Time, Laura Blue, July 28, 2010

A healthy social life may be as good for your long-term health as avoiding cigarettes, according to a massive research review released Tuesday by the journal PLoS Medicine.

Researchers at Brigham Young University and the University of North Carolina at Chapel Hill pooled data from 148 studies on health outcomes and social relationships — every research paper on the topic they could find, involving more than 300,000 men and women across the developed world — and found that those with poor social connections had on average 50% higher odds of death in the study’s follow-up period (an average of 7.5 years) than people with more robust social ties.

That boost in longevity is about as large as the mortality difference observed between smokers and nonsmokers, the study’s authors say. And it’s larger than differences in the risk of death associated with many other well-known lifestyle factors, including lack of exercise and obesity. “This is not just a few studies here and there,” says Julianne Holt-Lunstad, lead author on the review and an associate professor of psychology at Brigham Young University. “I’m hoping there will be recognition from the medical community, the public-health community and even the general public about the importance of this.”

The friend effect did not appear to vary by sex or by age, with men and women of all ages and health statuses showing roughly equal benefit. Nor were lonely people unusually susceptible to any one disease in particular.

But if it’s true that we get by with a little help from our friends, then how, exactly, do our friends do it? That is, how does “social integration” — measured by surveys and questionnaires about friends, family size, marital status and the number of household residents — influence long life? The short answer is that we don’t really know yet. “The truth of the matter is that the critical evidence on psychosocial processes and health have come about only within the last 10 to 15 years — even though there’s been a lot of theory on it since the 1970s,” says psychology professor Bert Uchino at the University of Utah.

That may help to explain why doctors, for the most part, have yet to embrace social support as a factor in good health, on par with smoking habits, diet or exercise. Without a good sense of the physiological mechanisms that may link feelings of loneliness, for instance, to biological markers like blood pressure and resting heart rate, it has been easy to dismiss the power of social connections as nothing more than an artifact of the data or, worse, as touchy-feely pseudoscience.

To be sure, the direct physical evidence of the health benefits of social support is much more preliminary than the population-level association reported by Holt-Lunstad. But the evidence is mounting, says Uchino, who has written widely on the physiological links between social life and health outcomes. (Uchino did not contribute to the new review in PLoS Medicine, but has collaborated with Holt-Lunstad on other projects and was, once upon a time, also her grad-school adviser.)

We turn to family and friends for obvious tangible support when we’re sick — from help preparing meals to keeping track of pills, appointments and insurance forms. And caring about others may also prompt us to take better care of ourselves. “A really good example, of course, is someone who has a child,” Uchino says. That new bond is often the impetus to quit smoking, to drink less or to curb any number of risky pastimes.

But the influence of social ties may be even more powerful than that. Social relationships, it seems, may also help our bodies help themselves.

Recent lab studies have shown that, in a stressful situation, blood pressure and heart rate will increase less when people are accompanied by a person who is close to them. Brain imaging also shows neurological differences between a person who is alone and a person who has support: in a lab-induced tense situation, brain activity in the anterior cingulate cortex, a region activated in times of stress, is attenuated when people have a close friend or relative alongside them. And it’s not just adult stress. In an experiment published this spring, children who were allowed to talk to their mothers after a stressful encounter — giving an impromptu speech or doing math problems in public — showed increased levels of oxytocin, a neurotransmitter thought to dampen the hormonal stress response, compared with children who did not have contact with their mothers.

In one of the most famous experiments on health and social life, Sheldon Cohen at Carnegie Mellon University exposed hundreds of healthy volunteers to the common cold virus, then quarantined them for several days. Cohen showed that the study participants with more social connections and with more diverse social networks — that is, with friends from a variety of social contexts, such as work, sports teams and church — were less likely to develop a cold than the more socially isolated study participants.

The immune systems of people with lots of friends simply worked better, fighting off the cold virus often without symptoms. Studies suggest that the immune response may be affected by stress hormones — catecholamines and glucocorticoids — so that a strong social life thus affects immune function by helping people keep physiological stress in check.

