Even a little exercise can really change your life's trajectory

One day you go to the doctor and he says “you have diabetes”, as if you just got it.  WRONG!  You’ve been working on it for years – many, many years.  Your sugar ever so slowly starts to climb (your body can’t keep up) until it reaches the level that your regular doctor finally tells you’ve hit the dreaded “D”-level.  But as you’ve heard, exercise can make a huge difference – but how much of a difference?  

This study, while small, has profound implications.  Hang in there while I try to explain it – it’s a little complicated if you are unfamiliar with the particulars.  Some definitions first.

Think of an oral glucose tolerance test (OGGT) as drinking a sickeningly sweet drink all at once, then checking blood sugar levels an hour and two later.  Insulin sensitivity is how relatively self-explanatory – how sensitive your body is to insulin (hint – it should be really sensitive), and type 2 diabetes is all about insulin insensitivity (also known as glucose intolerance).  

The study takes young (average age 35) people who are sedentary or moderately active, normal to slightly overweight, with no evidence of diabetes and tests them with OGGTs.  First, they’re asked to sit around for 4 days and then they’re tested, giving us some blood sugar and insulin levels.  They are then asked to do an easy jog for 30 minutes and are tested again on the following day.  

The findings are profound – a significant drop in blood sugars and insulin levels after the simple jog.  That’s after 1 jog!  What if someone actually did REGULAR exercise!!!  

Research studies have shown that a full 25% of normal, skinny, healthy, active youth (college age) already show evidence of being on the way to diabetes.  I’m sure some of these subjects were among the group that would have qualified, but if we can’t know who’s at risk, and we have an opportunity to seriously impede progress to a life-threatening condition, why wouldn’t we take advantage!?!  

But hey, here I am talking about exercise again.  Go figure.

FROM MEDSCAPE INTERNAL MEDICINE / BY MANASI TALWADEKAR

A Single Jog Can Improve Glucose Metabolism in Young Adults

TOPLINE:

In healthy young adults, a single 30-minute bout of outdoor aerobic exercise significantly reduces fasting and 1-hour glucose levels during an oral glucose tolerance test (OGTT) the next day and improves insulin sensitivity.

METHODOLOGY:

• Recent studies have identified 1-hour post-load glucose concentration during an OGTT as a specific and early predictor of diabetes, and exercise has long been known for its metabolic benefits in people with and without diabetes.

• The researchers investigated the effect of a single bout of aerobic exercise on 1-hour post-load glucose levels during an OGTT in 32 young, healthy, normal-weight or marginally overweight individuals (mean age, 35 years; 14 women and 18 men) with a sedentary or moderately active lifestyle.

• The participants underwent an initial OGTT after at least 4 days of physical inactivity, followed by a second OGTT the day after a single 30-minute bout of aerobic exercise.

• The exercise session consisted of a light jog for 30 minutes, monitored using a metabolic holter to quantify energy expenditure and exercise intensity. The participants did not undertake any exercise outside the lab sessions.

• Blood glucose levels were measured, and insulin sensitivity and secretion were estimated using surrogate indices derived from OGTT glucose and insulin assays, including the Matsuda index, oral glucose insulin sensitivity (OGIS) index, and quantitative insulin sensitivity check index, as well as the homeostasis model assessment (HOMA) of insulin resistance and of beta-cell function (HOMA-B).

TAKEAWAY:

• A single 30-minute bout of aerobic exercise significantly reduced 1-hour post-load glucose levels from 122.8 mg/dL at baseline to 111.8 mg/dL ( P  = .03) the day after exercise.

• Postexercise insulin levels also were significantly lower 1 hour after glucose load, decreasing from 57.4 IU/mL at baseline to 43.5 IU/mL the day after exercise ( P = .01).

• Insulin sensitivity improved significantly after exercise, as indicated by increases in the Matsuda index ( P  = .02) and OGIS index ( P  = .04), along with a reduction in insulin resistance ( P  = .04).

• The study found a trend toward increased beta-cell function the day after an exercise bout, as indicated by a nonsignificant increase in HOMA-B from 144.7 at baseline to 167.1 after exercise.

IN PRACTICE:

“Improvement in 1-hour post-load plasma glucose following a single session of aerobic physical activity suggests that exercise could have a direct effect on T2D [type 2 diabetes] risk and cardiovascular risk,” the authors wrote.

SOURCE:

The study was led by Simona Moffa, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, and Gian Pio Sorice, University of Bari "Aldo Moro," Bari, Italy. It was published online in the Journal of Endocrinological Investigation .

Not when you eat, but HOW LONG you're eating makes a difference - and quickly!

I believe that everyone should NOT EAT for MORE THAN 12 hours a day.  There are lots of variations under the topic – TIME RESTRICTED EATING.  There’s been some data about making your eating window early in the day is better than later in the day, and that it might be better for weight loss.  While that’s interesting, this study shows that didn’t make a difference.  

What it did show, and what’s frankly more important, is that, even after only 3 days there’s a clear improvement in blood sugar levels when you restrict your eating to 8 hours a day.  None of the subjects had frank diabetes, but were all at substantial risk that they were heading that way.  As such, any improvement in sugar levels would translate into, at the least, a delay in frank diabetes, but might have greater effects to keep patients from actually becoming diabetic at all.  

Please let me know if you have any questions – a phone call might be really clarifying!

FROM MEDSCAPE INTERNAL MEDICINE / BY BECKY MCCALL

Early vs Late Fast Window: Is One More Effective?

A daily 8-hour eating window controls blood glucose whether followed early or late in the day by people at risk for type 2 diabetes, showed a time-restricted eating (TRE) study presented at the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting.

The study, examining shifting the time of day for the 8-hour eating window along with a tightly controlled diet, found that 8 hours of TRE — whether early or late in the day — led to a significant improvement in the time spent within a normal daily blood glucose range and in glycemic variability.

"We didn't show a benefit in terms of early versus late TRE, but we did show a benefit of time-restricted eating within a window of 8 hours per day," said study lead Kelly Bowden Davies, MSc, PhD, from Manchester Metropolitan University, Manchester, England, when presenting the work. "It doesn't matter when you restrict eating, but if you restrict it to 8 hours then, according to our study, it benefits glycemic control in people at risk of type 2 diabetes."

The researcher added that the effect was seen after only 3 days, and "demonstrates its therapeutic role in adults at risk of type 2 diabetes, which warrants investigation in the longer term."

The current study examined the effect of shifting the time of day for the TRE window from early (8 am-4 pm) to late (12:00 pm-8 pm) in people at risk of developing type 2 diabetes due to a lifestyle characterized as sedentary and poor diet.

Previous studies indicate that TRE, which limits when, but not what, individuals eat, can improve insulin sensitivity and A1c in people at risk for type 2 diabetes.

But Bowden Davies pointed out that the effect of TRE on glycemic variability remained unclear. While prior work had attributed the positive effects of TRE to reduced energy intake, this study provided a diet where energy consumption matched energy expenditure — taking into account sex, age, weight, height, and activity level, termed a "eucaloric" diet.

"Some research groups recognize that if we manipulate the time at which we eat, then we can better align with circadian metabolic rhythms to improve whole body insulin sensitivity and glycemic variability," explained Bowden Davies. "It may be that eating in the morning may be better aligned [with circadian rhythms] and cause greater improvement in glucose control."

Three-day TRE plan led to blood glucose control

In a cross-over study design, all 15 participants were randomized to follow the early and late TRE regimens with a 7-day washout period in the middle. Participants had a mean body mass index (BMI) of 27.7 kg/m2, a mean waist circumference of 73 cm, were sedentary, and followed a poor diet.

