Tag Archives: Risk

Gluten-free diet carries increased obesity risk, warn experts

Substituting everyday staples with gluten-free foods could increase the risk of obesity, experts have warned, after finding that such products often contain higher levels of fats than the food they aim to replace.

A gluten-free diet is essential to those with coeliac disease – an auto-immune condition that is thought to affect 1% of Europeans – while the regime is also proving increasingly popular among those without the disease. But while a host of gluten-free products are on the market, researchers have said they have a very different nutritional make-up to conventional staples.

“There is very little [consumers] can do about it,” said Joaquim Calvo Lerma of the Instituto de Investigación Sanitaria La Fe in Spain and co-author of the research. “Unfortunately consumers can [only] eat what is available on the market.”

Calvo Lerma’s warning comes after he and his and colleagues compared 655 conventional food products to 654 gluten-free alternatives across 14 food groups including breads, pasta, breakfast cereals, biscuits and even ready meals, covering a range of brands.

The results – presented at the annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition – reveal that, overall, gluten-free products were more energy-dense than their conventional counterparts.

The team found that, on average, gluten-free bread loaves had more than twice the fat of conventional loaves, while gluten-free breads in general had two to three times less protein than conventional products. Gluten-free biscuits were also found to be lower in protein but higher in fat, while gluten-free pasta had lower levels of sugar and just half of the protein of standard pasta.

Calvo Lerma warned that gluten-free foods could be contributing to an increased risk of obesity, particularly among children who are more likely to eat products like biscuits and breakfast cereals. He urged consumers to compare gluten-free products across brands to find those with the lowest fat content.

Calvo Lerma also called on manufacturers to innovate. “It is the responsibility of the food industry to produce these type of gluten-free products from other materials that are much healthier or have a [more] enhanced nutritional profile than the current raw materials being used, like cornflour or potato starch,” he said, pointing out that healthier products could be made, for example, using grains such as buckwheat or amaranth.

He added that manufacturers should also add more complete and clearer labels to products to highlight their nutritional content, including levels of vitamins and minerals.

Benjamin Lebwohl, from the coeliac disease centre at Columbia University, who was not involved in the research, said that the study backs up previous evidence that gluten-free foods are nutritionally suboptimal. But while a gluten-free diet is essential for coeliacs, it is not intrinsically healthy or unhealthy, he added. “It depends on the choices you make as part of the gluten-free diet,” he said.

Sarah Sleet, chief executive of Coeliac UK, said the latest findings tie in with the charity’s own research, adding that further development of lower-fat, gluten-free products would be welcomed.

David Sanders, professor of gastroenterology at the University of Sheffield, noted that other studies have found gluten-free and conventional foods to have similar nutritional value. “The jury is out,” he said.

But Sanders cautioned that there is no evidence a gluten-free diet has benefits for those without gluten sensitivity or coeliac disease. “Once you go into the territory of dietary restrictions without medical symptoms then you are running the gauntlet of missing out on various vitamins or minerals without realising it,” he said.

Common painkillers may raise risk of heart attack by 100% – study

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Risk of myocardial infarction is greatest in first month of taking NSAIDs such as ibuprofen if dose is high, say researchers

Commonly prescribed painkillers including ibuprofen increase the likelihood of having a heart attack within the first month of taking them if consumed in high doses, a study suggests.

All five nonsteroidal anti-inflammatory drugs (NSAIDs) examined could raise the risk as early as the first week of use, an international team of researchers found.

Related: Should I stop taking Ibuprofen?

Continue reading…

Can your multivitamin increase the risk of Alzheimer’s disease?

Many of us want to improve our odds of getting into old age in the best of shapes by using multivitamins. I do it. You probably do it, too. But can your multivitamin increase the risk of Alzheimer’s disease? Recent research focuses on copper, a common ingredient of many multivitamins as a possible suspect in dementia.

“For some time it has been clear that copper toxicity plays a major role in Alzheimer’s disease,” says professor George Brewer, a researcher at University of Michigan.

It all started with Larry Spark’s rabbits. In his West Virginia laboratory Dr. Larry Sparks, a researcher investigating the effect of high cholesterol diet in Alzheimer’s disease (AD), developed an animal model of this disease. He and his team fed rabbits with high-fat diet until they developed AD-like disease (and you thought you had a depressing job!). When he moved his lab to Arizona, to his surprise he found that he no longer was able to induce dementia in his animals. What happened? He maintained the same conditions (same breed of rabbits, identical food etc.). The only change, he realized after some time, was that in West Virginia he used tap water, whereas in Arizona the water was distilled. After experimenting with different substances in water he narrowed it down to a difference in the levels of copper.

But keep in mind: this doesn’t make copper a villain. Copper remains an important trace element; its deficiency can cause as much trouble as its excess. It is a crucial component of many enzymes.

We get 75% of our copper from food such as shellfish, nuts, grains, many fruits and vegetables and chocolate.  It is so-called “organic copper” or copper-1. Over millennia our bodies figured out a safe way of handling it through processing it through liver, which works like a distribution center, sending it to whatever cells may need it.

Then, there is remaining 25%, inorganic copper or copper-2, which we get from water (leached from copper piping) and more recently from supplements.  It slightly differs from copper-1 in that it is unattached to any bigger molecules.  As a result, it shows up in our blood almost immediately after ingestion, as it bypasses the secure channels in liver. What’s more concerning, it can cross through the blood-brain barrier, an important mechanism, which decides which substances can cross safely into the brain.