But turning such research into full-fledged medical advice isn’t easy. “It’s hard to legislate social relationships,” Holt-Lunstad says. “And we all know that some relationships are better than others, and not all relationships are entirely positive.”

Since Holt-Lunstad’s new study reviewed the statistical association between mortality risk and relationship quantity, rather than perceived quality, she wonders whether we wouldn’t see even stronger benefits if we focused only on the good relationships. Bolstering these connections may ultimately help people stay healthier than trying to build connections between complete strangers, as in, say, a cancer support group. (Studies on the physical health benefits of support groups show mixed results.) “We need to pay better attention to naturally occurring relationships and to fostering those,” Holt-Lunstad says.

Read more: http://www.time.com/time/health/article/0,8599,2006938,00.html#ixzz0v92wZgnm

Wide Social Networks Are Key to Good Health, Says Study – TIME.

Every five years the American public gets a newly tweaked directive on what we’re supposed to be eating.

And every five years the American public largely ignores it.

For example, the 2005 Dietary Guidelines for Americans recommend we eat 2 1/2 cups of vegetables and 2 cups of fruit a day. But according to the Centers for Disease Control and Prevention, only about 14 percent of adults are even coming close.

Special interest groups, however, watch the guidelines closely and are speaking out. Just last week, nearly 50 speakers from industry and the science and health communities went to Washington to provide oral comments on the proposed guidelines for 2010, which will be released at the end of the year.

The proposed recommendation to reduce salt intake dramatically drew a statement from Morton Satin, Salt Institute vice president of science and research, that “no modern society consumes so little salt.”

The Healthy Eating Pyramid displayed here is the one created by Harvard School of Public Health, and is the only pyramid solely based on scientific evidence.

Dr. Richard Feinman, on behalf of the Nutrition and Metabolic Society, invited members of the federal Dietary Guidelines Advisory Committee to a debate on the guidelines’ proposed decrease in saturated fat consumption, saying that carbohydrates eaten with saturated fats were the real problem. The Weston Price Foundation, which advocates the healthful properties of fat from pastured animals, also took issue.

A dietary supplements industry group called the Council for Responsible Nutrition objected to the proposed statement that “a daily multivitamin/mineral supplement does not offer health benefits to healthy Americans.” The council said the committee’s report implies “it’s reasonable to allow people to live with nutrient inadequacies.”

If the guidelines are largely ignored by the average American, why do health and industry groups care so much about influencing them?

“I think to a certain extent they are followed,” said Weston Price Foundation President Sally Fallon, whose organization also supports the consumption of whole, rather than processed, foods. “Schools who get federal money and prisons are supposed to be following them for their menus.”

Have questions about the new food guidelines? Many do. Reporter Monica Eng answers some of them at Trib Nation.

Dr. Robert Post, deputy director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion, said all public comments are taken into consideration along with scientific reviews and lively debate within the committee’s meetings.

He noted that last month the department debuted something called the Nutrition Evidence Library, a new online resource cataloging the latest science on nutritional matters and the ways the USDA interprets it to create policy.

But some observers still worry that the guidelines may be too influenced by industry concerns.

“I believe that by supporting low-fat products and grain products, rather than actual low-fat foods and whole grains like quinoa and teff, they are just trying to support the food industry,” said Adele Hite, a University of North Carolina public health graduate student who represented the Committee for a Healthy Nation during last week’s meeting.

The USDA started giving out nutritional advice more than 100 years ago with a table of food composition and dietary standards that later morphed into food shopping guides for various income levels. In 1992 the agency developed the food pyramid, an image in which horizontal bars represented food groups.

In 2005 the pyramid was given a new look (and renamed My Pyramid) in which the bars were replaced by vertical stripes that some argued made it hard to read at a glance.

“The new pyramid is not so much an information image as something to send people to the mypyramid.gov Web site,” explained USDA spokesman John Webster.

“While making it, there was a concern that it was not specific enough,” Webster said. “But as we added more information it started to look like a Christmas tree. Finally we said we can’t continue to add more information and still make it meaningful, and so decided to put the information on the Web.”

Congress mandates that a committee on the dietary guidelines convene every five years to review the latest science and state of the American diet to make adjustments, but the pyramid usually does not change as often. It will likely get another makeover in early 2011 as part of the national Let’s Move campaign against childhood obesity.