"Participants were normoglycemic so had good glucose control, but due to having overweight and obesity, they are considered as having risk factors for the development of type 2 diabetes," noted Bowden Davies.

Before the TRE period, participants provided researchers with a dietary record. If they started on the early TRE, they crossed over to the late TRE after the washout period, and vice versa, she explained.

Continuous glucose monitoring (FreeStyle Libre 2, Abbott Laboratories) was carried out across the study to assess the daily time spent in euglycemia (3.9-7.8 mmol/L) and provide markers of glycemic variability, including mean absolute glucose, coefficient of variation, and mean amplitude of glucose excursions. Blood draws both pre- and post-TRE period provided biochemical measurements, and anthropometric readings were also taken.

There were nine female participants, with a mean age of 52 years, a BMI of 28 kg/m2, and an A1c level of 37.9 mmol/mol (5.6%). They tended to snack across an eating period of 14 hours per day or more (habitual eating). They were assigned to two different investigational eating patterns for 3-day durations: Early or late, and these findings were compared with those from participants who continued their habitual eating.

Participants were provided with a eucaloric, standardized diet [50% carbohydrates, 30% fat, and 20% protein] to be eaten during the TRE period, whereas they ate as usual (ie, as and what they wanted) when not on the TRE regimen.

No changes were seen in the biochemistry markers assessed. "Given they only followed the TRE for 3 days, this is unsurprising," remarked Bowden Davies. "We did see weight loss after only 3 days of TRE of around 1.1 kg across the two interventions," she reported.

Referring to the early vs late TRE regimen, she added that "we didn't see a benefit [no significant differences in glycemic control] of early compared with late TRE, but we did see a benefit of restricting the eating window to 8 hours per day, so both conditions [early and late TRE regimens] had a benefit on glucose control."

Variables of blood glucose control were also reduced while on the TRE regimen compared with habitual eating (more than 14 h/d), with significantly increased time spent within the normal blood glucose range on average by 3.3%, and also reduced mean absolute glucose by 0.6 mmol/L, coefficient of variation by 2.6%, and mean amplitude of glucose excursions by 0.4 mmol/L.

"Within 3 days, this is quite striking," Bowden Davies pointed out.

She added that these data were interim analyses, but "these are positive in terms of participants seeing a benefit in glucose control and glycemic variability, which is a risk factor for developing type 2 diabetes but also for microvascular complications. We also saw improved time in range in terms of tight glucose control."

"Even in 3 days, there were small, subtle differences which are subclinical — but this is not a clinical cohort. The results are statistically significant and a promising piece of data to suggest a feasible intervention that could be translated across different populations," she said, adding that over a longer time period, changes between TRE timing might show changes in people at risk for type 2 diabetes who don't have compromised circadian rhythms.

Moderating the session was Lutgarda Bozzetto, MD, from the University of Naples Federico II, Naples, Italy. She told Medscape Medical News, "It's a hot topic right now, and the finding that there's no difference in the time of day when the restricted eating is done suggests that in people at risk of diabetes, the hormonal flux and cycle involved in blood glucose control is not so strong or sensitive."

Using a continuous glucose monitor, they can look at their blood glucose levels after eating, and this might "be powerful in guiding behavioral change," said Bozzetto.

Stay out of the Hospital? GET OFF THE COUCH!

I probably sound like a broken record (does anyone know what that reference even means?) – EXERCISE is THE MOST POWERFUL intervention available for your health.  And here’s another article that supports that.  A group of older patients (oh my, I might actually be in this group?!?) with average age of 69 ½ years, but mostly women, were entered into a private gym supervised exercise program and that yielded hospitalization rates at only ½ of those who didn’t exercise!  They only saw a significant difference in women (there probably weren’t enough men to show the statistical difference), and the population was hardly committed to the long term, but even with that, the women crushed it.  It’s not the best study (some clear potential confounders), but heck, I’m piling on when it comes to the need for exercise!  Let’s get moving!

FROM AJPM / BY Donald S. Wright, MD, MHS, Bin Zhou, MS, Catherine X. Wright, MD, Robert S. Axtell, PhD, Abeel Mangi, MD, Basmah Safdar, MD, MSc

Association Between Exercise Program Participation and Hospitalization of Older Adults

Abstract

Introduction

Government and insurance sponsored exercise programs have demonstrated decreased hospitalizations, but it is unclear if this is the case for self-referred programs.

Methods

In this retrospective cohort study from 2013 to 2020, older adults who participated for at least three months at a community-based exercise center (participants) were compared with those who did not (nonparticipants). Each completed a baseline physical assessment and periodic reassessments thereafter. These data were paired with regional hospital data and a national mortality database. Statistical analysis and modeling were performed from 2020 to 2023. Survival to all-cause hospitalization was assessed with a priori subgroup comparison by gender and cox proportional hazard modeling by age, gender, and comorbidities.

Results

The cohort included 718 adults, mean age 69.5 years (SD 8.4), with 411 (57.2%) participants and 307 nonparticipants. Mean follow-up was 26.7 months. Participants had similar baseline measures of fitness (p>0.05) but were more likely to be retired and less likely to have diabetes or prior stroke than nonparticipants. Sustained participation was associated with a reduced rate of all-cause hospitalization (9.0% vs. 12.7%, p=0.02), even when adjusted (HR 0.54; 95% CI 0.34, 0.87, p=0.01). This decrease was noted only in women (p=0.03) but not in men (p=0.49), gender was nonsignificant after adjustment for comorbidities (p=0.15).

Conclusions

Exercise program participation was independently associated with decreased risk of all-cause hospitalization, with possible differential effects by gender. Further randomized trials of the benefits of personalized exercise programs are warranted to assess sex- and gender-specific effects.

Ozempic / Mounjaro can be hard on your body -- help it out

GLP-1s (Mounjaro, Ozempic, Zepbound, Wegovy) can be really helpful with weight loss.  It improves how your body uses sugar, helps burn fat and can translate into rapid weight loss in some people.  However, it slows the gut down tremendously, can increase nausea dramatically and effects many people severely enough to cause more than half of them to not finish a course of therapy.  For the people who do tolerate it and it works, they have significant metabolic risks because it works.  

Big weight loss means losing a bunch of fat, but it often comes with protein or lean body mass.  Also, bone density can drop, vitamins can be missing and constipation can be severe.  The article describes advice from one doc who’s seen lots of these weight loss folks and gives some good information for everyone. 

FROM MEDSCAPE INTERNAL MEDICINE / BY JEAN HANKS, BA, MS, RDN

Five Essential Nutrients for Patients on GLP-1s

Fatigue, nausea, acid reflux, muscle loss, and the dreaded "Ozempic face" are side effects from using glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) such as semaglutide or the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA tirzepatide to control blood sugar and promote weight loss. 

But what I've learned from working with hundreds of patients on these medications, and others, is that most (if not all) of these side effects can be minimized by ensuring proper nutrition. 

Setting patients up for success requires dietary education and counseling, along with regular monitoring to determine any nutritional deficiencies. Although adequate intake of all the macro and micronutrients is obviously important, there are five nutrients in particular that clinicians should emphasize with their patients on GLP-1 RAs or GIP/GLP-1 RSs. 

Protein

My patients are probably sick of hearing me talk about protein, but without the constant reinforcement, many of them wouldn't consume enough of this macronutrient to maintain their baseline lean body mass. The recommended dietary allowance (RDA) for protein (0.8 g/kg bodyweight) doesn't cut it, especially for older, obese patients, who need closer to 1.0-1.2 g/kg bodyweight to maintain their muscle mass. For example, for a 250-lb patient, I would recommend 114-136g protein per day. This is equivalent to roughly 15 oz of cooked animal protein. It's important to note, though, that individuals with kidney disease must limit their protein intake to 0.6-0.8 g/kg bodyweight per day, to avoid overtaxing their kidneys. In this situation, the benefit of increased protein intake does not outweigh the risk of harming the kidneys.