We have evolved to handle copper-1 safely, but copper-2 is a different matter altogether. Excess of copper-2 in water is a new phenomenon and our organisms don’t have efficient pathways to handle the increased amount of this mineral. But we may be making matters worse by getting even more of copper-2 in our bodies by taking it in form of supplements (almost all copper in supplements and multivitamins is copper-2).

So how does copper affect the brain?  In a nutshell, it increases oxidative stress and beta amyloid plaque formation. Beta amyloid is a protein that forms the plaques, which are hallmark of Alzheimer’s disease.  It is possible that forming the beta amyloid clumps may be body’s way to cope with increased oxidative damage from metals like copper.  But after its role has been fulfilled, the body will try to eliminate excess of beta amyloid. If removal is unsuccessful, as a result beta amyloid will aggregate in plaques, gumming up the work of the neurons.

More recently researchers from University of Rochester found that adding small amounts of copper to water fed to mice has affected that cleanup mechanism.  The blood-brain barrier become leaky, admitting even more copper into the brain circulation.

There is another factor, which can make problems with inorganic copper even worse. You saw it in Larry Spark’s rabbits. It turns out that eating a diet high in red meat and trans fatty acids increases absorption of copper, enough to make a difference in cognition. Perhaps this is just how it works in rats, you wonder. Maybe it was one-off result? Fair point. Alas, no.

Look at the results of this study done on seniors in Chicago. In 2006, Morris and his colleagues published the results of 6 years follow up on over 3700 residents of Chicago, 65 and older. The researchers looked at dietary content of copper and fat and following patients’ memory with four different tests. There was a strong association of memory problems with high copper intake (mostly from vitamin supplements) and fatty diet. In fact, the risk of dementia in people whose copper intake was in the top 20%, was increased six fold (yes, you read that right – six fold!). Interestingly, there was no such correlation in people who avoided saturated and trans fats.

Could this be the key to the increased rate of dementia we have observed in the last 60 years? George Brewer, professor at University of Michigan, and one of the main researchers on copper and brain, thinks that it may be the case. He proposed that the high prevalence of Alzheimer’s disease (20% of those 70 and older and 30% of 80 and above) arose in context of increased affluence in US after WWII, which brought with it diet rich in meat and processed food and widespread use of copper plumbing.

Consider this: the rates of Alzheimer’s disease in undeveloped countries are only a fraction of what we see in US. For instance, in rural India its prevalence in people over 65 is only about 1%. In Nigeria it is even lower, at about 0.5%. Their diet contains much less saturated and trans fats. And there is much less infrastructure in terms of plumbing, copper or otherwise. Now, look at Japan, admittedly a developed country, but with low prevalence of dementia (8%). They have rejected copper plumbing because of concern about its toxicity. But, when Japanese migrate to Hawaii (where use of copper plumbing is as common as in continental US), their rates of Alzheimer’s disease increase to match the rest of the population.

Did you know that over 80% of US households use copper plumbing? Environmental Protection Agency set its “action level” for copper content in water at 1.3 mg/L. But the amount of copper in water that jumpstarted the dementia in Larry Sparks’ rats was less that tenth of that, at 0.12 mg/L. Should we be concerned?

Concerned – yes. Ripping out your copper plumbing? Probably overkill. As this is all rather new, the researchers don’t have enough data to make definite recommendations yet. Here is what I do, as we are all awaiting more conclusive figures:

  • I use copper-free multivitamin. Almost all copper in multivitamins is copper-2, potentially toxic to the brain.
  • I stopped using unlined copper cooking pots, as they may leach some inorganic copper into food, particularly in higher acidity. But here should be no problem with copper cookware lined with ceramic or stainless steel.
  • It seems that dietary copper (copper-1) is safe. I don’t go out of my way to avoid copper-rich foods. However, if concerned, cooking beans and grains will reduce the amount of copper by 50%.
  • I never use hot water tap for cooking. Heat increases corrosive properties of water and with that – copper leaching from the plumbing.
  • For drinking water – I let the faucet run for at least 30 sec. I haven’t been able to find and studies on that and to my knowledge and there is no consensus on how long is enough – I’ve seen numbers anywhere from 15 sec to 5 min. You could use the flush water for watering the plants, washing the dishes etc. to minimize the waste.
  • I use water filter for all drinking and cooking water. Reverse osmosis filter will eliminate 97-98% of copper-2. Activated carbon and ion exchange resins filters, like Brita will work, too.
  • If you have copper pipes, like I do, it may be worthwhile to test the water copper content. A single test (copper only) from local water testing company costs about $ 30.
  • Finally, if you worry about your memory, you may run it by your doctor, and ask to have your serum copper and zinc level tested. Calculate your copper/zinc ratio (divide copper over zinc; make sure they are reported in the same unit, usually μg/dL). Desirable copper/zinc ratio is 0.7-1, but it may increase with age and inflammatory diseases. Should your ratio be above 2, talk to your doctor about zinc supplementation. Don’t do it on your own – there may be some real, irreversible downsides to over supplementing zinc. Stay tuned – I will be writing about copper/zinc ratio as a biomarker of aging, cognition and inflammation soon.

