol with the specific intention of getting drunk, typically leads to alcohol- induced harm.

Having more than 4 standard drinks at one sitting for women, or 5 for men, has negative social consequences such as increased risk of trauma, traffic accidents and violence.

And for your liver, repeated episodes of binge drinking are detrimental and associated with a marked increase in the risk of developing cirrhosis.

Binging also appears to have specific detrimental effects on heart health and is associated with an increased risk of death from heart disease.

My recommendations

The scientific evidence surrounding moderate alcohol intake and health is not totally resolved. I, personally, am a believer that moderate alcohol offers net benefits to a person’s health but there are many others in the scientific community who interpret the data differently.

There’s a term in astronomy known as ‘the Goldilocks zone’.

The Goldilocks zone is the region around a star where planets are at just the right temperature to have liquid water. Not so hot that all the water is burnt off, and not so cold that the water is frozen, but just right.

A glass of wine at Christmas probably isn’t enough to reap the metabolic benefits that moderate alcohol intake has been associated with.

If, however, you have a glass of wine with your evening meal 3, 4 or even 5 nights a week, you are definitely in the Goldilocks zone.

https://www.couriermail.com.au/lifestyle/qweekend/drinking-adds-two-years-to-your-life-find-out-which-alcohol-is-the-healthiest/news-story/d6c2d5a2b8734dea7122d238e2f33484

Alzheimer's could be stopped or even reversed by putting patients in oxygen chambers, study claims

An oxygen therapy given to patients in pressurised rooms could halt or even reverse Alzheimer's disease, a study has found.

A small-scale trial of six older people with early stage of memory loss called Mild Cognitive Impairment (MCI) saw their symptoms improve from five 90-minute oxygen treatments a week for three months, researchers at Tel Aviv University found.

The treatment - called hyperbaric oxygen therapy (HBOT) - involves patients inhaling oxygen through a mask in a pressurised chamber.

It significantly increases the amount of oxygen in the body's tissues, which has previously been found to encourage healing.

And when the treatment was administered to mice, it removed amyloid plaques from the brain, which are a tell-tale sign of Alzheimer's disease.

The experts believe the therapy works by changing the structure of vessels in the brain and allowing for increased blood flow. Reduced blood flow to the brain has already been linked with the onset of dementia.

Dementia - the name for symptoms linked with ongoing memory decline - is the UK's biggest killer and someone develops the condition every three minutes, according to the Alzheimer's Society. There is currently no cure.

Some 850,000 Britons have the condition - with one and six of them aged over 80 - and the figure is expected to reach 1.6million by 2040.

The study, published in the journal Aging, examined six patients aged around 70 who did not have Alzheimers, but suffered from severe memory loss called MCI, which can act as an early sign of Alzheimer's.

Researchers administered 60 daily HBOT sessions to the group over three months and measured the blood flow in their brain before and afterwards through an MRI scan.

WHAT IS A HYPERBARIC CHAMBER AND HOW IS IT USED?

A hyperbaric chamber is a highly-pressurized room or tube where a patient is given pure oxygen to breathe.

The air pressure in these chambers is three times higher than normal pressure outside.

Lungs operate on gas exchange, which happens more or less efficiently at different pressures.

At this higher air pressure, the lungs are able to take in more oxygen than under normal conditions.

All the body's tissues require oxygen to live and stay healthy, so in a hyperbaric chamber the lungs take in more oxygen which is then carried throughout the body to restore tissues that may be struggling or infected.

Oxygen also help to reduce inflammation and encourage new blood vessels to grow.

WHAT ARE HYPERBARIC CHAMBERS USED TO TREAT?

Hyperbaric oxygen therapy is a proven treatment for decompression sickness, a condition that some people develop after SCUBA diving, wherein the high pressure of being deep under water causes nitrogen to form in their blood vessels.

This typically causes muscle and joint aches and fatigue, but in rare cases can prove fatal. Hyperbaric oxygen therapy reverses the process that allows the dangerous nitrogen bubbles to form.

According to the Mayo Clinic, doctors may also recommend hyperbaric oxygen therapy for:   

Anemia, severe
Brain abscess
Bubbles of air in your blood vessels (arterial gas embolism)
Burn
Decompression sickness
Carbon monoxide poisoning
Crushing injury
Deafness, sudden
Gangrene
Infection of skin or bone that causes tissue death
Non-healing wounds, such as a diabetic foot ulcer
Radiation injury
Skin graft or skin flap at risk of tissue death
Vision loss, sudden and painless  
 
Although claims have been made that the therapy helps a whole hosts of other medical issues, there is only scientific evidence to support the above uses.

There isn't significant reason to believe it treats conditions like fibromyalgia, depression or chronic fatigue syndrome.

The volunteers also completed memory tests before and after the treatment.

HBOT is used to treat a host of conditions including injured or infected tissue and decompression sickness, which usually affects deep-sea divers who emerge from deep water too quickly. Studies have also found it could help men suffering from impotence.

Justin Bieber revealed last year that he sleeps in a hyperbaric chamber to get more oxygen to his brain, which he said reduced his stress levels.

After the HBOT sessions, the researchers spotted 'significant' increases of 16 to 23 per cent in blood flow in several parts of the brain.

This suggests that the treatment expanded the width of blood vessels and reduced the thickness of blood vessel walls, the experts said.

And the participants scored 16.5 per cent higher on subsequent memory tests, six per cent more on concentration and 10.3 per cent higher on information processing.

Professor Uri Ashery, an expert in neurobiology at Tel Aviv University, told the Telegraph: 'Elderly patients suffering from significant memory loss at baseline revealed an increase in brain blood flow and improvement in cognitive performance, demonstrating hyperbaric oxygen therapy's potency to reverse core elements responsible.'

They also tested the treatment on mice with Alzheimer's and found it slashed the number of amyloid plaques - which stop brain cells from communicating with each other - by nearly 30 per cent.

And the plaques that weren't removed shrunk by 18 per cent, according to their paper.

The mice also built better nests and moved through mazes faster.

Professor Ashery said: 'We have discovered for the first time that hyperbaric oxygen therapy induces degradation and clearance of pre-existing amyloid plaques, and the appearance of newly formed plaques.'

But the researchers said the treatment needs to be tested on a larger number of patients to confirm their findings.

And as it stands, oxygen therapy would be very difficult to routinely administer across the UK. as there are very few hyperbaric chambers.

Professor Tom Dening, an expert in dementia at the University of Nottingham, told the Telegraph: 'Presumably to be useful, the treatment would have to be continued indefinitely, so any patients would have to be very highly motivated and have good transport links to the treatment facility.

'If we consider that the number of people with dementia in the UK is approaching one million, it is hard to see how hyperbaric oxygen could ever be available on this scale.

'In short, it's an interesting idea but a long way off meeting the usual criteria to become a standard treatment.'

Dr Susan Kohlhaas, the director of research at Alzheimer's Research UK, said: 'Many of the Alzheimer's treatments that are currently being tested are drugs that target the hallmark disease proteins directly, but it's important we maintain a broad spectrum of potential approaches.

'Larger scale clinical trials with many more people are needed to ascertain whether this treatment is effective, particularly when measuring longer term benefits to memory and thinking.

