May 2005

Vol. 4, No. 5

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My Favorite Five Articles Found in Recent Medical Journals


Dairy and Type-2 Diabetes – Wrong Conclusion
 

Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study by Hyon K. Choi in the May 9, 2005 issue of the Archives of Internal Medicine found dietary patterns characterized by higher dairy intake, especially low-fat dairy intake, may lower the risk of type-2 diabetes in men.1  They used data from The Health Professionals Follow-up Study – an ongoing longitudinal study of 51,529 male dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians who were 40 to 75 years of age in 1986.  Those consuming the most low-fat dairy had 12 % less risk of developing diabetes compared to those eating the least amount.

The proposed mechanism for less diabetes was: dairy products may have favorable effects on body weight, the major determinant of type 2 diabetes.  However, there was no association with body weight and dairy consumption found in this study – in other words, those eating more dairy were the exact same weight as those eating less dairy – countering their hypothesis for why dairy causes less diabetes.
 

Comment:
 

News headlines worldwide claimed “Milk may keep diabetes away” and “Low-fat dairy prevents diabetes” and “Dairy blocks diabetes.”  May 9, 2005 must have been one of the dairy industry’s happiest days.  The findings, however, are irrelevant because there is no “cause and effect” relationship shown between the consumption of dairy and diabetes prevention.  The curious reader will discover that this study only shows that people who choose more dairy foods, and especially low fat dairy, as part of their diet have less diabetes than those who choose less dairy.  This finding is easy to explain without inventing some novel preventative property of cow’s milk.

The dairy industry has traditionally targeted their messages to health conscious people who generally eat better and exercise more – because of these habits these people have less type-2 diabetes.  This better lifestyle for the higher dairy group is confirmed by the observations from this study that those eating more dairy (especially low-fat dairy) also ate more fruits and vegetables, ate more carbohydrates, were more physically active, drank less alcohol, and were less likely to have high blood pressure and high cholesterol.  So, what is so hard to figure out here and why did the news media miss the obvious? 

Those drinking less milk must be drinking something else – maybe more high-sugar soda drinks to wash down their high-fat, high-sodium foods that gave them elevated cholesterol and blood pressure. In other words, people who don’t listen to health messages, even false ones from the dairy industry, have worse diets in general, exercise less, and have more diabetes – but these researchers and the media failed come to this obvious conclusion – and the public pays the price with worsening health. 

Type-2 diabetes is a disease of overnutrition (see my February 2004 newsletter).  The body responds to excess body fat accumulation by becoming insulin resistant and later stages of this resistance are characterized by changes, such as elevated blood sugar (people develop type-2 diabetes).

The authors of this study should be ashamed of themselves for suggesting dairy products cause weight loss (they didn’t in their study).  Even the employees of the dairy industry know better – although their ads don’t share this truth with the public. (See my April 2005 newsletter article:  Dairy for Weight Loss – Another Big Fat Lie.)  Cow’s milk is intended to grow a calf from 60 pounds to 600 pounds.  The same researchers who did this study (from the Harvard School of Public Health) have in the recent past linked a diet high in red meat, processed meat, high-fat dairy products, and refined grains, combined with obesity and inactivity, with a high risk for type 2 diabetes in men.2  Other studies have also made the link between type-2 diabetes and more dairy food consumption.3-5

One of my greatest concerns for this misinformation is that it will be interpreted to mean that dairy foods are good for diabetics.  These metabolically compromised people are at very high risk of cancer, heart disease, osteoporosis, kidney failure, and blindness – problems aggravated by all the animal protein and saturated fat in dairy products.  Diabetics also have serious bowel dysfunction which dairy is notorious for causing.  (See my May 2003 newsletter article:  Marketing Milk and Disease.)  This publicity may also cause some people to believe that type-1 (childhood) diabetes is no longer believed to be due to an autoimmune reaction from cow’s milk protein.  (See my July 2002 newsletter article:  The Pancreas - Under Attack by Cow-Milk.)  Well-informed people will not be derailed by this kind of nonsense and will clearly understand that cow’s milk is our most serious dietary health hazard.
 

1)  Choi HK, Willett WC, Stampfer MJ, Rimm E, Hu FB.  Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study.  Arch Intern Med. 2005 May 9;165(9):997-1003.