Resources:

Brewer GJ. Copper-2 ingestion plus increased meat eating leading to increased copper absorption are major factors behind the current epidemic of Alzheimer’s Disease. Nutrients 2015;7:10053-64

Brewer GJ, Kaur S. Zinc deficiency and zinc therapy efficacy with reduction of serum free copper in Alzheimer’s Disease. Int J Alzeimers Dis. 2013; 2013:586365

Squitti et al. Low copper diet as a preventive strategy for Alzheimer’s Disease. Neurobiol Aging. 2014 Sep;35 Suppl 2:S40-50

Morris MC et al. Dietary copper and high saturated and trans fats intakes associated with cognitive decline. Arch Neurol 2006 Aug;63(8):1085-8

https://www.cdc.gov/healthywater/drinking/private/wells/disease/copper.html

Anna Lamnari, MD on Facebook
Anna Lamnari, MD

Dr. Anna Lamnari is an internist, geriatrician and integrative practitioner with almost 20 years of clinical practice. She is passionate about healthy, vibrant aging and natural ways of improving memory. Follow her on: www.aginglikeaboss.com.

Can your multivitamin increase the risk of Alzheimer’s disease?

Many of us want to improve our odds of getting into old age in the best of shapes by using multivitamins. I do it. You probably do it, too. But can your multivitamin increase the risk of Alzheimer’s disease? Recent research focuses on copper, a common ingredient of many multivitamins as a possible suspect in dementia.

“For some time it has been clear that copper toxicity plays a major role in Alzheimer’s disease,” says professor George Brewer, a researcher at University of Michigan.

It all started with Larry Spark’s rabbits. In his West Virginia laboratory Dr. Larry Sparks, a researcher investigating the effect of high cholesterol diet in Alzheimer’s disease (AD), developed an animal model of this disease. He and his team fed rabbits with high-fat diet until they developed AD-like disease (and you thought you had a depressing job!). When he moved his lab to Arizona, to his surprise he found that he no longer was able to induce dementia in his animals. What happened? He maintained the same conditions (same breed of rabbits, identical food etc.). The only change, he realized after some time, was that in West Virginia he used tap water, whereas in Arizona the water was distilled. After experimenting with different substances in water he narrowed it down to a difference in the levels of copper.

But keep in mind: this doesn’t make copper a villain. Copper remains an important trace element; its deficiency can cause as much trouble as its excess. It is a crucial component of many enzymes.

We get 75% of our copper from food such as shellfish, nuts, grains, many fruits and vegetables and chocolate.  It is so-called “organic copper” or copper-1. Over millennia our bodies figured out a safe way of handling it through processing it through liver, which works like a distribution center, sending it to whatever cells may need it.

Then, there is remaining 25%, inorganic copper or copper-2, which we get from water (leached from copper piping) and more recently from supplements.  It slightly differs from copper-1 in that it is unattached to any bigger molecules.  As a result, it shows up in our blood almost immediately after ingestion, as it bypasses the secure channels in liver. What’s more concerning, it can cross through the blood-brain barrier, an important mechanism, which decides which substances can cross safely into the brain.

We have evolved to handle copper-1 safely, but copper-2 is a different matter altogether. Excess of copper-2 in water is a new phenomenon and our organisms don’t have efficient pathways to handle the increased amount of this mineral. But we may be making matters worse by getting even more of copper-2 in our bodies by taking it in form of supplements (almost all copper in supplements and multivitamins is copper-2).

So how does copper affect the brain?  In a nutshell, it increases oxidative stress and beta amyloid plaque formation. Beta amyloid is a protein that forms the plaques, which are hallmark of Alzheimer’s disease.  It is possible that forming the beta amyloid clumps may be body’s way to cope with increased oxidative damage from metals like copper.  But after its role has been fulfilled, the body will try to eliminate excess of beta amyloid. If removal is unsuccessful, as a result beta amyloid will aggregate in plaques, gumming up the work of the neurons.

More recently researchers from University of Rochester found that adding small amounts of copper to water fed to mice has affected that cleanup mechanism.  The blood-brain barrier become leaky, admitting even more copper into the brain circulation.

There is another factor, which can make problems with inorganic copper even worse. You saw it in Larry Spark’s rabbits. It turns out that eating a diet high in red meat and trans fatty acids increases absorption of copper, enough to make a difference in cognition. Perhaps this is just how it works in rats, you wonder. Maybe it was one-off result? Fair point. Alas, no.

Look at the results of this study done on seniors in Chicago. In 2006, Morris and his colleagues published the results of 6 years follow up on over 3700 residents of Chicago, 65 and older. The researchers looked at dietary content of copper and fat and following patients’ memory with four different tests. There was a strong association of memory problems with high copper intake (mostly from vitamin supplements) and fatty diet. In fact, the risk of dementia in people whose copper intake was in the top 20%, was increased six fold (yes, you read that right – six fold!). Interestingly, there was no such correlation in people who avoided saturated and trans fats.

Could this be the key to the increased rate of dementia we have observed in the last 60 years? George Brewer, professor at University of Michigan, and one of the main researchers on copper and brain, thinks that it may be the case. He proposed that the high prevalence of Alzheimer’s disease (20% of those 70 and older and 30% of 80 and above) arose in context of increased affluence in US after WWII, which brought with it diet rich in meat and processed food and widespread use of copper plumbing.

