Couch Potatoes CAN Cut Cancer Risk

Unless you’ve been under a rock, you probably heard about this one. 

In the past we’ve discussed that exercise is the single greatest thing you can do for your health (yes, more than diet!), and of course there’s always push back as to how much do I have to do?  The key concept is MED – minimal effect dose.  What’s the LEAST I have to do to see an effect?  Great general concept, really needs to be applied broadly.  

This study shows that literally 4 ½ minutes a day of moderate to vigorous activity (hard to really call it “exercise”) will significantly lower your risk of cancer (20% reduction).  If you just look at the cancers known to be related to low activity, this 4 ½ minutes translates to a 31% reduction in cancer development.  The very least you can get away with is 3.4 minutes daily total, with a 17% reduction in the incidence (new diagnosis) of cancer.  And the activity can be up to 1 minute at a time – we’re talking fast walking or stair climbing. And if you’re feeling lazy, know that there was no significant difference between 1 minute “exertions” and 2 minute “exertions”.  

So what’s your excuse now?

By the way, we have lots of similar things we can do to help you LIVE BETTER.

FROM MEDPAGE TODAY / BY MIKE BASSET

Couch Potatoes Take Note: Climb Some Stairs to Cut Cancer Risk

— Short bouts of vigorous activity may be a "promising" intervention for those who can't exercise

For adults who can't or don't like to exercise, short periods of vigorous activity as simple as climbing a flight of stairs may be enough to lower their risk of cancer, according to a large cohort study.

Compared with no vigorous intermittent lifestyle physical activity, the median daily duration of periods of vigorous activity up to 1 minute (totaling 4.5 minutes per day) was associated with a 20% reduction in total cancer risk (HR 0.80, 95% CI 0.69-0.92), reported Emmanuel Stamatakis, PhD, of the University of Sydney in Australia, and colleagues.

Moreover, there was also a 31% reduction in the risk of a physical activity (PA)-related cancer -- a composite of cancer sites known to be possibly associated with low physical activity (HR 0.69, 95% CI 0.55-0.86), they noted in JAMA Oncology.

"Daily VILPA [vigorous intermittent lifestyle physical activity] may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time," Stamatakis and colleagues wrote. "Long-term trials with cancer-related biomarker outcomes and well-designed cohort studies with wearable devices should further explore the potential of VILPA as a cancer prevention intervention for nonexercising individuals and for those who find structured exercise unappealing."

The researchers also found that a "minimal dose" of 3.4 minutes of vigorous activity per day was associated with a 17% reduced risk of total cancer incidence (HR 0.83, 95% CI 0.73-0.93), while 3.7 minutes daily was associated with a 28% reduced risk of physical activity-related cancer incidence (HR 0.72, 95% CI 0.59-0.88).

In an editorial accompanying the study, Linda S. Lindström, MSc, PhD, of Karolinska University Hospital in Stockholm, and colleagues, noted that studies have suggested that physical activity can also improve physical fitness, muscle strength, cancer-related fatigue, and quality of life among cancer survivors, adding that whether the results of this study can be extrapolated to cancer patients needs to be evaluated.

In any event, they said that it is clear that most individuals benefit from physical activity, "and the key is to make exercise a habit."

However, based on the findings of this study, they pointed out that even sporadic episodes of brief, vigorous physical activity can positively affect health and reduce the risk of disease, adding that "any physical activity is better than none."

This analysis included 22,398 adults from the U.K. Biobank accelerometry subsample (mean age 62 years, 54.8% women, 96.0% white). Only individuals who reported no leisure time exercise and one or fewer recreational walks a week were included.

Vigorous intermittent lifestyle physical activity is defined as short periods of vigorous physical activity such as bursts of fast walking or stair climbing. Stamatakis and colleagues said that it should only be measured with wearable trackers, such as the wrist-worn accelerometers used by participants in the U.K. Biobank accelerometry studyopens in a new tab or window.

Participants with cancer, cancer in remission, a cancer event during the first year after accelerometry baseline, or inadequate wear time were excluded.

Analyses were adjusted for age, sex, body mass index, education level, smoking status, alcohol consumption, sleep duration, fruit and vegetable consumption, medications, parental cancer history, prevalent cardiovascular disease, daily durations of light- and moderate-intensity physical activity, and daily duration of longer vigorous exercise bouts.

During a mean follow-up of 6.7 years (149,650 person-years), 2,356 new cancer events were reported (1,084 in physical activity-related cancer sites).

Most (92.3%) vigorous activity occurred in bouts of up to 1 minute; the results related to 1-minute bouts were similar to those for up to 2 minutes, the authors noted.

Cut Cancer by Keeping to a Schedule?

