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What Exactly Makes Up A Healthy Diet?

By David Templeton, Pittsburgh Post-Gazette (TNS)

BOSTON — Put 20 of the world’s top nutrition scientists in a room together and what do you get? A 90-minute debate about what a vegetable is and, specifically, whether tubers such as potatoes fit in that category.

While the scientists couldn’t come to a consensus on potatoes at the recent Oldways conference, they did — finally — provide clarity overall on what we’re supposed to eat as part of a healthful diet: more vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes and nuts. The group also recommended moderate alcohol consumption, with lower consumption of red and processed meats, sugar-sweetened drinks and refined grains.

Following this pattern should help people avoid spikes in blood sugar, clogged arteries, digestive disorders and chronic disease, it said.

The group also agreed with the 2015 Dietary Guidelines Advisory Committee’s endorsement of the Mediterranean Diet, the Vegetarian Diet and the Healthy American Diet.

Oldways, a Boston-based nutrition information nonprofit headed by Sara Baer-Sinnott, led the charge in seeking common ground on which foods and food groups are healthful and which ones people should limit or avoid.

A key problem she sees is the daily barrage of media reports about bacon and butter being good, or kale being toxic, or meat diets being the ultimate in good health. This prompted her to invite 20 of the leading nutrition scientists — Walter Willett, David Katz, Dean Ornish, Neal Barnard, T. Colin Campbell and S. Boyd Eaton among them — to work on a consensus of what foods can extend longevity and prevent chronic disease to benefit people and the planet.

Food and nutrition journalists and bloggers also were invited to discuss how and why the science so often is distorted by reports extolling the virtues of foods long deemed unhealthful while condemning foods scientifically proven to be beneficial. The often noted example was Time magazine’s June 2014 cover story, “Bacon is back.”

“No wonder people say they are confused and have no idea how they should eat and therefore just give up,” Oldways stated in its conference introduction. “Adding to the confusion, public perception is that nutrition advice changes every day, leaving many of us scratching our heads and saying, ‘Can’t those experts agree on anything?’ “

Dr. Eaton, the Harvard scientist who is known as the father of the Paleo Diet, surprised the other scientists by noting that whole plant foods were healthiest, and that he recommended meat consumption only a few times a month, with fish being the most healthful meat. The consensus was that meat consumption should focus mostly on fish and less so, poultry. Beef and processed meats should be limited or avoided.

The Common Ground conference, held Nov. 17-18, wasn’t a cakewalk. It was more of a food fight, with advocates for various diets, including vegans, Paleo and Mediterranean diets, convening with others advocating the benefits of meat and dairy in one room for many hours.

Hence, the sizzling debate about the healthfulness of potatoes. “There was not common ground on including potatoes,” said Dr. Willett, the Harvard University who helped lead the conference.

In addition to offering general support for the Dietary Guidelines Advisory Committee recommendations issued in February, it opposed Congress’ decision to censor that committee’s recommendations advocating sustainability.

“Food insecurity cannot be solved without sustainable food systems,” states the Common Ground report. “Inattention to sustainability is willful disregard for the quality and quantity of food available to the next generation, i.e., our own children.”

Oldways is establishing a network of scientists, including many involved in the conference, as a media resource for stories about food, nutrition, including those rogue scientific studies that counter more established nutritional science without regard for the methodology or quality of the study. The news-making studies often lack supportive studies.

“When Sara contacted me, we were working on parallel paths,” said Dr. Katz, a Yale University nutritionist who is founding director of its Prevention Research Center and president of the American College of Lifestyle Medicine.

The consensus statement can be read here: oldwayspt.org

©2015 Pittsburgh Post-Gazette. Distributed by Tribune Content Agency, LLC.

Photo: All kinds of nuts, such as walnuts, above, play a key role in a healthy diet, according to scientists and dietitians. (Larry Roberts/Pittsburgh Post-Gazette/TNS)

 

How Much Can Lower Blood Pressure Reduce Health Risks?

By David Templeton, Pittsburgh Post-Gazette (TNS)

PITTSBURGH — A dramatically lower systolic blood pressure — that big number after the blood-pressure cuff has deflated — may be necessary to reduce risk of cardiovascular and kidney disease and even death.

Current guidelines to keep systolic blood pressure below 140 millimeters of mercury (mm Hg) might need to plummet below 120 to reduce the health risks of hypertension.

