How Much Fish Oil Is Good?

Look at table 5 in this study:

Fatty Acid Composition Of Plasma Phospholipids And Risk Of Prostate Cancer In A Case-Control Analysis Nested Within The European Prospective Investigation Into Cancer And Nutrition, American Journal of Clinical Nutrition, 2008

It shows that high blood levels of the omega-3 fatty acid EPA was associated with increased risk for high-grade prostate cancer. As well, it shows an increased risk for high-grade prostate cancer with high levels of the omega-3 alpha-linolenic acid (the type of omega-3 found in plant sources such as flax and walnuts). (Some saturated fats also show increased risk for localized and advanced prostate cancers but I was more interested in the omega-3s right now.)

Just this week a study reported an increased risk for aggressive prostate cancer from high blood levels of the omega-3 fatty acid DHA.

There does seem to be something going on with omega-3 fats and more aggressive forms of prostate cancer. It's hard to tell just from these studies if the relationship involves intake. These are epidemiological studies so cause and effect is not clear. When it comes to cancer, we don't have the benefit of human intervention trials (which is why we don't know for certain if smoking causes lung cancer).
________
Other Known Drawbacks To Omega-3 Fatty Acids

Omega-3 fatty acids can be immunosuppressive:

• Omega-3 intake results in fewer immune cells such as natural killer (NK) cells. NK cells recognize tumors and are important against cancers and viral infections.
  - Leukocyte Numbers And Function In Subjects Eating N-3 Enriched Foods: Selective Depression Of Natural Killer Cell Levels, Arthritis Research and Therapy, 2008
  
  
• Omega-3 intake reduces immune cell activity.
  "Fish oil caused a significant reduction (mean decline: 48%) in NK cell activity that was fully reversed by 4 wk after supplementation had ceased."
  - Dietary Supplementation With Eicosapentaenoic Acid, But Not With Other Long-Chain N-3 Or N-6 Polyunsaturated Fatty Acids, Decreases Natural Killer Cell Activity In Healthy Subjects Aged >55 Y, American Journal of Clinical Nutrition, 2001

Omega-3 fatty acids are associated with an increased risk for cardiac death:

• A significant increase in sudden cardiac death was associated with a group given fish oil capsules in this study.
  - Secondary Prevention Of CHD In UK Men: The Diet And Reinfarction Trial And Its Sequel, Proceedings of the Nutrition Society, 2007
  
  
• This cardiac death was also seen in men with angina in the DART-2 trial, primarily those taking fish oil supplements.
  - Lack Of Benefit Of Dietary Advice To Men With Angina: Results Of A Controlled Trial, European Journal of Clinical Nutrition, 2003
  
  
• DART-2 was included in a meta-analysis which stated:
  "UK guidelines encourage the general public to eat more oily fish, and higher amounts are advised after myocardial infarction. This advice should continue at present but the evidence should be reviewed regularly. It is probably not appropriate to recommend a high intake of omega 3 fats for people who have angina but have not had a myocardial infarction."
  - Risks And Benefits Of Omega 3 Fats For Mortality, Cardiovascular Disease, And Cancer: Systematic Review, British Medical Journal, 2006

________
How Much Fish Oil Is Good?

The Japanese in Okinawa in 1950, some of the longest lived people in the world, were consuming fish at about 1% of their total calories - half an ounce a day. That's about one 3-ounce serving of fish a week.

Mainland Japanese in the 1950s were consuming fish at about 4% of their total calories - 62 grams or 2 ounces a day. Recent data¹ show Japanese to be eating about the same as they did then, ~60 grams a day. Depending on the fish (e.g. catfish, tuna, mackerel), that's 100-200 mg omega-3 a day.

So, a gram of omega-3s a day is more than 5 times the amount the Japanese eat, and 20 times the amount older Okinawans ate. Given the evidence accruing for harm linked to higher intakes of omega-3, it seems prudent to limit consumption - both of fish and fish oil.
________¹ Dietary Patterns And Cardiovascular Disease Mortality In Japan: A Prospective Cohort Study, International Journal of Epidemiology, 2007

How To Plant Potatoes

"Place each potato in its hole with the end with the most eyes pointing upwards."

________

Omega-3 Fatty Acid DHA Found To Increase Risk For Prostate Cancer

Omega-3 fatty acids are polyunsaturated fatty acids thought to have an anti-inflammatory effect. They may, but this study doesn't support it:

Serum Phospholipid Fatty Acids And Prostate Cancer Risk: Results From The Prostate Cancer Prevention Trial, American Journal of Epidemiology, April, 2011

Men with the highest levels of one type of omega-3 (docosahexaenoic acid (DHA), found abundantly in fish oil) were two and a half times more likely to have an aggressive form of prostate cancer than men with the lowest levels:

"Docosahexaenoic acid was positively associated with high-grade disease (quartile 4 vs. 1: odds ratio (OR) = 2.50)."
...
"The study findings are contrary to those expected from the antiinflammatory effects of these fatty acids and suggest a greater complexity of effects of these nutrients with regard to prostate cancer risk."

The curious thing ... polyunsaturated fats, including omega-3s, are easily oxidized, owing to their greater number of reactive double bonds. Once fats become oxidized in the body they can become pro-inflammatory.