'We know the diseases that cause dementia begin in the brain many years before symptoms like memory loss show and it's likely for treatments to be effective at slowing down the diseases that cause dementia, they need to be given earlier rather than later.'

https://www.dailymail.co.uk/health/article-9977043/Alzheimers-stopped-reversed-putting-patients-oxygen-chambers-study-claims.html

Antibiotics may raise colon cancer risk, massive study suggests

 
Taking antibiotic drugs may raise the risk of developing colon cancer five to 10 years down the line, according to a new study of more than 40,000 cancer cases in Sweden.

Past studies hinted that antibiotics can cause lasting changes to the gut microbiome — the community of microbes that live in the digestive tract — and that these changes may be linked to a heightened risk of colon cancer. Now, in the largest epidemiological study to ever explore this link, researchers report that the heightened risk may be specific to cancers in the so-called proximal colon, the part of the colon that connects to the small intestine and starts in the lower-right abdomen.

"It's very clear, when we looked at the data, that it's very confined to the proximal, or right-sided colon," senior author Sophia Harlid, a cancer researcher at Umeå University in Sweden, told Live Science. And in fact, the antibiotic-related cancer risk was greatest at the start of the proximal colon, called the "ascending colon," which extends from the lower- to upper-right abdomen.

People who took antibiotics for more than six months bore the highest cancer risk, according to the research, published Wednesday (Sept. 1) in the Journal of the National Cancer Institute. Compared with people who'd taken no antibiotics, these individuals had a 17% higher chance of developing cancer in the ascending colon.

That said, even short courses of antibiotics carried an associated cancer risk, albeit a far smaller one than what was seen with the months-long regimens, the team found. This data may provide yet another reason to rein in the overprescription of antibiotics, besides preventing the emergence of antibiotic-resistant superbugs, Harlid said.

These new findings echo the results of a similar, but smaller, U.K.-based study, published in 2019 in the journal Gut. The Swedish study "came right in line with other data that was emerging … which actually improves confidence that there's an association," Dr. Cynthia Sears, senior author of the U.K. study, who was not involved in the newest research, told Live Science.

It's important to note that these studies only identify a correlation; they don't show that antibiotics directly cause the subsequent colon cancer, said Sears, who is a professor of medicine and oncology at the Johns Hopkins University School of Medicine and a professor of molecular microbiology and immunology at the Bloomberg School of Public Health. That said, there are theories as to how the drugs may make the proximal gut more vulnerable to cancer growth.

"Our thinking is that you're disrupting the balance of the microbiota," and this may allow infectious bugs like Escherichia coli and Klebsiella pneumoniae to gain prominence where they'd usually be outcompeted by other microbes, Sears said. This in turn may ramp up inflammation in the colon, generating reactive chemicals that could damage DNA and generate tumors. In addition, the inner lining of the intestine may then become more permeable, allowing bacteria to infiltrate the colon walls and join together in slimy structures called biofilms. Studies suggest that almost all proximal colon cancers — nearly 90% — are associated with such biofilms, Sears said.

The proximal colon may be particularly vulnerable to these changes because it endures the greatest spillover of antibiotic drugs from the small intestine, Sears said. Then, as the drugs move through the colon, their molecules steadily break down. That said, these potential mechanisms still need to be studied further, but for now, the new study strengthens the case that some link exists between antibiotics and colon cancer, she said.

The new study used data from the Swedish Colorectal Cancer Registry to identify tens of thousands of colorectal cancer patients who had been diagnosed between 2010 and 2016. Data from the Swedish Prescribed Drug Register allowed the team to track these patients' antibiotic use between 2005 to 2016, to see if any patterns emerged. They also compared the cancer patients to more than 200,000 cancer-free people from the wider Swedish population.

While the team uncovered a clear link between antibiotics use and cancer in the ascending colon, they found no such link to cancers in any part of the distal colon or rectum.  

The team wanted to pin down why the drugs might drive cancer in the proximal colon. To do so, they searched the prescribed drug register for methenamine hippurate — a medicine that helps prevent urinary tract infections in people who get them frequently.

Although it has antibacterial effects, the drug doesn't alter the gut microbiome because it can only be activated by the high acidity of urine, Harlid explained. So based on the theory that antibiotics raise the risk of cancer by messing with gut bugs, methenamine hippurate should not be linked to the same increased risk. And in sifting through all their data, the team found that this was the case: only antibiotics that affect gut bugs, not methenamine hippurate, showed a link to colon cancer.

These results further support the antibiotics-cancer link, but the study still has its limitations. For instance, the datasets didn't include any information on individuals' diets, smoking habits or alcohol use, all of which can also raise the risk of colon cancer. Similarly, the authors could not determine which patients might be taking antibiotics for an underlying condition like inflammatory bowel disease, also linked to colon cancer. In addition, the Swedish Prescribed Drug Register provides information on drug prescriptions, but cannot reflect whether individuals finished their complete course of antibiotics, for instance.

But because the study is so large, it "definitely hints in the right direction," Harlid said.

In a few years time, the team hopes to perform an even larger follow-up study, when more data has accumulated, and they're interested in seeing whether specific colon cancer subtypes show a stronger association with antibiotics. Cancers can be split into subtypes based on the behavior of their tumor cells and what genetic mutations they carry, and these subtle differences affect where the cancer grows and how it responds to treatments, according to the National Cancer Institute.

Meanwhile, Sears and her colleagues are currently collecting data on the microbiomes of individuals with early-stage colon cancer, to pinpoint specific gut bugs that are unusually depleted or overgrown. As scientists continue to study why microbes make a difference in colon cancer, for now, doctors should be selective in when and how they prescribe antibiotics, Sears said.

In theory, for those who do have to take antibiotics, dietary supplements could potentially be designed to help bring their microbiome back into balance, Sears said. One such supplement was recently trialed in malnourished children and helped them cultivate a diverse assortment of gut bugs, Live Science previously reported. But again, for now, the best course of action is simply to avoid taking antibiotics when they're not needed, she said.

https://www.livescience.com/colon-cancer-antibiotic-use-link.html

Follow the Science, At Least on Nutrition

If we’ve learned anything from the Covid-19 pandemic, it’s the make-or-break importance of solid, up-to-date scientific information – and the regulatory flexibility necessary to respond to new information quickly. At least with some aspects of Covid prevention and treatment, “follow the science” became the guiding mantra, as sustained inquiry into the coronavirus progressed at warp-speed, leading to scientific breakthroughs and three vaccines in only months, rather than the normal years or even decades.

However, related research also confirmed the truth that a healthy diet is key to preventing, managing and recovering from Covid-19 (and other diseases).

That’s why it’s surprising, and exasperating, that many suggestions in the 2020 Dietary Guidelines for Americans – the official government recommendations for a healthy diet – were based on outdated data. Rather than following the science, they have too often lagged behind recent findings or been subjected to apparently politicized science. That needs to change.

Dietary Guidelines are more than advice on how to eat. They form the basis of federal food policies and programs, nutrition education, and various public and private disease prevention initiatives. Formulated in consultation with the Dietary Guidelines Advisory Committee, the Guidelines serve as a reference tool, influence what’s on food labels, and dictate what foods are allowed in school lunch programs.