The main changes proposed for the dietary guidelines include reducing daily sodium intake from 2,300 milligrams to 1,500 milligrams, reducing the percentage of saturated fat in the diet from 10 percent to 7 percent, reductions in foods with added sugars and an avoidance of artificial trans fats altogether. The report also highlighted the importance of vitamin D, calcium, potassium and dietary fiber, and it recommends eating 8 ounces of seafood a week.

Because most Americans already consume more sodium than was recommended in the last version of the guidelines, the new target of 1,500 milligrams is likely to pose formidable challenges to American consumers, not to mention food processors who rely on sodium as a flavor enhancer, preservative and binder.

Some experts acknowledge that although the proposed guidelines may force manufacturers to reformulate processed foods for schools and prisons that follow the standards, they may have little effect on what consumers eat at restaurants or at home.

“I think people ignore them when it comes to eating more fruits and vegetables and reducing refined sugars, but they will listen when they see the permission to eat six to 11 servings of grain per day,” Fallon said.

The proposed 2010 guidelines are the first to acknowledge America’s dire obesity epidemic and the roles environment and communication play in actually getting the public to follow the suggestions.

They cite “powerful influences that currently promote unhealthy consumer choices, behaviors and lifestyles” in our environment and call for cooperation with the Department of Health and Human Services to encourage improvements in areas including health, nutrition and physical education in schools; greater financial incentives to purchase, prepare and consume healthful food; more health-promoting foods and portions offered in restaurants and by manufacturers; and more exercise-friendly communities.

Among the questions the committee considered for this year’s guidelines was how much and what kinds of fish consumption it could endorse given the latest research on mercury contamination.

Unlike the current food pyramid, the government’s latest proposed advice takes into consideration the health threats posed by mercury, a toxic metal that taints certain types of fish and can trigger learning difficulties in children and neurological and heart problems in adults.

The proposed guidelines reflect a 2004 joint advisory from the Food and Drug Administration andEnvironmental Protection Agency that cautions young children, pregnant women, nursing mothers and women of childbearing age not to eat swordfish, shark, king mackerel and tilefish because of high mercury levels. It also advises those groups to consume no more than 12 ounces of fish a week, including no more than 6 ounces of canned albacore tuna.

An online version of the current food pyramid continues to recommend swordfish and tuna, four years after the Tribune first reported on the government’s contradictory advice. The National Academy of Sciences has sharply criticized the government for not doing enough to advise consumers about which fish are safest to eat, a job that has fallen to nonprofit health groups.

Based on the government’s own testing, Consumers Union, the publisher of Consumer Reports magazine, says the chances that any type of canned tuna will contain high levels of mercury are great enough that pregnant women should never eat it.

“You can get all of the benefits of fish and avoid the dangers of mercury by eating low-mercury fish,” said Jean Halloran, the group’s director of food policy initiatives. “It’s been distressing to see the government isn’t doing a better job helping women make smart choices.”

The seafood industry has argued that advising women about high- and low-mercury types of fish would scare them away from eating seafood altogether. Yet a 2008 federal study found a decline in the number of women nationwide with high levels of the toxic metal in their bodies, even though those women were eating the same amount of seafood. The finding suggested that consumer advisories about mercury had started to work.

via Food pyramid: New dietary guidelines coming from U.S. government – chicagotribune.com.

As California contemplates legalizing the sale of marijuana, the real war over intoxicants in this country is, as always, over alcohol.

Since Prohibition ended in 1933 with the 21st Amendment to the Constitution — which repealed the 18th Amendment authorizing the ban on alcohol — states, counties and municipalities have see-sawed back and forth over alcohol sales. States are still passing laws on the sale of alcohol on Sundays, and municipalities and counties are still voting on whether to permit local alcohol purchases.

But as an addiction psychologist and alcohol epidemiologist, I am more interested in another debate over alcohol: whether it can be good for you. This issue arises every five years as the United States issues new dietary guidelines, including for alcohol consumption. In 1990, the Dietary Guidelines for Americans firmly declared that alcohol “has no net health benefit, is linked with many health problems, is the cause of many accidents and can lead to addiction. Their consumption is not recommended.”