Update, April 29: From the press release¹ that accompanied the study:

Lead author Theodore Brasky, Ph.D, postdoctoral research fellow in the Hutchinson Center’s Cancer Prevention Program:

"We were stunned to see these results and we spent a lot of time making sure the analyses were correct. ... Our findings turn what we know — or rather what we think we know — about diet, inflammation and the development of prostate cancer on its head and shine a light on the complexity of studying the association between nutrition and the risk of various chronic diseases."

Another interesting bit:

"Among the study participants, very few took fish oil supplements – The majority got omega 3s from eating fish."

More discussion at: How Much Fish Oil Is Good? ________¹ A High Percentage Of Omega-3 Fatty Acids In The Blood Is Linked To An Increased Risk Of Aggressive Prostate Cancer, Fred Hutchinson Cancer Research Center, April 2011

Why Do The Japanese Have Less Heart Disease?

Dr. Davis at the Heart Scan Blog is discussing the lower rates of heart disease in Japan compared to the US:
Why Do The Japanese Have Less Heart Disease?, Heart Scan Blog

They do have less heart disease. Below is cardiovascular mortality from 1990 to 1998 in Japanese and US men.


Source: Coronary Heart Disease Risk In Japan – An East/West Divide?, European Heart Journal, 2004.

He offered some dietary reasons, including the Japanese higher intake of seaweed, seafood, green tea, soy foods and lower intake of animal products (except seafood), sweet foods, and "the lack of a 'eat more healthy whole grain' mentality."

I don't know with great certainty how the Japanese are eating that's different from us so I'll take his word. I did think they ate a lot of rice. I know the Okinawans eat, or ate, a low-fat diet that included a lot of sweet potatoes.

He cited this study:
Dietary Patterns And Cardiovascular Disease Mortality In Japan: A Prospective Cohort Study, International Journal of Epidemiology, 2007

Which analyzed dietary patterns from 40, 547 Japanese men and women. They identified 3 dominant eating patterns:

1. A "Japanese" pattern
2. An "animal food" pattern
3. A dairy/fruit/vegetable pattern.

Pattern 1. (Japanese) differed from pattern 3. (dairy/fruit/vegetable) in that it included higher intakes of sodium, fish, soybean, seaweed and green tea. The two groups were similar in fruit and vegetable intake.

The median intake for rice in the highest quartile of these patterns was:

1. 567 grams
2. 744 grams
3. 524 grams

I thought that was a lot of rice, regardless of group. It was even more at lower quartiles. So I looked at the caloric intake for each group in corresponding quartiles:

1. Japanese pattern: 6861 kj = 1639 calories
2. Animal food pattern: 7458 kj = 1781 calories
3. Dairy/fruit/veg pattern: 5466 kj = 1305 calories

These seem low, unless I'm miscalculating. Anyway, I tried to figure what portion of those calories rice contributed. I used NutritionData's entry for Rice, White, Steamed, Chinese Restaurant:

Portion of calories contributed by rice:

1. 567 grams of rice contributed 855 calories (567x199cal/132g = 855), 52% of calories
2. 744 grams of rice contributed 1122 calories (744x199/132 = 1122), 42% of calories
3. 524 grams of rice contributed 790 calories (524x199/132 = 790), 61% of calories

Of course, these are estimates. And I don't know more about the type of rice they ate. But it does seem like a lot of rice.

Here's their fat, protein, and carb intake (in parentheses is the percentage that nutrient contributed):

Median total fat intake, highest quartile (g):

1. 41 (41x9 = 369 kcal. 369/1639 = 23%)
2. 41 (41x9 = 369 kcal. 369/1781 = 21%)
3. 41 (41x9 = 369 kcal. 369/1305 = 28%)

Median protein intake, highest quartile (g):

1. 74 (74x4 = 296 kcal. 296/1639 = 18%)
2. 72 (72x4 = 288 kcal. 288/1781 = 16%)
3. 69 (69x4 = 276 kcal. 276/1305 = 21%)

Carb intake, highest quartile (by default):

1. (100% - 23 + 18 = 59%)
2. (100% - 21 + 16 = 63%)
3. (100% - 28 + 21 = 51%)

The study found the Japanese dietary pattern (1.) was associated with a decreased risk of cardiovascular disease (CVD) mortality, the "animal food" dietary pattern (2.) was associated with an increased risk of CVD mortality, but the dairy/fruit/vegetable pattern (3.) was not.

Groups 1. and 2. were similar in macronutrient makeup. Although, the sources of those nutrients were different. That boosts Dr. Davis' argument that seafood (seaweed and fish), soy, and green tea may have a beneficial effect (at least among Japanese).

I do see a difference in macronutrients between Japanese and Americans. Japanese eat less fat (although, not as low as they were eating in the 1950s when fat contributed a mere 8% of calories), more carbohydrate, and possibly fewer calories overall. American men get about 33% of their calories from fat and 47% of their calories from carbohydrate. (NHANES 1999-2000.)
________Photo of rice from Rice Wisdom.

Eating Out

35 photographs of outdoor eating - around the world:
Street Eats, Foreign Policy, April 25, 2011

All pressed up against his cheeks...

