Salt and cardiovascular health – not as evil as we once thought

salt

If you are worried about your cardiovascular health, one of the things you want to avoid is salt. This was based on ancient research that seems to show even moderate salt intake could do all kinds of bad things for your cardiovascular system.

I was always skeptical of these claims because if you’ve got a healthy set of kidneys, the body has an amazing ability to regulate salt levels in the body. Of course, maybe there is some level of salt consumption that increases the blood pressure, cause retention of water, and other issues that lead to cardiovascular issues.

Recently, a very large prospective epidemiological study examined levels of salt consumption versus cardiovascular events. What did they find? Only high levels of salt consumption are linked to cardiovascular health. Continue reading “Salt and cardiovascular health – not as evil as we once thought”

Omega-3 supplements have little effect on cardiovascular disease and mortality

omega-3 supplements

I have been skeptical of supplements for a long period of time. Supplements are generally of low quality, they don’t prevent or cure cancer, they don’t prevent colds, they can’t boost the immune system, and they don’t prevent heart disease. Now there is a powerful review of omega-3 supplements that shows that it has little effect on cardiovascular disease.

Unless one has a chronic disease or is chronically malnourished, there are precious few instances where supplements are necessary. A couple of cases where supplements may be critical include prenatal folic acid supplements to prevent neurological defects in the developing fetus, vitamin C to prevent scurvy, and vitamin D supplements for individuals who do not produce enough endogenous vitamin D. In each of these cases, however, supplements are necessary to counteract a micronutrient deficiency that results from a chronic deficiency in the diet.

The benefits of omega-3 supplements have always been intriguing to me because it is a supplement that I thought might be useful for improving cardiovascular health. But as I reviewed before, the evidence seemed awfully weak. With this new study, there may be no evidence whatsoever supporting the use of omega-3 supplements, at least for cardiovascular disease. Continue reading “Omega-3 supplements have little effect on cardiovascular disease and mortality”

Mediterranean diet and cardiovascular diseases study retracted – “aw nuts”

mediterranean diet

Although I think that most diets are bogus and healthy outcomes are not very well supported by scientific research, I have been a proponent of the so-called Mediterranean diet. It seems to have been linked to lower risks of cancer, cardiovascular disease, and some other chronic health conditions.

The claims of researchers who stated that the so-called Mediterranean diet, rich in plants, olive oil, fish, nuts, and other foods, was linked to lower risks of cardiovascular disease. It was a pivotal and robust cohort study, a powerful form of epidemiological study that sits near the top of the hierarchy of medical research, that influenced a lot of recommendations about the proper diet for people. The study was so powerful that I switched to that diet personally.

But lucky for the planet, science is self-correcting, and some aspects of the original study caused concerns, and the Mediterranean diet study was retracted and republished with corrections.

Does this mean that the Mediterranean diet was and is bogus? No, but let’s take a look at the whole story. Continue reading “Mediterranean diet and cardiovascular diseases study retracted – “aw nuts””

Dietary supplements make costly urine – not helpful for CVD

dietary supplements

I have never been a fan of dietary supplements pushed by Big Supplement, the less regulated, less evidence-based, more pseudoscientific mirror image of Big Pharma. Recently, a meta-review published in a respected journal examined whether there were any causal links between various dietary supplements and cardiovascular disease (CVD). They only found one, folic acid, that might have an effect on CVD, but, in that case, causality might not be so clear.

Just to be perfectly clear, no one on the side of real science-based medicine would dismiss using dietary supplements to treat chronic medical conditions. Many people have had surgeries, illnesses, and other medical conditions where certain supplements are necessary for the patient to survive. But these are highly specific requirements, not general quack claims that taking supplements will somehow miraculously treat colds and flues, prevent cancer, or some other nonsense.

Essentially, if you’re taking dietary supplements for no medical reason other than you believe it makes you healthier, let’s stick to facts – all that you are doing is having your kidneys create some very costly urine. Human physiology, based on a couple of billion years of evolution, automatically regulates its needs for micronutrients – excess amounts do not stick around to make you healthier, it just becomes a component of your pee.