Don’t panic and don’t let your blood pressure spike. Just stay tuned.

“I would say to wait for more information,” said Indu Poornima, the Allegheny General Hospital director of nuclear medicine and director of the hospital’s Women’s Heart Center. “But it’s always worthwhile to have a discussion with your doctor to see if the patient would benefit with a more aggressive target.”

On Sept. 11, the National Heart, Lung, and Blood Institute stopped its Systolic Blood Pressure Intervention Trial, or SPRINT, when results showed that patients maintaining systolic blood-pressure levels below 120 experienced 30 percent fewer cardiovascular events — heart attacks, heart disease and strokes — than those following current guidelines of below 140, reporting 25 percent fewer deaths.

The Data and Safety Monitoring Board that monitors such studies recommended the trial be halted. It would be unethical to deny all 9,300 study participants the option of seeking better blood pressure control to reduce health risks.

The NHLBI now is analyzing results before publishing them in a medical journal while continuing part of the study focused on whether elevated blood-pressure levels affect cognitive function in older adults.

“We’re working hard to finish the paper and submit it to a journal. I don’t want to specify a date, but it will be within a few months,” said Lawrence Fine, NHLBI’s SPRINT project officer. “Once a paper of this kind with these kinds of results is published, I’m sure that any future guideline group will look at it and integrate it with other research into their recommendations for new guidelines.

“Our job is to provide research information to the larger scientific community and health professionals, so when you have a trial like this one that’s completed successfully, we feel we accomplished our mission,” he said.

During the study, participants were divided into two groups, one using medications to reach a targeted systolic rate of less than 140, which on average required two hypertension medications. The intensive-treatment group on average received three medications to keep levels below 120.

The trial involved 100 health centers in the United States and Puerto Rico, including a local University of Pittsburgh trial involving 140 patients. SPRINT didn’t include patients with diabetes or those who’ve had strokes or polycystic kidney disease because other studies have focused on those populations, with a current blood-pressure target below 130/80.

According to the institute, “high blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems”; one in three adult Americans (about 78 million) having the condition. The World Health Organization and other medical organizations say high blood pressure poses the greatest risk for disease and death.

Blood pressure is measured as a ratio of systolic pressure — the pressure in arteries when the heart beats (or heart muscle contracts) — over diastolic pressure, which is arterial pressure between heart beats, according to www.Heart.org . High blood pressure generally involves the stiffening of blood vessels as people age, largely due to dietary and other lifestyle factors.

There’s evidence, however, that the risk of cardiovascular disease begins rising at 11|0, said Jackson Wright, a Pittsburgh-area native who led one of five research networks in the SPRINT study at the University Hospitals Case Medical Center in Cleveland. He also directs the center’s clinical hypertension program.

“It’s very clear that relaxing treatment for blood pressure control over age 60 no longer is appropriate,” Dr. Wright said, noting the average trial participant age was 68, with 28 percent older than 75.

If SPRINT findings hold up, guideline targets should be lowered, he said. “The question obviously is what to do with patients at 120, and at what point do you use aggressive control with medications rather than changes in lifestyle?”

While awaiting study results, Dr. Wright said, “the last thing I want to do is relax blood-pressure control.”

SPRINT likewise begs the question of whether patients and doctors should take immediate action to reduce blood pressure or await study details.

“It’s hard to tell other health care providers how they should react, but this will prompt discussion for all patients over 50 with high blood pressure who don’t only have hypertension, but a high risk of cardiovascular disease, chronic kidney disease or past cardiovascular events,” said Molly B. Conroy, site principal investigator for SPRINT at Pitt, where she’s an associate professor of medicine and epidemiology. “What this will cause me to do with patients with high blood pressure is to make them aware of the new impact treatment can have and start a discussion of whether intensifying medication would be appropriate,” she said.

Hypertension drugs — including ace inhibitors, diuretics, calcium channel blockers and beta blockers — especially for elderly patients can pose side effects including lightheadedness that boosts the risk of falling. They also can lead to fatigue and drain a person of stamina. Others might cause allergic reactions, while calcium channel blockers can cause ankles to swell, Dr. Conroy said.
The good news is that most of the drugs are available in generic form at reduced costs.

Dr. Poornima at Allegheny General Hospital said trial results don’t surprise her. She already has witnessed better results among her own patients at levels below 120/80. While it may be too early to put trial results into action, “it calls attention to goals of blood pressure being lower, and if that is demonstrated in the study, then it would mean changes in blood-pressure management,” she said.