It's often challenging for patients with suppressed appetites to even think about eating a large hunk of meat or fish, let alone consume it. Plus, eating more than 3-4 oz of protein in one meal can make some patients extremely uncomfortable, owing to the medication's effect on gastric emptying. This means that daily protein intake must be spread out over multiple mini-meals. 

For patients who need more than 100 g of protein per day, protein powders and premade protein shakes can provide 20-30 g protein to fill in the gaps. Although I always try to promote food first, protein supplements have been game changers for my patients, especially those who find solid food less appealing on the medication, or those who avoid animal protein. 

Clinicians should have their patients monitor changes in their lean body mass using a dual-energy x-ray absorptiometry scan or a bioelectrical impedance scale; this can be a helpful tool in assessing whether protein intake is sufficient. 

Fiber

Even my most knowledgeable and compliant patients will experience some constipation. Generally speaking, when you eat less, you will have fewer bowel movements. Combine that with delayed gastric emptying and reduced fiber intake, and you have a perfect storm. Many patients are simply not able to get in the recommended 25-35 g fiber per day through food, because fibrous foods are filling. If they are prioritizing the protein in their meal, they will not have enough room for all the vegetables on their plate. 

To ensure that patients are getting sufficient fiber, clinicians should push consumption of certain vegetables and fruits, such as carrots, broccoli, brussels sprouts, raspberries, blackberries, and apples, as well as beans and legumes. (Salads are great, but greens like spinach are not as fibrous as one might think.) If the fruit and veggie intake isn't up to par, a fiber supplement such as psyllium husk can provide an effective boost.

Vitamin B12

Use of these medications is associated with a reduction in vitamin B12 levels, in part because delayed gastric emptying may affect B12 absorption. Low dietary intake of B12 while on the medications can also be to blame, though. The best food sources are animal proteins, so if possible, patients should prioritize having fish, lean meat, eggs, and dairy daily. 

Vegetarians and vegans, who are at an increased risk for deficiency, can incorporate nutritional yeast, an excellent source of vitamin B12, into their daily routine. It is beneficial for patients to get bloodwork periodically to check on B12 status, because insufficient B12 can contribute to the fatigue patients experience while on the medication.

Calcium

Individuals should have calcium on their radar, because weight loss is associated with a decrease in bone mineral density. Adequate intake of the mineral is crucial for optimal bone health, particularly among postmenopausal women and those who are at risk of developing osteoporosis. The RDA for calcium is 1000-1200 mg/d, which an estimated 50% of obese individuals do not take in. 

Although dairy products are well-known for being rich in calcium, there are other great sources. Dark green leafy vegetables, such as cooked collard greens and spinach, provide nearly 300 mg per cup. Tofu and sardines are also calcium powerhouses. Despite the plethora of calcium-rich foods, however, some patients may need a calcium supplement.

Vitamin D

Vitamin D deficiency or insufficiency is common among individuals with obesity, so even before these patients start the medications, supplementation may be warranted. The vitamin's role in promoting calcium absorption, as well as in bone remodeling, make adequate intake essential for patients experiencing significant weight loss.

Clinicians should emphasize regular consumption of fatty fish, such as salmon, as well as eggs, mushrooms, and vitamin D–fortified milks. But unfortunately, that's where the list of vitamin D–rich foods ends, so taking a vitamin D supplement will be necessary for many patients.

Regularly monitoring patients on GLP-1 RAs through bloodwork to check vitamin levels and body composition analysis can be helpful in assessing nutritional status while losing weight. Clinicians can also encourage their patients to work with a registered dietitian who is familiar with these medications, so they can develop optimal eating habits throughout their health journey. 

76 Breast Cancer Linked Chemicals found in Food Packaging -- and in People!

It should come as no surprise – today, everyone is TOXIC, and I don’t mean they give off bad energy.  I mean that our bodies are all exposed to things that we don’t want IN our bodies.  Back in the day, people talked about leaded gasoline and paint.  So lead was taken out of gas and paint.  But interestingly, jet fuel is still leaded and exhausts continue to spew lead into the atmosphere. 

What people don’t talk about is what happened to all that lead?  Obviously, lead is heavy.  It falls (out of the sky from planes), but it used to spew out of car exhausts.  Where did it all go?

Mostly, it dropped to the pavement, or was aerosolized and carried short distances to land on some property.  And then it drained into the soil, or perhaps the water supply.  Ultimately, it ends up in the food supply, amongst other places.  Point being that it can end up in us.  

There are now over 30,000 chemicals that have been created that are “new to nature”.  The vast majority of them have not been tested for safety.  The government actually has a certification known as GRAS that specifically states it has not been tested for safety (GRAS stands for Generally Regarded as Safe – an extrapolation from some similar products previously evaluated).  Lots and lots of “stuff” gets into the environment and years later someone figures out it not good for us.   

The CNN report (don’t get political – it’s health news!) summarizes a toxicology paper that describes how food packaging materials have been demonstrated to leak into foods they are holding.  And a number of those chemicals end up in the humans that eat the food.  BPA was one of the chemicals that only relatively recently was declared as a bad actor and mostly removed from packaging (think baby bottles in the microwave!! Yikes).

These kinds of toxicities drive all kinds of health issues.  Understanding your level of personal toxic burden can be very helpful in avoiding future disasters.  Understanding your personal genetic tendencies in how well you are able to clear these toxins is another important piece of the puzzle to potentially keeping out of the TOXIC SOUP that may all await us if we keep on our current path.  

If any of these things concern you, please, let’s have a conversation.

FROM CNN HEALTH / BY SANDEE LAMOTTE

Chemicals linked to breast cancer leach into our foods, study finds

Nearly 200 chemicals connected to breast cancer are used in the making of food packaging and plastic tableware, and dozens of those carcinogens can migrate into the human body, a new study found.

“There is strong evidence that 76 known or potential breast carcinogens from food contact materials recently purchased all over the world can be found in people,” said study coauthor Jane Muncke, managing director and chief scientific officer at the Food Packaging Forum, a nonprofit foundation based in Zurich, Switzerland, that focuses on science communication and research.

“Getting rid of these known or suspected carcinogens in our food supply is a huge opportunity for cancer prevention,” Muncke said.

Of the recently detected chemicals in food packaging, 40 are already classified as hazardous by regulatory agencies around the world, according to the study.

“So many of these chemicals have already been classified as human health hazards, yet they are still allowed to be used in food contact materials, thus allowing them to migrate into the food we eat,” said Jenny Kay, a research scientist at Silent Spring Institute, a scientific research organization focused on the link between chemicals, women’s health and breast cancer. She was not involved in the study.

Rates of early-onset breast cancer in women under 50 are increasing, and experts said the trend cannot be explained by genetics alone.

“Rates of colon cancer are also rising in younger people,” said Dr. Len Lichtenfeld, former deputy chief medical officer for the American Cancer Society who was not involved in the study.

“Is it obesity? Is it alcohol? Is it the lack of physical activity? Is it environmental? There are a lot of reasons,” Lichtenfeld said, “and it’s going to take a long time to sort which has the most impact, as some of these chemicals may be high risk, some low risk.”

The Consumer Brands Association, which represents the consumer products industry, told CNN that its members adhere to the US Food and Drug Administration’s evidence-based safety standards.