Consider this: the rates of Alzheimer’s disease in undeveloped countries are only a fraction of what we see in US. For instance, in rural India its prevalence in people over 65 is only about 1%. In Nigeria it is even lower, at about 0.5%. Their diet contains much less saturated and trans fats. And there is much less infrastructure in terms of plumbing, copper or otherwise. Now, look at Japan, admittedly a developed country, but with low prevalence of dementia (8%). They have rejected copper plumbing because of concern about its toxicity. But, when Japanese migrate to Hawaii (where use of copper plumbing is as common as in continental US), their rates of Alzheimer’s disease increase to match the rest of the population.

Did you know that over 80% of US households use copper plumbing? Environmental Protection Agency set its “action level” for copper content in water at 1.3 mg/L. But the amount of copper in water that jumpstarted the dementia in Larry Sparks’ rats was less that tenth of that, at 0.12 mg/L. Should we be concerned?

Concerned – yes. Ripping out your copper plumbing? Probably overkill. As this is all rather new, the researchers don’t have enough data to make definite recommendations yet. Here is what I do, as we are all awaiting more conclusive figures:

  • I use copper-free multivitamin. Almost all copper in multivitamins is copper-2, potentially toxic to the brain.
  • I stopped using unlined copper cooking pots, as they may leach some inorganic copper into food, particularly in higher acidity. But here should be no problem with copper cookware lined with ceramic or stainless steel.
  • It seems that dietary copper (copper-1) is safe. I don’t go out of my way to avoid copper-rich foods. However, if concerned, cooking beans and grains will reduce the amount of copper by 50%.
  • I never use hot water tap for cooking. Heat increases corrosive properties of water and with that – copper leaching from the plumbing.
  • For drinking water – I let the faucet run for at least 30 sec. I haven’t been able to find and studies on that and to my knowledge and there is no consensus on how long is enough – I’ve seen numbers anywhere from 15 sec to 5 min. You could use the flush water for watering the plants, washing the dishes etc. to minimize the waste.
  • I use water filter for all drinking and cooking water. Reverse osmosis filter will eliminate 97-98% of copper-2. Activated carbon and ion exchange resins filters, like Brita will work, too.
  • If you have copper pipes, like I do, it may be worthwhile to test the water copper content. A single test (copper only) from local water testing company costs about $ 30.
  • Finally, if you worry about your memory, you may run it by your doctor, and ask to have your serum copper and zinc level tested. Calculate your copper/zinc ratio (divide copper over zinc; make sure they are reported in the same unit, usually μg/dL). Desirable copper/zinc ratio is 0.7-1, but it may increase with age and inflammatory diseases. Should your ratio be above 2, talk to your doctor about zinc supplementation. Don’t do it on your own – there may be some real, irreversible downsides to over supplementing zinc. Stay tuned – I will be writing about copper/zinc ratio as a biomarker of aging, cognition and inflammation soon.

Resources:

Brewer GJ. Copper-2 ingestion plus increased meat eating leading to increased copper absorption are major factors behind the current epidemic of Alzheimer’s Disease. Nutrients 2015;7:10053-64

Brewer GJ, Kaur S. Zinc deficiency and zinc therapy efficacy with reduction of serum free copper in Alzheimer’s Disease. Int J Alzeimers Dis. 2013; 2013:586365

Squitti et al. Low copper diet as a preventive strategy for Alzheimer’s Disease. Neurobiol Aging. 2014 Sep;35 Suppl 2:S40-50

Morris MC et al. Dietary copper and high saturated and trans fats intakes associated with cognitive decline. Arch Neurol 2006 Aug;63(8):1085-8

https://www.cdc.gov/healthywater/drinking/private/wells/disease/copper.html

Anna Lamnari, MD on Facebook
Anna Lamnari, MD

Dr. Anna Lamnari is an internist, geriatrician and integrative practitioner with almost 20 years of clinical practice. She is passionate about healthy, vibrant aging and natural ways of improving memory. Follow her on: www.aginglikeaboss.com.

Backlash after report claims saturated fats do not increase heart risk

Saturated fat does not increase the risk of a heart attack by clogging up arteries, three cardiologists have said in a challenge to medical thinking, sparking a furious backlash.

In an editorial published in the British Journal of Sports Medicine the cardiologists also write that relying on foodstuffs marketed as “low fat” or “proved to lower cholesterol” to avoid heart disease is “misguided”.

A key previous research study, they say, “showed no association between saturated fat consumption and all-cause mortality, coronary heart disease, CHD mortality, ischaemic stroke or type-2 diabetes in healthy adults”. Instead they say that a Mediterranean-style diet and 22 minutes of walking a day are the best ways to prevent heart problems.

The paper co-authored by Pascal Meier, a cardiologist at University College London and editor of the journal BMJ Open Heart; Rita Redberg, the editor of the American journal JAMA Internal Medicine; and Aseem Malhotra, a cardiologist at the NHS’s Lister hospital in Stevenage, has triggered furious criticism from a range of experts in cardiology and evidence-based medicine. Some said the views were not based on reliable evidence and would mislead consumers and further confuse the public over which foods they should eat and which they should avoid.

They also dismiss the potential for a smaller intake of saturated fats to help prevent heart disease. “There is no benefit from reduced fat, including saturated fat, on myocardial infarction [heart attacks], cardiovascular or all-cause mortality,” they say.