It’s time to take a look at this article about dietary supplements and cardiovascular disease. Maybe I’ll convince you to save some money each month, and spend it on something like investing in a better diet. Continue reading “Dietary supplements make costly urine – not helpful for CVD”

Statins prevent cardiovascular deaths – a new systematic review

statins prevent cardiovascular death

Now for something completely different, let’s not talk about vaccines – we’re going to discuss statins! There have been more and more robust studies that statins prevent cardiovascular events, including death. Nevertheless, statins have been controversial, and are used by the alternative medicine (not medicine) lovers as an example of all kinds of medical malfeasance.

As I’ve mentioned before, I hang out on Quora answering questions about a lot of topics, mostly vaccines and cancer. But I also occasionally answer questions about statins, and I regularly state that statins prevent cardiovascular events. And just as regularly, I’ll get nasty comments (see Note 1) claiming everything from my being a Big Pharma shill to I don’t know anything about anything.

So let’s take a look at this new systematic review, and try to put to rest the nonsensical dismissal of the claim that statins prevent cardiovascular events, including death. Continue reading “Statins prevent cardiovascular deaths – a new systematic review”

Coffee health benefits – is it supported by real science?

coffee health benefits

I am an degenerate coffee addict. This has been so since I took my initial drink during my first chemistry finals as a college freshman. My coffee consumption hasn’t decreased much since then. I drink coffee because of its taste and the caffeine. Potential coffee health benefits are, personally, way down the list of reasons for drinking it. And frankly, I’m always skeptical of claimed health benefits for any food, unless there’s some really strong scientific evidence, which is generally lacking.

But recently, news outlets have been touting a couple of robust studies that seem to indicate that there are significant coffee health benefits. For those who know me, I rarely accept popular news sites analysis of scientific research. I think my loyal readers expect me to look at the science and see if there is any validity to the claims made by the press.

Claims about coffee health benefits and claims goes back centuries. It cured alcoholism. Coffee made you work longer. It was good for your heart. Drinking it was bad for your heart. It increases risks of some cancers. Wait, it decreases risks of some cancers. In other words, we really didn’t have vigorous evidence supporting anything definitive with respect to the drink’s health benefits or detriments.

It’s time to look at these two new studies and see what they tell us about drinking coffee.

Coffee health benefits – the first study

The first study we’re going to examine, from Gunter et al., published in the Annals of Internal Medicine. At a meta level, this epidemiological study was run by respected scientists, with the results published in a very high impact factor (17.2020) journal. Moreover, the study included around 520,000 participants in 10 European countries, which makes it one of the largest studies to date on coffee health benefits.

Compared to some of the horrifically bad studies that we have seen making outrageous claims about this or that food, drink or diet, this study is impressive. This is the kind of study that is equivalent to some of the best vaccine epidemiological research out there.

But what does the results say? To be blunt, they found that drinking more coffee would significant lower a person’s risk to all mortality.

The hazard ratio (HR), which compares the risk of dying between the coffee-drinking and non-coffee groups, was 0.88. In other words, there was a 12% reduction in all death causes in men who were in the upper quartile of coffee consumption. The HR for women in the upper quartile of consumption was 0.93, or a 7% reduction.

Frankly, a 12% or 7% difference in mortality is interesting and intriguing, but from a perspective of evidence-based medicine, it’s difficult to say this is clinically meaningful. However, if there are no known risks to coffee, which would have been uncovered by this study, the importance of those decreases in mortality become more substantial.

There were more significant results for certain diseases. The HR for coffee consumption and digestive disease mortality for men was 0.41 (a 59% reduction), and for women was 0.60 (a 40% reduction). Interestingly, for women, the HR for coffee drinking and circulatory disease mortality was 0.78 and cerebrovascular disease mortally was 0.70. However, the HR for coffee drinking and ovarian cancer mortality was 1.31, or a 31% increase.

The authors concluded, without much wiggle room:

Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country.

Review of the first study

Although the results appeared to fairly solid, I think it’s important to be critical of the results. First, we have no data that shows us whether or not coffee drinkers are just a healthier subgroup of people irrespective of their coffee drinking (they did separate out smokers from this study). Maybe coffee drinkers exercise more or eat less fats than the average person – these confounding factors have not examined carefully.

Second, like I discussed before, dose makes the poison, and dose also makes the medicine. Is there a level of coffee consumption at which point the risks outweigh the benefits? That’s not clear in this paper.