Just as important, health-care professionals and policy makers determine nutritional recommendations for especially vulnerable groups – such as pregnant women, young children and adolescents. All these people depend on (and assume there is) sound science behind the Guidelines.

Given the link between nutrition and health, one would think the congressionally required dietary Guidelines would be of high scholarly quality, accurate and scientifically up-to-date, particularly since they are published just once every five years. Indeed, the statute that mandates publication specifically requires that they be based on “the preponderance of current scientific and medical knowledge.”

Unfortunately, updates that include Recommended Dietary Allowance (RDA) values for various nutrients receive less attention.

Part of the science behind the guidelines is Dietary Reference Intakes (DRIs) that tell us how much of any given nutrient a healthy person needs, from macronutrients (proteins, fats and carbohydrates) to vitamins and minerals. Surprisingly, except for sodium and potassium, none of the DRIs have been updated in the last ten years; others, like magnesium and vitamin C, have had no updates since the 1990s.

So, on closer look, the “new” 2020 dietary guidelines turn out to be the fifth consecutive congressionally-mandated iteration of old, often outdated science, packaged in a new cover. Not surprisingly, the 2020 Advisory Committee recommended urgent extensive updates to existing DRIs, for most nutrients, for all age and sex groups and life stages, to better characterize potential risks of dietary inadequacy and excess.

If these official dietary recommendations are to mean anything, the underlying science must be current and the DRIs must be updated – right now, and more regularly in the future.

The 2020 Advisory Committee report on that point is clear: “The DRIs are essential resources for evaluating the nutritional quality of current dietary patterns for the American public, and the Committee has identified where updates are needed for the DRIs to be relevant in the Dietary Guidelines process.”

That’s why it should have been big news when former Deputy Undersecretary of Agriculture for Food Nutrition and Consumer Services Brandon Lipps’ team secured DRI research funding before leaving office. For some reason, though, there was hardly any media coverage.

Instead, ahead of the 2020 Guidelines’ publication, misguided news reports announced an expected reduction in RDAs for alcoholic drinks and added sugars – in the midst of the Covid lockdowns, when millions of Americans were increasing their intakes, as a way to cope with their isolation and boredom. But without new studies to justify them, USDA and HHS made no changes to the 2015 recommendations.

By contrast, a big change that was introduced in the 2020 Guidelines involved recommendations for young infants from birth to two years of age. For example, they suggested that babies and toddlers shouldn’t have any sweets in their first 24 months, even though there is no new science to support that new guideline. Making that change even more troubling, the very young are probably more vulnerable to the effects of using outdated DRIs than any other age group.

In another example, it’s been a long time since the last DRI update for choline, a nutrient that particularly affects infants. Certain animal source foods – such as eggs – provide sufficient amounts of choline, which appears to improve cognitive development that begins during infancy and lasts into school-age years.

Researchers at Cornell University recently discovered that women who consume twice the recommended intake of choline during their third trimester of pregnancy – a time of rapid brain development – deliver lasting neuro-protective benefits to their babies. Enhanced cognitive effects observed in the children (increased attention, memory and problem-solving skills) were still maintained at age 7.

Surprisingly though, since choline was first granted a DRI in 1998, the DRI for infants across all domestic food policy has not been based on even one actual clinical trial. It’s been based on the average level of choline in breast milk. That certainly appears to make the choline-intake recommendation entirely random and inadequate, especially for parents who follow vegan diets

DRIs have to be kept up-to-date, and ongoing, relevant research on any nutrition-health nexus must be incorporated into them.

In yet another example, the Guidelines also mention tooth cavities as a significant diet-related chronic disease.  And yet the Guidelines ignore the large body of evidence showing the role that chewing sugar-free gum can play in improving oral health by increasing saliva production and discouraging snacking.

In fact, the Guidelines almost entirely overlooked the importance of oral health to overall health, even though wider health benefits linked to a healthy oral biome include the prevention of heart disease, pre-eclampsia and eclampsia (a pregnancy complication characterized by high blood pressure), periodontitis (a serious gum infection that can destroy gums and even jawbones) and diabetes.

Chewing sugar-free gum has been associated with faster post cesarean recovery. Researchers have even suggested a link between oral health and Covid: coronavirus may spread into the bloodstream through infected gums, causing a more severe disease in people with poor oral hygiene.

To restate the obvious, if the government is going to publish Dietary Guidelines for Americans every five years, agencies need to follow the science. Rather than regurgitating and reprinting old information, and expecting us to follow it on faith, these highly influential Guidelines need to be based on current scientific knowledge. Our health and the health of our children are too important for anything less.

Whether it’s nutrition, Covid or climate change, the last thing we need is more sloppy politicized science, and more policies, laws and regulations dictated by “woke” or “cancel culture” agendas that put our well-being way down on the list of government priorities.

<i>Via email from Paul Driessen</i>

‘Potentially dangerous’ levels of microplastics found in rice: researchers

<i>Note that word "potentially".  A near synonym would be "unproven".  And even the chief researcher says: "I don’t think people should be concerned".

Note that most plastics are inert so any toxic level would be high</i>


A world first study has found rice contains a ‘potentially dangerous’ contaminating item, with levels highest in instant rice.

One of Australia’s most popular staple foods has been found to harbour “potentially dangerous” microplastics, a world-first Australian study has found.

University of Queensland researchers at the Queensland Alliance for Environmental Health Sciences identified 3-4mg of plastic in an average 100g single serve of uncooked rice.

The study, published today in the Journal of Hazardous Materials, also found instant or pre-cooked rice contained four times more plastic – averaging 13mg per 100g serve.

Lead author Dr Jake O’Brien said they found washing rice before cooking reduced plastics contamination by 20 to 40 per cent.

Dr O’Brien said they used everyday rice bought from a local store for the research. An average grain of rice was 8mm long, with microplastics defined as a plastic material measuring 5mm or less.

The researchers tested for seven different plastic types ranging from the most common plastic, Polyethylene to plastics used in clothing and food production, laminates, technical engineering, polystyrene, acrylics and tube piping.

The innovative method developed and used by the UQ research team is based on the plastic quantification technique used in their previous studies on plastics in seafood species and sewage sludge.

Dr O’Brien said the presence of microplastics was relatively low, but there was still much to be learned about their effects on human health.

“I don’t think people should be concerned, I think people should be aware,” he said.

“Currently there are many unknowns about how harmful consuming microplastics is to human health, but we do know exposure can cause an element of risk.”

He said it was still very early days in research to develop methods to measure plastic contamination in foods, and it was “really challenging to determine our exposure and exposure sources of these chemicals.”

“We hope this study encourages further research on where plastic contamination of rice is occurring, so we can reduce contamination and increase community awareness of where plastic exposure happens on a daily basis,” he said.

“In future studies, we aim to incorporate a measure of the plastic size, along with the concentration, because potential health impacts from microplastics are likely size dependent.”

Dr Thava Palanisami, a senior research fellow at The University of Newcastle, has been researching microplastics for many years.

In 2019 he co-led a project that combined data from more than 50 studies on the ingestion of microplastics by people.

The project led to a report that suggested people were consuming about 2000 tiny pieces of plastic every week. This was on average 5g – the size of a credit card.