Everybody has an internal clock.  It’s called your Circadian rhythm.  When you keep to a regular schedule (assuming of course it’s not an insane schedule), your body can work out when it’s best to do the things that are necessary to keep itself healthy.  If you’re all over the map from a timing perspective, varying activities like eating and sleeping wildly from day to day, you’re body literally won’t know what to do when.  And this sort of thing can lead to cancer.  So….don’t do that.  Work toward a regular schedule – the main issues involve rising and sleeping at relatively consistent times, as this could legitimately decrease your risk of cancer.  Not that hard to do…

FROM SCIENTIFIC AMERICAN / BY LYDIA DENWORTH

Adjusting Your Body Clock May Stave Off Cancer

Research shows that disrupting the body’s circadian rhythm raises cancer risk, and resetting it may bring that risk down

I usually get up by 7 A.M. and am in bed by 10 P.M. I tend to eat meals at the same times of day, too. This may sound a little dull, but it's essential for my productivity. It's also a schedule that rarely disrupts my body clock. And a steady clock, it turns out, just might help me and many other people avoid cancer and some other diseases, according to new research.

What I call a body clock really means circadian rhythms, from the Latin for “about” and “day.” These are the body's internal biological pacemakers, physiological fluctuations that help us adjust to the phases of a 24-hour day by synchronizing with environmental cues such as light, dark, temperature and food intake. These rhythms affect sleeping and waking, feeding and fasting, endocrine cycles, immune function, and cell growth.

For some time now epidemiological studies of night-shift workers have linked disruptions in circadian rhythms to cancer and other diseases. Much of the evidence concerned breast cancer and to a lesser extent prostate cancer. Duration of shift work made a difference—nurses who worked night shifts for up to 30 years were at moderately increased risk for breast cancer compared with those who did shorter stints, and those who worked such shifts for more than 30 years had the highest risk. In 2019 the World Health Organization reaffirmed and updated a research statement from the agency showing that shift work is a probable carcinogen.

Now there is even more evidence involving other types of malignancies, including liver, lung and colorectal cancers, from a spate of new studies. “We're starting to understand the reasons these things happen,” says Selma Masri, a circadian biologist at the University of California, Irvine, who has shown how circadian disruption pushes colon cancer progression by interfering with the way certain genes are expressed.

The cancer connection comes about through several mechanisms. Circadian disruption affects metabolic pathways, the chemical reactions that produce energy in the body. It tampers with immune function. It also compromises the fidelity of DNA repair in cells. Adult human cells divide every 18 to 24 hours, and one function of the circadian clock is to tell cells to do that at night to avoid DNA damage from sunlight. “When the clock gets disrupted, cells don't know when to divide,” says circadian biologist Satchidananda Panda of the Salk Institute for Biological Studies. “They can divide faster and become a tumor.”

Circadian disruption doesn't only occur in shift workers. It happens when we consistently don't get a good night's sleep—scientists say this can mean waking up for two or three hours between 10 P.M. and 5 A.M. at least once a week. Wakeful episodes can be caused by jet lag, staying out late, or looking at blue-light-emitting phone screens—which mimic daylight—at night. When and what we eat also cues our rhythms, just as light and dark do, so add snacking at midnight to the list of things to avoid.

The growing understanding of circadian rhythms also could offer help through what's known as chronotherapy. Certain chemotherapy treatments, for example, are more effective when given in accordance with a patient's rhythms. Now researchers are exploring differences in the timing of radiation therapy. Drugs that bolster natural rhythms are also under investigation.

Shift work is critical and not going away, says Katja Lamia, a circadian biologist at Scripps Research, but there might be ways of reducing its toll on the body. Her research suggests that subtle increases in body temperature might be an important factor in circadian disruption. If that turns out to be right, Lamia says, “we can use noninvasive monitoring of body temperature in shift workers to evaluate who's at risk and take a personalized scheduling approach.”

For those who don't work at night, changing some routines might be enough. A good night's sleep should be a priority. Eating habits can also play a role. Panda and his colleagues are investigating a practice known as time restricted eating (TRE) or intermittent fasting. That might mean delaying breakfast by an hour or two until cortisol levels drop and eating dinner at least three hours before your habitual bedtime. In a 12-week study of firefighters, TRE benefited their metabolic health and improved their sleep. In mice, it has been shown to reduce the risk of cancer or to slow the growth of tumors.

Maybe, Panda says, respecting our circadian rhythms can help protect our time-sensitive bodies.

What's the Best Time to Exercise?

20 years ago I would tell patients that they’re best time to exercise would be pre-dinner.  I figured that as the body’s metabolism starts to slow, and we would exercise at that time, we could get a double benefit – push the metabolism back up, and if you time it before a meal, that metabolism will use the soon to be delivered calories.  (Peak occurs normally after late morning – peak metabolism occurs as a spike in response to the cortisol surge that typically wakes people up, and the metabolism rise follows that spike) This timed combination would improve people’s weight management, as well as keeping their input matching the body’s needs.  