2)  Fung TT, Schulze M, Manson JE, Willett WC, Hu FB.  Dietary patterns, meat intake, and the risk of type 2 diabetes in women.  Arch Intern Med. 2004 Nov 8;164(20):2235-40.

3)  Montonen J, Knekt P, Harkanen T, Jarvinen R, Heliovaara M, Aromaa A, Reunanen A.  Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol. 2005 Feb 1;161(3):219-27.

4)  Archer SL, Greenlund KJ, Valdez R, Casper ML, Rith-Najarian S, Croft JB.  Differences in food habits and cardiovascular disease risk factors among Native Americans with and without diabetes: the Inter-Tribal Heart Project.  Public Health Nutr. 2004 Dec;7(8):1025-32.

5)  Parillo M, Riccardi G.  Diet composition and the risk of type 2 diabetes: epidemiological and clinical evidence.  Br J Nutr. 2004 Jul;92(1):7-19.

 

 

The Best Breast Cancer Treatment: Diet and Exercise

 

Physical activity and survival after breast cancer diagnosis by Michelle Holmes published in the May 25, 2005 issue of the Journal of the American Medical Association found physical activity, like walking 3 to 5 hours a week at an average pace, reduced the absolute risk of death for women with breast cancer by 6% over 10 years.1 

On May 16, 2005 Rowan Chlebowski, MD, of Harbor-UCLA Medical Center Los Angeles presented the first results from the Women’s Intervention Nutrition Study of 975 middle-aged women with breast cancer assigned to a low-fat diet.2  Over 5 years of study these women were found to have fewer recurrences than those who remained on the high-fat American diet.  In the diet intervention group, women lowered their fat intake from 29% to 20% of calories.   Unfortunately, meat, dairy, poultry, butter and other sources of animal fat were not eliminated on this “low-fat diet’ – nor was there any evidence that these women cut their calorie intake or ate more fruits and vegetables.

On average, 9.8% of women on the “low-fat diet” had a recurrence at 5 years and those on the standard American diet had a 12.4% rate of recurrence.  The absolute risk reduction was 2.6%.  On the low fat diet, women lost 4 pounds.  For women with tumors that were relatively insensitive to estrogen (estrogen negative, usually premenopausal women), the risk of recurrence was reduced even more – about twice as much.

In both studies the researchers suggested that the interventions (exercise and diet) worked by causing weight loss and by lowering cancer-promoting hormones, like insulin and estrogen.

 

Comments:  I published the first study on the benefits of a very low-fat diet for women with breast cancer in 1984.3  For all of my professional career I have advocated diet and exercise as the primary approaches to breast cancer (with very conservative surgery – like a lumpectomy – and some anti-estrogen therapy).   About 12 years ago I had the founder of this study (the Women’s Intervention Nutrition Study), Ernst Wynder, MD, on my radio show – also, about the same time, Dr. Chlebowski was a guest on my TV and radio shows.  I asked both of them, “If you believe in the benefits of a low-fat, plant-food based diet for women with breast cancer, why do you feed your research subjects a diet filled with the foods that cause and promote cancer?”  Their answers were similar: Neither researcher believed women would make such a drastic change – to give up dairy, meat, poultry and oil entirely.  But how would they know?  They never asked any of them to make this change. 

I know, from decades of experience, that most women presented with correct information, and a little help, will gladly make whatever changes are necessary to stay healthy and alive.  And besides, it should not be up to the doctor to decide what a woman is willing to do to stay alive.  Therefore, my approach continues to be to teach women (and men) with (and without) breast cancer the best diet I know.  The McDougall diet is 7% to 10% fat and contains only plant foods (starches, vegetables, and fruits).

The survival benefits of exercise reported here are comparable to those of chemo- and hormone- therapy which yield an absolute 10-year reduction in mortality of 7 to 11% for women less than 50 years old, and a 2 to 3% reduction for women 50 to 69 years-old.4    Remember, exercise provided a 6% reduction in mortality in all age groups over 10 years.1  Benefits on mortality are yet to be reported for diet.  When results are finally reported, I believe diet will be found to reduce risk of death far more than any conventional therapy – but that’s not setting the bar very high, since neither radiation nor surgery prolongs life, and chemical therapies do dreadfully little.  Further information on diet for the treatment of breast cancer can be found in the McDougall Program for Women book.