Dr Palanisami said the presence of that quantity of microplastics in rice was a concern.

“Generally the smaller the size, the more potentially dangerous it can be to health,” he said. “It can get into the blood stream and the organs.”

Dr O’Brien said the research, while still in its very early days, showed washing rice before use was the best way to reduce risk. He said future research would examine other staple foods, including grains.

https://www.couriermail.com.au/news/national/potentially-dangerous-levels-of-microplastics-found-in-rice-researchers/news-story/e1ce014648c52fcce65bcd226937e094

Another attack on your bacon and sausages

The usual story: Tiny hazard ratios taken seriously. This is particularly unimpressive when one notes the international data sources -- very different countries and cultures. The opportunity for confounding variables was obviously large.

Maybe some people in some poor countries ate a lot of sausages and we know that poor people have worse health. So it was poverty that produced the effect, not sausages

Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21

ABSTRACT

Background
Dietary guidelines recommend limiting red meat intake because it is a major source of medium- and long-chain SFAs and is presumed to increase the risk of cardiovascular disease (CVD). Evidence of an association between unprocessed red meat intake and CVD is inconsistent.

Objective
The study aimed to assess the association of unprocessed red meat, poultry, and processed meat intake with mortality and major CVD.

Methods
The Prospective Urban Rural Epidemiology (PURE) Study is a cohort of 134,297 individuals enrolled from 21 low-, middle-, and high-income countries. Food intake was recorded using country-specific validated FFQs. The primary outcomes were total mortality and major CVD. HRs were estimated using multivariable Cox frailty models with random intercepts.

Results
In the PURE study, during 9.5 y of follow-up, we recorded 7789 deaths and 6976 CVD events. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) was not significantly associated with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Similarly, no association was observed between poultry intake and health outcomes. Higher intake of processed meat (≥150 g/wk vs. 0 g/wk) was associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004).

Conclusions
In a large multinational prospective study, we did not find significant associations between unprocessed red meat and poultry intake and mortality or major CVD. Conversely, a higher intake of processed meat was associated with a higher risk of mortality and major CVD.

https://doi.org/10.1093/ajcn/nqaa448

Eating one rasher of bacon a day increases your chance of getting dementia by 44%, study into dangers of processed meats suggests

The heading above is misleading. The Hazard Ratios were all very low, indication a most tenous relationship between diet and dementia. The results allow for their being no real relationship at all

Eating processed meat such as sausages, bacon and burgers could dramatically increase the risk of getting dementia, new research shows.

The findings suggest that eating just one rasher of bacon a day could increase your chances of developing the disease by a staggering 44 per cent.

However meat-lovers need not despair, as scientists conducting the study also found that eating some unprocessed meat including beef, pork and veal can protect against dementia.

In the study, people who ate 50g a day of unprocessed meat were almost 20 per cent less likely to develop the condition.

The research, by Leeds University, explored a potential link between eating meat and developing dementia using data from 500,000 people.

Professor Janet Cade, who supervised the research, said: 'Anything we can do to explore potential risk factors for dementia may help us to reduce rates of this debilitating condition.

'This analysis is a first step towards understanding whether what we eat could influence that risk.'

Researchers investigated links between eating different types of meat and dementia risk.

The team studied data from the UK Biobank database containing genetic and health information from half a million Brits aged 40 to 69 between 2006 and 2010.

This included how often people snacked on different kinds of meat, with six options from never to once or more daily.

Vegetarian and vegan diets were not looked at specially but the study did include people who avoided red meat.

Over an average of eight years, almost 2,900 dementia cases emerged.

This was seen in people who were generally older, more economically deprived, less educated, more likely to smoke, less physically active, more likely to have stroke history and family dementia history, and more likely to carry a dementia-related gene.

More men than women were diagnosed with dementia in the study.

Professor Cade said: 'Some people were three to six times more likely to develop dementia due to well established genetic factors, but the findings suggest the risks from eating processed meat were the same whether or not a person was genetically predisposed to developing the disease.

'Those who consumed higher amounts of processed meat were more likely to be male, less educated, smokers, overweight or obese, had lower intakes of vegetables and fruits, and had higher intakes of energy, protein, and fat including saturated fat.'

Meat consumption has previously been associated with dementia risk, but this is believed to be the first large-scale study of participants over time to examine a link between specific meat types and amounts, and the risk of developing the disease.

Lead researcher Huifeng Zhang, a PhD student at the University of Leeds, said: 'Worldwide, the prevalence of dementia is increasing and diet as a modifiable factor could play a role.

'Our research adds to the growing body of evidence linking processed meat consumption to increased risk of a range of non-transmissible diseases.'

There are around 50 million dementia cases globally, with around ten million new cases diagnosed every year.

Alzheimer's Disease makes up 50 per cent to 70 per cent of cases, and vascular dementia around 25 per cent.

Its development and progression are associated with both genetic and environmental factors, including diet and lifestyle.

Ms Zhang added: 'Further confirmation is needed, but the direction of effect is linked to current healthy eating guidelines suggesting lower intakes of unprocessed red meat could be beneficial for health.'

The findings were published in the American Journal of Clinical Nutrition Monday.

https://www.dailymail.co.uk/news/article-9387307/Eating-one-rasher-bacon-day-increases-chance-getting-dementia-44-study-suggests.html

The abstract

Meat consumption and risk of incident dementia: cohort study of 493,888 UK Biobank participants

Huifeng Zhang

ABSTRACT

Background
Worldwide, the prevalence of dementia is increasing and diet as a modifiable factor could play a role. Meat consumption has been cross-sectionally associated with dementia risk, but specific amounts and types related to risk of incident dementia remain poorly understood.

Objective
We aimed to investigate associations between meat consumption and risk of incident dementia in the UK Biobank cohort.

Methods
Meat consumption was estimated using a short dietary questionnaire at recruitment and repeated 24-h dietary assessments. Incident all-cause dementia comprising Alzheimer disease (AD) and vascular dementia (VD) was identified by electronic linkages to hospital and mortality records. HRs for each meat type in relation to each dementia outcome were estimated in Cox proportional hazard models. Interactions between meat consumption and the apolipoprotein E (APOE) ε4 allele were additionally explored.

Results
Among 493,888 participants included, 2896 incident cases of all-cause dementia, 1006 cases of AD, and 490 cases of VD were identified, with mean ± SD follow-up of 8 ± 1.1 y. Each additional 25 g/day intake of processed meat was associated with increased risks of incident all-cause dementia (HR: 1.44; 95% CI: 1.24, 1.67; P-trend < 0.001) and AD (HR: 1.52; 95% CI: 1.18, 1.96; P-trend = 0.001). In contrast, a 50-g/d increment in unprocessed red meat intake was associated with reduced risks of all-cause dementia (HR: 0.81; 95% CI: 0.69, 0.95; P-trend = 0.011) and AD (HR: 0.70; 95% CI: 0.53, 0.92; P-trend = 0.009). The linear trend was not significant for unprocessed poultry and total meat. Regarding incident VD, there were no statistically significant linear trends identified, although for processed meat, higher consumption categories were associated with increased risks. The APOE ε4 allele increased dementia risk by 3 to 6 times but did not modify the associations with diet significantly.