This study suggests that for those with the biggest issues around calorie utilization (diabetics), moving exercise to the afternoon will have better results than those exercising in the morning.  It just goes to show that if you pay attention, it’s not hard to anticipate what the “real research” will show.  Like I’ve said before, it’s not that hard to be ahead of the curve.

FROM CNN ONLINE/ BY AMY WOODYATT

People with type 2 diabetes may benefit from exercising in the afternoon, study shows. Researchers concluded that "timing does seem to matter" when it comes to physical exercise.

People with type 2 diabetes should exercise in the afternoon instead of the morning to manage their blood sugar, a new study has found.

“In this study, we (have) shown that adults with type 2 diabetes had the greatest improvement in glucose control when they were most active in the afternoon,” co-corresponding author Dr. Jingyi Qian, from the Division of Sleep and Circadian Disorders at Massachusetts’ Brigham and Women’s Hospital, said in a statement.

“We’ve known that physical activity is beneficial, but what our study adds is a new understanding that timing of activity may be important too,” Qian added.

A team of researchers from Brigham and Joslin Diabetes Center studied data from more than 2,400 people who were overweight and diagnosed with type 2 diabetes, and were wearing a waist accelerometry recording device – something that measures vibration or acceleration of motion – to measure their physical activity.

After reviewing data from the first year of the study, researchers found that those who did “moderate-to-vigorous” physical activity in the afternoon had the greatest reduction in blood glucose levels.

According to Harvard’s School of Public Health, examples of “moderate” activity include brisk walking, mowing the lawn with a power mower and playing badminton recreationally, while “vigorous” activity includes hiking, fast jogging, a basketball or soccer game or cycling at 14-16 miles per hour.

You can tell if you are exercising at a moderate aerobic level if you’re able to talk but not sing your favorite song, according to the US Centers for Disease Control and Prevention.

When looking at data from the fourth year of the study, the team found that those who exercised in the afternoon maintained a reduction in blood glucose levels, and had the highest chance of being able to stop taking glucose-lowering diabetes medication.

Type 2 diabetes is the most common type of diabetes, and occurs when the body becomes resistant to insulin, or doesn’t make enough insulin, according to the World Health Organization.

Mostly found in adults, it is associated with older age, obesity, family history, physical inactivity and race/ethnicity.

People with diabetes are at risk of complications including nerve damage, vision and hearing problems, kidney disease, heart disease and premature death.

The study’s authors note that the observational study does come with limitations, as it didn’t measure sleep or diet.

“Timing does seem to matter,” said co-corresponding author Dr. Roeland Middelbeek, assistant investigator at Joslin Diabetes Center. “Going forward, we may have more data and experimental evidence for patients to give more personalized recommendations.”

Dr. Lucy Chambers, Head of Research Communications at Diabetes UK, said of the study: “Keeping physically active can help people with type 2 diabetes manage their blood sugar levels and reduce their risk of developing serious diabetes-related complications such as heart disease and kidney failure, as well as improving their overall wellbeing.

Chambers, who was not involved with the study, emphasized the need for people to exercise where they can.

“This new research found that regular ‘moderate-to-vigorous’ physical activity – whether in the morning, midday, afternoon or evening – was associated with lower average blood sugar levels in people with type 2 diabetes. Afternoon exercise was linked with the greatest benefits but the reasons for this are unclear and current evidence on optimal times for exercising is mixed.

“If you’re living with type 2 diabetes, the most important thing is to find an exercise you enjoy and that you can incorporate into your routine in the long-term – whether it’s before work, on your lunch break, or in the evening,” she added.

The team’s findings are published in the journal Diabetes Care.

Bitten by a Tick: What's My Risk of Getting Sick?

Climate change is causing the increase in toxic encounters (I don’t mean those people you can’t spend time with), especially during the warmer months, and into the fall.  That means more mosquitoes, more ticks, more chances of getting sick from these insect bites.  But how do you know when it’s reasonable to worry about it?  This article tells a pretty clear story – essentially, the key is 24 hours.  IF you can find the tick BEFORE it’s been on you for a full day, you will most likely NOT get infected with Lyme or similar tick-borne diseases.  BUT YOU’VE GOT TO CHECK!  When you come back inside from being out in nature, give yourself a once-over.  It’s helpful if you don’t expose skin, but it it’s super hot out and you want to be out, that can be tough.  But it’s all a balancing act, after all.

FROM MEDPAGE TODAY / BY KRISTINA FIORE

Here's when you need to call a healthcare provider -- and when you don't

While tickborne diseases have been on the rise across the U.S.opens in a new tab or window, outdoor enthusiasts can take comfort knowing that most common infections aren't transmitted quickly, researchers said.

For instance, Borrelia burgdorferi, the bacteria that cause Lyme disease -- which is "far and away the most common tickborne disease in the U.S." -- take more than 24 hours to be transmitted from the tick to the host, according to Jonathan Oliver, PhD, a public health entomologist at the University of Minnesota.