"Enjoying a watermelon at the bazaar in Dhahran, Saudi Arabia, 400 kilometers east of the capital, Riyadh, on May 16, 2008."



"A Palestinian man sells fresh-squeezed orange juice in the refugee camp of Beddawi in the ancient coastal city of Tripoli, north of Beirut, on Aug. 17, 2010."


"Nepalese vendors wait for customers at a vegetable market outside Kathmandu on Feb. 16."

The one above reminds me of our Italian Market down on 9th Street (in Philadelphia, shown below). It's thought to be the oldest outdoor market of its size in the US. Of course, not many structures here are as old as those in Asia, but these row houses, as we call them, in South Philly probably date back to colonial times.




________Photos of the Italian Market from Project for Public Places,

Blaming Soda ... Or Pop Or ...

Does Soda Cause Obesity? If it doesn't, why would we tax it? Or ban the use of food stamps for it?

Lack Of Findings For The Association Between Obesity Risk And Usual Sugar-Sweetened Beverage Consumption In Adults – A Primary Analysis Of Databases Of CSFII-1989–1991, CSFII-1994–1998, NHANES III, And Combined NHANES 1999–2002, Food And Chemical Toxicology, 2007

"Conclusion: multiple lifestyle factors and higher dietary fat intake were significantly associated with obesity risk. Populations who frequently consumed sugar-sweetened beverages (SSB), primarily HFCS* sweetened beverages, did not have a higher obesity rate or increased obesity risk than that of populations which consumed SSB infrequently."
* High-fructose corn syrup

If we're going to tax a food to combat the obesity epidemic - the stated reason for taxing soda - why don't we tax a food that is associated with obesity? The study above found dietary fat is a likely culprit.

I don't mean to play study ping pong here. I'm not for taxing any food. I just think there are other, likely political, reasons for singling out soda.

Reducing access to food, whether through taxes or other disincentives, affects lower income people disproportionately. Because everyone needs food. This is the definition of a regressive tax. I think the sales tax is another example of a regressive tax. (But I'm not an economist so don't pummel me.) The sales tax may appear on the surface to be equitable ... the same 6% for everyone (in PA at least). But in reality it uses up a greater portion of a low-income person's buying-basket than a high-income person's basket.

I'm not defending multi-billion-dollar food corporations' buck-making off of cheap, high-profit, often subsidized food. Indeed, as Ronald said, why don't we tax them instead? Use the money to offset tax breaks for businesses that provide affordable, fresher, healthier food in underserved communities?

Soda may not be the healthiest thing we ingest, but there's no reason the poor should be burdened more by these proposals.


Click to enlarge.
________

Calcium Supplements Found (Again) To Increase Risk For Heart Attack, Stroke

The leading cause of death for women in America is heart disease.¹ It now looks like some of those heart attacks (and strokes) may have been provoked by the calcium supplements women were taking to protect their bones. (Heart disease is the leading cause of death in men too, but I don't think men are pressured as much as women to take calcium. Men may also be refraining because of the spectacular association between calcium and prostate cancer.)

A revisit of data in the huge Women’s Health Initiative (WHI) study found that women who took calcium supplements increased their risk for heart attack and stroke:

Calcium Supplements With Or Without Vitamin D And Risk Of Cardiovascular Events: Reanalysis Of The Women’s Health Initiative Limited Access Dataset And Meta-Analysis, British Medical Journal, April 2011

The original WHI analysis showed no such risk. But that was because thousands of women who were already taking calcium before the study weren't told to stop. If those calcium-takers ended up in the placebo group (which was supposed to receive no calcium), you might expect them to show similar heart attack risk as intervention groups (which did receive calcium). That's exactly what they found.

This new analysis looked at women who weren't taking calcium before the study. If those women were randomized to a group that received calcium, it did indeed increase their risk for heart attack and stroke.


The Amount Of Calcium Didn't Matter

Here's Dr. Ian Reid, senior author of the new analysis:

"It is actually taking a supplement that matters, not how much of it you take, that causes this increase in heart risk."

And from a HeartWire interview:

"That makes sense, [Reid] says, since even small levels of supplemental calcium create "abrupt" increases in blood calcium levels within hours. This speaks to one criticism levied at the group's earlier work—namely, that the cardiovascular events seemed to be occurring too swiftly to be related to calcified plaques.
...
MI spikes likely reflect a more acute response to blood calcium levels, including changes in platelet function, blood coaguability, or endothelial cell activity."
- Calcium Supplements And Cardiovascular Events: New Data, More Debate, HeartWire, April 19, 2011

I would like to add to those mechanisms something readers of this blog already know - calcium lowers vitamin D levels, and vitamin D is thought to be cardio-protective:

"If serum levels of calcium are high, production of 1, 25 D is suppressed by reduced parathyroid hormone production."
- Dairy Products, Calcium, and Vitamin D and Risk of Prostate Cancer, Epidemiologic Reviews, 2001

The present analysis found no benefit in taking vitamin D.

