Is red wine the key to long life?

According to the World Health Organisation, there were 600 million people aged 60 years or more in the year 2000, and by 2025 it is estimated that there will be 1.2 billion. Coping with impending old age is a natural part of the progression of life, but scientists in America hope that they could increase longevity and limit the effect of age-related illnesses through a simple pill that contains molecules found in red wine. But what has been discovered so far and how far away is any potential pill?

What were the headlines?

The research was widely reported in UK newspapers and websites, gaining headlines such as, “Yeast in red wine yields the secret of a long life”, “Mediterranean diet ‘extends life'”, “Red wine ‘cure for nuke blitz'”, “Toast to long life with red wine” and “Wine’s link to long life”.

Some elements of the study were only briefly reported, with some of the reports focusing on the potential benefits of drinking red wine and consuming a Mediterranean-style diet instead.

What is the bigger picture?

The research was reported at a scientific conference in Arolla, Switzerland and subsequently appeared in the advanced online issue of the journal Nature on 24 August 2003. The study was jointly carried out by scientists from the Harvard Medical Schooland BIOMOL Research Laboratories, a biochemical reagents company in Philadelphia, America.

In a series of laboratory experiments, they discovered that certain types of molecules, called polyphenols, could extend the life of yeast by 70 per cent. These polyphenols are found in foods such as red wine, olive oil, fruits and vegetables. On further investigation it was found that the most potent polyphenol was resveratrol – found in red wine – which helped yeast cells live as much as 60-80 per cent longer. Quercetin, another polyphenol, found in olive oil, had a similar effect.

Polyphenols are already recognised as having antioxidant benefits and as being helpful in the battle against illnesses such as heart disease and cancer, but the new study adds to this knowledge and suggests that certain ones could have additional properties.

When yeast and laboratory worms are fed a restricted calorie diet, their speed of ageing is slowed and they have extended lifespans. It has been found that restricting their diet increases the activity of a certain family of enzymes called sirtuins. The researchers say that polyphenols appear to stimulate these sirtuin enzymes and extend the organism’s lifespan. Their experiments showed that 17 molecules stimulated a human sirtuin called SIRT1 and a yeast sirtuin called Sir2.

“We think sirtuins buy cells time to repair damage,” said molecular biologist David Sinclair, assistant professor of pathology at Harvard Medical School. “There is a growing realisation from the ageing field that blocking cell death – as long as it doesn’t lead to cancer – extends life span.”

His co-author, Konrad Howitz, director of molecular biology at BIOMOL, said,”The sirtuin stimulation provided by certain, but not all, polyphenols may be a far more important biological effect than their antioxidant effect.”

Other species, such as mammals, are already known to live longer when their calorie intake is restricted. The researchers theory is that plant polyphenols may increase in response to stressful conditions and stimulate sirtuins in a bid for survival – a hypothesis they term xenohormesis.

“The sirtuin enzymes are found in almost every species, including plants, fungi and humans,” explained Dr. Sinclair. “Their role seems to be to protect cells from damage and keep them alive, which results in less disease and longer life.”

“Humans have seven sirtuins (SIRT 1-7) and the hope is that they also function to protect our cells and prevent disease. But it is too early to say for sure. At the very least, the study suggests a new line of research that may eventually lead to a major advance in medicine.”

Although resveratrol was the most effective, Dr. Sinclair says quercetin, which is found in foods such as onions, apples, tea, berries, olives, broccoli and lettuce, is also promising. “The molecule seems to have many health benefits in lowering cholesterol, preventing blood cells from sticking together similarly to aspirin, and suppressing cancer in rodents,” he explained.

“Although there is still a long way to go from simple organisms to humans, this study has brought the possibility of delaying age-related diseases with a pill to a point where we can say, as scientists, it is a real possibility. The discovery points to a new line of research into drugs that could one day make people significantly healthier in their old age,” he said.

He was keen to emphasise that any work would focus on improving health, not manipulating genetics. “We will only make people live longer by making them healthier. We are mimicking calorie restriction which, in rats and monkeys, slows diseases of old age, including heart disease, osteoporosis and cancer,” he said.

The next stage is to start testing on mice. If that proves successful and the mice do live longer, then Dr. Sinclair says he anticipates, “starting human trials sometime shortly thereafter.”

What does this mean?