 

1)  Holmes M, Chen W, Feskanich D, Kroenke C, Colditz G.  Physical Activity and Survival After Breast Cancer Diagnosis. JAMA. 2005;293:2479-2486.

2)  http://www.washingtonpost.com/wp-dyn/content/article/2005/05/16/AR2005051600353.html

3)  McDougall J. Preliminary study of diet as an adjunct therapy for breast cancer.  Breast 10:18-24, 1984.

4)  Early Breast Cancer Trialists' Collaborative Group.  Multi-agent chemotherapy for early breast cancer.  Cochrane Database Syst Rev. 2002;(1):CD000487.

 

 

What’s New in Prostate Cancer Treatment?

 

Three studies published over the past month may influence the way a patient with prostate cancer is treated, but will the changes be in the patient’s best interest?1,2,3

First Study:  20-year outcomes following conservative management of clinically localized prostate cancer by Peter Albertsen in the May 4, 2005 issue of the Journal of the American Medical Association found, “The annual mortality rate from prostate cancer appears to remain stable after 15 years from diagnosis, which does not support aggressive treatment for localized low-grade prostate cancer.”  A study with similar findings was published in 2004 in this same journal.4   The results of both studies lead to the same clinical conclusions: “Men with well-differentiated disease (low Gleason score) rarely require treatment, while men with poorly-differentiated disease treated with androgen (testosterone) deprivation will usually die from prostate cancer.” 

Second Study: Radical prostatectomy versus watchful waiting in early prostate cancer by Anna Bill-Axelson in the May 12, 2005 issue of the New England Journal of Medicine found “Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial.”2

Third Study:  Increased risk of rectal cancer after prostate radiation: a population-based study by Nancy Baxter in the April 2005 issue of Gastroenterology found, “…a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.”  Rectal cancer was 70% higher in areas exposed to radiation.3


Comments:  Doctors want to help their patients and it is very difficult to tell someone that the treatments available are of little value.  Therefore, the first study (cited above) will be easily forgotten, and the second study with more optimistic findings will become a big part of the standard sales pitch for prostate surgeons.  The truth is we do not know if there is any benefit from radical surgical treatment of prostate cancer.  My understanding of this disease leads me to believe that ultimately research will show that surgery and radiation translate into no survival benefits.  Read my February and March 2003 newsletter articles on prostate cancer to understand why I have reached this conclusion.  For the sake of patients with prostate cancer, especially those who have chosen radical surgery, I hope I am proven wrong.

Many men will choose radiation therapy for prostate cancer, believing this approach will give them the same chance of living long lives with few of the nasty side effects from radical surgery.  However, one serious side effect, which now has to be considered, since Baxter’s report is radiation-induced cancers. 

I am an advocate for the conservative treatment of prostate cancer and that means essentially doing nothing “medical” – no surgery, radiation, or chemotherapy in almost all cases.  Breast cancer treatments have been studied much more extensively than those for prostate cancer.  The results show no survival benefits for any kind of surgery or radiation.  Hormone therapy (antiestrogen) and chemotherapy (probably working through reduction of female hormones) has shown a small survival benefit.  Many people believe that prostate cancer in men is analogous to breast cancer in women – including the issues of cause, prevention, early detection, and treatment.  If this is true, then studies will ultimately show that, like breast cancer, prostate cancer is:

 

  • Caused by the rich Western diet (fats, proteins, hormones, and environmental chemicals)

  • More likely to occur in poorly nourished people (due to the Western diet)

  • Already advanced by the time of initial diagnosis

  • Ineffectively detected by screening (PSA and DRE)

  • Treated effectively for the local part of the disease with surgery and radiation

  • Treated ineffectively for the distant spread (metastasis) by surgery and radiation

  • Treated with limited benefits with anti-hormone therapies

  • Treated with medical therapies that always have serious side effects

  • Such an unaggressive disease in most cases that the cancer would never have caused any trouble for the patient if never detected

  • Sometimes a very aggressive cancer that has, in this case, already spread throughout the body long before detection

  • Just as deadly even after treatments by surgery or radiation – no matter how extensive the therapy

  • Best treated with a low-fat, plant-based diet and exercise because these therapies deal with the disease at the root causes.