Instead of adopting a low-fat diet, people seeking to cut their risk of heart problems should instead follow “an energy-unrestricted Mediterranean diet (41%) fat supplemented with at least four tablespoons of extra virgin olive oil or a handful of nuts”.

But critics responded by accusing the co-authors of naiveté, ignoring evidence which contradicts their theories and simplifying a hugely complex issue.

Dr Amitava Banrejee, a senior clinical lecturer in clinical data science and honorary consultant cardiologist at UCL, said: “Unfortunately the authors have reported evidence simplistically and selectively. They failed to cite a rigorous Cochrane systematic review which concluded that cutting down dietary saturated fat was associated with a 17% reduction in cardiovascular events, including CHD, on the basis of 15 randomised trials.”

Dr Gavin Sandercock, director of research at Essex University, rejected the trio’s claims about the benefit of “replacing refined carbohydrates with healthy high fat foods” as not true and not based on any existing evidence. “We must continue to research the complex links between fat, cholesterol and heart disease but we must not replace one myth with another”, Sandercock said.

Christine Williams, professor of human nutrition at Reading University, said the cardiologists’ dietary advice was impractical, especially for poorer people. “The nature of their public health advice appears to be one of ‘let them eat nuts and olive oil’ with no consideration of how this might be successfully achieved in the UK general population and in people of different ages, socioeconomic backgrounds or dietary preferences,” she said.

However, some experts did back the authors. Dr Mary Hannon-Fletcher, head of the school of health sciences at Ulster University, hailed their views as “the best dietary and exercise advice I have read in recent years. Walking 22 minutes a day and eating real food. This is an excellent public health message.

“The modern idea of a healthy diet where we eat low-fat and low-calorie foods is simply not a healthy option. All of these foods have been so altered they are anything but healthy. So eating real foods in moderation and exercising daily is the answer to keeping fit and healthy; it’s just too simple a message for the public to take on board,” she said.

Gaynor Bussell, a dietitician and member of the British Dietetic Association, also offered the authors qualified support. “Many of us now feel that a predominantly Med-style diet can be healthy with slightly more fats and fewer carbs, provided the fats are ‘good’ – such as in olive oil, nuts or avocados,” she said.

However, saturated fats should comprise no more than 11% of anyone’s food intake, she said – far less than the 41% fat level backed by the co-authors.

While carbohydrates should still be part of every meal, people should routinely consume high fibre or wholegrain versions, Bussell said.

Williams also accused the BJSM of publishing opinions seeking to portray saturated fats as “innocent” in the causation of heart disease in order to generate headlines. “Some would argue the journals have a very credible business model based on attracting controversy in an area of great importance to public health where clarity, not confusion, is required,” she said.

Stroke and dementia risk linked to low-sugar drinks, study finds

Consuming a can a day of low- or no-sugar soft drink is associated with a much higher risk of having a stroke or developing dementia, researchers claim.

Their findings have prompted renewed questions about whether drinks flavoured with artificial sweeteners can increase the risk of serious illness, as heavily sugared drinks have already been shown to do.

“Drinking at least one artificially sweetened beverage daily was associated with almost three times the risk of developing stroke or dementia compared to those who drank artificially sweetened beverages less than once a week,” according to the American researchers who carried out a study published in Stroke, the journal of the American Heart Association.

“After adjustments for age, sex, education (for analysis of dementia), calorific intake, diet quality, physical activity and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischaemic stroke, all-cause dementia and Alzheimer’s disease dementia,” the co-authors write.

Those consuming at least a can of so-called diet drinks every day were 2.96 times more likely to suffer an ischaemic stroke and 2.89 times more likely to develop Alzheimer’s disease than those who drank them less than once a week, they found.

Ischaemic strokes occur when blood cannot get to the brain because of a blockage, often one caused by a blood clot forming in either an artery leading to the brain or inside a vein in the brain itself. They comprise the large majority of the 152,0000 strokes a year which occur.

Surprisingly, though, the research also contradicted previous studies by finding that sugared drinks did not raise the risk of either serious outcome. It is based on data for more than 4,300 participants in the Framingham Heart Study, a long-term medical research project in the United States.

“To our knowledge, our study is the first to report an association between daily intake of artificially sweetened soft drink and increased risk of both all-cause dementia and dementia because of Alzheimer’s disease,” the co-authors added.

However, they admitted that they cannot prove a causal link between intake of diet drinks and development of either medical condition because their study was merely observational and based on details people provided in questionnaires logging their food and drink habits.

Matthew Pase, a senior fellow in the department of neurology at Boston University’s school of medicine who was one of the co-authors, said that despite no evidence of a causal link, the apparent connection between sweetened drinks and the two conditions “does identify an intriguing trend that will need to be explored in other studies”.

This is not the first time that sweetened drinks have been implicated in the development of serious ill-health. The paper quotes the Northern Manhattan study as having found that “daily consumption of artificially sweetened soft drink was associated with a higher risk of combined vascular events but not stroke”. It also cites the conclusion of the Nurses Health study and Health Professionals follow-up study that “greater consumption of sugar and artificially sweetened soft drinks was each independently associated with a higher risk of incident stroke over 28 years of follow-up for women and 22 years of follow-up for men”.

Sales of diet versions of soft drinks have boomed in recent years as sales of fully sugared ones have declined sharply.