"If you do tick checks every day and make sure you remove any attached ticks, your risk of Lyme disease is very low, even if the tick was infected," Oliver told MedPage Today.

That's because Borrelia don't live in the salivary glands of the tick. Instead, they live in the mid-gut and "need to be activated by the tick taking a blood meal," he explained. Only then can they migrate to the salivary glands and be transmitted to the host, he said.

Infectious disease physician Del DeHart, MD, of the University of Michigan Health-West, agreed that there's "no need to seek medical care after most tick bites, particularly if you see them and remove them."

"If you catch them early, then you really decrease the risk that they're going to transmit anything to you," DeHart said.

There are many types of ticks and they transmit "a greater diversity of pathogens than any other vector," Oliver noted, from bacteria and viruses to protozoans. The ticks of greatest concern for disease transmission are those with broad host ranges, including the blacklegged tick (Ixodes scapularis), the lone star tick (Amblyomma americanum), and the American dog tick (Dermacentor variabilis).

The blacklegged tick -- also known as a deer tick -- transmits Borrelia burgdorferi, the bacteria Anaplasma phagocytophilum, which cause anaplasmosis, and the protozoan Babesia microti, which causes babesiosis, Oliver said. It can also transmit Powassan virus, which is "pretty rare but can be very bad," he added. "It can cause encephalitis and meningitis and can be lethal."

The lone star tick can transmit the bacteria Ehrlichia, which cause ehrlichiosis, as well as Bourbon virus and Heartland virus, Oliver said. Both viral diseases are "extremely rare as far as we know, but they can cause encephalitis-type symptoms."

The American dog tick can transmit Rickettsia rickettsii, which cause Rocky Mountain spotted fever. "There are a variety of spotted fever diseases of varying severity, but Rocky Mountain spotted fever is the really bad one," he explained.

Luckily for humans, infection risk is not just a function of time the tick has been attached, but also by the proportion of the tick population that's infected with any given disease. Lyme is the most common disease, Oliver said, partly because a third to a half of adult blacklegged ticks carry Borrelia. About a quarter to a third of nymph blacklegged ticks will carry the bacteria, but they're smaller than adults so can be more difficult to spot.

Other diseases are far less common. Oliver estimated that less than 10% of lone star ticks will carry Ehrlichia species that cause ehrlichiosis, and less than 1% of American dog ticks will carry Rickettsia rickettsii.

Nonetheless, "if a tick attached long enough, it will eventually transmit whatever diseases it is carrying," he said.

That's why prevention is of utmost importance, DeHart said, noting that using tick repellent and wearing long pants -- and tucking them into your socks -- are two key ways to prevent tick bites when outdoors. In addition to tick checks after being outside, people should also check themselves periodically "so you can pick them off," he said.

"Make sure to check places you may not think of -- the groin area, between your butt cheeks," DeHart added. "Ticks love to go to warm places, so doing a really thorough tick check is important."

There's no need to call a doctor after most tick bites, DeHart said, particularly if you find them and remove them. If the tick is engorged or has been attached a long time, however, it's not a bad idea to have it identified for potential future reference.

Academic labs can do the identification, or some services can even do identification via images alone, he added.

"If it can be identified and it's a dog tick and you're not in an area where worries about that are significant, then you don't need to worry much about it. If you're in an area with Rocky Mountain spotted fever, then you would," DeHart said. "If it's not a blacklegged tick, you don't need to worry about Lyme disease. So it can be helpful if you get it identified."

People who've been bitten by a tick should seek medical attention if they develop a significant rash, or flu-like symptoms including a fever or a headache, he said, as those are common signs of infection with many of the tickborne diseases.

DeHart noted that CDC's reference manual for healthcare providersopens in a new tab or window on tickborne diseases in the U.S. is particularly helpful for physicians, as it contains images for tick identification, geographic distribution of the most common tickborne diseases, and their most frequent symptoms.

If you just keep moving, diabetes is a lot harder to get!

Here’s another study that demonstrates the benefit of exercise in avoiding the development of diabetes.  And as I’ve mentioned before, the benefit starts to accrue at literally 5 minutes a day, but has the highest benefit at more than 1 hour a day.  Any activity exceeding a walk of 3 mph, like vacuuming, or walking stairs qualifies.  If you think about being active around an hour a day compared to doing essentially nothing (tv, etc), that drops your risk of developing diabetes by 3/4s.  Get up, get moving.  It’s just not that hard – and it’s just not really exercise!

From british journal of sports medicine / by Mengyun Luo, Chenhao Yu, Borja Del Pozo Cruz, Liangkai Chen, Ding Ding

Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study

Abstract

Objective Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk.

Methods This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013–2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models.

Results During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3–25.9 min/day, 0.41 (0.34 to 0.51) for 26.0–68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk.

Conclusion Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D.

