By Julie Deardorff
Dr Kim Williams thought he followed a heart-healthy diet: He avoided red meat and fried foods. He ate his chicken breast without the skin.
Then in 2003, the Chicago cardiologist realised his level of LDL, the so-called “bad” cholesterol, was too high. Inspired by a patient’s success with a plant-based diet, Williams began using “meat substitutes” for protein. Within six weeks, he says, his LDL level plummeted almost by half into the healthy range.
Now a firm believer in the vegan way of eating — no meat, fish, eggs or dairy — Williams is about to step into a prominent leadership role as president of the American College of Cardiology. When he wrote an essay on the benefits of a plant-based diet for cardiac patients, it kicked off yet another rancorous debate over how people should eat to best protect their hearts.
Supporters praised Williams, chief of the cardiology division at Rush University Medical Center, for highlighting the widely accepted health benefits of eating fruits and vegetables. Critics grumbled about the “food police” and questioned whether a physician with such an influential position should be advocating for a diet that many view as extreme.
“Doctors who recommend a vegan diet are experimenting on their patients,” said Dr Jack Wolfson, an Arizona cardiologist who encourages “Paleo” nutrition, or eating unprocessed foods that can be hunted or gathered, including meat.
Williams says he’s surprised by the polarised reaction and dismisses the idea that veganism is “experimental” given the considerable data gathered on people who eat that way. But he’s also eager for large-scale, randomised trials and acknowledges there are many ways to eat more healthfully.
“Anything someone does to move away from the Standard American Diet will make a huge difference in terms of diabetes, hypertension, obesity and heart disease,” said Williams, referring to the nation’s high consumption of sugar, saturated fat and processed foods.
“Given the health implications of diet, putting the issue in front of people who live with an epidemic of heart disease is not a bad thing,” he added.
The debate underscores the personal and complex nature of nutrition science. Though fruits and vegetables are part of any healthy diet, there’s no consensus on the best way to eat, causing endless confusion and frustration for consumers.
Williams’ statements in support of a plant-based diet — an option naturally low in saturated fat — came not long after a study published in March famously challenged the conventional wisdom that people who consume more saturated fat are at higher risk of heart disease.
Vegan products are easier than ever to find in stores and restaurants, reflecting the diet’s increasing popularity. The trendy high-protein, high-fibre Paleo or “caveman” diet includes grass-produced meats and seafood and excludes grains, potatoes and legumes.
Among those who choose a plant-based diet, many cite health reasons, but environmental and ethical concerns are more important for others.
Vegans eat no animal products — including meat, fish, eggs, dairy and, often, honey. But though Williams eats like a vegan, he doesn’t describe himself that way because of the term’s other connotations. Many vegans avoid all animal-based products, including leather, fur, silk, wool and some soaps and cosmetics, for ideological reasons.
“It just happens that my view on a plant-based diet agrees with those groups,” Williams said. “For me, it’s a health and diet statement.”
Vegetarians generally abstain from eating animal flesh of any kind. Dairy is usually OK, and some eat eggs. Pescetarians are vegetarians who also eat fish and seafood. The term flexitarian refers to people who primarily eat plant-based foods but might indulge when they smell bacon.
Well-planned vegetarian diets, including vegan ones, are nutritionally adequate and appropriate for nearly everyone, including pregnant women and elite athletes, according to the Academy of Nutrition and Dietetics. The US National Institutes of Health says a varied vegetarian diet can reduce the risk of obesity, heart disease and Type 2 diabetes, as well as lower blood pressure.
But experts also say vegans and vegetarians who aren’t careful can wind up consuming a high-carbohydrate diet lacking in basic nutrients. “You can eat white bread and Oreos, a bunch of Boca Burgers, and a gallon of sweetened soy milk and be ‘vegan,’” Dr Ashwani Garg wrote in response to Williams’ essay on MedPage Today.
Garg, a family medicine practitioner in suburban Hoffman Estates, said in an interview that he commends Williams for raising the issue of nutrition but would rather see him promoting plant-based nonprocessed foods in general.