Defra’s Family Food Survey, published last month, found that sales of regular soft drinks fell by 34.6% between 2010 and 2014, while low-calorie drinks purchases increased by 35.8%. Now just 38% of all soft drinks consumed are fully sugared, it said.

However, experts and health charities warned against reading too much into the new findings reported in Stroke.

“This research does not show that artificially sweetened drinks cause dementia. But it does highlight a worrying association that requires further investigation,” said Dr James Pickett, head of research at Alzheimer’s Society.

Naveed Sattar, professor of metabolic medicine at Glasgow University, said: “This is an interesting paper, but I would strongly caution against the conclusion that artificially sweetened drinks may increase the risk of stroke and Alzheimer’s. There is little other strong evidence to support a link between artificially sweetened drinks and adverse health outcomes.”

The results could have been skewed by people who had already become ill switching to low- or no-sugar drinks, Sattar added.

Dr Mary Hannon-Fletcher, head of health sciences at Ulster University, said: “These data are sound as far as they go. However it is important to note ‘the associations between recent and higher cumulative intake of artificially sweetened soft drinks and dementia were no longer significant after additional adjustment for vascular risk factors and diabetes mellitus’ – as the editor also pointed out. So are the conclusions sound? Perhaps not.”

Gavin Partington, director general of the British Soft Drinks Association, said: “Despite their claims, the authors of this observational study admit they found no cause and effect and provide no science-based evidence whatsoever to support their theories.

“In fact, based on the evidence, Public Health England is actively encouraging food and drink companies to use low-calorie sweeteners as an alternative to sugar and help people manage their weight.”

However, Tam Fry, a spokesman for the National Obesity Forum, warned consumers not to see low- or no-sugar drinks as healthy. “Don’t be fooled by the use of the word diet. Diet drinks were dreamed up as a description by an industry wanting to lull you into believing that it was a healthy thirst-quencher. Whether you’re thin or fat and thirsty, and not near a good old-fashioned tap, buy yourself bottled water,” Fry said.

It’s good to hear cycling to work reduces your risk of dying. But that’s not why I do it | Laura Laker

It may not be a surprise to see another study suggesting that cycling to work can drastically reduce your chances of getting cancer and heart disease – those who ride bikes for transport already know how good it makes them feel. However, it’s perhaps yet another motivation for those who don’t, to dust off their bikes – and remember some other reasons cycling to work is so great.

In a five-year study of 263,450 UK commuters, published in the BMJ, researchers at Glasgow University found regular cycling cut the risk of death from any cause by 41%, and the incidence of cancer and heart disease by 45% and 46% respectively.

The cyclists in the study were riding an average of 30 miles per week; that’s three miles each way, five days per week. Cycling at a leisurely 10mph, that would take about 20 minutes each way – a manageable distance for most people.

At present only 3% of the UK population commute by bike, while 36% use a car. If we increased cycling in this country to German levels by 2025, we would save £1.8bn in health benefits and £284m thanks to less congestion.

Ask anyone who cycles to work why they do it, and they’ll have a story to tell, whether it’s about how good it makes them feel, how they saved money, lost weight, or won a battle with depression. Most people will tell you how enjoyable it is.

My commuting story began at university. I remember being astonished one morning when I realised my friend Szilvia had cycled from Finsbury Park in the rain. Getting on a bike and riding five miles in such conditions sounded miserable, but she looked happy and bright, and told me how great it was.

We lived fairly close to one another and she offered to ride with me one day. As I pedalled frantically to keep up with her through Regent’s Park, and Camden, it was like I’d grown wings. Before long, like her, nothing short of a gale force wind with pigeon-sized hailstones was going to stop me from experiencing this feeling every day.

For the first time in my life I started getting fit. I arrived at university feeling awake, alert, and generally in a good mood. I continued to cycle to various temp jobs around London after graduation, carrying my work clothes in a pannier and getting changed in the loos.

On crisp, sunny mornings, I’d cycle through the city feeling like it had rolled out the red carpet just for me. I’d levelled up on urban living: I’d whizz past the stationary traffic and queues for buses and try not to look too smug.

I’d chat to others at the traffic lights. Often I’d get to places quicker than public transport could carry me. Often it was the best part of the day.

Fitting exercise into your daily routine is infinitely easier than trying to carve out a slice of it to go to the gym. Without even trying, you get fitter if you cycle. It is no surprise that levels of physical activity are declining as fewer people cycle or walk to work.

In the cities of cycle friendly countries, such as the Netherlands and Denmark, up to 41% of people commute by bike because it’s easy to do and it feels safe. Decades of investment in cycling infrastructure have made it that way. These countries have learned that most people prefer protected, direct routes on main roads, and low-traffic neighbourhood streets. This means people of any age can cycle, from the very young to the elderly. In the Netherlands, for example, 20% of 80-84 year olds regularly cycle.

Imagine if the UK was like the Netherlands, where 20% of 80-84 year olds regularly cycle


Imagine if the UK was like the Netherlands, where 20% of 80-84 year olds regularly cycle. Photograph: Rory Buckland L/Alamy Stock Photo

In the UK, meanwhile, we’ve had decades of car-centric planning, and minuscule levels of funding for cycling. Even though cycling is statistically safe, it doesn’t always feel it, and this fear of sharing road space with motor traffic is the key reason people don’t cycle or stop after trying it.