Conclusion
These findings highlight processed-meat consumption as a potential risk factor for incident dementia, independent of the APOE ε4 allele.

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Vitamin D not helpful with COVID

There are a number of drug and supplement treatments that are said to help with COVID.  Vitamin D can now be crossed off the list

Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19, A Randomized Clinical Trial

Igor H. Murai et al.

Question  What is the effect of a single high dose of vitamin D3 on hospital length of stay among hospitalized patients with moderate to severe coronavirus disease 2019 (COVID-19)?

Findings  In this randomized clinical trial that involved 240 hospitalized patients with moderate to severe COVID-19, a single dose of 200 000 IU of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay (median of 7.0 vs 7.0 days; unadjusted hazard ratio for hospital discharge, 1.07).

Meaning  The study does not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19 in hospitalized patients.

Abstract

Importance  The efficacy of vitamin D3 supplementation in coronavirus disease 2019 (COVID-19) remains unclear.

Objective  To investigate the effect of a single high dose of vitamin D3 on hospital length of stay in patients with COVID-19.

Design, Setting, and Participants  This was a multicenter, double-blind, randomized, placebo-controlled trial conducted in 2 sites in Sao Paulo, Brazil. The study included 240 hospitalized patients with COVID-19 who were moderately to severely ill at the time of enrollment from June 2, 2020, to August 27, 2020. The final follow-up was on October 7, 2020.

Interventions  Patients were randomly assigned to receive a single oral dose of 200 000 IU of vitamin D3 (n = 120) or placebo (n = 120).

Main Outcomes and Measures  The primary outcome was length of stay, defined as the time from the date of randomization to hospital discharge. Prespecified secondary outcomes included mortality during hospitalization; the number of patients admitted to the intensive care unit; the number of patients who required mechanical ventilation and the duration of mechanical ventilation; and serum levels of 25-hydroxyvitamin D, total calcium, creatinine, and C-reactive protein.

Results  Of 240 randomized patients, 237 were included in the primary analysis (mean [SD] age, 56.2 [14.4] years; 104 [43.9%] women; mean [SD] baseline 25-hydroxyvitamin D level, 20.9 [9.2] ng/mL). Median (interquartile range) length of stay was not significantly different between the vitamin D3 (7.0 [4.0-10.0] days) and placebo groups (7.0 [5.0-13.0] days) (log-rank P = .59; unadjusted hazard ratio for hospital discharge, 1.07 [95% CI, 0.82-1.39]; P = .62). The difference between the vitamin D3 group and the placebo group was not significant for in-hospital mortality (7.6% vs 5.1%; difference, 2.5% [95% CI, –4.1% to 9.2%]; P = .43), admission to the intensive care unit (16.0% vs 21.2%; difference, –5.2% [95% CI, –15.1% to 4.7%]; P = .30), or need for mechanical ventilation (7.6% vs 14.4%; difference, –6.8% [95% CI, –15.1% to 1.2%]; P = .09). Mean serum levels of 25-hydroxyvitamin D significantly increased after a single dose of vitamin D3 vs placebo (44.4 ng/mL vs 19.8 ng/mL; difference, 24.1 ng/mL [95% CI, 19.5-28.7]; P < .001). There were no adverse events, but an episode of vomiting was associated with the intervention.

Conclusions and Relevance  Among hospitalized patients with COVID-19, a single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19.

https://jamanetwork.com/journals/jama/fullarticle/2776738

Eat as much fish or as little fish as you like. No amount will protect you from heart disease

The journal article:

Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries

Deepa Mohan et al.

Question  Is there a difference in the association of fish consumption with risk of cardiovascular disease (CVD) or of mortality between individuals with and individuals without vascular disease?

Findings  In this analysis of 4 international cohort studies of 191 558 people from 58 countries on 6 continents, a lower risk of major CVD and total mortality was associated with higher fish intake of at least 175 g (2 servings) weekly among high-risk individuals or patients with vascular disease, but NOT in general populations without vascular disease; a similar pattern of results was observed for sudden cardiac death. Oily fish but not other types of fish were associated with greater benefits.

Meaning  Study findings suggest that fish intake of at least 175 g (2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD, but not in the general population.

Abstract

Importance:  Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids, and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown.

Objective:  To examine whether the associations of fish consumption with risk of CVD or of mortality differ between individuals with and individuals without vascular disease.

Design, Setting, and Participants:  This pooled analysis of individual participant data involved 191 558 individuals from 4 cohort studies—147 645 individuals (139 827 without CVD and 7818 with CVD) from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study and 43 413 patients with vascular disease in 3 prospective studies from 40 countries. Adjusted hazard ratios (HRs) were calculated by multilevel Cox regression separately within each study and then pooled using random-effects meta-analysis. This analysis was conducted from January to June 2020.

Exposures:  Fish consumption was recorded using validated food frequency questionnaires. In 1 of the cohorts with vascular disease, a separate qualitative food frequency questionnaire was used to assess intake of individual types of fish.

Main Outcomes and Measures:  Mortality and major CVD events (including myocardial infarction, stroke, congestive heart failure, or sudden death).

Results:  Overall, 191 558 participants with a mean (SD) age of 54.1 (8.0) years (91 666 [47.9%] male) were included in the present analysis. During 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major CVD (HR, 0.95; 95% CI, 0.86-1.04) or total mortality (HR, 0.96; 0.88-1.05). By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD (HR, 0.84; 95% CI, 0.73-0.96) and total mortality (HR, 0.82; 95% CI, 0.74-0.91) was lowest with intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. Fish with higher amounts of ω-3 fatty acids were strongly associated with a lower risk of CVD (HR, 0.94; 95% CI, 0.92-0.97 per 5-g increment of intake), whereas other fish were neutral (collected in 1 cohort of patients with vascular disease). The association between fish intake and each outcome varied by CVD status, with a lower risk found among patients with vascular disease but not in general populations (for major CVD, I2 = 82.6 [P = .02]; for death, I2 = 90.8 [P = .001]).

Conclusions and Relevance:  Findings of this pooled analysis of 4 cohort studies indicated that a minimal fish intake of 175 g (approximately 2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777338?guestAccessKey=51b4948a-350e-4e3b-838d-c8f5c2458e01&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=030821

An apple a day really DOES keep the doctor away! Chemicals in the fruit can boost brain function and reduce your risk of Alzheimer's disease, scientists say

<i>In mice</i>

Natural compounds found in apples can reduce the risk of developing Alzheimer's and other forms of dementia, scientists say.

High concentrations of compounds in apples and other plants, known as phytonutrients, stimulate the creation of neurons, in a process called neurogenesis.

Neurons are highly excitable cell that transmits information to parts of the body via electrical signals – and they boost our learning and memory abilities.  

Two compounds – quercetin in apple peel and dihydroxybezoic acid (DHBA) in apple flesh – generated neurons in the brains of mice in lab tests.

Interestingly, apple juice was not found to significantly contribute to neurogenesis, suggesting the benefits apply to eating the whole apple and not just a glass of juice.

The research was led by experts from the German Centre for Neurodegenerative Diseases (DZNE) in Bonn, Germany.  