Commenting on the findings, Dr. Hannah Theobald, a nutrition scientist at the British Nutrition Foundation said, “A lot more research needs to be conducted before these findings can be translated to humans, but it is an exciting finding.”

“Polyphenols are produced by plants in response to attack by viruses, fungi and bacteria,” she explained. “They exhibit antioxidant properties and may help protect against some cancers and heart disease. Resveratrol is found in red wine, red grape juice and peanuts, while flavones are found in olive oil.”

One of the aspects highlighted by the research, and perhaps the factor most applicable to people today, is that it adds to the idea of consuming a Mediterranean-style diet – which tends to be rich in olive oil, red wine and fresh fruits and vegetables.

“There is a plethora of research suggesting that Mediterranean-type diets are associated with lower rates of chronic disease, such as cardiovascular disease and certain cancers,” said Hannah. “This research adds further weight to this and offers a new potential mechanism whereby diets rich in olive oil, fruits and vegetables, cereals, grains and moderate amounts of wine may offer protection and increase longevity.”

Similarly, Belinda Linden, head of medical information at the British Heart Foundation, said, “Mediterranean diets can be healthy as they include a high level of fruit and vegetables and we also know that moderate alcohol consumption (1-2 units per day) may have a protective effect against coronary heart disease.”

However, she warned, “We also need to keep in mind that, while it is nice to enjoy a drink on occasions, too much alcohol can have an adverse affect on the heart.”

Amanda Wynne, spokesperson for the British Dietetic Association, said, “It will be interesting to see more research in this area, especially on humans.”

What does this mean to me?

With no quick-fix anti-ageing pill available and no guarantees that one will become available in the future, preparing for old age and limiting the risks of related illnesses largely comes down to looking after your health.

“There is good evidence that a diet based on lots of fruits, vegetables and whole grain cereals is conducive to good health and will reduce the risk of developing cancer and heart disease in the longer term,” explained Amanda Wynne.

“Light to moderate consumption of wine does confer to some protective effect against diseases such as coronary heart disease,” she added. “Advice is, however, to keep within the sensible drinking guidelines, so no more than 2-3 units a day for women and no more than 3-4 units a day for men. Have some drink-free days too, and avoid binge drinking.”

Although some supplements containing resveratrol and quercetin are available, “at the current time we cannot recommend taking supplements as there is no evidence that these will be effective or safe,” advises Amanda. “Dietary strategies are definitely the best approach.”

Summary

The American longevity research is certainly proving interesting, but as it’s still in its early stages much more research is needed before it will be clear whether or not this can be applied to humans. In the meantime, it does highlight the benefits of a Mediterranean-style diet – something that can be applied to life today.

Do vitamins C and E reduce Alzheimer’s risk?

What is Alzheimer’s disease?

Alzheimer’s disease is a form of dementia that tends to affect people after the age of 60 years. The risk of developing it increases with age.

In Alzheimer’s disease the nerve cells (neurons) in the brain are slowly destroyed, resulting in memory loss and difficulty in completing simple tasks. As the disease progresses personality and emotional changes, often combined with depression, can become evident.

For more on Alzheimer’s disease, please see BUPA’s Alzheimer’s disease factsheet.

How common is Alzheimer’s disease in the UK?

Approximately 425,000 people in the UK have Alzheimer’s disease.

Why did the researchers look at whether vitamin C and vitamin E use reduced the risk of developing Alzheimer’s disease or not?

Alzheimer’s disease is caused by progressive damage to nerve cells in the brain. While it is not know what causes the nerve damage seen in Alzheimer’s disease, there are a number of theories that may explain how it occurs.

One way in which nerve damage can occur is by a process called “oxidative stress”. This is where molecules produced by the body, called free radicals, react with cells.

Certain vitamins, including vitamin C and vitamin E, mop up free radicals in the body and prevent them from damaging the body’s cells. These vitamins are known as antioxidants and are know to combat the effects of ageing on the body.

For more on vitamins, please see BUPA’s Vitamins article.

What were the findings of the research?

The American researchers studied the use of vitamin supplements in elderly (65 years or older) people in Cache County in Utah. Between 1995 to 1997, the researchers asked 4740 people about their use of supplements. These people were followed up in 1998 to 2000 and, of the 3227 survivors, 104 of them had developed Alzheimer’s disease.

