 | What Your Doctor Is Reading | | |
Update from the Medical Journals: August 2009
August 31, 2009  By Mary Pickett, M.D.
Harvard Medical School What's the latest news in the medical journals this month? Find out what your doctor is reading. Americans: For a Healthy Heart, Eat Less Sugar Those spoonfuls of sugar in our daily diet are contributing to obesity and poor heart health, says the American Heart Association (AHA). The AHA issued an important new dietary recommendation online on August 24. The statement will appear in the September 19 issue of the journal Circulation. The AHA lists the "prudent upper limit" of sugar per day depending on a person's age, gender and amount of physical activity. The statement applies to sweeteners that are added to processed foods and beverages as well as the sprinkle of sugar you might use at home in baking and at the table. These include corn syrup, cane sugar, brown sugar and honey. Between 1970 and 2005, Americans increased their daily average intake of added sweeteners by 19%. Half of the increase came from sweetened beverages, including sodas. More sugar in our diets means more total calories consumed. This trend has serious health implications: Research in the past several years has linked added sugars in the American diet to epidemics of obesity, diabetes, cholesterol problems and high blood pressure. | Did you know? | According to the American Heart Association, between 2001 to 2004, Americans ate the following amounts of added sugars a day: - Average child or teenager – 21 to 34 teaspoons
- Average woman – 18 teaspoons
- Average man – over 25 teaspoons
Where did the added sugars come from? - Soft drinks account for 33% of the added sugar intake for Americans as a whole.
- Table sugars, candy, cakes, cookies, pies and fruit drinks together contribute 40%.
| | The AHA recommends Americans cut their sugar intake to the following maximum per day: - Women – 5 teaspoons
- Men – 9 teaspoons
- Children 4 to 8 years old – 3 teaspoons
(Adults who are sedentary or drink alcohol regularly should eat less that the recommended amounts.) To put these quantities in perspective, a single 12-ounce soda has about 8 teaspoons of sugar. The extra sweeteners in our diets also mean that we get less of the essential nutrients we need, such as calcium, iron, vitamin A and zinc, says the AHA. Recent research also that suggests that dietary sugars may change our actual metabolism — the rate at which our bodies expend energy or burns calories. In human and animal studies, fructose has been linked to increased triglyceride levels, high blood pressure, insulin resistance (the cause of type 2 diabetes), inflammation fatty liver, and abdominal obesity. This collection of conditions has been linked with heart disease and is called the "metabolic syndrome." The most effective way to reduce sugar in your diet is to stop drinking sweetened beverages on a regular basis. Experts are far less worried about sweetened yogurt, milk, cereals and ice cream because these foods have some nutritional value. Back to top 1 in 10 Americans Takes Antidepressants Ten percent of Americans over the age of six take an antidepressant medicine. That adds up to 27 million Americans. This is double the number from 10 years ago. Antidepressants are now the most widely prescribed class of medicines in the United States. These findings are based on household surveys with 18,993 individuals in 1996 and 28,445 individuals in 2005. A comparison of these surveys was published in the August issue of the Archives of General Psychiatry. During the time that we doubled antidepressant use, fewer Americans sought psychotherapy. In 1996, almost one in three people diagnosed with depression had psychotherapy. In 2005, that number dropped to about one in five (19.87%). What does this say about Americans? It suggests that we prefer pills to other treatments. Are more people suffering from depression now than before? An increase in depression can only account for a small part of the increase in antidepressant use. The increase is better explained by the fact that doctors are prescribing these medicines more liberally, and patients often ask for them. Certainly many people have benefited from taking antidepressants. But despite the huge increase in the number of prescriptions, there has been only a modest decrease in the suicide rate in this country. Suicide rates are considered a measure of success in depression treatment. In 1990, there were 12.4 suicides per 100,000 people. According to the most recent data, from 2004, the suicide rate was 11.05 per 100,000 people. This is hardly an improvement considering the amount of antidepressants out there! These medicines are generally safe, but there are potential risks. Antidepressant use might increase the risk of suicide. Case reports and two randomized placebo-controlled trials with children have identified suicide events that occurred within days or weeks of starting or increasing the dose of an antidepressant medication. Also, two studies have found a link between a certain type of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) and a loss of bone strength. The widespread use of antidepressants may indicate that many people are taking antidepressants for longer than needed. Major depression is usually a temporary illness. Experts agree that a person being treated for depression should continue taking the prescribed medicine for at least six months. But many people can gradually taper off the medication when their depression is under control for six months or more. Back to top More News in Brief - Vertebroplasty may not improve fracture pain. A popular procedure called vertebroplasty restores a collapsed vertebra (compression fracture of the spine) to its previous height by injecting cement. Unfortunately, two studies published in the August 6 issue of the New England Journal of Medicine show that the procedure isn't effective for most patients. Both studies compared one group of patients' symptoms after vertebroplasty to symptoms of another group of patients who had local anesthesia and a pretend injection of cement. The patients did not know which treatment group they were in. The Mayo Clinic study involved 131 patients whose symptoms were assessed one month after the procedures. The second study enrolled 78 patients and measured symptoms six months after the procedures. Symptoms were similar in treated and untreated groups. Back braces, bed rest and pain medicines are other treatments that can be used to treat a vertebral fracture.