 

1)  Albertsen PC, Hanley JA, Fine J.  20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005 May 4;293(17):2095-101.

2)  Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S, Spangberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlen BJ, Johansson JE; Scandinavian Prostate Cancer Group Study No. 4.  Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005 May 12;352(19):1977-84.

3)  Baxter NN, Tepper JE, Durham SB, Rothenberger DA, Virnig BA.  Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology. 2005 Apr;128(4):819-24.

4)  Johansson JE, Andren O, Andersson SO, Dickman PW, Holmberg L, Magnuson A, Adami HO.  Natural history of early, localized prostate cancer. JAMA. 2004 Jun 9;291(22):2713-9.

 

 

Calcium and “Vitamin D” Do Not Prevent Fractures

 

Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care by Jill Porthouse in the April 30, 2005 issue of the British Medical Journal found,  “… no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture.”  This study observed 3314 women, 70 years and older, over a period of 25 months.  Half of the women were given 1000 mg of calcium and 800 IU of vitamin D daily.  The other half received no supplements. Fracture rates did not differ between those who took the supplements and those who did not.

 

Comment:  Fractures are the result of poor bone tissue, not calcium gain or loss.  The intestine absorbs the amount of calcium needed to mineralize the bone.  Generally, if the bone tissues are healthy they will hold more calcium and appear denser on testing.  The dietary requirement for calcium is very small and there is always sufficient calcium in the diet to meet the body’s needs. Because there was no deficiency in the first place, adding more as a pill cannot possibly be of benefit. (See my October 2004 newsletter article – Resisting the Broken Bone Businesses: Bone Mineral Density Tests and the Drugs That Follow)

Likewise, adding vitamin D pills is not a remedy unless the patient suffers from vitamin D deficiency.  As you read in the lead article of this month (May 2005) – deficiency would be the result of inadequate sunlight exposure – not a pill deficiency.  However, pills mean profit, so pill companies are constantly looking for research to help sell their pills.  Unfortunately for Nycomed, the pill-supplier for this study, these results will be bad for business.  Do you think Nycomed will include these results in their next advertisement campaign?

 

Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, Baverstock M, Birks Y, Dumville J, Francis R, Iglesias C, Puffer S, Sutcliffe A, Watt I, Torgerson DJ. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care  BMJ. 2005 Apr 30;330(7498):1003.

 

 

“Liver Cleansing” with Olive Oil and Lemon Juice – Myth

 

Could these be gallstones? Asked Christian Sies in the April 16, 2005 issue of the Lancet.  A 40-year-old patient with many 1 to 2 mm gallstones underwent a “liver cleansing” with apple and vegetable juice, followed by 600 ml (20 ounces) of olive oil and 300 ml (10 ounces) of lemon juice, taken over several hours.   She painlessly passed semisolid green “stones” with her stool.  She brought them to her doctor, who examined them under a microscope and found no crystalline structures (as would be seen in an actual gallstone).  Heating to 40 degree C for 10 minutes caused the “stones” to melt.  Analysis showed they contained no cholesterol, bilirubin, or calcium (like a real stone might have).  Chemical analysis found the “stones” were fat globules mostly from the olive oil.  The investigators next made similar balls that looked like stones in their lab by mixing olive oil and lemon juice and then drying the mixture.  Sometime later, the actual stones, which were made of cholesterol, were removed from the woman’s gallbladder by a surgeon.

 

Comments:  Many people believe this alternative therapy really works, but the “gallbladder flush” is a myth.  Gallstones are a result of supersaturation of the bile with cholesterol from the Western diet and they become stubbornly packed in the gallbladder.  About 15% of people in Western societies have gallstones – eventually they become so common in middle-aged women that as many as half of them carry around stones – and most don’t know it.  Gallstones that cause no pain or other symptoms should be left alone, rather than removed.  (For more information on gallstones, please see my newsletter:  April 2002 – A Stone-Free and Happy Gallbladder and May 2002 – Die With Your Gallstones.)

 

Sies CW, Brooker J.  Could these be gallstones?  Lancet. 2005 Apr;365(9468):1388.

 

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