Why I Always Look Ahead When it Comes to Patient Health

We've been doing this for years! Now the American Heart Association thinks it might be a good idea.

As you may have heard, I think of myself as “ahead of the curve”.  Of course, in US medicine, the curve is around 20 yrs long, so, in itself, that might not be saying much!  Regardless, a recent article in the Journal of the American Heart Association suggests that testing the population for NT-proBNP might be a good idea.  Well, I started doing that ABOUT 10 YEARS AGO!  

NT-proBNP is a small protein that is made in the heart muscle that is released in response to the stretch of the muscle.  Too much stretch, too much NT-proBNP, and as “too much” might suggest, that’s bad.  Long ago it was found that high levels of NT-proBNP are tied to heart failure, and the rise in levels can predict upcoming episodes.  But even modest elevations can show the stretch, and give a window into general heart health.  

The study suggests that the levels may tie to overall mortality, not just cardiovascular deaths.  

I guess I’ll keep doing it.

FROM JAHA / By Justin B. Echouffo‐Tcheugui, Sui Zhang, Natalie Daya, John W. McEvoy, Olive Tang, Stephen P. Juraschek, Chiadi E. Ndumele, Josef Coresh, Robert H. Christenson and Elizabeth Selvin

NT‐proBNP and All‐Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study

Background

NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle‐aged and older populations, have suggested that NT‐proBNP has prognostic value in ambulatory adults.

Methods and Results

We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT‐proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT‐proBNP with all‐cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self‐reported history of CVD). There were 3155 deaths (1009 CVD‐related) over a median 17.3 years of follow‐up. Among individuals without prior CVD, elevated NT‐proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all‐cause (hazard ratio [HR], 1.67 [95% CI, 1.39–2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61–5.11]). Associations of NT‐proBNP with all‐cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05).

Conclusions

In a representative sample of the US adult population, NT‐proBNP was an important independent risk factor for all‐cause and CVD mortality. NT‐proBNP may be useful for monitoring risk in the general adult population.

To Drink or Not to Drink? That is the question...

For a long time there’s been this idea that a drink or two a day will actually extend your life.  That’s been at odds with the fact that alcohol is clearly a toxic substance – it is a direct poison to heart muscle, for example.  The concept of hormesis is usually employed as the argument – the idea of whatever doesn’t kill you makes you stronger.  Well, that’s not what the latest up-dated meta-analysis shows.  In fact, there’s no real health difference between not drinking, less than 2 drinks a day and even 2-3 drinks a day.  If you got to 3-4 drinks, though, there’s nearly a 20% increase in all-cause mortality (risk of dying), and at more than 4 ½ drinks a day that risk goes up 35%!

SO, if you want a drink, have one, or even two (assuming your heart can take it!), but going further regularly will cost you. SKOL!

FROM MEDPAGE TODAY / BY KRISTEN MONACO

That glass of red wine with dinner probably won't protect you from an early grave, according to an updated meta-analysis on the longevity impact of alcohol.

Compared with never-drinkers, "low-volume" drinkers who kept daily alcohol intake under two drinks (1.3 to 24 g ethanol) each day didn't see any reduction in the risk for death from any cause (relative risk 0.93, 95% CI 0.85-1.01), found researchers led by Jinhui Zhao, PhD, a scientist and senior data analyst at the University of Victoria's Canadian Institute for Substance Use Research, in British Columbia.

A typical 12-oz beer or 5-oz glass of wine in the U.S. contains about 14 g of pure ethanol.

"Medium-volume" consumers who threw back about three drinks per day (25 to 44 g of ethanol) also didn't see any significant protection or harm from their habits when compared with non-drinkers (RR 1.05, 95% CI 0.96-1.14), the group reported in JAMA Network.

"Our study gives strong grounds for scepticism regarding the comforting idea that alcohol in moderation is good for health," co-author Tim Stockwell, PhD, also of the University of Victoria, told MedPage Today by email, adding that there continues to be controversy on this topic.

"The idea that alcohol is beneficial in moderation has a profound influence on global, national, and regional estimates of alcohol's impact on health and safety," he explained. "It also has profound implications for guidelines prepared by health authorities for alcohol drinkers wishing to reduce health risks."

While low or moderate alcohol intake didn't appear to increase the risk for death in this study, it was consistent with others in suggesting there also weren't any actual health benefits, said Timothy K. Brennan, MD, MPH, chief of clinical services for the Addiction Institute of Mount Sinai in New York City.

"No alcohol is best," he told MedPage Today. "Drinking less is always better for our bodies than drinking more."

"It is clear from this study -- and many others -- that heavy drinking not only increases the likelihood of developing a variety of diseases, but it also increases the risk of dying," noted Brennan, who wasn't involved with the study.

Drinking any more than about three drinks in a typical day started to catch up with folks, the researchers found.

