Artificial Sweeteners Not So Sweet When It Comes to Cancer Risk

Lots of concerns/controversy swirl around artificial sweeteners, and has for years. The latest French study demonstrates a couple of ingredients, one of which – aspartame (Nutrasweet/Equal) -- is used in all kinds of sugar-free products in the US, and around 6000 products worldwide, raises the risk of cancer by 13% at levels that are above the equivalent of 2 oz of diet soda a day (a little less than 20 mg/day). Of course, the FDA says that the safe dose is the equivalent of 21 cans – 220 Lmes higher than the study suggests.

Sucralose (Splenda) was NOT associated with an increased cancer risk. Is it safe?? WELL – I’d go with safe-er....

FROM MEDPAGE TODAY / BY KRISTEN MONACO

— Consumption of certain sugar alternatives linked to a 13% higher risk of developing cancer

Artificial sweeteners in place of real sugar may not be such a healthy alternative, a French cohort study suggested.

Over a median follow-up of 7.8 years, adults deemed "high consumers" of artificial sweeteners faced a higher risk of developing cancer compared with non-consumers (HR 1.13, 95% CI 1.03-1.25), reported Charlotte Debras, a PhD candidate at the Sorbonne Paris Nord University in France, and colleagues in PLoS Medicine.

When looking at specific types of artificial sweeteners, aspartame and acesulfame potassium were the two culprits that seemed to drive this overall cancer risk:

• Aspartame: HR 1.15 (95% CI 1.03-1.28)

• Acesulfame potassium: HR 1.13 (95% CI 1.01-1.26)

Artificial sweeteners in general were linked with a 13% increased risk for developing obesity-related cancers, including colorectal, stomach, liver, mouth, pharynx, larynx, esophageal, breast (with opposite associations pre- and post-menopause), ovarian, endometrial, and prostate cancers (HR 1.13, 95% CI 1.00-1.28). Aspartame alone was linked with a 15% higher risk for obesity-related cancers (HR 1.15, 95% CI 1.01-1.32), and a 22% higher risk for developing breast cancer (HR 1.22, 95% CI 1.01-1.48).

In fully adjusted models, even low consumption of these artificial sweeteners -- including both aspartame and acesulfame potassium individually -- was tied to a significantly higher risk for all cancers (HR 1.14, 95% CI 1.05-1.25).

However, sucralose consumption at any level wasn't linked to cancer risk, including for site-specific cancers, the researchers noted.

"Findings from this study are very original since, to our knowledge, no previous cohort study had directly investigated the association between quantitative artificial sweetener intakes per se -- distinguishing the different types of sweeteners and cancer risk," Debras and co-author Mathilde Touvier, PhD, also of Sorbonne Paris Nord University, jointly told MedPage Today.

"But these results are in line with our initial hypothesis and with previous scientific literature," they added. "Indeed, some observational studies have investigated the associations between cancer risk and the consumption of artificially sweetened beverages (used as a proxy) and found increased risk of cancer, suggesting that artificial sweeteners present in these types of beverages might play a role in the development of cancer."

The implications of these findings are far reaching, since artificial sweeteners are prevalent in foods and beverages consumed by millions daily, they pointed out.

While the findings need to be replicated in other larger-scale studies, they "provide important and novel information to address the controversies about the potential adverse health effects of these additives, in the context of the ongoing re-evaluation of food-additive sweeteners by the European Food Safety Authority and other health agencies globally," Debras and Touvier noted.

"In line with official recommendations from several public health agencies, these findings do not support the use of artificial sweeteners as safe alternatives for sugar in foods or beverages," they added.

Drawing on the population-based NutriNet-Santé cohort, the researchers assessed dietary intake data from French adults (mean age 42), including 24-hour dietary records that were collected every 6 months. Incident cancer cases during follow-up were also self-reported every 6 months.

A total of 3,358 incident cancer cases were diagnosed during follow-up. Mean age at diagnosis was 59.5, and the most common cancer types were obesity-related (2,023 cases), breast (982 cases), and prostate (403 cases).

Overall, artificial sweeteners were consumed by 36.9% of the cohort -- with aspartame the most common (58% of all consumption), followed by acesulfame potassium (29%), and sucralose (10%). The most popular foods that drove up artificial sweetener consumption were soft drinks with no added sugars, table-top sweeteners, yogurt, and cottage cheese.