“Packaging exists to protect and keep food safe for consumption,” said Sarah Gallo, the association’s senior vice president of product policy and federal affairs, in an email.

“The FDA reviews and approves food contact substances through their science and risk-based system before they go to market,” Gallo said. “The agency’s post market review also provides continuous safety analysis and regulation of the approved substances.”

The FDA has been under fire for its failure to act quickly on health concerns about some 14,000 chemicals known to be added to food. The agency will hold a public meeting Wednesday to present its ideas on how to improve its post-market food analyses.

Possible breast carcinogens

In 2007, Silent Spring published a list of 216 chemicals that can cause mammary tumors in rodents — a key method for determining toxicity, according to experts.

A January 2024 update to that list found 921 possibly carcinogenic chemicals, including 642 that may stimulate estrogen or progesterone production, another known risk factor for breast cancer.

“The fact that so many potential breast carcinogens are present in food packaging and can migrate into our food is just one example of how many chemicals we are unwittingly exposed to every day,” said Kay, who coauthored the 2024 study update published in Environmental Health Perspectives.

“Many of the mammary carcinogens are hormone disruptors, too, and many of the chemicals on our list can also damage DNA,” she said. “Consumers should not have to keep track of all of the scientific literature on what chemicals to avoid. It should be on regulators to recognize the danger and take action.”

Carcinogens in plastic, paper and cardboard

The new study, published Tuesday in the journal Frontiers in Toxicology, compared the Silent Springs database of known carcinogens for breast cancer with the Database on Food Contact Chemicals Monitored in Humans, or FCChumon.

FCChumon, created by the Food Packaging Forum, is a list of food contact chemicals that have been detected in human breast milk, blood, urine and tissues.

“The new study took our list of potential breast carcinogens and compared it to their list of chemicals that have been found in food contact materials to find out which of potential breast carcinogens could be getting into people’s diets,” Kay said. “That’s a great way to prioritize chemicals for regulatory action.”

The study found such chemicals as benzene, a known carcinogen connected to breast cancers in animals and people; 4,4’-Methylenebis-(2-Chloroaniline), a probable carcinogen linked to bladder cancer; 2,4-Toluenediamine, found to cause breast and other cancers in animals; and 3,3′-Dimethylbenzidine and o-Toluidine, which are dyes used to color plastic and paper.

“Dyes can be used in plastics, paper, cardboard and the like and can have some pretty toxic properties,” Kay said. “Plastics are not the only culprit.”

In fact, while the study found most of the exposure to carcinogens came from plastics used in food packaging, 89 suspected carcinogens were found in paper and cardboard containers.

“Paper has additives such as emulsifiers and adhesives, say if papers are glued together, or there’s a plastic layer glued to the paper,” Muncke said.

PFAS, phthalates and other worrisome chemicals are used to make plastic soft and flexible and to produce grease-proof food containers.

A number of the chemicals found in the study were bisphenols, phthalates or perfluoroalkyl and polyfluoroalkyl substances, known as PFAS — worrisome chemicals that have been linked to many health concerns.

Often called “forever chemicals” because they do not break down in the environment, PFAS are used in food packaging to prevent grease and water from soaking through food wrappers and beverage cups. PFAS can also be found in the ink used to print logos and instructions on food containers.

Chemicals in the PFAS family are linked to high cholesterol, cancer and various chronic diseases as well as a limited antibody response to vaccines in both adults and children, according to a report by the National Academies of Sciences, Engineering, and Medicine.

Phthalates have been linked to childhood obesity, asthma, cardiovascular issues, cancer and premature death in people ages 55 to 64.

Bisphenol A, or BPA, is an endocrine disruptor that has been linked to fetal abnormalities, low birth weight, and brain and behavior disorders in infants and children. In adults, the chemical has been linked to the development of diabetes, heart disease, erectile dysfunction, cancer and a 49% higher risk of early death within 10 years.

Steps to take to reduce exposure

While it’s up to regulatory agencies to make sweeping changes to protect the food supply, there are steps consumers can take to reduce the risk of toxic chemicals and carcinogens, according to Silent Spring.

To Live Longer, Get to Know Your Toes

I mentioned sometime in the past a study that tied standing on one leg to mortality risk.  The same guy has worked out more details around flexibility and mortality.  Over 13 years, the difference between being pretty flexible and not being flexible is translated into a difference from 1% up to 18-26%!! That’s a crazy difference, but, as usual, you really need to parse this result.  They plainly admit that they didn’t stratify people with regards to activity or lifestyle going into the study, so it might be that the less flexible group was already sicker and that contributed to the difference.  The difference varied by gender –flexible vs less flexible translated into a doubling of mortality for men, a 5-fold increase for women.  

What this doesn’t tell us is whether or not stretching regimens will help these statistics, but it’s clear other aspects of this kind of thing does make a difference – balance training, strength training, etc all translate to better outcomes.  It mostly follows (though not a given) that stretching would be beneficial, if not for mortality, at least for quality of life.  

An easy way to start is with sun salutations – a cornerstone of yoga.  A great, comprehensive review of how to start is here: https://www.youtube.com/watch?v=L4Z7lix6Qao&ab_channel=YouAligned

Get STRETCHING!

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FROM MEDSCAPE / BY BRENDA SANDBURG

The more flexible you are as you age, the longer you're likely to live.

That's the conclusion of a new study that associated increased flexibility in middle age with a lower odds of mortality over the next dozen or so years.

The prospective cohort study, which evaluated the flexibility of more than 3100 men and women in Brazil, found body flexibility was strongly and inversely associated with mortality risk over a 13-year follow-up period.

Claudio Gil Araújo, MD, PhD, the research director of the Exercise Medicine Clinic-CLINIMEX in Rio de Janeiro, who led the study, said his group was not surprised by the results. "We found what we expected. Reduced flexibility was related to poor survival," he said.

The findings, published today in the Scandinavian Journal of Medicine & Science in Sports, used data from 2087 men and 1052 women who underwent a medical-functional evaluation at CLINIMEX. They received a body flexibility score, called the Flexindex, based on range of motion in 20 movements in seven joints, with a minimum score of 0 and a maximum score of 80.

Among the 3139 participants, there were 302 deaths (9.6%) during a mean follow-up of 12.9 years with cardiovascular diseases and cancer the most common underlying causes in men and women, respectively.

"The probability of death during nearly 13 years of follow-up was close to 1% when Flexindex scores exceed 49 for men and 56 for women," Araújo told Medscape Medical News. "On the other hand, for men and women placed in the lower 10th percent of Flexindex scores, death rates were, respectively, 26.9% and 18.2%."

Barry Franklin, PhD, director of preventive cardiology and cardiac rehabilitation at Corewell Health William Beaumont University Hospital in Royal Oak, Michigan, and a co-author of the new study, said men with the poorest flexibility were nearly twice as likely to die over the follow-up period than men with high flexibility. Women with the poorest flexibility were almost five times more likely to die than those with high flexibility.

Flexibility Assessment and Training

Araújo opened CLINIMEX in 1994, and since then, its staff of five physicians have evaluated more than 10,000 individuals using the Flexitest. Araújo has published two previous studies on flexibility. The first showed that the ability to rise from a sitting position on the floor is a strong predictor of longevity, and the second demonstrated that the inability to stand on one leg for at least 10 seconds is linked to an increased risk for death over 7 years.

Araújo and his colleagues believe the current study is the first to assess the association between levels of body flexibility and mortality. But the observational analysis was unable to establish causality, and therefore, they could not show a definitive mechanism to explain the association between low levels of flexibility and premature mortality.