But in 1995, based on the results of studies identifying subjects who drank and did not drink and then following their health outcomes over time, the guidelines modestly declared — amid a sea of information about the dangers of drinking — that “alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history” and that “current evidence suggests that moderate drinking…is associated with a lower risk for coronary heart disease in some individuals.”

A firestorm resulted over these words, led by the late Sen. Strom Thurmond (R-S.C.), a notorious teetotaler. Somehow, the section came through intact, to the amazement of a member of the committee writing the guidelines, Marion Nestle, then-chairwoman of the Department of Nutrition, Food Studies and Public Health at New York University. “It’s a miracle, a miracle,” she told the New York Times. “It is a triumph of science and reason over politics. The committee process was very contentious, but the outcome makes the fuss seem worthwhile.”

Well, the same forces are back doing battle for the 2010 edition of the guidelines. In the intervening years, quite a bit of evidence has accumulated to take the statement of alcohol’s benefits even further. The 2010 guidelines’ alcohol section group is headed by epidemiologist Eric Rimm of Harvard Medical School, where he is a co-director of the Health Professionals Follow-Up Study that has tracked doctors’ and nurses’ health outcomes and drinking for decades. But the opposition this time around is not teetotaler Southern politicians.

According to the experts charged with creating the alcohol section, strong evidence indicates that “the lowest mortality risk for men and women [occurs] at the average level of one to two drinks per day, [and] is likely due to the protective effects of moderate alcohol consumption on CHD [coronary heart disease], diabetes and ischemic stroke as summarized in this chapter.”

In other words, people who have a couple of drinks daily live the longest! Adding what for some is insult to injury, the group also noted: “Moderate evidence suggests that compared to non-drinkers, individuals who drink moderately have a slower cognitive decline with age.” Moderate drinkers not only live longer, they are more alert while doing so!

Despite these proposed additions to the guidelines, the overwhelming burden of the alcohol section is to portray the negative health, psychological and addictive effects of alcohol. But this has not been enough to avoid a sharp blowback from medical, public health and addiction professionals, who have started a campaign to limit these recommendations out of a fear their impact “would likely be to encourage greater daily consumption of alcohol, discourage appropriate caution about using alcohol for health benefits, and open the door for the alcohol industry to misrepresent federal alcohol consumption guidelines to consumers.”

And so it goes — the war over alcohol in America continues ad infinitum.

via Alcohol and the Dietary Guidelines for Americans – latimes.com.

The evening’s menu featured grass-fed, antibiotic-free beef over pasta, fresh seasonal vegetables and fresh organic peaches — items right at home in the city’s finest restaurants.

Instead, the dishes were prepared for visitors, staff and bed-bound patients at Swedish Covenant Hospital.

The Northwest Side hospital is one of 300 across the nation that have pledged to improve the quality and sustainability of the food they serve, not just for the health of their patients but, they say, the health of the environment and the U.S. population.

For many of these institutions, the initiative includes buying antibiotic-free meats. Administrators say they hope increased demand for those products will reduce the use of antibiotics to treat cattle and other animals, which scientists believe helps pathogens become more resistant to drugs. The Centers for Disease Control and Prevention estimate that antibiotic-resistant infections kill 60,000 Americans a year.

Although the U.S. doesn’t keep national records on antibiotic use in animals, the Union of Concerned Scientists estimates that up to 70 percent of all antibiotics used in the U.S. are administered to healthy animals to speed growth and compensate for crowded living conditions. Some of these drugs, such as penicillin and tetracycline, are also used to treat sick people.

Last week, as a congressional panel debated the nontherapeutic use of antibiotics in agriculture, Rep. Jan Schakowsky, D-Ill., presented a petition organized by the nonprofit coalition Health Care Without Harm and signed by more than 1,000 health care professionals supporting the Preservation of Antibiotics for Medical Treatment Act. Introduced by Rep. Louise Slaughter, D-N.Y., it would phase out the nontherapeutic use in animals of seven types of medically important antibiotics.