By comparing the use of supplements in 1995-1997 to the development of Alzheimer’s disease, the researchers found:

  • use of a high-dose supplement of vitamin E and a high-dose supplement of vitamin in combination reduced the risk of developing Alzheimer’s disease
  • use of a high-dose supplement of vitamin E in combination with a multivitamin supplement that contained vitamin C also reduced the risk of developing Alzheimer’s disease
  • use of a high-dose supplement of vitamin E on its own did not reduce the risk
  • use of a high-dose supplement of vitamin C on its own did not reduce the risk
  • use of a multivitamin supplement on its own did not reduce the risk

From these results, the researchers argue that it is important that high-dose individual supplements of vitamins C and E are taken in combination for the vitamins to have a positive effect.

What does this research mean?

These results suggest that regularly taking vitamin C and E supplements may reduce the risk of developing Alzheimer’s disease due to the antioxidant effect of these vitamins.

However, there are number of issues that need to be considered before it can be recommended that people take regular vitamin C and E supplements:

  • there may be other reasons why people’s risk of developing Alzheimer’s disease was reduced
  • the levels of vitamin C and E in these individual supplements was much higher than the recommended daily allowances for these vitamins
  • the results are drawn from people reporting their use of supplements at the beginning of the study, with no follow up on their supplements use at the end of the study. Because of this there is no information as to whether or not the people kept on regularly taking the supplements during the time of the study.

What other reasons might explain the reduction in risk of developing Alzheimer’s disease?

It is known that other factors influence the risk of developing Alzheimer’s disease, namely:

  • gender
  • age
  • level of education
  • general health

The researchers found that those people who took the vitamin E or C supplements were more likely to be female, younger, better educated and in better general health than the other people in the study. Since it is possible that these factors can reduce the risk of developing Alzheimer’s disease anyway, the researchers employed statistical analysis to try to cancel these effects out. After doing this, the researchers still found that taking high-dose vitamin E in combination with vitamin C had a positive effect on reducing risk.

How high were the levels of vitamin C and vitamin E in the supplements?

The recommended daily allowance of vitamin C is 60mg and for vitamin E it is 10mg.

Multivitamins supplements in America normally contain 75-90mg of vitamin C and 15mg of vitamin E.

However, the individual supplements contain high doses of the vitamins: 500-1000mg of vitamin C and up to 680mg of vitamin E.

Is it a good idea to take these vitamins at such high levels?

Vitamin C at high levels is not normally harmful, but doses above 1000mg can cause nausea, stomach cramps and diarrhoea.

Prolonged intake of vitamin E at high levels (above 540mg) can cause abdominal pain, nausea, vomiting and diarrhoea. It can also lead to impaired uptake of other useful vitamins.

The Alzheimer’s Society suggests that we eat five portions of fruit and vegetables a day, along with oily fish and nuts in our general diet, to gain all the vitamins, minerals and essential fatty acids we need. They point out that increasing evidence suggests that there are strong links between a good varied diet, a healthy heart and a healthy brain.

What can we do to reduce our risk of developing dementia?

  • don’t smoke
  • keep fit by exercising regularly
  • keep your blood pressure in check and avoid salty foods
  • keep your cholesterol under control and cut out the fat
  • live life to the full – enjoy friendships and stimulating hobbies
  • drink red wine in moderation
  • eat five portions of fruit and vegetables a day
  • eat at least one portion of oily fish a week
  • wear a helmet when cycling or motorcycling and don’t box.

How good are sun lotions?

BUPA investigative news – Updated 23 March 2004. First published: 6 October 2003
written by Rachel Newcombe, reporter for BUPA’s Health Information Team

In the UK there are 65,000 cases of skin cancer each year, with 2,000 proving fatal, and numbers are said to be rising faster than for any other form of cancer. Part of the reason is thought to be due to our changing lifestyles, for example more people are sunbathing and taking more holidays in sunnier climates, increasing their exposure to harmful UV rays.

Part of the Government’s safe sun message advises people to use protective sunscreen but, according to new research, while useful for protecting against UVB rays, lotions are less protective against harmful UVA. What’s more, it’s possible that people might be staying out in the sun longer because they think their skin is being protected, actually increasing their exposure to UVA.

The danger from UVA rays has been given further backing by Australian research that was published in March 2004. In this study, Australian researchers found that UVA rays caused DNA damage to the cells deep within the skin. It is this layer of cells that regenerates our skin and it is feared that damage to the DNA of these cells may increase a person’s risk of developing skin cancer.