Already, she said, she’s more aggressive in younger patients and those at higher risk for cardiovascular or kidney disease, with hopes that trial results will better explain the impacts of tighter control in different age groups and disease levels.

“I was expecting (SPRINT results) would be the case because I always believed you target levels closer to normal,” Dr. Poornima said. “That’s what we should aim for.”

(c)2015 Pittsburgh Post-Gazette. Distributed by Tribune Content Agency, LLC.

According to the National Heart, Lung, and Blood Institute, “high blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems,” with one in three adult Americans having the condition. (Photo courtesy Fotolia/TNS)

Just A Taste Of Alcohol For Children Is Too Much, Research Shows

By David Templeton, Pittsburgh Post-Gazette

PITTSBURGH — A parent enjoying an alcoholic drink might find his or her young child to be curious about what’s in that bottle or glass.

It raises the question: Should the parent offer the child just a taste? Will it remove the temptation or encourage use or even abuse?

University of Pittsburgh researcher John E. Donovan said previous research findings prompt his recommendation against parents’ offering their children a taste of alcohol. Even if research, so far, shows no harm from only a taste, it also has shown no benefit. So why encourage alcohol consumption?

His current study published online in the journal Alcoholism: Clinical & Experimental Research sought to identify factors that prompt children to taste or sip alcohol at ages as young as 8 or 10.

Research already has identified two factors predicting whether a 12-year-old child has tasted alcohol — the child’s attitude toward giving it a try and a family environment supportive of alcohol use.

But the study led by Donovan, a Ph.D. and associate professor of psychiatry and epidemiology at Pitt, and co-written by Brooke S.G. Molina of Pitt’s departments of psychiatry and psychology, found that parental approval more so than the child’s psychological proneness is key to whether children 8 or 10 years old already have tasted alcohol.

“Children who sipped alcohol before age 12 reported that their parents were more approving of a child sipping or tasting alcohol and more likely to be current drinkers than those yet to have a sip,” he said. Parents’ comments confirmed that conclusion.

The study involving 452 children (238 girls and 214 boys 8 or 10 years old), and their families from Allegheny County, sought to identify factors that predict whether a child will start to sip or taste alcohol before age 12. One key finding is “that sipping during childhood is not itself a problem behavior, like delinquent behavior or drug use,” Donovan said.

A previous study he conducted determined that nearly two-thirds (66 percent) of 12-year-olds have at least tasted alcohol.

Children often have their first taste of alcohol during family gatherings or celebrations, he said. Parents in the study, even those regularly drinking in the presence of their children, did not roundly approve of offering their children a taste. But some were less opposed to it.

“We don’t really know yet whether childhood sipping or tasting (of alcohol) has any future negative consequences,” he said. “But our previous research found that sipping or tasting alcohol by age 10 was significantly related to early-onset drinking — that is, having more than a sip or a taste before age 15.”

Previous research also found early-onset drinking, as opposed to just tasting, to be associated with numerous negative outcomes for adolescents and young adults, including alcohol abuse and dependence, illicit drug use, prescription drug misuse, delinquent behavior, risky sexual behavior, motor vehicle crashes, and job problems, among others. But it’s not yet known whether just a taste or sip can lead to early consumption of alcohol and later negative outcomes.

But that information could eventually be drawn from already gathered information from Donovan’s ongoing longitudinal study, which is one that follows the same participants through time. “I don’t know whether sipping or offering a sip or taste can have any consequences later on,” he said. “So we shouldn’t assume there is no problem. You have to make your own decision, but it suggests that it may be a problem, and they shouldn’t have a taste.

“What we’re saying is that drinking with the family does not protect against problems or heavier involvement with alcohol later in life,” he said. “It doesn’t have a good benefit. It doesn’t help the child. It doesn’t prevent problems. If it is not helpful, why engage in it? It could create problems.”

AFP Photo/Justin Sullivan

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New Cancer Immunotherapy Treatment Shows Promise

By David Templeton, Pittsburgh Post-Gazette

PITTSBURGH — With no more treatments available, the Oxford, Connecticut, man undertook the dreaded task of discussing with his wife how his demise would affect her, their 5-year-old son and 1-year-old twins.