Last month the Food and Drug Administration also released draft guidelines for the “judicious use” of antibiotics for growth promotion in animals. The CDC and the U.S. Department of Agriculture support the FDA’s guidance, which states that “using medically important antimicrobial drugs for production or growth enhancing purposes … in food-producing animals is not in the interest of protecting and promoting the public health.”

Meat producers respond that there is not enough evidence to definitively link human antibacterial-resistant infection to animal use.

“The CDC, FDA and USDA all say that they believe there is a link, but we don’t know,” said Dave Warner, spokesman for the National Pork Producers Council. “They believe it, so they are going to ban these products because of a belief and not a scientific fact?”

Hospital administrators who have signed on to buy antibiotic-free meat say they hope to use their purchasing power to discourage the use of antibiotics in agriculture. According to the Association for Healthcare Foodservice, the institutions spend about $9.6 billion on food and drink a year.

An early adopter of healthier hospital menus, Swedish Covenant’s director of nutrition, Maria Simmons, started serving grass-fed antibiotic- and hormone-free Tallgrass beef nearly five years ago. While the hospital’s purchases of other sustainable foods have fluctuated with budgets and availability, this item has been a constant.

Simmons said the hospital uses the beef in one menu item a day served to patients and in the cafeteria, including “meat sauces, Salisbury steaks, meatloaf, beef stew and in our Korean seaweed soup.”

Diane Imrie, director of nutrition services at Fletcher Allen Health Care in Vermont, also started serving antibiotic-free beef at the hospital in recent years as part of her plan to switch to local, seasonal, sustainable food.

“When we started a sustainability council at the hospital a few years ago, antibiotic reduction was one of the first things on my list,” she said. “I think it has the most impact on farming, the environment and public health.”

Imrie estimated that her food costs rose about $67,000 last year when she switched to antibiotic-free chicken from conventional. “But that’s also about the same cost as treating a single MRSA infection,” she said, referring to drug-resistant staphylococcus bacteria.

Like Simmons, Imrie said she has found inventive ways to offset the cost of the antibiotic-free meats, such as choosing ground beef and stewing cuts instead of more expensive options. Simmons said the beef she buys ranges from 50 cents to $1 more a pound.

Simmons also said she is able to negotiate with vendors because the hospital buys food in large amounts. “Once they realize the volume and the fact that you will keep buying this, they work with you,” she said.

Carolyn Lammersfeld, national director of nutrition at Cancer Treatment Centers of America, oversees a menu full of organic, antibiotic-free chicken, beef and dairy at the organization’s facilities across the country.

Using the ingredients is primarily a response to patient demand, Lammersfeld said, but the centers are also “watching the controversy over the nontherapeutic use of antibiotics and their potential to cause resistant strains of bacteria.”

via Hospitals buy antibiotic-free meat, citing drug resistance concerns – chicagotribune.com.

The government says it will retain the Food Standards Agency, following concerns the independent watchdog would be scrapped under reforms.

But it will hand over some responsibilities to government, Health Secretary Andrew Lansley confirmed.

The Department of Health will oversee nutrition policy and the Department for Environment, Food and Rural Affairs will handle food labelling.

This, says the government, will leave the FSA to focus on food safety.

Related stories

Q&A: The Food Standards Agency

Charities said government must follow through with this reorganisation and “should not let the good things the FSA achieved disappear into a black hole”.

The FSA was set up as an independent food safety watchdog in 2000, in the wake of the BSE crisis and a number of high-profile outbreaks and deaths from foodborne illness.

More recently, the FSA has led calls for the Europe-wide introduction of a traffic light system requiring food companies to label the front of their products with red, amber or green symbols to denote the amounts of fat, saturated fat, salt and sugar contained per serving.

Mr Lansley said bringing some policy-based functions ‘in house’ made sense. Nearly 100 of the Agency’s posts will be moved, leaving 2,000 remaining staff.

“It’s absolutely crucial for the Food Standards Agency to continue providing independent expert advice to people about food safety. But bringing nutrition policy into the Department makes sense.

“It will enable a clear, consistent public health service to be created, as our Public Health White Paper later this year will set out.