The cutoffs between "high consumers" and "low consumers" were sex-specific: 17.44 mg/day in men and 19.00 mg/day in women for total artificial sweeteners, 14.45 mg/day in men and 15.39 mg/day in women for aspartame, 5.06 mg/day in men and 5.50 mg/day in women for acesulfame potassium and 3.46 mg/day in men and 3.43 mg/day in women for sucralose.

People who consumed artificial sweeteners tended to be women, younger, smokers, less physically active, more educated, and more likely to have prevalent diabetes compared with those who avoided artificial sweeteners.

One in Four Medicare Patients Harmed in Hospitals, Nearly Half Preventable

Hey – this is horrifying.

If anyone doubts that the current healthcare system needs a major overhaul, this might go a long way to removing those doubts.  It has become more and more important to stay ahead of the game, maintain or improve your health to make absolutely sure you don’t have to go to the hospital!!

Years ago, I participated in a program where people working at a premier hospital were asked if they would be comfortable letting the system work for their family, or would they need to “chaperone” them through the system.  It was unanimous – NO WAY would anyone let their family brave the system on their own.  Do you need to know any more?

Please – let’s see what opportunities you might have to distance yourself further from the hospital!

FROM MEDPAGE TODAY / BY CHERYL CLARK

— CMS needs to do more to penalize facilities with avoidable adverse events, report says

Medicare patients continue to experience harm during hospital stays, even after a decade of intensive efforts to decrease provider-caused adverse events, according to a report from the HHS Office of Inspector General (OIG).

Among the roughly 1 million Medicare patients who were discharged from hospitals in October 2018, a total of 258,323 experienced an adverse or temporary harm event during their stay.

And 12% experienced events that led to longer stays, lifesaving interventions, permanent harm, or death. "This projects to 121,089 Medicare patients having experienced at least one adverse event during the 1-month study period," the report stated.

Of these adverse events, 45% were said to have been preventable. According to the report, such events were linked to substandard or inadequate care -- for example, using more aggressive pain management regimens after surgery than necessary, or unnecessary delays in scheduling surgeries.

In one of many case studies and patient stories included in the report, a patient required surgery to remove dead tissue from the small intestine. "However, providers unnecessarily delayed surgery for 5 days while the patient continued to deteriorate. This delay led to a cascade of harms that included worsening of the small intestine, contamination of the abdomen with pus, septic shock with an associated kidney injury, and delirium," the report noted.

Ten percent of adverse events contributed to patient deaths, translating to 1.4%, or 14,800 patients, during the 1-month study period.

Leah Binder, president and CEO of the Leapfrog Group, which routinely grades hospitals on various safety measures, called the report's findings "outrageous."

"None of us would drive a vehicle or check into a hotel if we thought we had a one in four chance of being harmed from the experience," she said.

The report also showed that 13% of patients experienced temporary harm, which required intervention but did not prolong their hospital stay or require life-sustaining measures, and over 40% were determined to be preventable. However, such events were sometimes serious and could have caused further harm had providers not noticed and quickly intervened, the OIG said.

Common adverse and temporary harm events included those related to medication use, involving delirium or other mental status changes; pressure ulcers or injuries; complications from procedures or surgeries such as intraoperative hypotension; and hospital-acquired infections (HAIs).

Of particular concern, the OIG found that patient harm events were almost as widespread as they were found to be in 2008 among a similar sample size. Back then, 27% of the patients sampled experienced a harmful event. However, the report noted that the 2018 population had a greater prevalence of comorbidities than the 2008 sample, with more "being treated for more clinically complex conditions and diagnoses than in the past."

Adverse events result in higher costs for beneficiaries who have to pay more in deductibles and co-payments because of additional care required. The report estimated that for some treated beneficiaries, additional expenses amounted to more than $40,000. "Combined, we estimated the cost for all events to be in the hundreds of millions of dollars for October 2018," the report stated.

The OIG noted that CMS has two policies designed to deter hospital-acquired conditions (HACs), including cuts in reimbursement to hospitals with higher rates of such conditions. However, "because the policies use narrowly scoped lists of HACs and employ specific criteria for counting harm events, they have limited effectiveness in broadly promoting patient safety," the report said. "Of the harm events we identified, only 5% were on CMS's HAC Reduction Program list and only 2% were on CMS's Deficit Reduction Act HAC list."