So what do these findings mean for people wanting to sunbathe and use sunscreens?

What were the headlines?

The sunscreen research in October 2003 was picked up by the majority of UK newspapers and websites, gaining front page coverage on some of them. The headlines included, “Cancer warning over sun creams”, “Sun lotion ‘raises risk of cancer'”, “Sunscreens fail to offer full protection”, “Sun cream cancer alert”, and “Sun lotions ‘are not effective'”.

What is the bigger picture?

The October 2003 research was carried out by scientists, led by Professor Roy Sanders, at the Restoration of Appearance and Function Trust (RAFT) at Mount Vernon Hospital in Northwood, Middlesex, and details were published in the October issue of the Journal of Investigative Dermatology.

Tests were carried out with three leading brands of high sun protection factor (SPF) sunscreen, all of which claim to protect against UVA. A technique called electron spin resonance (ESR) was used to detect free radicals in human skin – a sign of UVA penetration and skin damage. Patients undergoing surgery, for example for breast reductions, agreed to donate samples of skin and the sunscreens were applied to the skin in the recommended doses – 2mg/cm2.

Dr. Rachel Heywood, a principal scientist at RAFT, explained the process to BUPA. “We exposed skin to a UVA light source and we were able to detect free radicals which are produced in response to UVA light. We measured how much high-factor sunscreens, all offering UVA protection, were actually protecting against this free radical production.”

They discovered that the UVA protection offered by leading sunscreen brands was not what might be expected. Furthermore, even when sunscreens were applied in the recommended concentration, they afforded much lower protection against the melanoma-inducing and skin-ageing UVA light than against UVB.

“We were expecting that it [UVA protection] would be lower than the UVB protection,” said Dr. Heywood, “but we were surprised by how much lower it was.”

The scientists are concerned that people may use sunscreens to stay out in the sun longer and, although they’re well protected against UVB, may not be getting the protection they need against UVA.

As a result of their findings, the researchers conclude, “Since the use of sunscreen creams encourage people to stay longer in the sun and the protection offered by these creams against UVB far outweighs that against UVA – the use of sunscreen creams may therefore indirectly increase the risk of developing the skin malignancy melanoma, rather than protect against it.”

What does this mean?

Commenting on the October 2003 findings, Dr. Mark Birch-Machin, a skin cancer expert at Cancer Research UK, said, “This study highlights the fact that no sunscreen can offer total protection against UV and you should not rely exclusively on it for protection from the sun’s harmful ultra-violet rays. Sunscreen should be used as the last line of defence against the sun, but is still an important component of being SunSmart.”

A spokesperson for the Department of Health, who run a Sunsafe campaign, said that although sunscreen is important, it won’t block all UV rays, so should be used in conjunction with other practical methods, such as wearing a hat, T-shirt or sunglasses and staying in the shade during the peak sun strength time.

They also warned that it’s very possible that, “people who spend more time in the sun because they’re wearing sunscreen, without taking other precautions, could result in increasing their risk of skin cancer”.

Sunscreen manufacturers have insisted their products are safe, but point out that people need to use them sensibly and not depend solely on sunscreens to protect them from the damaging effects of the sun.

Although some of the October 2003 coverage has reported the study in a negative light, dismissing the value of sunscreens, RAFT see it as a positive move and hope that better UVA sunscreens will be developed as a result. “We believe the UVA should match the UVB protection, so that people can make a safe assessment about the protection against damage caused by both UVA and UVB. We’re hoping to work with sunscreen manufacturers to achieve that,” said Dr. Heywood.

She added that, “The emphasis is on improved protection, rather than completely abandoning sunscreen – we’re not recommending that. It’s more about sensible sunscreen use with the awareness that it doesn’t provide complete protection against the UVA effects at the moment.”

What does this mean to me?

Although the sunscreens tested offered little protection against UVA, experts aren’t advocating giving up on sunscreen altogether, as it does protect against UVB. Instead, the consensus is that sunscreen should still be used to complement other sun safety measures.

As Dr. Mark Birch-Machin explained, “As Cancer Research UK’s SunSmart campaign advises, people should stay out of the sun particularly around the middle of the day, cover up with clothes and a brimmed hat, seek shade and apply sunscreen factor 15 or higher in generous amounts.”