Dr. Reid:

"Our own recommendation is to critically review the use of calcium supplements, since the data in this paper suggests that they do more harm than good."
Women Taking Calcium Supplements May Risk Heart Health, Researchers Say, HealthDay, April 19, 2011

________ ¹ CDC: Leading Causes of Death in Females, United States, 2006
That's a photo of the pills I used to take, be still my heart.  Wait.

Two Tomatoes, One Radish, Half A Carrot

________My 2:00 p.m. snack

Trends In Prescription Drugs

From:
13 Huge Trends In America's Prescription Drug Habit, Business Insider, April 21, 2011

We're spending more on drugs (although growth is trending down):



The government is paying a larger share of this spending over time - private payers' (insurance companies or our wallets) share is declining while public payers' (Medicare and Medicaid) share is increasing:



If we want to phase out public healthcare spending (e.g. Wisconsin Rep. Paul Ryan's budget plan, "The Path to Prosperity") we're moving in the wrong direction.
________
Here are the drugs we're buying. These are name brands. They aren't entirely representative of our habits since 78% of the drugs we buy are now generics (which is contributing to the downward growth in the first graph).

Top 15 drugs in America (highest grossing, by prescription):

1. Lipitor (statin, lowers cholesterol)
   
2. Nexium (heartburn)
   
3. Plavix (prevents blood clots)
   
4. Advair Diskus (asthma)
   
5. Abilify (antipsychotic)
   
6. Seroquel (antipsychotic)
   
7. Singulair (asthma)
   
8. Crestor (statin, lowers cholesterol)
   
9. Actos (diabetes)
   
10. Epogen (anemia from kidney disease)
    
11. Remicade (Crohn's, rheumatoid arthritis)
    
12. Embrel (arthritis)
    
13. Cymbalta (antipsychotic)
    
14. Avastin (cancer)
    
15. Oxycontin (pain)

Here's the IMS Institute report, "The Use Of Medicines In The United States: Review of 2010" (pdf). I saw the article before the report. I think the report gives a better feel for how and why growth is slowing. In fact, here are two charts in the report (but not the article) I found interesting:



IMS says:

"This may reflect the enduring effects of the macroeconomy, high unemployment levels and rising healthcare costs; it may also include more patients losing coverage and others managing spending carefully."

Have you put off a visit to a healthcare provider because of cost?

And...


More prescriptions were written for antidepressants than for any other drug in 2006, 2007, and 2008. In 2009 and 2010 lipid drugs squeezed past them, but barely. We need to give mental health a bigger spotlight.
________

Photographer Isa Leshko's Elderly Animals

Isa Leshko: Elderly Animals (10 photos)

"As I’ve worked on this project, though, I’ve come to realize that these images are a testament to survival and endurance. And they raise questions about what it means to be elderly."
- Isa Leshko

Marino, Bronze Turkey, Age 5

There's something about this Irish Wolfhound I indentify with. "Of great size and commanding appearance" I am not. Maybe it's the curiosity.


Kelly, Irish Wolfhound, Age 11
________Thanks to BL.

Banning Use Of Food Stamps For Soft Drinks

What do you think? Should sugary drinks be placed on SNAP's ineligible list? I'm against it. At least, I haven't been convinced.

This is not the same as banning soft drink vending machines in schools. These are adults - working adults, disabled adults, seniors - people who have paid and are paying thousands of dollars in taxes to protect themselves in times of need. Unemployment Benefits and Social Security Benefits fall into this category.

I wouldn't like my boss telling me what foods I could purchase with my paycheck. How does he know what's best for me? If you're going to ban soda for health reasons, why not ban chips, candy, cookies, and cake? Or meat and cheese ("saturated fat" as the USDA calls them)? Or grains? Or bread products? Or soy products? Or dairy? Each of these foods has a group that advocates against their consumption. And then, as you ban specific foods, how do you manage programs like Meals-On-Wheels or Adult Day Care which allow food stamps?

If you're going to restrict at all, why not ask the recipients of the program what they prefer? They're the ones who have to live with it. "We have $x to allot. Which items would you like to have that cover, and which will you forfeit?"

That's if you're running the SNAP program solely as a nutrition program. I can't help but see government-sponsored food programs as a type of subsidy, in part. They are as much about using tax dollars to boost particular agricultural sectors as they are about attending to citizens' nutritional needs.

"Antibiotic Resistance Is One Of The Greatest Threats To Public Health We Face Today"

Those are the words of Dr. Lance Price, lead researcher in a study that found 96% of the meats they tested (136 samples, 80 brands, 26 stores) that were infected with Staphylococcus aureus bacteria (almost half were infected) had a strain resistant to at least one antibiotic; 52% had a strain resistant to 3 or more.

Nationwide Study Finds US Meat And Poultry Is Widely Contaminated: Multi-Drug-Resistant Staph Found In Nearly 1 In 4 Samples, Review Shows, Study (TGen) Press Release, April 15, 2011

Two bits stood out for me in this Reuters article:
Some Bacteria In Grocery Meat Resistant To Antibiotics: Study

1. These quotations from Price:

"When you bring in that raw product, you almost inevitably contaminate your kitchen with these bacteria."

"The bacteria is always going to be there, but the reason why they're resistant is directly related to antibiotic use in food animal production. ... To put it all on the consumer is really directing blame at the wrong end of the food chain."