Rounds of chemotherapy, drug treatments and a bone-marrow transplant all had failed to put Paolo Cavalli’s adult B-cell acute lymphoblastic leukemia into remission. His prognosis was poor.

“With no treatment, I was looking at that time frame” of a few months, he said.

But in a happy twist of fate, Cavalli would receive a new cancer treatment called cancer immunotherapy, which uses the immune system to fight cancer. It’s a field many researchers now are pursuing, with University of Pittsburgh immunologist Olivera Finn being one of its pioneers.

In a phase one human clinical trial, a Memorial Sloan Kettering Cancer Center team in New York City used a gene to engineer patients’ immune cells to attack B-cell leukemia. The results were dramatic. Of 16 patients suffering the final stages of B-cell leukemia, 14 went into complete remission, including Cavalli.

The study, published online Wednesday in Science Translational Medicine, says “the results strongly support the therapeutic potential” for engineered immune-cell therapy.

“These extraordinary results demonstrate that cell therapy is a powerful treatment for patients who have exhausted all conventional therapies,” stated Michel Sadelain, director of the Center for Cell Engineering at the cancer center. “Our initial findings have held up in a larger cohort of patients, and we are already looking at new clinical studies to advance this novel therapeutic approach in fighting cancer.”

Sloan Kettering’s success with the blood-based cancer raises optimism that the method could be adapted to target tumor-based cancers, including lung, pancreatic, breast and prostate.

T cells are immune cells that attack viruses, bacteria and parasites. In Sadelain’s therapy, T cells taken from the patient are engineered in the laboratory to include a gene that makes the T cell target the CD19 protein on the surface of B cells, including cancerous ones.

When the T cells are reintroduced into the patient, they target cancerous B cells, leading to remission in as few as eight days but more typically within 24 days. Sadelain said he has some understanding of why two patients didn’t respond to the treatment.

The “living cell” treatment involves T cells replicating themselves inside the body to pose a persistent threat to cancer cells, eventually leading to remission. “In the treatment, we remarkably induced complete remission with engineered T cells,” Sadelain said.

Next, Sadelain will conduct a phase two trial with more patients to confirm results, with the goal of persuading the U.S. Food and Drug Administration to forgo requirements for a phase three trial, which can be cost-prohibitive. Finn said that’s also her hope with her vaccine for colorectal and other tumor-based cancers.

Traditional therapy for the B-cell leukemia involves rounds of chemotherapy and drug treatments in pursuit of complete remission, which allows a person to undergo a bone-marrow transplant. In that procedure, the cancerous bone marrow is destroyed and replaced with healthy bone marrow from a donor.

Because it’s still unclear whether the treatment can be curative, 10 of the patients in remission underwent bone-marrow transplants, with two deaths resulting from transplant complications, Sadelain said.

Finn, a distinguished professor of immunology in Pitt’s School of Medicine, is engineering immune cells to target and destroy an abnormal variant of protein that exists on the surface of precancerous and cancer cells. That protein is necessary for the cancer to survive and progress.

The immune response engineered by the vaccine destroys precancerous cells on polyps in the colon and prevents development of colon cancer in those predisposed to the disease. She’s also testing the vaccine in pancreatic, lung and breast cancers that feature the same abnormal protein.

Finn wasn’t involved in the Sloan Kettering study, but she said she’s familiar with it. The success was expected.

“I think Michel (Sadelain) is one of the best” in that approach to treating cancer, she said. “The results, as good as they are, occurred because he is dealing with a blood cancer that is more susceptible to T cells. Now we are waiting to see how they work in pancreatic, lung and breast cancer, which are tumor cancers.”

Even with expected results, the high success rate “is wonderful,” she said.

“In that particular disease and that target, it would have been expected, and it’s nice that they got those results,” said Finn, whom Sadelain described as a luminary in the growing research field of engineering immune cells against cancer.

Cavalli, who operates three Cavalli Pizza restaurants, said he’s optimistic about his health but is living day to day. He’s feeling well, he said, eight months after the June treatment. But in a risky decision, he will not undergo bone-marrow transplant, with expectations the treatment cured his leukemia, thanks to Sadelain and team.

“All the doctors that I’ve seen are brilliant,” Cavalli said. “We need more people like them. Dr. Sadelain not only is an intellect but he’s also a great person. He’s positive and he’s optimistic. He’s the type of person that changes the world.”

Photo: epSos.de via Flickr