The authors noted several limitations of their study. The participants were primarily affluent Whites, and the researchers did not control for the time of day flexibility was measured or for variables such as diet and physical activity. They also acknowledged reduced flexibility may be a consequence of poor lifestyle habits rather than a causal risk factor for mortality.

Jonathan Bonnet, MD, MPH, an exercise expert at the Stanford Center on Longevity Lifestyle Medicine in California, said the researchers used a more robust evaluation of flexibility than a traditional sit-and-reach test. However, he expressed concern that the primary comparisons were of the upper and lower 10% of performers and that the average differences in Flexindex scores between people who died and those who survived were only a handful of points in an 80-point test.

"People who are not flexible probably have other health-related issues that limit their mobility and those who are very flexible are either genetically different from inflexible individuals or are doing something to maintain or increase their flexibility to a high level," Bonnet said. "Not knowing how active or inactive people are at baseline when flexibility was assessed or over the duration of the study limits how confident we can be that flexibility is the cause of mortality."

Bonnet, a member of the American College of Lifestyle Medicine, noted that the latest guidelines on physical activity from the US Department of Health and Human Services do not include recommendations on stretching, given the lack of data demonstrating its specific health benefits. While maintaining mobility and range of motion in joints is important for long-term health, he said the new study does not provide sufficient evidence to recommend stretching as a way to reduce mortality.

"Until there are more data that can show a cause-and-effect relationship with stretching and health outcomes, time is better spent doing aerobic and muscle-strengthening activities," Bonnet said.

Franklin said future studies could better account for missing potential confounders like physical activity and whether individuals were taking protective medications, such as aspirin, cholesterol-lowering drugs, or beta-blockers. Studies also are needed to assess whether training-induced gains in flexibility are specifically related to increases in survival and whether their findings apply to people over the age of 65, he said.

The current findings "give us some additional ammo to say, 'Wow, being more flexible may, in fact, improve long-term survival or outcomes'," Franklin said. Regardless, flexibility still "improves quality of life, it improves balance and reduces the potential for falls, and all those things make it worthy of better recognition or appreciation by the general public and clinicians," he added.

Araújo said he would like his research to influence people's health. "While to exercise regularly is advisable, what really matters is to be physically fit and not only in aerobic or strength fitness but also in flexibility," he said. "The study is adding a new and, I believe, important 'relevant for survival' label on flexibility assessment and training."

Recommended Stretches for Increased Mobility and Flexibility

Matthew Accetta, MS, exercise physiologist at Hospital for Special Surgery in New York City

Matthew Accetta, MS

Hip Hug Stretch

This stretch effectively targets the gluteal muscles, piriformis, and other deep hip rotators, which can become tight from prolonged sitting or lack of movement. Tight hips can contribute to lower back pain. By stretching the hip muscles, you can reduce tension and pressure on the lower back. Regularly performing this stretch helps to improve hip joint mobility, which is essential for maintaining functional movement and preventing stiffness as you age.

• Start by sitting and crossing one leg over the other.

• Hug your knee to your chest.

• Focus on keeping your chest up to feel the stretch in the glute.

• Hold for 20-30 seconds.

• Repeat on the opposite side.

Half Kneeling Hip Flexor Stretch

As people age, they often spend more time sitting, which can lead to tight hip flexors. This stretch specifically targets these muscles, helping to alleviate tightness and improve mobility. Tight hip flexors can contribute to poor posture by pulling the pelvis into an anterior tilt, which can lead to lower back pain and other postural issues. Stretching these muscles helps to counteract this effect and promote better posture.

• Kneel on a pad (the side you kneel on is the side being stretched); position the front leg far enough away so the front knee stays behind the toes.

• With a tall posture, engage your abdominals and tuck your tailbone by engaging your glutes until a stretch is felt in the front of the thigh on the kneeling leg.

• Hold for 20-30 seconds.

• Repeat on the opposite side.

Calf Stretch at a Wall

Tight calf muscles can lead to discomfort and limit the range of motion in the ankles. Stretching the calves helps to maintain and improve flexibility in these muscles. Flexible calf muscles contribute to better mobility in the ankles and feet, making daily activities like walking, climbing stairs, and running more comfortable. Tight calves can increase the risk for strains, Achilles tendonitis, and other injuries. Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.

• Stand in a staggered stance in front of a wall with your arms stretched out.

• Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.

• Hold the stretch for 15-30 seconds.

• Repeat on the opposite side.

Standing Quad Stretch

Regularly stretching the quadriceps helps maintain and improve flexibility in these muscles, which is crucial for overall lower body mobility. Flexible quadriceps are less prone to strains and injuries. Tight quadriceps can contribute to knee pain and discomfort by exerting excessive pressure on the knee joint. Stretching these muscles helps alleviate this pressure and reduce knee pain.

• While standing, hold onto a countertop or chair back to assist in balance.

• Bend your knee by grasping your ankle with one hand and moving your foot toward your buttocks.

• Gently pull on your ankle to bend your knee as far as possible.

• Maintain the position for 30 seconds.

• Repeat on the opposite side.

Seated Hamstring Stretch

Regularly stretching the hamstrings helps maintain and improve their flexibility, which is crucial for the overall mobility of the lower body. Tight hamstrings can contribute to lower back pain by pulling on the pelvis and causing an anterior pelvic tilt. Stretching these muscles can help alleviate tension and reduce back pain. Hamstring flexibility helps to contribute to a better range of motion in the hip and knee joints, making daily activities such as walking, bending, and reaching easier.

• Sit on the front half of a firm chair with your back straight.

• Extend one leg out in front of you with your heel on the floor and your toes pointed up.

• Bend the opposite knee so that your foot is flat on the floor.

• Center your chest over your straight leg.

• Slowly lean forward at the hips until you feel a stretch in the back of your thigh.

• Hold the stretch for 30 seconds.

• Slowly return to your original position and repeat on the opposite side.

Does Time Restricted Eating (some call it Intermittent Fasting) result in weight loss?

In recent months the excitement about fasting has died down a bit, but there’s lots of interesting data surrounding it’s utility.  Most of the excitement centered around, you guessed it – the possibility that it would drive weight loss.

We’ve talked about this a bit in the past – it’s important to get the terminology right.  Many/most Americans fail to get a full 12 hour fast overnight.  To me, that’s an absolute necessity – you’ve got to NOT eat for more time than you DO eat (if you eat late - 8 or 10pm, then you shouldn’t eat again until the earliest at 8 am or 10 am, respectively).  Time Restricted Eating (TRE) is when you restrict your eating window to shorter than 10 hours, all the way down to OMAD (one meal a day) with a 2 hour eating window.  Intermittent Fasting (IF) is when you DON’T eat for 24 hours at a stretch.  These fasts may be repeated a few times a week.  Fasting is when there is no food for extended periods, usually 3 to 5 days.  Each of these have some benefits, but with the longer fasting windows resulting in ever increasing risks, some of which are nearly impossible to overcome as the patient gets older.   

As I’ve mentioned, NOT eating for more than 12 hours a day is a good thing.  Most people can easily tolerate 14 hours of not eating – most women don’t benefit from longer daily fasts, though some do.  Many men do well around 16 hours (8 hour eating window).  Once you’re used to it, it becomes pretty easy and there are definite benefits that have been described elsewhere.  

There continues to be some very real questions about what are the specific benefits of daily temporal restriction of caloric intake – this study does answer some of that uncertainty.  

Previous studies have suggested that merely restricting the eating window would end up restricting calories because people had less time to eat, resulting in weight loss.  Sounds silly, but it turns out that that is exactly what seems to be happening.  There was no weight loss associated with TRE versus the exact calorie match of usual eating.  They go on to make some interesting points about confounders (the TRE group went to bed earlier, so less active and thus, less calorie burn) – why stay up if you’re not going to have a snack watching TV?!?