The best I could tell you from the data from this particular study of coffee health benefits is that if you’re a coffee drinker, maybe there is a slight decrease in risk of mortality, so keep on drinking. But if you don’t like coffee (yeah, there are those types around), or the caffeine effects of coffee are not to your liking, I’m not sure you should worry about suddenly taking up the habit.

Coffee health benefits – the second study

This second study, from Park et al., was also published in the Annals of Internal Medicine, once again, a very high quality journal. At a meta level, it’s as high quality as the study from Gunter et al., although this study looked at coffee consumption from a slightly different perspective.

Park et al. surveyed over 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites, a broader ethic diversity than the first study. The researchers compared coffee consumption at various levels to a control group who drank no coffee. They adjusted for confounders such as smoking, age, alcohol intake, body mass intake, exercise, education and other factors.

For those who drank about 1 cup per day (in this case, they mean the English measurement of a cup, about 250 ml, not the standard “cup” in your local Starbucks which is about 500 ml), the HR was 0.88 or 12% reduction in total mortality. For 2-3 cups per day, the HR was 0.82. With consumption ≥ 4 cups per day, the HR was the same 0.82, or 18% reduction. All of these numbers were statistically significant.

Moreover, the researchers found that coffee increases longevity across various races.

Park et al. also found that drinking decaffeinated coffee had no effect, so you have to go for the real stuff to see these health effects.

The researchers concluded:

In summary, higher coffee consumption was associated with lower risk for all-cause death and death from heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease. Inverse associations were found in African Americans, Japanese Americans, Latinos, and whites; never-smokers, former smokers, and current smokers; those with preexisting heart disease or cancer; and healthy participants. Our findings support the recent dietary guidelines from the U.S. Department of Agriculture (33), which indicate that moderate coffee consumption can be integrated into a healthy diet and lifestyle, by confirming an inverse association with mortality and suggesting that association’s generalizability to different racial/ethnic groups.

Review of the second study

What I like about this study is that it had a better analysis of major confounders, which gives me more confidence that it’s showing a real decrease in mortality rates for coffee drinkers. Moreover, they have the semblance of a dose response which shows 3-4 cups probably gives you the best reduction in death rate, but I’d like to see much higher consumption, like 10 cups. Maybe there’s a lowered benefit as you drink more, so further research will be informative.

But I have to point out again, the reduction in mortality was, at best, 18%, which may not have any clinical significance.

Coffee health benefits – the summary

These two studies show that there is a strong biological possibility that there is some relationship between lowered mortality and coffee drinking. The European study showed that coffee lowered the risk of dying from liver disease, cancers in women, digestive diseases and circulatory disease.

Moreover, both studies showed that those who drank three or more cups a day had a lower risk for all causes of death than people who did not drink coffee.

Of course, these two studies don’t mean drinking coffee is for everyone. For some people, for example, drinking coffee can lead to serious issues such as cardiac arrhythmias. And of course, excess caffeine can lead to sleep disorders and other issues.

Finally, we don’t know what compound in coffee has this protective effect against mortality. Coffee may contain over 200 different chemicals and compounds, and it might take decades of additional research to identify what chemical (or chemicals) in coffee may provide these health benefits.

I’m going to stand by my point that I previously made. These results are interesting, but they’re not overwhelming. The large numbers in both of these studies to give credibility to the quality of the statistical analyses, but still the risk reduction from drinking coffee seems less than impressive.

I think my skepticism would be reduced if I knew what may be the contributing factor – is it that coffee drinkers are just better people? Or is it some chemical in the coffee? Maybe unhealthy people don’t drink coffee because of a physician’s recommendation, which adds bias to these studies?

So at this time, drink coffee if you like it. It may provide you with some benefit. If you shouldn’t drink coffee, or don’t like it, I don’t think there is enough evidence for you to suddenly change your habits. Coffee health benefits are intriguing, but not quite overwhelming yet.