People considered "high volume" drinkers in the study -- this included those who drank anywhere between 45 to 64 g of ethanol each day -- saw a 19% higher relative risk for all-cause mortality (RR 1.19, 95% CI 1.07-1.32).

Following an upward pattern, consumers of more than about 4.5 drinks a day (65 g ethanol) saw the highest risk for an early death, with a 35% higher risk for all-cause mortality compared with lifetime abstainers from booze (RR 1.35, 95% CI 1.23-1.47).

Even when compared with just the occasional drinker -- those who keep it under one drink a week -- high and higher-volume drinkers still saw significantly higher risks for death.

But the "safe" threshold for drinking was lower for women.

When just looking at data on females, even medium-volume drinking wasn't without health risks. Women drinking around two to three servings (25 to 44 g of ethanol) daily saw a 21% higher risk of death from any cause compared with women who completely abstained from alcohol (RR 1.21, 95% CI 1.08-1.36). On top of that, high- and higher-volume female drinkers had a 34% and 61% increased risk for death, respectively.

Overall, Brennan advised that men limit their alcohol intake to two drinks per day or less and women should limit their intake to one drink per day or less.

While all ages generally saw the same pattern -- higher all-cause mortality linked with more than three drinks per day -- the magnitude of this risk was more pronounced for those under age 56. Because of this, the researchers suggested future studies home in on this younger age group.

The fully adjusted models took into consideration factors like abstainer biases, age, sex, study country, drinking patterns, lifestyle factors, and more.

Data on over 4.8 million individuals and 425,564 deaths were compiled as part of this updated systematic review and meta-analysis, which included 107 studies in more than 20 countries published from 1980 to 2021.

These findings support those from two prior meta-analyses conducted by the same research group. In 2016, the researchers found a trend suggesting that low-volume daily drinking might help stave off death from any cause, but this risk reduction disappeared after adjustment for abstainer biases and quality-related study characteristics. A year later, the researchers found mixed results when looking at the link between alcohol and coronary heart disease.

As the third installment in their series, the current meta-analysis was able to incorporate the last few years of new data. "Our study summarized results from every published study on the topic canvassing the life experiences of nearly 5 million individuals," said Stockwell.

"Our focus is on the validity of the hypothesis that alcohol in moderation is beneficial for health," he added.

However, the group said that the available research on the topic is still riddled with drinker misclassification errors, as 86 of the studies included former drinkers or occasional drinkers in the abstainer group used for comparison. Only 21 of these studies were actually free of abstainer biases.

"The importance of controlling for former drinker bias/misclassification is highlighted once more in our results which are consistent with prior studies showing that former drinkers have significantly elevated mortality risks compared with lifetime abstainers," Zhao's group said.

For example, they found former drinkers carried a 26% higher risk for death from any cause than lifelong abstainers (RR 1.26, 95% CI 1.12-1.42). This lends support to the notion of "sick quitters," or former drinkers who quit due to health reasons.

Stockwell also pointed out how studies of older people are the most biased toward finding health benefits from moderate drinking.

"One of the reasons for this is that older people who continue to drink tend to be particularly robust and healthy, while those who stop drinking often do so because they have become unwell," he explained.

"Being able to continue drinking at an older age is a sign -- not a cause -- of good health," said Stockwell.

You CAN reverse Diabetes, but you better do exercise, too!

A really interesting study of prediabetes says that simply reversing prediabetes doesn’t cut your risk of dying. Of course, a big percentage of people will progress to diabetes, and their risk of dying goes up 50%.  But just getting the sugar normal will not, by itself, keep you alive longer.  You have to do exercise!  If you drop your sugar AND you do exercise you cut your risk of dying by around 30%, translating to another 2- 2.5 years of life. 

FROM MEDPAGE TODAY / BY KRISTEN MONACO

Reduced risk only seen in physically active patients, Taiwanese study found

Reversing prediabetes was not associated with a lower mortality risk, according to a Taiwanese cohort study of more than 45,000 adults.

Over 8 years of median follow-up, patients who reversed their condition to a state of normoglycemia didn't experience a significantly lower risk for all-cause, cancer-related, or cardiovascular-related death compared with those who remained in persistent prediabetes, reported Xifeng Wu, MD, PhD, of Zhejiang University in China, and colleagues.

"Interestingly, reversion to normoglycemia combined with the adoption of healthy behaviors, such as a higher level of physical activity and no current smoking, were associated with a substantially lower risk of death and longer life expectancy," the authors wrote in JAMA Network. "These findings highlight the importance of lifestyle modifications among individuals with prediabetes status."

Across multiple analyses looking at modifiable risk factors and all-cause mortality, the only groups with a significantly lower risk were patients who were physically active and either reversed their prediabetes (HR 0.72, 95% CI 0.59-0.87) or remained in a state of prediabetes (HR 0.77, 95% CI 0.66-0.90), with both groups compared with inactive individuals with persistent diabetes. These differences translated to roughly a 2- to 2.5-year longer life expectancy.