So, he's saying that cross contamination will likely occur. And if a consumer develops an antibiotic resistant infection from that contamination, it isn't their fault? Strong words. Finally.

2. The photo Reuters used to accompany the story:


"Customers Shop For Meat At Wal-Mart In Rogers, Arkansas, June 4, 2009."
Credit: Reuters/Jessica Rinaldi

What a story in a picture. This is such a vulnerable population.
________

Gary Taubes: "Is Sugar Toxic?"

Gary Taubes, author of "What If It's All Been A Big Fat Lie?" and Good Calories, Bad Calories has a new article in the New York Times' Magazine today: "Is Sugar Toxic?" (Thanks, shaun.)

I just started reading it. I'll report back.

The New York Times' Well blog is accruing comments:
Talk To Gary Taubes About Sugar

Background

Taubes is a low-carb advocate. In his book, Good Calories, Bad Calories, he said:

"Carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be."

"Refined carbohydrates, starches, and sugars are the dietary cause of coronary heart disease and diabetes."

"Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behavior."

"Consuming excess calories does not cause [Taubes' emphasis] us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger."

(I don't necessarily agree with him, I'm just offering a backdrop.)________
Update, April 14 - Some thoughts:

Nothing in this article convinced me that sugar (or a component of it - fructose) is inherently toxic. However, since it is the dose that makes the poison, I think sugar is likely toxic at high doses. This is true about many nutrients: vitamin A, vitamin D, folic acid (as seen here), water. They are all toxic at high doses.

It is easier to ingest toxic amounts of these substances when they are provided in a processed - and so more concentrated - form. You would have to eat about 3 apples or 4 bananas or 10 cups of chopped carrots in one sitting to get the 29g of fructose in one medium (21 ounce) cola beverage. (From: High-Fructose Corn Syrup VS. Table Sugar)

I agree with a premise of the article, that the accumulation of fat in liver (but I'll add - also in muscle and other tissue) plays a role in insulin resistance, and that insulin resistance plays a role in diabetes and other diseases. However, there are a number of factors that lead to this kind of fat deposition.

• You could, for example, have a disturbance in beta-oxidation in the mitochondria. Say your carnitine gate was blocked or maybe you didn't have a lot of gates, or you had a diminished number of mitochondria. This could lead to accumulation of fat within the cell, and a subsequent decrease in insulin sensitivity. This is a contributing factor in insulin resistance.
  
• You could also, for example, feed a high-fat diet. This has been shown to increase fat deposition within the cell leading to a decrease in insulin sensitivity.¹
  
• You could, for example, have to oxidize excess ethanol. The metabolism of ethanol from alcoholic beverages leads to an excess of NADH which promotes the synthesis of fatty acids, the deposition of fat, and increased insulin resistance.
  
• Speaking of alcohol, it, possibly by its affect on aromatase, along with other environmental endocrine disruptors have been shown to affect the production and activity of hormones (besides insulin) which also control lipogenesis.

I don't think sugar, or fructose, is a singular actor in insulin resistance. Although it may be a contributing factor. Even if you ate a lot of sugar, its level of toxicity would depend on how other parts of the equation are filled, as above. Everyone is unique.

It may be more illuminating to look at the diet as a whole, instead of an isolated component. I've seen a number of studies that implicate a "meat and potatoes" pattern (high fat plus high refined carbohydrates) in the development of metabolic disorders like diabetes. People don't eat just sugar. What other foods are they eating and how does this exacerbate metabolic problems? Taubes touched on this in his discussion of soldiers who died in the Korean War. Those who ate high-fat plus high-sugar diets (Americans) had more plaques in their arteries than those who ate low-fat (typically high-carb) plus low-sugar diets (Koreans).

Anyway, I don't see the harm in eating a peach, nor in putting 2 teaspoons of sugar (an equivalent amount of fructose) in a cup of tea. I don't think either of those meal items are toxic.
________¹ Prolonged Inhibition of Muscle Carnitine Palmitoyltransferase-1 Promotes Intramyocellular Lipid Accumulation and Insulin Resistance in Rats, Diabetes, 2001

High Folate Intake May Promote Colon Inflammation, Colon Cancer

I've come to understand that while getting too little of a nutrient causes problems, so does getting too much. This is true about folic acid. When it comes to the cells that line our colon, having too little folate predisposes those cells to developing tumors.¹ Drinking alcohol makes that situation worse. However, if cancerous tissue happens to be there, folate supplementation will accelerate its growth.¹

Here's a recent study that moves beyond epidemiology:

Altered Folate Availability Modifies The Molecular Environment Of The Human Colorectum: Implications For Colorectal Carcinogenesis, Cancer Prevention Research, April, 2011

Ten volunteers received supplemental folic acid (1 mg/d) for 8 weeks. A second group of 10 consumed a low-folate diet for 8 weeks (they were admitted to hospital as inpatients for this purpose).

Biopisies of the sigmoid colon and rectum revealed an increase in markers of inflammation in the supplemented group. The authors hypothesized:

"Excessive folate supplementation might promote colorectal carcinogenesis by enhancing proinflammatory and immune response pathways."