Most people feel better and sleep better if they don’t eat late – stop eating at least 90 minutes before bed, and better yet, 2 hours plus.  These folks got virtually all of their calories before 1 pm – now that’s an early dinner!  The Blue Light special becomes a midnight snack….

FROM MEDSCAPE / BY DIANA SWIFT

Time-Restricted Eating Fails for Weight Loss and Glucose Homeostasis

In the setting of isocaloric eating, time-restricted eating (TRE) did not reduce weight or improve glucose homeostasis relative to a usual eating pattern (UEP), a small randomized controlled trial found.

The results suggested that any effects of TRE on weight observed in prior studies may be due to reductions in caloric intake and not timing, according to Nisa M. Maruthur, MD, MHS, of the Division of General Internal Medicine at the Johns Hopkins School of Medicine in Baltimore, and colleagues.

Published in Annals of Internal Medicine, the 12-week trial randomly assigned 41 adults aged 18-69 years with obesity and prediabetes or diet-controlled diabetes 1:1 as follows: To TRE, involving a 10-hour eating window with 80% of calories consumed before 1 PM, or to UEP, involving a ≤ 16-hour window, with at least 50% of calories consumed after 5 PM. The regimen in each group was based on the OmniHeart unsaturated fat diet and the SPICE study.

"The diet was similar to the DASH [Dietary Approaches to Stop Hypertension] diet for hypertension and maybe a bit higher in unsaturated fat and micronutrients," said study co-author Scott J. Pilla, MD, MHS, an assistant professor of medicine at the Johns Hopkins Bloomberg School of Public Health, Baltimore, in an interview. For each participant, macro- and micronutrient content remained constant throughout the study period, with total calories individually determined at baseline and ranging from 1600 to 3500 kcal/d. "That differs from some TRE studies in which calories were adjusted according to whether participants lost or gained weight," he said. "This was a purely mechanistic study to determine the impact of time of eating alone with no change in calories." 

Although the current findings revealed no weight loss advantage, some evidence suggests that limiting the food consumption window to 4-10 hours naturally reduces energy intake by approximately 200-550 calories per day and can result in a loss of 3%-5% of baseline body weight for 2-12 months. In addition, TRE has been shown to improve metabolic risk factors, such as insulin resistance, blood pressure, and triglyceride concentrations — but not in this study.

The Cohort

The mean age was 59 years, 93% of patients were women, and 93% were Black. The mean body mass index was 36, and the mean baseline weight was 96.2 kg — 95.6 kg in the TRE group and 103.7 kg in the UEP group.

At 12 weeks, weight decreased comparably by 2.3 kg (95% CI, 1.0-3.5) in the TRE group and by 2.6 kg (95% CI, 1.5-3.7) in the UEP group. Change in glycemic measures did not differ between the two groups.

Interestingly, self-reporting questionnaires revealed a slight reduction in physical activity in the TRE group, an effect that requires further study. "We don't know why but anecdotally, some TRE participants said they tended to go to bed earlier," Pilla said. Earlier bedtimes may put an end sooner to the daily eating pattern.

Subanalyses of the data are ongoing and will be published later.

"In the context of several clinical trials that suggest a benefit of TRE, our findings suggest that if or when TRE interventions induce weight loss, it is likely in part due to a reduction in energy intake, and therefore, clinicians can counsel patients that TRE may help them lose weight by decreasing their caloric intake," the authors wrote.

In an accompanying editorial, Krista A. Varady, PhD, and Vanessa M. Oddo, PhD, of the Department of Kinesiology and Nutrition at the University of Illinois Chicago, said the study results have important clinical implications. "Many patients stop following standard-care diets (such as daily calorie restriction) because they become frustrated with having to monitor food intake vigilantly each day," they wrote.

Although TRE is no more effective than other diet interventions for weight reduction, it offers a simplified approach to treat obesity by omitting the need for calorie counting. "TRE bypasses this requirement simply by allowing participants to 'watch the clock' instead of monitoring calories, while still producing weight loss," they wrote.

The straightforward nature of this diet makes it well suited for remote delivery, which can reduce the scheduling and financial barriers associated with inpatient visits, they added. "Moreover, TRE does not require the purchase of expensive food products and allows a person to continue consuming familiar foods, making it a high accessible diet for lower-resource populations."

Gastroenterologists and Obesity

Of late, support has grown for gastroenterologists to become actively involved in obesity treatment — even to "take ownership" of this field.

In a 2023 article in Gut, Michael Camilleri, MD, AGAF, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota, made the case for the natural fit between gastrointestinal (GI) specialists and obesity management. He noted that obesity is a significant risk factor for GI, pancreatic, and liver diseases. It can even affect inflammatory bowel disease.

"Treating obesity starting when patients present in gastroenterology and hepatology clinics has potential to impact serious consequences of obesity such as cardiovascular risks," he wrote.

Gastroenterologists already treat GI conditions with pharmacologic and surgical interventions that can also be used to treat obesity and improve glycemic control. These include pancreatic lipase inhibitors and incretin, bariatric endoscopy and surgery, and combination therapies targeting metabolic problems.

Not Kidding: Yellow Dye 5 May Be the Key to Invisibility

This is about as crazy as it gets.

Rub Twinkie dye on skin and it “disappears”.  Imagine watching your insides sloshing around!  Yikes!

But if you could actually see what’s going on without surgery, maybe Twinkie dye isn’t all bad?  

Have trouble when they need to get blood at the lab – not anymore!  

Well, it’s a little ways away, but the possibilities are interesting.

FROM MEDSCAPE / BY SARI HARRAR

The same dye that gives Twinkies their yellowish hue could be the key to invisibility. 

Applying the dye to lab mice made their skin temporarily transparent, allowing Stanford University researchers to observe the rodents' digestive system, muscle fibers, and blood vessels, according to a study published September 5 in Science.

"It's a stunning result," said senior author Guosong Hong, PhD, who is assistant professor of materials science and engineering at Stanford. "If the same technique could be applied to humans, it could offer a variety of benefits in biology, diagnostics, and even cosmetics." 

The work drew upon optical concepts first described in the early 20th century to form a surprising theory: Applying a light-absorbing substance could render skin transparent by reducing the chaotic scattering of light as it strikes proteins, fats, and water in tissue. 

A search for a suitable light absorber led to FD&C Yellow 5, also called tartrazine, a synthetic color additive certified by the US Food and Drug Administration for use in foods, cosmetics, and medications. 

Rubbed on live mice (after areas of fur were removed using a drugstore depilatory cream), tartrazine rendered skin on their bellies, hind legs, and heads transparent within 5 minutes. With the naked eye, the researchers watched a mouse's intestines, bladder, and liver at work. Using a microscope, they observed muscle fibers and saw blood vessels in a living mouse's brain — all without making incisions. Transparency faded quickly when the dye was washed off.

Someday, the concept could be used in doctors' offices and hospitals, Hong said. 

"Instead of relying on invasive biopsies, doctors might be able to diagnose deep-seated tumors by simply examining a person's tissue without the need for invasive surgical removal," he said. "This technique could potentially make blood draws less painful by helping phlebotomists easily locate veins under the skin. It could also enhance procedures like laser tattoo removal by allowing more precise targeting of the pigment beneath the skin."