Physically active individuals were clocking 7.50 or more metabolic equivalent of task (MET) hours per week, while inactive individuals were getting less than 3.75 MET hours per week. No benefit was seen for individuals who were "moderately" active (3.75-7.49 MET hours per week). Though it depends on someone's body weight, a brisk walk can typically range from 3 to 6 METs, according to the CDC.

While individuals with obesity didn't see a significant death protection by reversing prediabetes (HR 1.10, 95% CI 0.82-1.49) compared with those of normal weight with persistent prediabetes, those who stayed in a prediabetic state with obesity carried an excess risk for death (HR 1.33, 95% CI 1.10-1.62).

And normoglycemia still couldn't offset the risks that came with smoking, as current smokers carried a similar 60-61% higher mortality risk whether they had achieved normoglycemia or remained in persistent prediabetes when compared with never smokers with persistent prediabetes. This translated to roughly 3 to 3.5 years less of life expectancy for the current smokers.

This pattern was not seen with alcohol drinkers, though.

The 45,782-person population-based cohort study gathered data from the Taiwan MJ Cohort Study, which recruited participants from 1996 to 2007. In the entirely Asian cohort, 63% were men, and average age was 44.6 years.

Within the first 3 years after study enrollment, 3.9% progressed to full-blown type 2 diabetes, while 37.2% reversed back to normoglycemia. Over the median 8-year follow-up period, 1,528 deaths occurred, including 671 from cancer and 308 from cardiovascular disease.

Not surprisingly, those who progressed to full-blown type 2 diabetes over the 3-year period had a higher risk for all-cause and cardiovascular-related mortality than those who persistently stayed in the prediabetic state:

• All-cause mortality: HR 1.50 (95% CI 1.25-1.79)

• Cardiovascular-related mortality: HR 1.61 (95% CI 1.12-2.33)

Wu and co-authors noted that the results of their study "extended previous findings by confirming that the association between prediabetes and the risk of death might be explained by progression from prediabetes to diabetes."

Diabetes status was ranked according to fasting plasma glucose level by American Diabetes Association criteria: normoglycemia (<100 mg/dL), prediabetes (100-125 mg/dL), diabetes (≥126 mg/dL). All were measured with overnight fasting blood samples taken in the morning.

Genetic evaluation should be used for more than chemotherapy!

Currently, in conventional medical practice, the term “personalized medicine” routinely refers to identifying the genetics of some cancerous tumor so as to “tune” chemotherapy.  Of course, I’ve been using genetic evaluations from a wide variety of providers depending on specific needs, none of which involves a cancerous tumor.  The attached abstract hints at the value that an appropriate genetic evaluation could have for both individuals and populations.  By running patients with high blood pressure through a genetic test panel (only 10 genes) that then translated into much more effective high blood pressure treatment in a much shorter time than in the population receiving usual care.  Since about 45% of strokes occur in patients with hypertension who aren’t adequately controlled, controlling blood pressure more quickly through genetic could easily pay for itself in better outcomes (and it real dollars!).  

One could ask why we don’t do this… but that would just be a silly question, right?

FROM SCIENCE TRANSLATIONAL MEDICINE / BY QI SHEN HONGHONG ZHANG, YIMING HUANG, MINGYU LI, HAO ZHAO, ZHIWEN YANG, HAIJING ZHAO, QI LIU, ZIHAO FU, SHU WANG

Genetic variants among individuals have been associated with ineffective control of hypertension. Previous work has shown that hypertension has a polygenic nature, and interactions between these loci have been associated with variations in drug response. Rapid detection of multiple genetic loci with high sensitivity and specificity is needed for the effective implementation of personalized medicine for the treatment of hypertension. Here, we used a cationic conjugated polymer (CCP)–based multistep fluorescence resonance energy transfer (MS-FRET) technique to qualitatively analyze DNA genotypes associated with hypertension in the Chinese population. Assessment of 10 genetic loci using this technique successfully identified known hypertensive risk alleles in a retrospective study of whole-blood samples from 150 patients hospitalized with hypertension. We then applied our detection method in a prospective clinical trial of 100 patients with essential hypertension and found that personalized treatment of patients with hypertension based on results from the MS-FRET technique could effectively improve blood pressure control rate (94.0% versus 54.0%) and shorten the time duration to controlling blood pressure (4.06 ± 2.10 versus 5.82 ± 1.84 days) as compared with conventional treatment. These results suggest that CCP-based MS-FRET genetic variant detection may assist clinicians in rapid and accurate classification of risk in patients with hypertension and improve treatment outcomes.