Participants were taking a milligram (mg) of folic acid. It's not hard to get a mg (equal to 1000 micrograms (mcg)) of folic acid in a day, not since the FDA in 1996 required all flour and uncooked cereal grains be fortified with folic acid (at 140 mcg/100 grams). The recommended allowance (or DRI: Dietary Reference Intake) for folic acid in this country is 400 mcg. A basic multivitamin usually contains that, but so does a bowl of fortified breakfast cereal. Add some pasta and a piece or two of bread, which are now fortified, and you're well over 800 mcg, the amount found to increase cancer risk in this study.² (And the amount in those Twinlab Folic Acid Caps pictured.)

Taking vitamins is not as innocent as supplement manufacturers lead us to believe.
________
¹ Role of Folate In Colon Cancer Development And Progression, The Journal of Nutrition, 2003
² Cancer Incidence And Mortality After Treatment With Folic Acid And Vitamin B12, JAMA, 2009

The Rich And The Rest

Nobel Prize winning economist Joseph Stiglitz wrote about America's increasing wealth gap in the latest issue of Vanity Fair:

Of The 1%, By The 1%, For The 1%, Vanity Fair, May Issue

He says that, currently, 1% of our population controls 40% of our country's wealth. It didn't used to be that way. Just 25 years ago, 12% of the population controlled 33% of our wealth. The gap between rich and poor has widened and the gap is self-propagating ... the top 1% is on the path to control the majority of America's wealth.

For the top 1% life has gotten very good. Their incomes have risen 18% in the last decade while those in the middle have seen not just smaller rises but falling incomes.

Some ways the 1% are different from us:

• The top 1 percent rarely serve in the military—the reality is that the “all-volunteer” army does not pay enough to attract their sons and daughters, and patriotism goes only so far.
  
• The wealthiest class feels no pinch from higher taxes when the nation goes to war: borrowed money will pay for all that.

As for America being the place where hard work leads to success, Stiglitz says, "the chances of a poor citizen, or even a middle-class citizen, making it to the top in America are smaller than in many countries of Europe."

Here's something that surprised me:

"Virtually all U.S. senators, and most of the representatives in the House, are members of the top 1 percent when they arrive, are kept in office by money from the top 1 percent, and know that if they serve the top 1 percent well they will be rewarded by the top 1 percent when they leave office."

That makes me think the wrangling about the budget today, with the possibility of a government shutdown, is being done by people who are out of touch with most Americans. Stiglitz says so much:

"The more divided a society becomes in terms of wealth, the more reluctant the wealthy become to spend money on common needs. The rich don’t need to rely on government for parks or education or medical care or personal security—they can buy all these things for themselves. In the process, they become more distant from ordinary people, losing whatever empathy they may once have had.

They also worry about strong government—one that could use its powers to adjust the balance, take some of their wealth, and invest it for the common good."

The common good. There was a time, Stiglitz says, when Americans cared about the common good, more out of a sense of pragmatism than idealism. At one time we appreciated that "paying attention to everyone else’s self-interest—in other words, the common welfare—is in fact a precondition for one’s own ultimate well-being."
________

Screening Food For Radiation

I saw this story and had some thoughts:

Screening the Day’s Catch for Radiation, New York Times, April 5, 2011*

1. Wouldn't it be nice if restaurants and food retailers also had a bacteria wand they could wave over food to detect levels of toxic microorganisms? People get sick and die from E. coli too. Not to downplay the radiation risk though, because...

2. They keep saying the radioactivity in food in not harmful. "Everything detected has been well below levels considered dangerous." This is not true. All radiation increases risk for cancer. Not to sound alarmist though because normal metabolism creates radicals that can damage DNA too. Radiation from ground (radon) and air (cosmic) also bombard our cells. What matters is how well a body repairs damage.

3. What would growers like Earthbound Farms in California do if they did find unacceptable levels of radioactivity in their fields, their soil? Abandon them? Truck acres of soil out and truck acres of uncontaminated soil in? I'm beginning to think that these tests are primarily to calm a jittery public so they will continue buying product.

4. Where is all the contaminated food going? Do they use it to make pet food? Do they burn it or throw it in a landfill? Feed it to farmed fish and livestock? Don't all these methods just move the contamination from one place to another? And we're back to what to do with all our nuclear waste. Really, we need to answer this question before we build more nuclear reactors.


* The New York Times now has a pay wall after 20 articles/month. I read that you can still read an article if you're entering their site from a link on a blog. I hope that's true!
________Photo from New York Times: "A chef at Le Bernardin in Manhattan checking fish for radiation on Tuesday."

Cultural Differences

________

The Glorification of Gluttony

An article criticizing the glorification of self-indulgence appeared in the Atlantic last month:

The Moral Crusade Against Foodies: Gluttony Dressed Up As Foodie-ism Is Still Gluttony, BR Myers for The Atlantic, March 2011

Myers characterized members of the foodie community as:

Self-involved - Myers quotes Francine Prose in her prize-winning Saveur article Faith and Bacon:

"Yet she finds it unrealistic to hope that humans could ever suppress their "baser appetites ... for the benefit of other humans, flora, and fauna." "

Vulgar - Myers quotes Dana Goodyear in her article in Best Food Writing 2010:

"[Goodyear] tells how a restaurant served head cheese (meat jelly made from an animal's head) to an unwitting Jew:"

"One woman, when [chef Jon] Shook finally had a chance to explain, spat it out on the table and said, “Oh my fucking God, I’ve been kosher for thirty-two years.” Shook giggled, recollecting. “Not any more you ain’t!” "

Intolerant - Says Myers, "One must never spoil a dinner party for mere religious or ethical reasons." Quoting Anthony Bordain:

"Taking your belief system on the road - or to other people’s houses - makes me angry."