From Cake Frosting to Groundbreaking Research

Yellow 5 food dye can be found in everything from cereal, soda, spices, and cake frosting to lipstick, mouthwash, shampoo, dietary supplements, and house paint. Although it's in some topical medications, more research is needed before it could be used in human diagnostics, said Christopher J. Rowlands, PhD, a senior lecturer in the Department of Bioengineering at Imperial College London, UK, where he studies biophotonic instrumentation — ways to image structures inside the body more quickly and clearly. 

But the finding could prove useful in research. In a commentary published in Science, Rowlands and his colleague Jon Gorecki, PhD, an experimental optical physicist also at Imperial College London, note that the dye could be an alternative to other optical clearing agents currently used in lab studies, such as glycerol, fructose, or acetic acid. Advantages are the effect is reversible and works at lower concentrations with fewer side effects. This could broaden the types of studies possible in lab animals, so researchers don't have to rely on naturally transparent creatures like nematodes and zebrafish. 

The dye could also be paired with imaging techniques such as magnetic resonance imaging (MRI) or electron microscopy. 

"Imaging techniques all have pros and cons," Rowlands said. "MRI can see all the way through the body albeit with limited resolution and contrast. Electron microscopy has excellent resolution but limited compatibility with live tissue and penetration depth. Optical microscopy has subcellular resolution, the ability to label things, excellent biocompatibility but less than 1 millimeter of penetration depth. This clearing method will give a substantial boost to optical imaging for medicine and biology."

The discovery could improve the depth imaging equipment can achieve by tenfold, according to the commentary. 

Brain research especially stands to benefit. "Neurobiology in particular will have great use for combinations of multiphoton, optogenetics, and tissue clearing to record and control neural activity over (potentially) the whole mouse brain," he said.

Refraction, Absorption, and The Invisible Man

The dye discovery has distant echoes in H.G. Wells' 1897 novel The Invisible Man, Rowlands noted. In the book, a serum makes the main character invisible by changing the light scattering — or refractive index (RI) — of his cells to match the air around him.

The Stanford engineers looked to the past for inspiration, but not to fiction. They turned to a concept first described in the 1920s called the Kramers-Kronig relations, a mathematical principle that can be applied to relationships between the way light is refracted and absorbed in different materials. They also read up on Lorentz oscillation, which describes how electrons and atoms inside molecules react to light. 

They reasoned that light-absorbing compounds could equalize the differences between the light-scattering properties of proteins, lipids, and water that make skin opaque. 

With that, the search was on. The study's first author, postdoctoral researcher Zihao Ou, PhD, began testing strong dyes to find a candidate. Tartrazine was a front-runner. 

"We found that dye molecules are more efficient in raising the refractive index of water than conventional RI-matching agents, thus resulting in transparency at a much lower concentration," Hong said. "The underlying physics, explained by the Lorentz oscillator model and Kramers-Kronig relations, reveals that conventional RI matching agents like fructose are not as efficient because they are not 'colored' enough."

What's Next

Though the dye is already in products that people consume and apply to their skin, medical use is years away. In some people, tartrazine can cause skin or respiratory reactions. 

The National Science Foundation (NSF), which helped fund the research, posted a home or classroom activity related to the work on its website. It involves painting a tartrazine solution on a thin slice of raw chicken breast, making it transparent. The experiment should only be done while wearing a mask, eye protection, lab coat, and lab-quality nitrile gloves for protection, according to the NSF.

Meanwhile, Hong said his lab is looking for new compounds that will improve visibility through transparent skin, removing a red tone seen in the current experiments. And they're looking for ways to induce cells to make their own "see-through" compounds. 

"We are exploring methods for cells to express intensely absorbing molecules endogenously, enabling genetically encoded tissue transparency in live animals," he said.

Clickbait? -- Regular Cell Phone Use Linked to Higher Heart Disease Risk

Sometimes even the medical media aggregators get lazy and put up stories with titles that don’t tell the story as it is written.  

I hope people have come to understand the difference between association and causation.  

“Ice Cream causes drowning”.   Huh?  

In the summer, people eat more ice cream, they go swimming more, there are more drownings.  Association, obviously not causation.

This story, through a convoluted discussion, reports that regular cell phone users have greater risk of heart disease (it’s about a 4-11% increase).  But in the next sentence they talk about how sleep issues, psychological distress and neuroticism has substantial impact on those risks.  Is anyone surprised that they also say that smoking and diabetes act to increase the risk associated with cell phone use?  

The study doesn’t look at level of use – a cell phone user is defined as a weekly user – seriously??  

The commentary makes the point – take care of the stuff that really matters – don’t smoke, control sugar, blood pressure, get sleep, do exercise and the cell phone issue will likely not be enough to worry about.  

Are there people for whom using a cell phone is a problem – sure – remember “it depends”!

FROM MEDSCAPE / BY MARILYNN LARKIN

Regular Cell Phone Use Linked to Higher Heart Disease Risk

Using a cell phone for at least one call per week is linked to a higher risk for cardiovascular disease (CVD), especially among smokers and patients with diabetes, according to a new UK Biobank analysis.

"We found that a poor sleep pattern, psychological distress, and neuroticism significantly mediated the positive association between weekly mobile phone usage time and the risk for incident CVD, with a mediating proportion of 5.11%, 11.50%, and 2.25%, respectively," principal investigator Xianhui Qin, MD, professor of nephrology at Southern Medical University, Guangzhou, China, told Medscape Medical News.

Poor sleep patterns and poor mental health could disrupt circadian rhythms and endocrine and metabolic functions, as well as increase inflammation, he explained.

In addition, chronic exposure to radiofrequency electromagnetic fields (RF-EMF) emitted from cell phones could lead to oxidative stress and an inflammatory response. Combined with smoking and diabetes, this exposure "may have a synergistic effect in increasing CVD risk," Qin suggested

Risk Underestimated?

The researchers aimed to examine the association of regular cell phone use with incident CVD and explore the mediating effects of sleep and mental health using linked hospital and mortality records.

Their analysis included 444,027 participants (mean age, 56 years; 44% men) without a history of CVD from the UK Biobank. A total of 378,161 participants were regular cell phone users.

Regular cell phone use was defined as at least one call per week. Weekly use was self-reported as the average time of calls per week during the previous 3 months.

The primary outcome was incident CVD. Secondary outcomes were each component of CVD (ie, coronary heart disease, stroke, atrial fibrillation, and heart failure) and increased carotid intima media thickness (CIMT).

Compared with nonregular cell phone users, regular users were younger, had higher proportions of current smokers and urban residents, and had lower proportions of history of hypertension and diabetes. They also had higher income, Townsend deprivation index, and body mass index and lower education levels.

During a median follow-up of 12.3 years, 56,181 participants developed incident CVD. Compared with nonregular cell phone users, regular users had a significantly higher risk for incident CVD (hazard ratio, 1.04) and increased CIMT (odds ratio, 1.11).

Among regular cell phone users, the duration of cell phone use and hands-free device/speakerphone use during calls was not significantly associated with incident CVD. Yet a significant and positive dose-response relationship was seen between weekly cell phone usage time and the risk for CVD. The positive association was stronger in current vs noncurrent smokers and people with vs without diabetes.

To different extents, sleep patterns (5.11%), psychologic distress (11.5%), and neuroticism (2.25%) mediated the relationship between weekly cell phone usage time and the risk for incident CVD.

"Our study suggests that despite the advantages of mobile phone use, we should also pay attention to the potential harm of mobile phone use to cardiovascular health," Qin said. "Future studies to assess the risk-benefit balance will help promote mobile phone use patterns that are conducive to cardiovascular health."

Meanwhile, he added, "We encourage measures to reduce time spent on mobile phones to promote the primary prevention of CVD. On the other hand, improving sleep and mental health status may help reduce the higher risk of CVD associated with mobile phone use."