“I believe – in the-long term – we’ll have a clearer and less bureaucratic system for public health. The end result will focus on turning expert advice and support into better health.”

Caroline Spelman, Secretary of State for Environment, Food and Rural Affairs said: “It makes perfect sense to bring policy on food origin and associated labelling to Defra to sit with wider food policy. The Government has made very clear its commitment to clear and honest labelling – particularly origin labelling.

“These changes will enable the FSA to focus on food safety and it is right that this should stay in the hands of an independent body.”

Lord Rooker, Chair of the FSA, said: “Food safety and hygiene have always been at the heart of what the Agency does. They are our top priorities in protecting the interests of consumers.”

Peter Hollins, Chief Executive of the British Heart Foundation, said: “The Government must follow through with this reorganisation, by recognising its responsibilities in relation to food labels now it has brought the issue in-house.

“The FSA did much to promote healthy diets and now the Government must demonstrate it will not let the good things the FSA achieved disappear into a black hole.

“Regardless of the European jurisdiction issues, the Government should recognise it has an opportunity to put the health of the UK population first and continue battling for traffic light colours on food labels.”

via BBC News – Food Standards Agency ‘will remain’ government promises.

Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.

If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well.

Studies indicate that the effects of a vitamin D deficiencyinclude an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis.

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors.

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone.

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.

“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency

Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice.

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.

Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Penguin Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found.

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites.

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said.

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes.

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?

If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver.

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result inkidney stones, confusion and abnormal heart rhythms.

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

Personal Health – What Do You Lack? Probably Vitamin D – NYTimes.com.

What if my blood sugar’s too high today? Is it time for my blood pressure pill? With nagging text messages or more customized two-way interactions, researchers are trying to harness the power of cell phones to help fight chronic diseases.

“I call it medical minutes,” says Dr. Richard Katz of George Washington University Hospital in the nation’s capital.

He’s testing whether inner-city diabetics, an especially hard-to-treat population, might better control their blood sugar — and thus save Medicaid dollars — by tracking their disease using Internet-connected cell phones, provided with reduced monthly rates as long as they regularly comply.

Consider Tyrone Harvey, 43, who learned he had diabetes seven years ago only after getting so sick he was hospitalized for a week, and who has struggled to lower his blood sugar ever since. In May, through a study Katz began with nearby Howard University Hospital’s diabetes clinic, Harvey received a Web-based personal health record that he clicks onto using his cell phone, to record his daily blood sugar measurements.

If Harvey enters a reading higher or lower than preset danger thresholds, a text message automatically pings a warning, telling him what to do. And at checkups, doctors will use the personal health record, created by Indiana-based NoMoreClipboard.com, to track all his fluctuations and decide what next steps to advise.

“Hopefully you’re paying more attention to your numbers, too,” says Howard’s Dr. Gail Nunlee-Bland, whose clinic uses an electronic health record — your official medical history — that can automatically link to NoMoreClipboard’s consumer version and update it with things like medication changes.

The trend is called mobile health or, to use tech-speak, mHealth. If you’re a savvy smartphone user, you’ve probably seen lots of apps that claim to help your health or fitness goals — using your phone like a pedometer or an alarm clock to signal when it’s time to take your medicine.

Katz and other researchers are going a step further, scientifically testing whether more personalized cell phone-based programs can link patients’ own care with their doctors’ disease-management efforts in ways that might provide lasting health improvement.

“Mobile phones provide that opportunity for persons to get the feedback they need when they need it,” explains Charlene Quinn, an assistant professor at the University of Maryland medical school, who is testing a competing cell phone diabetes system from Baltimore-based Welldoc Inc.

After all, most of the population now carries a cell phone. Accessing the Internet with them is on the rise, too — nearly 40 percent of cell callers do, the Pew Internet & American Life Project reported last week — allowing more sophisticated digital health contact.

On the other hand, older adults are less likely to use smartphones. So are people who are sicker, with multiple chronic diseases, says Dr. Joseph Kvedar, director of the Center for Connected Health, a division of Boston’s Partners Healthcare.