'An apple a day keeps the doctor away – there may be some truth to this aphorism,' they say in their paper, published in Stem Cell Reports.

'In this study we demonstrate that apples contain pro-neurogenic compounds in both their peel and their flesh.'

The study showed that lab-grown stem cells from adult mouse brains generated more neurons and were protected from cell death when quercetin or DHBA were added to the cultures.  

Subsequent tests in mice showed that in distinct structures of the adult brain associated with learning and memory, stem cells multiplied and generated more neurons when the mice were given high doses of quercetin or DHBA.

The effects on neurogenesis were comparable to effects seen after physical exercise, which is a known stimulus for neurogenesis.

This suggested natural compounds in fruits, not just quercetin and DHBA but potentially others, may act in synergy to promote neurogenesis and brain function when given in high concentrations.

Given the wide consumption of apple juice, researchers also examined whether consumption of whole apple juice concentrate affected neurogenesis in the lab mice.

To eliminate any possible effect of the increased caloric intake of fruit sugar, a group of mice received a portion of sugar water with equal calories, as well as a control group that received normal drinking water.

Three weeks after being given apple juice, mice were trained to locate a submerged escape platform in a circular pool, known as the Morris water maze task.

This was designed to detect the contribution of adult-generated neurons to the overall performance in spatial navigation and cognitive flexibility.

However, apple juice supplementation was found to have no effect on adult neurogenesis or learning.   

'Given that the quercetin concentration in apple juice is very low (below 2 mg/litre) ... we conclude that this is likely an insufficient concentration of active phytochemical to modulate neurogenesis,' the team say.  

Researchers did point out that a 2010 study showed the consumption of apple juice improved behavioural symptoms in human patients with Alzheimer's.

Flavonoids, the abundant phytonutrients found in fruits and vegetables, can modulate molecular signalling pathways that influence cognitive abilities.

Dietary flavonoids are naturally occurring in fruit, vegetables, chocolate, and beverages like red wine and tea.

Although it's known an apple a day keeps the doctor away, two daily apples might be better to reduce the risk of suffering a heart attack or stroke, experts found in 2019.

When 40 people with slightly high cholesterol ate two large apples a day for eight weeks, it lowered their levels of 'bad' cholesterol by almost four per cent.

Two apples a day could help to reduce their risk of a stroke or heart attack, which can be caused by cholesterol hardening the arteries.

'It seems the old adage of an apple day was nearly right,' said study author Professor Julie Lovegrove, from the Hugh Sinclair Unit of Human Nutrition at the University of Reading, at the time.

'We believe the fibre and polyphenols in apples are important, and apples are a popular fruit among all ages, which are easy to eat and make great snack foods.'  

https://www.dailymail.co.uk/sciencetech/article-9254493/An-apple-day-reduce-Alzheimers-risk-scientists-say.html

Street lamps can increase your risk of CANCER: People who live near artificial neon lights are up to 55% more likely to be diagnosed with thyroid cancer

The journal article:  https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.33392

Good that the authors made no causal inferences. It is for starters a study of retired people so should not be generalized to other age cohorts.  There was also no way they could control for income so we may be looking at a poverty effect only

The study also used extreme quintiles, which suggests that there was no overall effect in the data

One also wonders why thyroid cancer was singled out.  Was it the only one showing any effect?  Very bad methodology if so

Living in an area with high levels of outdoor artificial light can increase the chance of developing thyroid cancer - with neon lights increasing the risk by 55 per cent, study shows.

Researchers from the University of Texas Health Science Center looked for a link between people developing thyroid cancer and levels of artificial outdoor light.

They looked at data from a cohort of 464,371 participants followed for about 13 years as part of the NIH-AARP diet and health study - then analysed satellite imagery to estimate levels of light in the areas where the people involved in the study lived.   

They found that those in areas with the highest level of night light pollution had a 55 per cent higher risk of developing thyroid cancer than those in low-light areas. 

They believe that one reason for the link is that light at night suppresses melatonin, a modulator of oestrogen activity - which may have an anti-tumour effect.  

Light pollution, also known as photopollution, is the presence of anthropogenic light in the night environment. 

Artificial light that’s excessive, obtrusive and ultimately wasteful is called light pollution, and it directly influences how bright our night skies appear. 

With more than nine million streetlamps and 27 million offices, factories, warehouses and homes in the UK, the quantity of light we cast into the sky is vast. 

While some light escapes into space, the rest is scattered by molecules in the atmosphere making it difficult to see the stars against the night sky. What you see instead is ‘Skyglow’. 

Over the past century, night scapes - particularly in cities - have changed dramatically due to the rapid growth of electric light, study authors said.

Studies have also reported an association between higher satellite-measured levels of nighttime light and elevated breast cancer risk.  

As some breast cancers could share a common link to thyroid cancer, lead author Qian Xiao and colleagues decided to hunt for an association between night light and later development of thyroid cancer.

They used the NIH-AARP Diet and Health Study - featuring data on hundreds of thousands of people aged 50 to 71 - recorded in 1995 and 1996.

Xiao then looked at satellite imagery of each of their homes to determine whether those living in high-light areas were more likely to develop thyroid cancer.

The team then examined state cancer registry databases to identify thyroid cancer diagnoses through 2011 and found 856 cases among the 464,371 volunteers.

'When compared with the lowest quintile of light at night, the highest quintile was associated with a 55 percent higher risk of developing thyroid cancer,' said Xiao.

'The association was primarily driven by the most common form of thyroid cancer, called papillary thyroid cancer, and it was stronger in women than in men,' he found.

In women, the association was stronger for localised cancer with no sign of spread to other parts of the body, while in men the association was stronger for more advanced stages of cancer, the team discovered. 

The association appeared to be similar for different tumour sizes and across participants with different demographic characteristics and body mass index. 

The researchers noted that additional studies are needed to confirm their findings. 

If confirmed, it will be important to understand the mechanisms underlying the relationship between light at night and thyroid cancer, Xiao said. 

The scientists noted that light at night suppresses melatonin, a modulator of oestrogen activity that may have important anti-tumour effects. 

Also, light at night may lead to disruption of the body's internal clock (or circadian rhythms), which is a risk factor for various types of cancer.

'As an observational study, our study is not designed to establish causality,' said Xiao, adding 'we don't know if higher levels of outdoor light at night lead to an elevated risk for thyroid cancer.' 

'However, given the well-established evidence supporting a role of light exposure at night and circadian disruption, we hope our study will motivate researchers to further examine the relationship between light at night and cancer, ' said Dr. Xiao. 

'Recently, there have been efforts in some cities to reduce light pollution, and we believe future studies should evaluate if and to what degree such efforts impact human health.'

The findings have been published in the journal Cancer. 

https://www.dailymail.co.uk/sciencetech/article-9236267/Street-lamps-increase-risk-thyroid-cancer-55-study-shows.html

Ditch the white bread! Eating more than seven portions of refined grains a day can increase your risk of early DEATH by 27%

Journal reference:  https://www.bmj.com/content/372/bmj.m4948

This study is nonsense on stilts.  What they actually found was that people in countries where they ate little white bread had fewer heart attacks and related problems. So Chinese people live longer than Americans?  Problem:  They don't.  Americans live a couple of years longer.