There are several limitations to the study in addition to its observational nature, which cannot show cause and effect. The questionnaires on cell phone use were restricted to phone calls; other use patterns of cell phones (eg, messaging, watching videos, and browsing the web) were not considered. Although the researchers adjusted for many potential confounders, unmeasured confounding bias (eg, the type of cell phone used and other sources of RF-EMF) cannot be eliminated.

Weak Link?

Commenting on the study for Medscape Medical News, Nicholas Grubic, MSc, a PhD student in epidemiology at the University of Toronto, Toronto, Ontario, Canada, and co-author of a related editorial, said, "I found it interesting that there was a connection observed between mobile phone use and CVD. However, it is crucial to understand that this link appeared to be much weaker compared with other well-known cardiovascular risk factors, such as smoking, diabetes, and high blood pressure. For now, mobile phone use should not be a major concern for most people."

Nevertheless, clinicians should encourage patients to practice healthy habits around their screen time, he advised. "This could include limiting mobile phone use before bedtime and taking regular breaks to engage in activities that promote heart health, such as exercising or spending time outdoors.

"For the time being, we probably won't see mobile phone use included in standard assessments for cardiovascular risk or as a focal point of cardiovascular health promotion initiatives," he added. Instead, clinicians should "focus on established risk factors that have a stronger impact on patients' cardiovascular health."

Nieca Goldberg, MD, a clinical associate professor of medicine at NYU Grossman School of Medicine in New York City and American Heart Association volunteer expert, had a similar message. "You don't have to go back to using a land line," she said. "Instead, patients should be more mindful of how much phone use is taking away from their physical activity, keeping them from sleeping, and causing them stress." Clinicians should also remember to counsel smokers on smoking cessation.

"It would be important for future studies to look at time spent on the phone and the type of activities patients are doing on their phones, such as social media, calls, texts, movies, or streaming TV shows," she said. "It would be important to see how phone use is leading to a sedentary lifestyle" and what that means for a larger, more diverse population.

Coffee Again -- Too Much of a Good Thing?

Back some time ago we talked about studies that showed coffee intake has a broad array of benefits.  At that time, the study suggested that the more coffee, the better you did, with some exceptions.  What they figured out was that most people who drank lots of coffee (more than 5 cups a day) had associated addictive tendencies that, not surprisingly, independently led to other problems.  If you excluded those addictive characters, the heavy coffee drinkers did the best.  

Now there’s an observational study that shows that the best option is around 3 cups of coffee a day – more is worse.  But is it really?  

Turns out that this study never controlled for other confounding factors – think, for example, smoking or alcohol or other addictive issues.  So is this really new news?  Not convinced.  

Of course, I’ve always thought that 3 cups is probably a good number.  After all, past that, you’re talking about a lot of caffeine, if nothing else!

Interestingly, this also talks about tea (no distinction between green or black) – and here it doesn’t make any difference once you get past 1 cup per day.  But that one cup definitely helps.

FROM MEDSCAPE / BY PAULINE ANDERSON

Too Much Coffee Linked to Accelerated Cognitive Decline

Drinking more than three cups of coffee a day is linked to more rapid cognitive decline over time, results from a large study suggest.

Investigators examined the impact of different amounts of coffee and tea on fluid intelligence — a measure of cognitive functions including abstract reasoning, pattern recognition, and logical thinking.

"It's the old adage that too much of anything isn't good. It's all about balance, so moderate coffee consumption is okay but too much is probably not recommended," study investigator Kelsey R. Sewell, PhD, Advent Health Research Institute, Orlando, told Medscape Medical News. 

The findings of the study were presented on July 30 at the Alzheimer's Association International Conference (AAIC) 2024. 

One of the World's Most Widely Consumed Beverages

Coffee is one of the most widely consumed beverages around the world. The beans contain a range of bioactive compounds, including caffeine, chlorogenic acid, and small amounts of vitamins and minerals.

Consistent evidence from observational and epidemiologic studies indicates that intake of both coffee and tea has beneficial effects on stroke, heart failure, cancers, diabetes, and Parkinson's disease. 

Several studies also suggest that coffee may reduce the risk for Alzheimer's disease, said Sewell. However, there are limited longitudinal data on associations between coffee and tea intake and cognitive decline, particularly in distinct cognitive domains.

Sewell's group previously published a study of cognitively unimpaired older adults that found greater coffee consumption was associated with slower cognitive decline and slower accumulation of brain beta-amyloid.

Their current study extends some of the prior findings and investigates the relationship between both coffee and tea intake and cognitive decline over time in a larger sample of older adults.

This new study included 8451 mostly female (60%) and White (97%) cognitively unimpaired adults older than 60 (mean age, 67.8 years) in the UK Biobank, a large-scale research resource containing in-depth, de-identified genetic and health information from half a million UK participants. Study subjects had a mean body mass index (BMI) of 26, and about 26% were apolipoprotein epsilon 4 (APOE e4) gene carriers.

Researchers divided coffee and tea consumption into tertiles: high, moderate, and no consumption.

For daily coffee consumption, 18% reported drinking four or more cups (high consumption); 58% reported drinking one to three cups (moderate consumption); and 25% reported that they never drink coffee. For daily tea consumption, 47% reported drinking four or more cups (high consumption); 38% reported drinking one to three cups (moderate consumption); and 15% reported that they never drink tea.

The study assessed cognitive function at baseline and at least two additional patient visits. 

Researchers used linear mixed models to assess the relationships between coffee and tea intake and cognitive outcomes. The models adjusted for age, sex, Townsend deprivation index (reflecting socioeconomic status), ethnicity, APOE e4 status, and BMI.

Steeper Decline 

Compared with high coffee consumption (four or more cups daily), people who never consumed coffee (beta = 0.06; SE = 0.02; P = .005) and those with moderate consumption (beta = 0.07; SE = 0.02; P = < .001) had slower decline in fluid intelligence after an average of 8.83 years of follow-up.

"We can see that those with high coffee consumption showed the steepest decline in fluid intelligence across the follow up, compared to those with moderate coffee consumption and those never consuming coffee," said Sewell, referring to illustrative graphs.

At the same time, "our data suggest that across this time period, moderate coffee consumption can serve as some kind of protective factor against cognitive decline," she added.

For tea, there was a somewhat different pattern. People who never drank tea had a greater decline in fluid intelligence compared with those who had moderate consumption (beta = 0.06; SE = 0.02; P = .0090) or high consumption (beta = 0.06; SE = 0.02; P = .003).

Because this is an observational study, "we still need randomized controlled trials to better understand the neuroprotective mechanism of coffee and tea compounds," said Sewell.

Responding later to a query from a meeting delegate about how moderate coffee drinking could be protective, Sewell said there are probably "different levels of mechanisms," including at the molecular level (possibly involving amyloid toxicity) and the behavioral level (possibly involving sleep patterns).

Sewell said that she hopes this line of investigation will lead to new avenues of research in preventive strategies for Alzheimer's disease. 

"We hope that coffee and tea intake could contribute to the development of a safe and inexpensive strategy for delaying the onset and reducing the incidence for Alzheimer's disease."

A limitation of the study is possible recall bias, because coffee and tea consumption were self-reported. However, this may not be much of an issue because coffee and tea consumption "is usually quite a habitual behavior," said Sewell.

The study also had no data on midlife coffee or tea consumption and did not compare the effect of different preparation methods or types of coffee and tea — for example, green tea vs black tea. 

When asked if the study controlled for smoking, Sewell said it didn't but added that it would be interesting to explore its impact on cognition.