SNPing out hypertension

Essential hypertension has multiple genetic risk factors that can affect both its incidence and response to treatment. Here, Shen and colleagues developed a simple, high-throughput fluorescent assay for detection of two different single nucleotide polymorphisms (SNPs) in a single reaction. They applied this method in a prospective study to screen for variants at a total of 10 loci associated with hypertension and guide medication use based on drug class-associated risks. Patients treated according to this precision medicine approach had improved blood pressure control over a 7-day period compared with those treated using standard guidelines. These results suggest that this assay should be further studied and may be useful in resource-limited settings.

With a Simple Blood Test, It’s Easier than Ever to detect Brain Injuries

Concussions are common and can have serious consequences.  If you show up at the ER with a head injury, chances are you’ll get a CT scan of your head.  But going forward that may be overkill – a blood test will reliably be able to tell you if you don’t need one.  That could save hours and hours at the hospital.  That would be great for most people.  Of course, conventional medical practice does little to help those who end up having a concussion, but we can help you with that.  There’s lots of options, all of which will help improve the condition more quickly, so long as you actually do something about it.  The usual advice is rest, take it easy.  Yes, but there are supplements and therapies that can be applied and accelerate healing.  Keep that in mind should you have this issue.  I’m here to help!

FROM ABBOTT LABS

Abbott has received U.S. Food and Drug Administration clearance for what will be the first commercially available laboratory traumatic brain injury (TBI) blood test, making it widely available to hospitals in the United States. The test, which runs on Abbott's Alinity® i laboratory instrument, will provide clinicians with an objective way to quickly assess individuals with mild TBIs, also known as concussions.

Abbott's Alinity i TBI lab test offers a new reliable result in 18 minutes to help clinicians quickly assess concussion and triage patients. For those with negative results, it rules out the need for a CT scan and can eliminate wait time at the hospital. The test measures two biomarkers in the blood that, in elevated concentrations, are tightly correlated to brain injury.

For decades, standard concussion assessment has remained the same, with doctors leveraging the Glasgow Coma Scale, a subjective doctor assessment, and CT scans to detect brain tissue damage or lesions. Having a blood test available could help reduce the number of unnecessary CT scans by up to 40%, potentially reducing costs to the healthcare system and the patient as well as the amount of time they spend in the emergency department.

Millions of people in the U.S. suffer a concussion each year, but more than half of people who suspect they have a concussion never get it checked.

"People sometimes minimize a hit to the head, thinking it's no big deal. Others wonder if a visit to the doctor or emergency room for a possible concussion will provide them with meaningful answers or care," said Beth McQuiston, M.D., medical director in Abbott's diagnostics business. "Now that this test will be widely available in labs across the country, medical centers will be able to offer an objective blood test than can aid in concussion assessment. That's great news for both doctors and people who are trying to find out if they have suffered a traumatic brain injury."

TBIs are caused by a bump, blow or whiplash to the head and can pose risk of both short- and long-term effects. People who experience a TBI may experience impairment of memory, movement, sensation (e.g., vision and hearing), and emotional functioning (e.g., personality changes, psychological symptoms). Effects of TBI can last anywhere from a few days post-injury or may be permanent. People who sustain a TBI are more likely to have another one – similarly to how a sprained ankle or torn ligament is more susceptible to future injury.

These effects are worsened by misdiagnosis or lack of diagnosis, so providing tools that can objectively aid in the evaluation of a TBI or concussion is essential to giving people the answers and treatment they need.

Abbott has been pioneering breakthroughs in TBI testing technology for over a decade. This FDA clearance complements Abbott's i-STAT TBI Plasma test, the first rapid blood test for concussion, which is already cleared by the FDA. With the Alinity i clearance, a TBI blood test can now be run on Abbott's high throughput Alinity i laboratory instrument. The advancement will make TBI testing more available because the Alinity i instrument is widely used in hospitals and laboratories across the U.S.

The Alinity i test can be used when a patient shows up to the hospital with a suspected mTBI within 12 hours of injury. A blood sample is drawn from the arm and sent to the lab for preparation and the test is run on the Alinity i instrument. Results are available in as little as 18 minutes and shared with the treating healthcare provider for evaluation.

Broadening the availability of the TBI blood test for use on lab-based instruments is an important step in Abbott's strategy to ensure its tests are available in all settings where people seek care for head injuries.

About Alinity i laboratory test for TBI

The Alinity i TBI test measures complementary biomarkers in blood plasma and serum - Ubiquitin C-terminal Hydrolase L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP), that, in elevated concentrations, are tightly correlated to brain injury. It provides test results with 96.7% sensitivity and 99.4% negative predictive value.

Testing for these two biomarkers in the immediate aftermath of an injury can help health care providers decide appropriate next steps and develop a plan to care for patients. The test is for use to aid in the evaluation of patients, 18 years of age or older, presenting with suspected mild traumatic brain injury (Glasgow Coma Scale score 13-15) within 12 hours of injury, to assist in determining the need for a CT (computed tomography) scan of the head.

The test previously received European Union clearance and has been available in markets outside the U.S. since 2021.