Kvedar notes that nearly any phone can handle simpler text-messaging programs. Among the biggest offered to date is the free text4baby, where government-vetted health tips timed to pregnant women’s due dates are texted weekly to about 50,000 participants so far.

Do these kinds of technologies work? There’s some short-term evidence, although no one knows if people stick with it once the novelty wears off:

_In a study of 70 Boston residents to improve cancer-preventing use of sunscreen, Kvedar found daily texts with reminders hooked to the weather forecast for six weeks increased sunscreen use by 40 percent.

_Researchers at New York’s Mount Sinai Medical Center found episodes of rejection dropped when they texted take-your-medicine reminders to 41 pediatric liver transplant recipients or their caregivers, adding another text nag to the parent if teen patients didn’t quickly respond that they’d taken their dose.

_The University of California, San Diego, went a step further, designing a text-message program to encourage weight loss where participants texted back answers to such questions as “Did you buy fresh raw vegetables to snack on this week?” Answering allowed more customized texted diet tips. In a pilot study of 75 people, text-message recipients lost about four more pounds in four months than those given printed dieting advice.

_The Internet-based approach offers even more two-way interaction. This fall, Quinn will report results of a 260-patient study using a range of Welldoc phone features, including more real-time monitoring of the blood sugar fluctuations users enter. A small Welldoc pilot study found users’ average blood sugar dropped over three months.

“What systems work best with patients has yet to be figured out,” says George Washington’s Katz, who is testing a version of that program, too — and worries not just about affordability when his study is over but whether interest will wane. “Otherwise, they find it’s a nice toy to start with, and forget about it.”

via From texting to apps, using cell phones for health – Yahoo! News.

Uncertainty about milk aside, the USDA’s recommendations are clear-cut.

In 2005, the agency in charge of the food pyramid started recommending three cups of dairy products a day for anyone over 8, a full cup more than before. By the USDA’s standards, one cup of yogurt, one and a half ounces of hard cheese, one-third cup of shredded cheese or two cups of cottage cheese counts as a cup of dairy. So, of course, does a cup of milk.

The USDA actively promotes dairy products — it administers the National Milk Processor Board that gave us the ubiquitous “Got milk?” media campaign — but the change in guidelines wasn’t simply an attempt to sell more milk, says Dr. Theresa Nicklas, a dairy researcher and professor of pediatrics with the Children’s Nutrition Research Center at the Baylor College of Medicine in Houston. According to Nicklas, the push for more dairy was driven by fears that Americans weren’t getting enough calcium, potassium and magnesium, nutrients that are relatively plentiful in milk.

“Low-fat dairy is a way to meet these nutrient needs without a lot of fat and calories,” she says. “It’s a unique nutritional package.” Like many milk researchers, Nicklas receives substantial research funding from the National Dairy Council.

Dairy products could obviously help people meet those goals, but Dr. Walter Willett, chairman of nutrition at the Harvard School of Public Health, feels the targets may be overly ambitious. He points out that much of the world doesn’t drink much milk or get anywhere close to 1,000 milligrams of calcium, “and their bones aren’t crumbling and falling apart all around us.”

The RDA for potassium is based on a small study measuring how much of the mineral it took to lower the blood pressure of hypertensive African American men.

In Willett’s mind, that’s a flimsy foundation for an RDA. On a break during a recent 150-mile bike ride, he paused to look at the label for the orange juice (another so-called good source of potassium). He calculated that he would need to get just about his entire day’s calories from juice to reach the 4,700-milligram mark. He decided he would just have to fall short.

Likewise, Willett says, one or two cups of milk might not be enough to help people reach guidelines for calcium and potassium. But he believes it’s enough for good health.

Milk: what USDA recommends and other opinions – latimes.com.

The Danish government has increased taxes on cigarettes, ice-creams, sweets and other products in an effort to make Danes healthier.

The tax reform came into effect Thursday and also means taxes have increased on soft drinks and flavored alcoholic beverages, so-called alcopops.

The tax per liter of ice-cream was increased to 4.25 kroner ($0.67) from 3.40 kroner ($0.56) previously, while the tax on cigarettes was raised by 2 kroner ($0.33) per pack.