So what is  going on?  All the effects were tiny and hence likely to be unstable.  Most of the hazard ratios were just above 1.00 whereas a figure of over 2.00 would normally be needed to support policy prescriptions.  So ignoring the study would be wisest

From a delicious piece of white toast to a bowl of pasta, many of us enjoy consuming refined grains.

But a new study has warned that eating too many of them can have serious consequences, including an increased risk of heart disease, stroke and even early death.

Refined carbohydrates, including croissants, white bread and pasta, have had the high fibre parts removed, meaning they get broken down faster and lead to rapid spikes in blood sugar levels when consumed.

Based on the findings, the researchers are urging people to consider replacing their favourite refined grains with wholegrain options, such as brown rice and barley.

The Wholegrains Council explained: 'White flour and white rice are refined grains, for instance, because both have had their bran and germ removed, leaving only the endosperm. 

'Refining a grain removes about a quarter of the protein in a grain, and half to two thirds or more of a score of nutrients, leaving the grain a mere shadow of its original self.'

In the study, researchers from Simon Fraser University looked at the effects of following a diet high in refined grains.

Their analysis included 137,130 participants from 21 countries, including those from low-, middle- and high-income areas.

Grains in the participants' diets were categorised into three groups – refined grains, whole grains and white rice.

Refined grains included goods made with white flour, including white bread, pasta, noodles, breakfast cereals, crackers and baked goods.

Meanwhile, whole grains included any foods made with wholegrain flours, or intact or cracked whole grains.

The analysis revealed that participants who consumed more than seven servings of refined grains per day were at a 27 per cent greater risk for early death.

This group was also found to be at a 33 per cent higher risk for heart disease, and a 47 per cent higher risk for stroke.

Professor Scott Lear, who led the study, said: 'This study re-affirms previous work indicating a healthy diet includes limiting overly processed and refined foods.'

https://www.dailymail.co.uk/sciencetech/article-9287387/Eating-seven-portions-refined-grains-day-increase-risk-early-DEATH-27.html

Step away from the omelette: Eating just half an egg a day increases your risk of DEATH by 7%

This finding is from a very carefully analysed study with good controls.  It even allowed for household income, which is unusual.

The analyses were however of quintiles, with most comparisons being with the lowest quintile.  Quintile analyses are always suspicious.  They suggest that there was no overall significance in the data. What would a simple correlation between egg consumption and lifespan show after partialling out confounders?  We are not told.  My guess that it would be so low as to be of no concern.  Complex statistics can conceal as much as they reveal


Boiled, fried, scrambled or in an omelette, whole eggs pose a threat to health and eating more of them increases your risk of death, a study claims.

Researchers found eating just half a whole egg — which includes the yolk and the white — increases the likelihood of dying by seven per cent.

Risk of death increases by a further seven per cent for every half an egg on top of this, so a person eating one egg a day has at 14 per cent greater chance of death than someone who avoids the food.

Chinese researchers who led the study believe high fat and cholesterol levels in eggs are to blame.

They warned that people should use only the whites or switch to healthier egg substitutes, which lower the risk of dying.

Substituting an equivalent amount of nuts or legumes for half a whole egg reduced death rates by up to a third. Poultry, dish or dairy products had a similar effect.

Researchers gave a questionnaire to more than half a million Americans  between 1995 and 1996 and followed them for 16 years.

Data from this study, published in PLOS ONE, shows 129,328 people who filled out the original form died.

Co-author Professor Yu Zhang, of Zhejiang University said: 'In this study, intakes of eggs and cholesterol were associated with higher all cause, cardiovascular disease and cancer mortality.'

Professor Zhang said: 'The increased mortality associated with egg consumption was largely influenced by cholesterol intake.'

The link between eggs and health has been debated for years. They have long been thought of as a healthy dietary addition.

They are included in many country's national dietary guidelines. But the food, specifically the yolk, is high in cholesterol - which is known to be harmful.

Researchers asked the participants about how much cholesterol they had as part of their diet on top of eggs and found an additional 300 milligrams of cholesterol a day were 19 per cent more likely to die over the next 16 years.

Deaths specifically from cancer and cardiovascular disease rose by 24 and 16 per cent, respectively.

There is no cholesterol in the white of a medium-large chicken egg, and around 186 mg in the yolk.

'Our findings suggest limiting cholesterol intake and replacing whole eggs with egg whites/substitutes or other alternative protein sources for facilitating cardiovascular health and long-term survival,' the authors say.  

The NHS says eggs are a good choice as part of a healthy, balanced diet. As well as being a source of protein, they also contain vitamins and minerals.

It says there is no recommended limit on how many eggs people should eat, but advises cooking them without adding salt or fat. Frying can increase their fat content by around 50 per cent.

'This research makes it possible to look at relationships between what people ate in the past and whether that could be related to disease or death in the future,' says Dr Ada Garcia, a senior lecturer in Public Health Nutrition at the University of Glasgow who was not involved in the research, saus.

'The authors took a very careful approach to analysed the data and consider many aspects that could distort the findings.

'The study concluded that retired people who ate more whole eggs seven per cent higher risk to develop cardiovascular disease. The highest consumption of eggs was about half a small egg in 2000 Kcal per day.'

However, she criticises the methodology and conclusions of the Chinese team, saying: 'Being overweight or obese, smoking or consuming too much alcohol and not being physically active are much more important factors to consider for prevention of chronic diseases and related death.

'The conclusions of this study are overblown. Blaming eggs alone for an increased risk of cardiovascular disease is a simplistic and reductionist approach to the concept of diet and disease prevention.'   

https://www.dailymail.co.uk/sciencetech/article-9241937/Eating-just-half-egg-day-increases-risk-DEATH-7.html

Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults

This is not a particuarly strong study methodologically but  I am putting it up as an all-too-rare study where the effect of poverty is examined  -- with the expected results

Sameed Ahmed M. Khatana et al.

Abstract

Importance:  After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear.

Objective:  To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults.

Design, Setting, and Participants:  Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010).

Exposures:  Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]).

Main Outcomes and Measures:  Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity.

Results:  Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, −0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, −0.4% [95% CI, −0.8% to −0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, −0.5% [95% CI, −0.9% to −0.1%]). After accounting for baseline prosperity and demographic and health care–related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year.

Conclusions and Relevance:  In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.

https://jamanetwork.com/journals/jama/fullarticle/2775712?guestAccessKey=e55b18ba-0cd5-475c-818b-832b75a0a4bc

Being fat can PROTECT you from certain diseases: People who eat foods high in saturated fats including bacon and cheese are less likely to develop acute pancreatitis

We're regularly told to minimise the amount of saturated fats we consume, but a new study suggests that eating foods rich in these fats could actually offer some protection against certain diseases.

Researchers have revealed that eating foods rich in saturated fats, including cakes, bacon and cheese, may reduce your risk of acute pancreatitis.

The US team analysed data from people in 11 countries on how different fats consumed by different nations – either unsaturated or saturated – are linked with the serious condition, where the pancreas becomes inflamed.  

Saturated fat is found in butter, lard, fatty meats and cheese – foods heavily consumed in western societies – while unsaturated fats are mostly found in oils from plants and fish and are prevalent in Asian and some South American diets.