Furthermore, when CMS counts infections associated with a surgical procedure in its formula to penalize hospitals, it counts only those involving the colon or an abdominal hysterectomy, so many other infections go uncounted, such as those occurring after a laminectomy.

Additionally, the report found that hospitals often omit specific codes that CMS uses to monitor the occurrence of HACs, thereby limiting the agency's awareness of some events in Medicare-certified hospitals.

According to the OIG and Binder, CMS should include more types of harm events in its formula for penalizing hospitals. The current policy shift appears to be steering the agency away from that, Binder noted.

"Though in the report CMS concurred with this recommendation, the agency is moving rapidly in the opposite direction, not growing the number of measures, but removing all the HACs and HAIs from payment consideration. CMS's Proposed Rule calls for suppressing all HACs and HAIs from use ... and replacing them with nothing," she said.

The report noted that "only the worst 25% of performers receive the 1% reduction each year." Furthermore, "hospitals that routinely are in the top three quarters of performance do not have a financial incentive through the HACRP [HAC Reduction Program] to improve more."

Blood Profile at Age 35 Linked to Subsequent Alzheimer's Dementia

The largest ongoing study of people in the community, the Framingham Study, has yielded some new associations worth thinking about. When looking at future Alzheimer’s risk, there is around a 15% increase for every 15 point increase in blood sugar, and around a 15% decrease for every 15 point increase in HDL (the good cholesterol) – starting from the age of 35! Elevated triglycerides also showed an increase risk of Alzheimer’s, if you had them high before you got to 51. So there might actually be reasons to take care of yourself BEFORE you get old! Who knew??!

FROM MEDPAGE TODAY / BY JUDY GEORGE

High-density lipoprotein (HDL) cholesterol and triglyceride levels in people as young as age 35 were linked with Alzheimer's dementia decades later in life, longitudinal data from the Framingham Heart Study showed.

Risk of Alzheimer's dementia fell by 15.4% during early adulthood (ages 35 to 50) and by 17.8% during middle adulthood (ages 51 to 60) for every 15 mg/dL increase in HDL cholesterol, reported Xiaoling Zhang, MD, PhD, of Boston University School of Medicine, and co-authors in Alzheimer's & Dementia.

A 15 mg/dL increase in blood glucose measured during middle adulthood was associated with a 14.5% increased Alzheimer's risk, they added. Triglyceride levels were associated with Alzheimer's only in the early adulthood group. Findings remained significant after adjusting for treatment.

"These findings show for the first time that cardiovascular risk factors, including HDL, which has not been consistently reported as a strong risk factor for Alzheimer's disease, contribute to future risk of Alzheimer's disease starting as early as age 35," Zhang said in a statement.

"While our findings confirm other studies that linked cholesterol and glucose levels measured in blood with future risk of Alzheimer's disease, we have shown for the first time that these associations extend much earlier in life than previously thought," added co-author Lindsay Farrer, PhD, also of Boston University.

The researchers looked at the influence of vascular risk factors on incident Alzheimer's dementia over time among Framingham Heart Study Offspring participants, a group that's been evaluated since 1971. Data on lipid fractions, glucose, blood pressure, BMI, and smoking were obtained prospectively from participants across nine quadrennial examinations.

Age-, sex-, and education-adjusted models were tested for each risk factor measured at each exam and within three adult age groups: early adults (ages 35 to 50, median 41), middle adults (ages 51 to 60, median 54), and late adults (ages 61 to 70, median 63.5).

A total of 271 participants (167 women, 104 men) diagnosed with Alzheimer's dementia were included in the analysis as cases. Of these, 225 people were without stroke, 24 people had Alzheimer's and stroke, and 24 people had mixed Alzheimer's and vascular dementia. People with a diagnosis of non-Alzheimer's dementia were excluded. Controls included 4,867 cognitively normal participants.

Mean follow-up periods for people in the early, middle, and late age groups were 35.2 years, 25.8 years, and 18.5 years, respectively. As participants grew older, they tended to have higher triglyceride and glucose levels, higher systolic and diastolic blood pressure, and lower HDL cholesterol levels. They also were more likely to be treated for diabetes, hypertension, and dyslipidemia.

Incident Alzheimer's dementia was negatively associated with HDL cholesterol for every 15 mg/dL increase in early adulthood (HR 0.85, 95% CI 0.72-0.99, P=0.041) and in middle adulthood (HR 0.82, 95% CI 0.70-0.96, P=0.014). This association remained significant with a similar effect size in the middle adulthood group when adjusted for dyslipidemia treatment (P=0.022).