Cardiologist Neil Stone, medical director of the vascular disease centre at Northwestern Medicine’s Bluhm Cardiovascular Institute, said the vegan diet hasn’t been conclusively shown to be better than other healthful eating patterns, including the DASH diet and the Mediterranean-style diet. Both emphasise fruits, vegetables, nuts, beans and seeds, but they differ in the amount of recommended fats.
Vegetables are also the foundation of Paleo nutrition, “but everyone should be eating some amount of meat and/or seafood on a weekly basis,” Wolfson said.
“I’m talking about free-range, grass-fed, healthy animals,” he added. “I’d never tell anyone to eat a burger with a bun.”
Wolfson, who sells duck and beef fat in his office to be used for cooking, points to research that has challenged the relationship between saturated fat and heart disease. But the question is far from settled.
In general, eating foods that contain saturated fats raises the level of cholesterol in the blood, and high levels of LDL cholesterol increase the risk of heart disease and stroke. But the impact can vary by individual. For some people, the cholesterol consumed in food has a greater impact on their blood cholesterol.
In addition, researchers tend to study isolated nutrients, but the foods we eat are more complex.
“I don’t recommend focusing on any single nutrient — including fat,” said Dr Stephen Devries, executive director of the Gaples Institute for Integrative Cardiology, a nonprofit that advocates for a greater role of nutrition in health care. “For example, cutting down on saturated fat but replacing it with sugar, leaves you no further ahead.”
In March, the journal Annals of Internal Medicine published a review of current literature that concluded the current evidence does not support the idea that consuming less saturated fat will prevent heart disease. Many experts quickly responded that people shouldn’t see the paper as a green light to eat all the steak and butter they’d like.
One complicating factor is that when people cut down on fats they tend to replace them with other foods that are bad for cardiovascular health, such as processed carbohydrates. “It’s not that saturated fats are good,” Stone said. “It’s what the saturated fat is replaced with that’s the problem. That’s what has confused America.”
Current guidelines from the American Heart Association restrict the consumption of saturated fats to about 6% of daily calories and encourage people to eat polyunsaturated fats, such as omega 3 and omega 6, to prevent heart disease. For someone eating 2,000 calories a day, that’s about 13g of saturated fat.
Williams’ conversion to vegan eating began in 2003 after a nuclear scan on a patient with severe heart disease showed startling improvement after she had followed a plant-based diet for six months while also exercising and meditating. He was surprised but later discovered several published studies documenting similar improvement. — Chicago Tribune/MCT
Experimental Ebola vaccine
effective in tests on monkeys
Tests of an experimental Ebola vaccine have shown positive results, protecting healthy monkeys from the virus, the National Institutes of Health announced, as West Africa grapples with an epidemic that has killed about 2,000 people.
Researchers gave four macaque monkeys a shot of the experimental vaccine, called ChAd3, and exposed them to high levels of the Ebola virus five weeks later. All the monkeys were protected, the NIH National Institute of Allergy and Infectious Diseases said.
The protection decreased over time, however: Ten months after receiving the vaccine, just two of the four were protected.
Researchers also tried giving monkeys the experimental vaccine and then, eight weeks later, a booster vaccine. Ten months after the initial dose, all four monkeys were fully protected, the institute said.
The authors of the latest study, published in the journal ‘Nature Medicine’, suggested that without the booster, the Ebola virus can quickly regain a foothold and attack the immune system.
Human safety trials of the ChAd3 vaccine were scheduled to start last week in Bethesda, Maryland, with preliminary results due by the end of 2014. In the current crisis, American officials overseeing the trials suggested that the availability of a tested vaccine would offer some assurance of protection to healthcare workers wary of going to West Africa.
The experimental vaccine was developed by the pharmaceutical giant GlaxoSmithKline. The research team was led by Nancy J Sullivan of the NIH and included scientists from Okairos, a biotechnology company that is now part of GlaxoSmithKline, and the US Army Medical Research Institute of Infectious Diseases. Separately, an Ebola-infected American doctor being treated in Nebraska has shown improvement but is still very ill, his wife said.
Dr Rick Sacra, 51, an obstetrician who lives in the Boston area, contracted the deadly virus while treating patients in Liberia as part of a missionary programme. He was flown to the Nebraska Medical Center in Omaha last week.
“Rick is very sick and weak, but slightly improved from when he arrived,” his wife, Debbie Sacra, said in a statement released by SIM USA, the missionary group to which Rick Sacra belongs.