Gluttonous - Myers quotes Todd Kliman in Best Food Writing:

"You eat and eat and eat ... long after you’re full. Being overstuffed, for the food lover, is not a moral problem."

Gluttony, as Myers notes, is not primarily an act of overeating, but an "inordinate preoccupation" with food - you can be thin and still be gluttonous. He ascribes that definition, as well, to the Catholic Church which had me wondering just how broad the Church defines it:

"... to eat or drink for the mere pleasure of the experience, and for that exclusively, is likewise to commit the sin of gluttony."
- Catholic Encyclopedia: Gluttony

But the Church doesn't limit the definition of gluttony to food. One may engage in spiritual gluttony, "the disposition of those who, in prayer and other acts of religion, are always in search of sensible sweetness." Pleasure for pleasure's sake, they say, "is a very great imperfection and productive of great evils."

From what I can tell, most people think Myers' criticisms are unfounded, or at least unfair.
________

Any Dose Of Radiation Increases Risk For Cancer

Radiation damages cells and DNA. The good news: DNA can be repaired by proteins encoded by DNA repair genes.^{1, 2}

Some people have a reduced capacity to repair DNA owing to inherited mutations in their DNA repair genes. Inherited tendencies to colon, breast, and ovarian cancers can involve reduced capacity to repair DNA. Apart from inherited mutations, DNA repair genes themselves can be damaged. DNA repair also naturally diminishes as we age.^{1, 2}

All ionizing radiation damages cells. There is no level of exposure below which changes to a cell do not occur.³ Some of this damage can be repaired. Some will result in cancer:


"FIGURE PS-4 In a lifetime, approximately 42 (solid circles) of 100 people will be diagnosed with cancer (calculated from Table 12-4 of this report). Calculations in this report suggest that approximately one cancer (star) per 100 people could result from a single exposure to 0.1 Sv of low-LET radiation above background." ³

X-rays and computed tomographic (CT) scans employ ionizing radiation. They are now the major source of medical radiation in this country. A single dose of 10 mSv (the dose from a typical CT scan of the chest, abdomen, or pelvis) produces a lifetime risk of developing a solid cancer or leukemia of 1 in 1000.³

This study estimated that approximately 29,000 future cancers could be related to CT scans performed in 2007 alone:
Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007, Archives of Internal Medicine, 2009

Much of the radiation to which we're exposed can't be controlled.⁴ Radiation from medical imaging ... we control.



________¹ Wikipedia: DNA Repair
² Retired Harvard Professor John Kimball's Biology Pages: DNA Repair
³ Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, National Academies Press, 2006
⁴ Report No. 160 - Ionizing Radiation Exposure of the Population of the United States (2009)
Pie chart from DiagnosticImaging.com

Don't Drink The Rain

Our Governor (Pennsylvania) released a statement about the rain last week:

Governor Corbett Says Public Water Supply Testing Finds No Risk to Public From Radioactivity Found in Rainwater (pdf), PA Office of the Governor, 28 March 2011

"On Friday, concentrations of Iodine-131, likely originating from the events at Japan’s damaged nuclear plants, were found in rainwater samples collected from Pennsylvania’s nuclear power plant facilities.
...
On Friday, rainwater samples were taken in Harrisburg, where levels were 41 pCi/L and at nuclear power plants at TMI and Limerick, where levels were 90 to 100 pCi/L.
...
The federal drinking water standard for Iodine-131 is 3 pCi/L.
...
[Radioactive Iodine] is not considered to be a health risk in Pennsylvania."

Well, don't drink the rain.
________Photo of ravens from Eileen Nauman's blog, Tales of Echo Canyon

Do Chemicals In The Environment Interfere With Vitamin D?

I've been curious about the calls for increased supplementation of vitamin D in recent years. The Institute of Medicine (IOM, a group that sets the DRIs/RDAs) after interrogating the vitamin D research barely budged in its updated recommendation last year, increasing it from 400 IUs/day to 600 IUs/day. (The RDA in the European Union is 200 IUs.) These numbers assume little to no sun exposure. Yet some groups such as the Vitamin D Council advocate for 5000 IUs/day and higher.

We determine deficiency or adequacy of vitamin D by measuring a compound in blood called calcidiol, also called 25-hydroxyvitamin D or 25(OH)D. Calcidiol is not the most biologically potent form of the vitamin. To make that form, our bodies attach another OH group to make calcitriol, also called 1,25-hydroxyvitamin D or 1,25(OH)D.