Analyses also showed:

• Triglyceride levels were associated with Alzheimer's dementia only in the early adulthood group, before (HR 1.33, 95% CI 1.02-1.57, P=0.0013) and after (HR 1.30, 95% CI 1.10-1.54, P=0.0018) adjusting for dyslipidemia treatment

• Blood glucose in middle adulthood was associated with Alzheimer's dementia per 15 mg/dL increase, before (HR 1.15, 95% CI 1.06-1.23, P=0.00029) and after (HR 1.18, 95% CI 1.08-1.29, P=0.00036) adjusting for diabetes treatment

• Diastolic blood pressure in late adulthood was associated with Alzheimer's dementia per 10 mm increase, before (HR 1.14, 95% CI 1.01-1.29, P=0.041) and after (HR 1.14, 95% CI 1.00-1.29, P=0.044) adjusting for treatment

• Other vascular risk factors, including low-density lipoprotein (LDL) cholesterol, total cholesterol, BMI, smoking, and systolic blood pressure, were not associated with Alzheimer's dementia in any stage of adulthood (P>0.05)

Future development of Alzheimer's dementia was progressively higher and likely to occur earlier among people who had blood glucose in pre-diabetic (100 to 126 mg/dL) and diabetic (>126 mg/dL) ranges in early adulthood and middle adulthood.

"Intervention targeting cholesterol and glucose management starting in early adulthood can help maximize cognitive health in later life," Farrer suggested.

That idea is supported by previous studies of Framingham Offspring participants showing that elevated coronary heart disease risk and metabolic syndrome were associated with lower cognitive performance at age 55, Zhang and co-authors noted.

"However, our results do not distinguish whether the influences of these risk factors on the development of Alzheimer's disease may be particularly damaging during early adulthood and midlife or reflect longer accumulated risk exposure," they wrote.

The study had several limitations, the researchers acknowledged. All participants were white, and some early measurements of lipids and glucose were not under fasting conditions. In addition, the findings were based on analyses of one-time measurements.

Why It’s Important to Master Stress

We are all under stress – nowadays, all the time.  That’s not how we were designed, and there are consequences.

The breathing technique at the end is great, but you don’t need a straw.  Simply 4 beats for the breath in, 8 beats for the breath out.  And it won’t take 5 minutes to feel better – probably more like a minute and a half.

FROM THE UNIVERSITY OF MINNESOTA CENTER FOR SPIRITUALITY & HEALING

Stress has a powerful impact on various aspects of your life—not only can it affect your mood, energy level, relationships, and work performance, stress can also cause and exacerbate a wide variety of health conditions. 

Impact on health

Persistent reactions to stress can lead to serious health problems, including:

• Cardiovascular disease. One study that tracked over 68,000 healthy adults for eight years found that those who reported feeling constantly under strain and unable to cope, among other symptoms of chronic stress, were likelier to die of cardiovascular disease. The results of another study associated chronic stress with a 40-60% increased risk of coronary heart disease.

• Digestive disorders. The “brain-gut” connection has a two-way effect: digestive disorders can cause stress, and the negative effects of stress can cause and aggravate digestive disorders. Part of the fight-or-flight response’s job is to halt digestion so the body can focus its energy on dealing with the perceived threat. Prolonged stress, then, can disrupt the normal digestive function and cause bloating, pain, and discomfort.

• Accelerated aging. Elissa Epel, a professor at the University of California, has focused much of her research on the relationship between stress and telomerase (the enzyme associated with aging). Her studies show that people with chronic stress in their lives, such as mothers with chronically ill children, have markedly shortened telomeres. In fact, one landmark study found that these women aged on average ten years faster than women who did not perceive chronic stress in their lives.

• Decreased immune functioning. Since the 1980s, research has found that stress can negatively affect the immune system. The American Psychological Association suggests that one cause of stress that might be most intricately linked to immune function is loneliness—people who don’t have a support system to lean on in stressful times wind up getting sicker more often.

According to the HeartMath Institute, other effects of stress include weight gain and obesity, headaches, irritability, diabetes, and insomnia, among others.

Impact on relationships

If you have ever spent time with someone who is suffering from severe stress, you’ll understand the ways it can affect how you two relate—the anger, irritation, and frustration that comes from stress can easily influence the things we say and how we treat one another.