Citations

  • Gunter MJ, Murphy N, Cross AJ, Dossus L, Dartois L, Fagherazzi G, Kaaks R, Kühn T, Boeing H, Aleksandrova K, Tjønneland A, Olsen A, Overvad K, Larsen SC, Redondo Cornejo ML, Agudo A, Sánchez Pérez MJ, Altzibar JM, Navarro C, Ardanaz E, Khaw KT, Butterworth A, Bradbury KE, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Grioni S, Vineis P, Panico S, Tumino R, Bueno-de-Mesquita B, Siersema P, Leenders M, Beulens JWJ, Uiterwaal CU, Wallström P, Nilsson LM, Landberg R, Weiderpass E, Skeie G, Braaten T, Brennan P, Licaj I, Muller DC, Sinha R, Wareham N, Riboli E. Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study. Ann Intern Med. 2017 Jul 11. doi: 10.7326/M16-2945. [Epub ahead of print] PubMed PMID: 28693038.
  • Park SY, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations. Ann Intern Med. 2017 Jul 11. doi: 10.7326/M16-2472. [Epub ahead of print] PubMed PMID: 28693036.

Shingles increase heart attacks – time for the vaccine

Shingles increase heart attacks

Shingles, a reactivated form of the chickenpox virus, is a painful rash that afflicts many people decades after the initial chickenpox infection. Now, we have data that shingles increase heart attacks (myocardial infarction) and strokes. This is more evidence that we need to end chickenpox with the chickenpox vaccine, and reduce the risk of shingles in those who have had chickenpox with the shingles vaccine.

Let’s take a look at shingles and this new study. Continue reading “Shingles increase heart attacks – time for the vaccine”

Benefits of omega 3 fish oil – something’s fishy

I have been skeptical of supplements for a long period of time. The supplements are generally of low quality, they don’t prevent or cure cancer, they don’t prevent colds, they can’t boost the immune system, and they don’t prevent heart disease. Now it’s the time to take a look at the benefits of omega 3 fish oil, something that is claimed by Big Supplement over and over. Is there anything there?

Unless one has a chronic disease or is chronically malnourished, there are precious few instances where supplements are necessary. A couple of cases where supplements may be critical include prenatal folic acid supplements to prevent neurological defects in the developing fetus and vitamin D supplements for individuals who do not produce enough endogenous vitamin D. However, just to keep this in perspective, excess folic acid for a long period of time may be correlated with increased rates of certain cancers.

The benefits of omega 3 fish oil has always been intriguing to me, because it is a supplement that I thought might be useful to improving health, especially cardiovascular health. Omega 3 fatty acids are generally found in fish, as it is produced by the phytoplankton that is the primary food source of much of the prey for larger fish and bio-accumulates up the food chain. However, for humans, there are other sources of omega 3 oils including walnuts and edible seeds, eggs, and other non-fish foods.

Epidemiological studies done in the late 1980s seem to indicate relatively low death rates due to cardiovascular disease in Inuit populations with high seafood consumption. These results began the rush to consume omega 3 supplements, and created a booming supplement industry.

However, since publication of those initial studies, much research has been done on seafood and heart disease. And the results don’t give much credence to the cardiovascular benefits of omega 3 fish oils as a useful supplement.

 

Continue reading “Benefits of omega 3 fish oil – something’s fishy”

Diet soda increases risk of stroke and dementia – does it?

diet soda increases risk

Two recent studies published in respected journals seem to indicate that diet soda increases risk of stroke and dementia. Not to give a free pass to sugary drinks, one of the studies seemed to indicate that either artificially sweetened or sugar filled drinks might be linked to a higher risk of Alzheimer’s disease.

Typical of the popular press and your average website, they accept the findings of these studies without any serious critique of these studies. US News blares a headline that says, “Health buzz: drinking diet soda linked to stroke, dementia risk, study says.” Thankfully, many of the headlines use the qualifier “may be linked,” but I’m afraid most people will overlook that nuanced discussion of these studies.

But what does the actual science say? Do these studies provide us with robust evidence that cutting out diet soda will suddenly decrease our risk of stroke, dementia or Alzheimer’s disease? Probably not, but let’s see what this data actually tells us.

 

Continue reading “Diet soda increases risk of stroke and dementia – does it?”

HPV vaccine adverse events – this time, POTS

I make my goal that if you’re going to make some claim that goes against the scientific consensus, then it must be done with high quality evidence, preferably published in a high quality medical or scientific journal. It better be peer reviewed. And it better be good research.

Even if the evidence meets that standard, there is an hierarchy of published evidence from meta- or systematic-reviews at the very top, and junk science published in pseudoscience-pushing websites at the bottom. But there is a range of scientific scholarship, and sometimes, even if an article is published in a top quality journal, the results may be misinterpreted, or even be poorly analyzed.

Continue reading “HPV vaccine adverse events – this time, POTS”