The scientists found that high levels of unsaturated fat stored around the abdominal organs generates more of a certain type of molecule that triggers cell injury, inflammation and even organ failure.   

Official advice from the NHS is to swap saturated fats for unsaturated fats in our diet to reduce the risk of heart disease.

While this study does not challenge this advice, it does suggest obesity can sometimes protect patients during certain types of acute illnesses.

This 'obesity paradox' has already been controversially suggested in previous studies, but not without backlash from other experts.

Foods high in saturated fat include:

Fatty red meats like pork and beef
Butter and products made of butter, including pastries and pies
Cakes and biscuits
Cheese, cream and ice cream
Chocolate

Unsaturated fats are those found in:

Nuts and seeds
Fish such as salmon and mackerel
Vegetable oils, including olive oil
Peanut butter
Avocados

'Here, we find that a higher proportion of dietary unsaturated fat can worsen AP [acute pancreatitis] outcomes at a lower adiposity than seen in individuals with a higher proportion of saturated fats in their diet,' say the researchers in their paper, published today in Science Advances.

Draft guidelines from the World Health Organisation recommend people get fewer than 10 per cent of their daily calories (150kcal-250kcal) from saturated fat and instead try to replace them with unsaturated.

Previous reports have observed that obesity appears to protect patients with acute medical issues such as burns, trauma and cardiovascular surgery.  

'Obesity sometimes seems protective in disease,' say the study authors, who are from the Mayo Clinic in Arizona and the Washington University School of Medicine in Missouri.

'This obesity paradox is predominantly described in reports from the Western Hemisphere during acute illnesses.'

However, the impact of fat composition on disease severity has remained unclear.

To better understand 'the obesity paradox', researchers assessed how the type of fats populations consume influence body fat composition and correlate with acute pancreatitis severity.

The team used 20 clinical reports from 11 countries that associated pancreatitis severity with a cutoff body mass index (BMI) of 30 – the point at which someone is officially classified as obese.

They also used seven clinical reports with a cutoff BMI of 25, and dietary fat data from the Food and Agriculture Organisation.

The researchers found a moderate correlation between the percentage of patients with severe acute pancreatitis and their unsaturated fat intake.

But they also observed that a severe form of this disease occurred in individuals with lower BMIs in countries that consumed food with fewer saturated fatty acids.

According to the team, visceral fat (stored around the abdominal organs) with a high unsaturated fat content leads to the generation of more non-esterified fatty acids (NEFAs).

These NEFAs trigger cell injury, systemic inflammation, and organ failure even in individuals with comparatively low body mass indexes (BMIs).

In contrast, visceral fat with a higher saturated fat content interferes with the production of these fatty acids, resulting in milder pancreatitis.

Researchers then conducted further experiments with mice in the lab.  

To test how fat composition affects pancreatitis outcomes, researchers fed mice either a diet enriched with linoleic acid (an unsaturated fatty acid) or palmitic acid (a saturated fatty acid).

When the researchers induced pancreatitis in the mice, only 10 per cent of those on the linoleic acid diet survived after three days.

This compared with 90 per cent of those on the palmitic acid diet.

By comparing the mice’s fat pads and fatty acid serum levels, the researchers found that saturated fats do not interact favourably with the enzyme pancreatic triglyceride lipase.

This leads to lower production of damaging long-chain NEFAs.  

'Therefore, visceral triglyceride saturation reduces the ensuing lipotoxicity despite higher adiposity, thus explaining the obesity paradox,' the researchers say.

The authors note that other factors they did not study, such as sex, genetic background, and the presence of other diseases, may also contribute to severe acute pancreatitis rates in humans.

In 2019, a team of scientists challenged the World Health Organisation's recommendation for people to cut down on saturated fats.

In their article published in the British Medical Journal, they argued that avoiding saturated fats entirely instead of considering the more general health impact of foods may mean important nutrients are missed.

Eggs, dark chocolate, meat and cheese, for example, are high in saturated but also contain a lot of vital nutrients and vitamins.

Researchers criticised the World Health Organisation for recommending that people cut down on saturated fats instead of being more specific.

In their report they said: 'Scientific and policy missteps may have led to many unnecessary deaths globally, and lessons should be learned.'

https://www.dailymail.co.uk/sciencetech/article-9201767/Low-saturated-fat-diets-exacerbate-acute-pancreatitis-study-finds.html

Effect of Vitamin B12 Injection on the Vocal Performance of Professional Singers

Hagit Shoffel-Havakuk et al.

Abstract

Importance  One-third of singers and vocal professionals report experiencing a benefit from empirical vitamin B12 injections for improvement of mild singing-related symptoms (eg, reduced stamina, vocal fatigue, and effort). However, there is no objective evidence to support or refute these claims.

Objective  To assess the presence and magnitude of the effect of empirical vitamin B12 injection on the vocal performance of singers.

Design, Setting, and Participants  A randomized, double-blind, placebo-controlled, crossover trial was conducted from November 7, 2017, to November 30, 2018, at an academic voice center among 20 active adult singers without dysphonia but with mild vocal symptoms. Individuals with known or suspected vitamin B12 deficiency or active or recent vitamin B12 treatment were excluded. Analysis was on a per-protocol basis.

Interventions  Participants were randomized to receive an intramuscular (deltoid) injection of either vitamin B12 (1000 μg of cyanocobalmin) or placebo (0.9% sodium chloride). After a washout period of at least 4 weeks, participants were crossed over to receive the opposite injection. Both the investigators and participants were blinded to the order of injections.

Main Outcomes and Measures  The participants completed the Singing Voice Handicap Index–10 (SVHI-10), the Voice Fatigue Index (VFI), and the Evaluation of the Ability to Sing Easily (EASE) before each injection and at intervals of 1 hour, 3 hours, 24 hours, 72 hours, and 1 week after the injection. The primary time point assessment was 72 hours after injection, and the SVHI-10 score was the primary outcome measure.

Results  Twenty singers (10 men; median age, 22 years [range, 19-42 years]) were enrolled. The improvements after either placebo or vitamin B12 injections were comparable to each other. At 72 hours after the vitamin B12 injection, the median difference in the SVHI-10 score was 1 (95% CI, –1 to 2) compared with 3 (95% CI, 0-4) after placebo. The median difference between differences at 72 hours between placebo and vitamin B12 injections were 1.5 (95% CI, –2 to 5) for the SVHI-10, 1 (95% CI, –9 to 9) for the VFI, and –1 (95% CI, –3 to 2) for the EASE. The improvements after both injections failed to reach the estimated minimal clinically important difference. Of the 20 participants, 4 (20%) reached the estimated minimal clinically important difference in their SVHI-10 score after 72 hours for both vitamin B12 and placebo injections.

Conclusions and Relevance  This randomized, double-blind, placebo-controlled, crossover trial found that after empirical vitamin B12 injection to improve mild voice-related symptoms, the improvement in self-reported voice measures in singers shows no meaningful difference compared with placebo.

https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2772879?guestAccessKey=d2ef0d86-d8cc-4ffd-8200-e47ccd17a04a&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamaotolaryngology&utm_term=mostread&utm_content=olf-widget_01212021