In a 2009 study, researchers Neff and Karney examined the lives of newlyweds and found that during periods of high perceived stress, people tended to react more intensely to the normal ups and downs in a relationship—creating, in effect, problems where there weren’t any. When we perceive high amounts of stress, we tend to blame or take out our frustrations on others. This can create real damage in a relationship, affecting communication and trust, which then becomes another source of stress.

Impact on job performance

Stress at work is very common—the fight-or-flight response reserved for true threats can often be triggered by a demanding manager or an upcoming deadline. But reacting to chronic stress can impair your ability to succeed at your job. In fact, stress can impact job performance in a variety of ways, including:

• Physical symptoms that recur on work days (for example, upset stomach, headaches)

• Difficulty making decisions

• Dread of work days

• Wanting to avoid or leave work

• Emotional swings at work (for example, anger outbreaks or feelings of helplessness)

• Procrastination

• Inefficiency

Stress can lead to burnout—emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work. For example, in a recent study from the prestigious journal Archives of Internal Medicine, over 45% of practicing physicians are experiencing at least one symptom of burnout, which can lead to dangerous mistakes and lapses in judgment that could affect a patient’s health. A similar pattern of burnout is undoubtedly found in many other occupations, demonstrating the importance of stress management in the workplace.

You Only See What You Believe.

We all have filters. Those filters have real value -- if we didn't have filters we would be quickly overwhelmed by all the inputs around us. As such, we only really absorb a small fraction of all the information that bombards us constantly. But how do we make those choices?

People are fond of saying "I have to see it to believe it". It's not true. Chances are that if you don't believe it (or believe in it)... you will look right by it and never actually see it.

YOU ONLY SEE WHAT YOU ALREADY BELIEVE. As humans, one of our strongest drives is what's called "confirmation bias". That means you look for things that confirm what you already believe, often times completely overlooking the contrary.

Be careful - this will effect your whole life and can really skew how you see yourself and those around you. It will absolutely isolate you from alternative views and further close your mind (think the Google and Facebook algorithms -- they only show you what agrees with your already held views).

I've attached a very elegant demonstration of how the same data can be viewed in multiple ways... and they are clearly all correct. Perhaps the politicians could learn something from this as well....

Open your mind ... see alternatives ... solutions might be right in front of you!

It's the New Year. Is it time for a NEW YOU?

RED or BLUE Pill?
​You can create your own reality. First, you have to see it, then you can be it.

I Got An Award!

Last night I was lucky enough to receive the Achievements in Health Care Award from the Long Island Business News. A very cool honor to be amongst a long list of distinguished healthcare people! I've attached a grainy video from the event, if you want to watch a little. Thanks to everyone who supported this effort - it's much appreciated. Happy Holidays!

Havoc at the Holidays

Recently I had the opportunity to present to one of my networking groups -- thanks to ABA-NY and Ellen Volpe for providing me the forum. I've attached a 4 minute video addressing some of the challenges of the Holiday Season and some things to pay attention to.

Happy Holidays!

More Details about PLACEBO - does it matter what it's called?

The previous post from Dr Chopra referenced a terrific article from the NY Times magazine. It speaks about the science of Placebo.

I'm struck by the fact that we once again need to name something (like all of Western Medicine, not necessarily aiding in its resolution), and by so doing, creating connotations that might not be appropriate. Why is the PLACEBO concept automatically a negative association? The evidence of it's power is largely unrefuted. Where I think the problem comes lies in its association with deception.

But the cool thing about PLACEBO is that deception IS NOT PART OF ITS POWER! Many studies have shown that even when you inform patients that what you're giving them has no intrinsic health value -- it still works (a percentage of the time)!

Why do we continue to dismiss the power of the therapeutic relationship?!? As someone who takes great care in working with and working for the health of my patients, it seems to me that this is probably THE MOST IMPORTANT PART OF WHAT I DO! Medication, supplements, etc. certainly have real value when properly employed. But the negative side effects of an thoughtfully placed hand on an arm are hard to discern, and their positive effects are frequently beyond what one might reasonably expect.

I am a big believer in the PLACEBO concept -- no, I don't give out sugar pills (not without prior notice!!), but I do try to engage the patient's spirit in the effort of wellness. Reorient your psyche, and your physical being will follow. As Henry Ford said "whether you think you can, or you think you can't -- you're right.” Why not be right - and better!?

​Love to hear your thoughts.