The government knows that every £1 spent on cycling brings £5.50 of benefits, but at present it spends just 72p per person per year on cycling, compared with £86 per person per year for roads. There is huge potential for more journeys to be cycled if that were to change.

Increased levels of cycling can bring benefits for everyone, whether they cycle or not. Bicycles take up far less road space than cars and emit no toxic fumes. They’re good for our high streets: on New York streets where cycle lanes were introduced average trade rose by a quarter. What’s more, bicycles are great social levellers – according to research, mass cycling could increase mobility of the nation’s poorest families by 25%.

If a magic pill were invented that could generate all of these benefits, we would be falling over ourselves to buy it. As it is, no magic is required, just steady, long-term planning and investment, and a commitment to the humble bicycle, so that more of us can enjoy the simple, life-giving joy of cycling from A to B.

Lack of post-hospital care ‘leaving mental health patients at risk’

Thousands of vulnerable people are being left at increased risk of suicide because NHS mental health teams in England and Wales are not checking up on them within a week of their discharge from hospital.

At least 11,000 people a year who have recently been in mental health inpatient care are not followed up within a week of coming home, despite guidelines requiring the NHS to contact them.

People discharged after hospital treatment for a mental health crisis should receive a visit or phone call to assess their needs, the National Institute for Health and Care Excellence (Nice) says. But figures obtained under freedom of information laws by the charity Mind show that one in 10 such people are not contacted.

“Patients should only be discharged from specialist mental health services when there are ongoing care arrangements in place for them. Failure to do so can put the person at risk of harm, their condition can relapse and it can mean they are more likely to go going back into hospital,” said Dr Paul Lelliott, the Care Quality Commission’s deputy chief inspector of hospitals.

Mind discovered that the Nice guidelines were often breached after receiving information from 54 of England’s NHS 56 mental health trust and one of Wales’s seven health boards.

“If you don’t get the right care after you leave, if you’re left to cope alone, you end up in a revolving door, going straight back into hospital or being at risk of taking your own life,” said Sophie Corlett, Mind’s director of external relations.

The widespread lack of follow-up “is not good enough. It’s a tragedy so many people so very recently leaving the care of hospitals are losing their lives,” she added.

Separate research by Mind, among 850 patients about their experience of after-hospital care, found that those who were not followed up were twice as likely to attempt to take their own lives and a third more likely to harm themselves.

They are also more than twice as likely to end up back in A&E suffering another crisis, the survey found.

Natalie, 26, from Somerset, who ended up in hospital after trying to take her own life, said the crisis team did not visit her for a week afterwards.

“When you’re that unwell, it’s hard getting through each day. Each hour is tough, so just 24 hours can feel like such a long time. I needed someone to talk to, to help me understand my thoughts and feelings. To see someone only after a week, it’s not enough,” she said.

The CQC’s Lelliott said pressure on mental health services, including to discharge patients to free up beds, should not compromise the aftercare they received.

“We know that hospitals are under increasing pressure to discharge patients as soon as possible but providers must not compromise their ongoing care responsibilities to their patients. It is vital that when they discharge patients into community, it is done in a safe way that ensures people get the continuity of care they deserve and have every right to expect,” he stressed.

Nice guidelines say all such patients should be contacted within a week, and those thought to be at risk of suicide within 48 hours. Last year’s National Confidential Inquiry into Suicide and Homicide found that most suicides occurred on the third day after release.

“Patients leaving hospital can feel unsupported as they return to the problems that may have led to their admission. Those first few days are the time of greatest risk,” said Prof Louis Appleby, the director of the confidential inquiry.

Barbara Keeley, the shadow minister for mental health, said: “Mind’s research is yet more evidence of the gap between rhetoric and reality with this government. We are seeing people in some of the most vulnerable positions with their mental health being put at further risk.”

The Liberal Democrat MP Norman Lamb, who was the mental health minister in the coalition government, backed Mind’s call for all discharged patients to be contacted within 48 hours. “The moral case for this proposal is overwhelming. When we know that the risk of loss of life through suicide doubles if there is no timely follow up, the government and NHS England have an absolute duty to act. But this requires investment in community support which is so often lacking.”

Prof Mark Baker, director of the Nice Centre for Guidelines, said it was reviewing its recommendations to see if they needed to be updated in the light of Mind’s findings.

NHS England said: “Improved access to mental health support for people in the community where they live is part of our plans for the biggest expansion of mental health services in Europe.”

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

People at risk of HIV in Scotland to be given PrEP drug on NHS

People at risk of HIV in Scotland are to be given drugs on the NHS that will protect them from infection, it has been announced, in a move that Aids campaigners say will put pressure on the authorities in England to end delays in providing the same medication despite two major court rulings.

In a major victory for campaigners, the Scottish Medicines Consortium (SMC) said pre-exposure prophylaxis (PrEP) would be free on the NHS to those who need it because they are at risk – for instance, if they have a partner with HIV. Access to the drugs could begin within weeks.

NHS England resisted rolling out PrEP due to its cost, although it is a lot cheaper than a lifetime of HIV treatment which could cost £360,000. It lost to campaigners in the high court and then the court of appeal, but those who want to take PrEP have been told they must wait for a big new trial to answer “significant outstanding implementation questions”.