The World Health Organization has called taxation one of the most effective interventions to fight alcohol-related harm, tobacco consumption and obesity.

The Brussels, Belgium-based European Public Health Alliance urged other EU members to follow Denmark’s example.

via Denmark ups taxes on sweets, cigarettes, alcopops – Business – msnbc.com.

How do you prevent a deadly disease that is projected to afflict one third of all Americans born today and is caused largely by hard-to-change habits such as too much soda and snacks and too little physical activity?

You could combine the broccoli and cauliflower in the school cafeteria for more colorful eye appeal. Put out 30 basketballs in gym class instead of two. Teach the wonders of water for 15 weeks straight (and remove everything else from vending machines).

Those changes – along with hundreds of others, large and small – signficantly reduced several major risk factors for type 2 diabetes, researchers concluded last week after studying the most comprehensive attempt yet to attack the epidemic through the schools.

Lifestyle prescriptions – you should eat a balanced diet – are notoriously difficult to stick with. But these limits were impossible to avoid.

“Instead of selling candy for a fund-raiser, they were selling carnations. And those are the sort of things that made it holistic across the environment,” said Wayne Grasela, senior vice president for food services in the Philadelphia School District, where six middle schools took part in the three-year national program.

The plan was to intervene early, before diabetes develops – and at a young enough age to learn new habits that could prevent or reduce obesity, a major risk factor for the disease. Numerous physicians helped craft the program, but all the action took place in the schools.

“They are already there. They already take physical education and they already eat lunch in the school,” explained Barbara Linder, who oversaw the study for the National Institutes of Health.

So researchers set about changing the school.

In gym, for example, “instead of doing layups, with most kids standing in line, we had things set up so balls were being passed back and forth while they waited,” said Gary D. Foster, director of Temple University’s Center for Obesity Research and Education, who chaired the national study.

Dumbbells, jump ropes, and medicine balls were distributed to groups, with rotations every 45 to 90 seconds to keep everyone moving. Pop music was played so that gyms were seen as “fun places to be with cool things to do,” Foster said.

In the cafeteria, the standard pizza was replaced with the same manufacturer’s whole-grain, lower-fat version. That shaved nearly 100 calories per slice and the kids didn’t notice, said Amy Virus, a registered dietician at Temple who coordinated the study’s nutrition component.

Nothing but water – not even 100 percent fruit juice – was stocked in vending machines. “Did they miss the juice? Sure, in the beginning,” Virus said, “but they got used to it. And they were buying the water.”

Supporting the effort were posters in classrooms (kids dancing, kids eating fruit), decals sent home over Christmas (TAKE THE FAMILY TV TURNOFF CHALLENGE!) and postcards in summer (“Be active for 60 minutes every day.”), even a healthy version of Jeopardy!, with 25 cards in English and Spanish.

An estimated 24 million Americans have diabetes, a chief cause of kidney failure, limb amputations, blindness, heart disease, and stroke. Although type 1 diabetes is caused by an auto-immune disorder, type 2 – more than 90 percent of the cases – is often linked to lifestyle factors that lead to weight gain and a gradual loss of the ability to control blood sugar.

Once rare before adulthood, type 2 diabetes has been rising steadily in children. Blacks and Hispanics are at particularly high risk; the government now projects that half of all babies born in those minority groups will develop diabetes later in life.

The new program was designed by researchers at seven major universities and targeted schools that enrolled high percentages of poor and minority students.

They began the interventions in 21 schools – three in each city – in the fall of 2006, when the students were in sixth grade; another 21 schools were designated as controls. A total of 4,603 students completed the study in June 2009, at the end of eighth grade.

Analysis showed that there were significantly greater reductions in several diabetes risk factors – body-mass index scores, average insulin levels, and the percentage of students with the largest waists – at the intervention schools vs. the controls.

All those differences were more pronounced among the 50 percent of students who were overweight or obese to begin with. Within that group, the interventions were associated with 21 percent lower odds of being obese at the end of eighth grade, the researchers reported.

The results were published last week online in the New England Journal of Medicine.

via Battling the bulge | Philadelphia Inquirer | 07/05/2010.