- New procedure may offer alternative to blood thinners to prevent strokes from atrial fibrillation. The irregular heart rhythm called atrial fibrillation can lead to strokes. Blood clots can form in the left atrium of the heart when it is not beating normally. The most tried-and-tested way to prevent these stroke is to take the blood-thinning medication warfarin (Coumadin). However, this medication can cause serious complications and requires regular blood tests to monitor the dose. In addition, eating leafy greens affects the drug's potency and the correct dose. A new way to prevent stroke without using blood thinners is being tested. The technique is described in the August 15 issue of the Lancet. More than 700 patients were randomly assigned either to receive long-term warfarin or a minimally invasive surgical procedure. (The procedure was performed through a minor incision in the skin.) During surgery, doctors fill an area of the left atrium with a mesh-covered wire frame. In atrial fibrillation, 90% or more of blood clots form in this area, so "framing off" the area prevents clots from exiting the heart. Patients who received the surgery were able to stop blood thinning medicines gradually over the next six months. When data were analyzed at the end of 18 months, the surgery group had more early complications than the group on blood thinning medications. The risk for stroke was about the same for both treatment groups. This procedure needs more perfecting and study before it can be considered a reasonable alternative for warfarin, because of the initial complication rate that was seen.
- Daily aspirin is linked to better colon cancer survival. A study in the August 12 issue of the Journal of the American Medical Association (JAMA) indicates that people with colon cancer are much less likely to die of the disease if they take a daily aspirin. The results are part of two large, ongoing studies: the Nurses' Health Study and the Health Professionals Follow-Up Study. Patients with colorectal cancer were followed for an average of 12 years. All of the patients in the study had surgery for their cancer; many patients also had chemotherapy. Researchers recorded aspirin use after diagnosis. Among 549 aspirin-users, 81 (close to 15%) died from the cancer during the years of the study. Among 730 people who didn't use aspirin, 141 (about 19%) died of the cancer. The aspirin users were nearly 30% more likely to survive their colorectal cancer. This was an observational study, which means that we can't say that taking aspirin caused fewer people to die from colon cancer. We can only say that aspirin use is associated with better outcomes. It could be, for example, that taking aspirin leads to earlier bleeding from a colon cancer and an earlier diagnosis. The connection between aspirin and colon-cancer survival will need more study. A randomized study can compare people who are assigned to take aspirin with people who are assigned to take a placebo pill, then record cancer survival.
- Tanning beds dramatically increase skin cancer risk. Sun exposure increases the risk for skin cancer. Fans of UV tanning beds, which expose you to UVA radiation rather than UVB radiation, hoped they could avoid the skin cancer risk. However, a comprehensive analysis of melanoma cancer cases has shown that the risk of melanoma increases by 75% when you use tanning devices before age 30, regardless of the type of UV radiation that the beds emit. World Health Organization (WHO) experts published the update online in the medical journal Lancet Oncology on July 29. The International Agency for Research on Cancer (IARC) has bumped sun beds (UV tanning beds) up to the highest cancer risk category — group 1 — designated 'carcinogenic to humans'.
Back to top Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.
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