She said she and her husband want to keep the media focus on the African countries ravaged by the disease. “We don’t want this story to be about Rick,” she said. “The story is the crisis in West Africa. That is what is most important. The world is coming to this fight late.”
This year’s Ebola outbreak is the worst on record, with a fatality rate of 53%, according to the World Health Organisation. Rick Sacra is the third American to be transported to the US this year after contracting the virus.
Nancy Writebol and Dr Kent Brantly, who were also missionaries in Liberia, recovered after treatment at a special infectious-disease unit at Emory University Hospital in Atlanta. Writebol and Brantly received an experimental medication, ZMapp, but it is unclear whether that helped them. — By Lauren Raab, Melissa Healy and Matt Pearce, Los Angeles Times/MCT
Anxiety, sleep drugs linked to
Alzheimer’s disease in older people
Older people who have relied on a class of drugs called benzodiazepines to reduce anxiety or induce sleep are at higher risk of going on to develop Alzheimer’s disease, new research finds, with those whose use of the medications is most intensive almost twice as likely to develop the mind-robbing disorder.
Benzodiazepines — marketed under such names as Xanax, Valium, Ativan and Klonopin — are widely used to treat insomnia, agitation and anxiety, all of which can be early signs of impending Alzheimer’s disease in the elderly. But the current study sought to disentangle benzodiazepines’ use in treating early dementia symptoms, probing instead the possibility that heavy use of the medications may permit, cause or hasten the onset of Alzheimer’s dementia.
The study compared the pattern of benzodiazepine use in 1,796 elderly people diagnosed with Alzheimer’s with that of 7,184 similar people who had no such diagnosis. Such a study design, conducted by French and Canadian researchers and published in the journal BMJ, cannot by itself establish that more intensive use of the medications causes Alzheimer’s disease. But it does strengthen such suspicions.
Among the study participants over 66 who were living independently in the Canadian province of Quebec, those who took low-dose benzodiazepine medication, or who took higher doses but very briefly or infrequently, did not see their Alzheimer’s risk go up five years after they were first prescribed such a medication. But the picture was more worrisome for those who frequently took long-acting benzodiazepines, who frequently took high doses, or who took any such drugs regularly over several months.
The benzodiazepines specifically considered by the researchers were the short-acting anti-anxiety medications alprazolam (Xanax), lorazepam (Ativan), oxazepam (Seresta) and diazepam (Valium), and the longer-acting anti-seizure and “hypnotic” drugs frequently used to treat insomnia: clonazepam (Klonopin), flurazepam (Dalmane), midazolam (Versed), nitrazepam (Mogadon), temazepam (Restoril) and triazolam (Halcion).
The widely prescribed medicines marketed as Ambien, Lunesta and Sonata (generically named zolpidem, eszopiclone and zaleplon) are “atypical benzodiazepines” and were not included in the analysis.
The authors of the study created an index that gauged the intensity of a participant’s benzodiazepine use and found that at the end of a five-year period following an initial prescription, Alzheimer’s risk mounted steadily. Those who took the cumulative equivalent of daily doses for three to six months over a five-year period were roughly 32% more likely than those who took none to develop Alzheimer’s. Those who took the cumulative equivalent of a full daily dose for more than six months were 84% more likely to do so.
There’s already strong research evidence that frequent or regular benzodiazepine use degrades memory and mental performance in humans and animals. And some research suggests that with regular use of this class of drugs, the receptors to which they bind in the brain become less active. And lower activity of those receptors has been linked to cognitive decline.
“In view of the evidence, it is now crucial to encourage physicians to carefully balance the risks and benefits when initiating or renewing a treatment with benzodiazepines and related products in older patients,” the authors wrote.
International medical guidelines recommend the use of benzodiazepines as treatment for anxiety disorders and transient insomnia, but caution that they are not meant for long-term use, and should not be taken steadily for more than three months. But many patients continue to take these drugs for years. In addition to their cognitive effects, benzodiazepines are widely implicated in the national epidemic of opioid pain medication overdoses and fatalities that result from mixing them with alcohol and opioid drugs. — By Melissa Healy, Los Angeles Times, MCTa