The National Aids Trust (NAT), which funded the court battle in England, said it was delighted PrEP would shortly be available in Scotland. “This game-changing prevention tool has the potential to massively reduce HIV rates and turn Scotland into a model internationally of how to do HIV prevention well. The speed and decisiveness of the Scottish process contrasts starkly with delays in the other three UK nations,” said Deborah Gold, NAT’s chief executive.

“Though we were jubilant when, following our two successful court cases, NHS England agreed steps to fund PrEP, we remain concerned that since that date, progress towards the ultimate goal of PrEP in England has been slow. It is difficult not to think of the possible thousands of HIV diagnoses that could have been prevented had the NHS in England not prevaricated, and we urge them to pursue the promised trial with appropriate urgency.”

The PrEP4Scotland Coalition (made up of HIV Scotland, Terrence Higgins Trust Scotland, Waverley Care and NAT) which has campaigned and negotiated with the Scottish authorities on the introduction of PrEP, said: “We applaud the SMC for taking this bold step to tackling HIV in Scotland. PrEP provides opportunities to reinvigorate how people at higher risk of HIV exposure engage with testing and prevention opportunities, and it is a vital opportunity to make a real reduction in the number of new HIV transmissions.”

Trials in several countries around the world including the UK have shown beyond doubt that PrEP works. The drug used is Truvada, which is one of a cocktail used to treat people infected with the virus and keep them well. PrEP has been hailed as one of the tools that could help end the Aids epidemic and efforts are being made to get it introduced into high-burden countries such as South Africa.

Every year about 5,000 people become infected with HIV in the UK and the rate among men who have sex with men is rising fastest. This was the group in whom the trials in the UK were done and where the evidence is strongest.

But NHS England dragged its feet because of the cost – estimated at potentially £20m a year to treat everyone who could benefit. It attempted to shift the bill to the local authorities, who are now responsible for public health, including HIV, obesity and smoking.

The local authorities said they could not afford to pay either. NAT sued NHS England in the high court and won last August. NHS England took its case to the court of appeal and lost again in November.

In December, NHS England said it would make the drugs available through a trial, which would enrol at least 10,000 people over the next three years.

NHS England said there were issues that needed addressing in a trial – which may include how consistently people take the daily tablets and how long they stay on the regime. But a trial also allows the NHS to obtain cheaper generic versions of the drug, rather than paying the market price to Gilead, the manufacturer and patent holder of Truvada. NHS England has already asked various companies to tender to supply the pills.

Prof Noel Gill, head of Public Health England’s HIV and STI department, said: “All the detailed work underpinning the clinical trial of PrEP is well under way and we expect it will commence by the summer 2017.”

Scotland’s decision to part with the NHS in England follows a huge community effort and years of campaigning, said HIV Scotland. “In 2016 HIV Scotland published a PrEP good practice guide, and administered Scotland’s expert group which produced prescribing criteria, cost assessments, and mapped information and training needs of workers and the community,” said its chief executive George Valiotis.

“Today, Scotland has made history in the fight against the HIV epidemic,” said
Robert McKay, national director for Terrence Higgins Trust Scotland. “PrEP can now be used as a vital tool – alongside condom use, regular testing and early treatment – to help bring an end to HIV transmission in Scotland.

“Not only will this make a life-changing difference to individuals by protecting them from a lifelong and stigmatised condition, but for every person who would have become HIV positive without PrEP, NHS Scotland will save £360,000 in lifetime treatment costs.”

Antibiotics overuse could increase bowel cancer risk, study finds

The overuse of antibiotics could increase a person’s risk of developing bowel cancer, the findings of a US study suggest.

Research published in medical journal Gut found extended use of antibiotics significantly increased the chance of polyp formation in the colon, a precursor of bowel cancer.

The findings add weight to emerging evidence that the type and diversity of bacteria in the gut may have a key role in the development of cancer, according to the authors of the study.

An Australian bowel cancer expert, Associate Professor Graham Newstead, the head of the colorectal unit at the Prince of Wales private hospital and director of Bowel Cancer Australia, said the research had “credence”.

“We know already that if you take antibiotics you frequently get diarrhoea,” Newstead said.

This happened because the antibiotic killed some of the normal bacteria, leading to an overgrowth of the abnormal bacteria in the gut.

But Newstead said the study did not look at the effect of antibiotics on the colon and caution must be taken.

US researchers monitored the health of more than 120,000 nurses, aged between 30 and 55, who were part of the the Nurses Health Study launched in 1976.

Between 2004 and 2010, 1,194 abnormal growths in the colon and rectum were diagnosed.

Those who had taken antibiotics for two months or more between the ages of 20 and 39 were 36% more likely to be diagnosed with an adenoma, or polyp, compared with those who had not taken antibiotics for any extended period in their 20s and 30s.

Similarly, women who had taken antibiotics for two months or more during their 40s and 50s were 69% more likely to be diagnosed with an adenoma.

And those who had taken these drugs for 15 days or more between the ages of 20 and 39, and between the ages of 40 and 59, were 73% more likely to be diagnosed with an adenoma.

“It does seem to indicate that people who have too many antibiotics might be at more risk of of getting polyps than people who have less of them,” Newstead said.

“And, remembering that not all polyps turn to cancer but the cancer comes from the polyps. If you have more polyps or tendency to get polyps then maybe you are slightly more at risk of getting cancer.”

The message to be taken from the study was not to use antibiotics for a “tickle” in the throat or a cold, Newstead said.