So, the vitamin D we eat in food, or in a pill, or make in our skin, or measure in our blood is not the active form of the vitamin. And unless we are truly deficient in these precursors (or prehormones), there is no guarantee that increasing any of them will increase levels of this active vitamin D hormone. It is active vitamin D which is responsible for the health benefits accruing from research, not what's in a pill.

Here's a study that supports the notion that taking extra vitamin D isn't helpful, in this case for bone:

Cholecalciferol Supplementation Throughout Winter Does Not Affect Markers Of Bone Turnover In Healthy Young And Elderly Adults, The Journal of Nutrition, March, 2010

"In conclusion, data from these randomized, controlled, double-blind, dose-related intervention trials in healthy 20- to 40-y and ≥64-y-old adults with relatively good calcium intakes would suggest that cholecalciferol [vitamin D] supplementation alone with up to 15 μg/d throughout winter, which achieved mean serum 25(OH)D concentrations of ∼70 nmol/L or more, had no effect on markers of bone turnover."

It found no improvement in markers of bone health from taking vitamin D3 ... in levels that at the time surpassed the IOM's recommendation.

By the way, the Vitamin D Council says:¹

"It is almost impossible to significantly raise your vitamin D levels when supplementing at only 600 IU/day (15 micrograms)."

This study clearly shows a significant increase in vitamin D levels when supplementing at 600 IUs. It also shows an increase in vitamin D levels when supplementing at lesser doses of 200 IUs and 400 IUs. (Remember, these are precursor vitamin D, not active vitamin D.)


Levels Of Active Vitamin D Are Tightly Controlled, Environmental Pollutants May Be Interfering With That Control

Levels of the potent hormonal vitamin D are tightly controlled, hanging around for just a few hours after being made. (That's one reason for measuring levels of the precursor 25(OH)D instead of the more active 1,25(OH)D. The precursor hangs around for several weeks.)

We make active 1,25(OH)D when, for example, we need more calcium since it promotes uptake of calcium from the intestine - we'll absorb more calcium from what we eat. Conversely, high levels of calcium and phosphorus (phos. sources: dairy, fish, meat, soda) inhibit conversion of 25(OH)D to active vitamin D through a feedback loop (managed by parathyroid hormone, see diagram to right and Vitamin D: The Active Form, And The Role Of Calcium)

What else controls how much hormonally active vitamin D we make? Or how efficiently its used? Prednisone and other steroidal drugs such as oral contraceptives. These drugs may impede conversion of calcidiol to calcitriol, or interfere with binding of calcitriol to its carrier protein or receptor. The result is disturbed vitamin D metabolism. Taking too much prednisone leads to lower bone density and osteoporosis.

The interference of steroidal drugs with vitamin D (a product of our endocrine system, also a steroid) has me thinking that other environmental chemicals could be crippling the activity of vitamin D in our body, things like pesticides and bisphenol-A in plastics which are known endocrine disruptors.

The Endocrine Society claims endocrine disruptors are "a significant concern to public health."

"There is growing interest in the possible health threat posed by endocrine-disrupting chemicals (EDCs), which are substances in our environment, food, and consumer products."
- Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement, Endocrine Reviews, June 2009

Endocrine disruptors are found in:

• Pesticides
  
• Industrial chemicals
  
• Plastics (such as bisphenol-A)
  
• Fuels
  
• Drugs
  
• Food

Food is a prominent source of human exposure to endocrine disruptors, and EDs bioaccumulate such that higher concentrations are found further up the food chain. Many EDs are hydrophobic or fatty (steroids are a type of fat) and dissolve in fatty tissue. Thus, fatty foods often contain higher levels of these chemicals:

"Persistent organic pollutants such as dioxins, furans and polychlorinated bromides enter the human food chain through the diets of food animals. The source of these organic compounds for food animals is contaminated forage and soils and the animal feed. Once ingested, the dioxins and other compounds are absorbed and stored in the fat of the animal. By continually re-feeding fat from such animals back to other animals, the dioxins are concentrated more and more, a process called bioaccumulation. When humans consume animal fat in meat and dairy products, they are exposed to these pollutants that are carcinogenic and toxic to the developing nervous system of the foetus and to young children."
- Public Health Implications Of Meat Production And Consumption, Public Health Nutrition, June 2005

________
In the end, perhaps we don't need to take more vitamin D (which doesn't correlate well with the hormonally active vitamin D anyway); perhaps we need to minimize our exposure to chemicals that interfere with vitamin D metabolism.

A final thought ... Paradoxically, a food we are advised to eat liberally to maintain bone heath is dairy food -- which, of the foods we consume, contains some of the highest levels of calcium, phosphorus, protein, and fat-soluble pollutants including endocrine disruptors. They all conspire to weaken bone, through a reduction of hormonally active vitamin D and an acid load that depletes bone of its minerals. The National Dairy Council knows this but promotes dairy consumption anyway:

"Excess dietary protein, particularly purified proteins, increases urinary calcium excretion. This calcium loss could potentially cause negative calcium balance, leading to bone loss and osteoporosis. These effects have been attributed to an increased endogenous acid load created by the metabolism of protein, which requires neutralization by alkaline salts of calcium from bone."
- National Dairy Council

________¹ Vitamin D Council Statement On FNB Vitamin D Report: Today The FNB Has Failed Millions, November 2010