The Department of Health stands by its existing Sunsafe advice, recommending that people use a broad spectrum sunscreen – SPF 15 or higher – in conjunction with other methods.

Dr. Heywood also emphasised that sunscreens should still be used and can be beneficial for UVB. “Sunscreens do protect against burning, which is caused by UVB, and they can protect against the cancers caused by UVB – basal and squamous cancers,” she explained.

“The UVB protection is now very good, but we’re finding that the UVA protection is much lower and it’s because of this that we’re concerned,” she added.

It’s also worth noting, say RAFT, that the sun protection factors (SPF) on sunscreens are only applicable to UVB – there’s no recognised standard rating available for the assessment of UVA filters at the moment.

Summary

Although benefits of UVA protection may seem limited in current sunscreens, the lotions are still useful for protecting against UVB rays and should continue to be used. The power of the sun can seem hard to avoid in the heat of the summer, but by following safe sun practices and taking care to protect vulnerable skin, the risk of developing skin cancer can be minimised.

Hot topic – Fruit may save your sight

Eating fruit has been found to reduce the risk of losing your eyesight in later life. In a study published in Archives of Ophthalmology, people who ate at least three servings of fruit per day were found to have more than one-third lower risk of developing an eye condition called age-related macular degeneration.

Below we look at the issue in more depth.

What is age-related macular degeneration?

Age-related macular degeneration is the most common cause of sight loss in people aged 60 years and older.

The macula is a small area at the centre of the retina, the area at the back of the eye that converts light into images. This area is responsible for seeing fine details, for example when reading or recognising people’s faces.1

Macular degeneration (also known as maculopathy) is when the cells of the macula become damaged and stop working. People with macular degeneration have blurry or distorted central vision, and sometimes see shapes and colours that are not there. Peripheral vision (vision at the outer edges of the eye) is not affected, and it does not result in complete blindness.1

What causes age-related macular degeneration?

There are two types of macular degeneration.

In 90 percent of people with macular degeneration the cells of their macula slowly stop working, due to wear and tear. It usually develops slowly, affects both eyes equally and is known as “dry” macular degeneration.1

In the other 10 percent of people with macular degeneration, the disease develops when small blood vessels behind the eye bleed, causing build up of fluid and scarring. This form of the disease can progress quickly, leading to severe and rapid loss of vision. It tends to affect one eye first, although the other is often affected later. This form is known as “wet” or neovascular macular degeneration.1

Who gets age-related macular degeneration?

Age-related macular degeneration is common in people aged 60 years and older.1 It accounts for almost 50 percent of people registered blind or partially sighted in the UK, and up to a third of UK people aged more than 70 have it.5

People are more at risk of developing age-related macular degeneration if they smoke, have high blood pressure or have close relatives with the condition.2

What can be done to treat age-related macular degeneration?

Unfortunately, there are no cures for the dry form of age-related macular degeneration currently available. However, there are lots of ways to make the best of the remaining peripheral vision. The RNIB can offer more advice about this.

www.rnib.org.uk

The wet form of macular degeneration can be treated by laser if it is detected at an early stage. Laser treatment may prevent vision from getting worse, slow down the progression of the condition and sometimes bring back sight that has already been lost.1

Because there are no effective treatments for late-stage age-related macular degeneration, prevention is important. For more on prevention, please see the final question and answer of this hot topic.

Does eating fruit help to reduce the risk of age-related macular degeneration?

Yes. People who ate three or more servings of fruit per day had 36 percent lower risk of developing the wet form of age-related macular degeneration than people who ate less than one and a half servings per day.

The results were similar for men and women.

Did fruit reduce the risk of all types of macular degeneration

No. The protective effect of eating fruit was only seen for the wet form of macular degeneration.

Which fruits are best?

Oranges and bananas were associated with the greatest reduction in risk of age-related macular degeneration. Other fruits were not so good at lowering the risk.

Do vegetables help to reduce the risk of age-related macular degeneration?

No. The researchers found that eating vegetables did not seem to have a effect on lowering age-related macular degeneration.

What else did the study look at?

The study also looked at dietary intake of antioxidant vitamins and carotenes (yellow or orange substances that are converted into vitamin A). A previous study showed high doses of antioxidants vitamins C and E, beta carotene and zinc delayed the progression of age-related macular degeneration.4

However, this study failed to show that antioxidant vitamins and carotenes had a protective effect.

Why does fruit reduce the risk of age-related macular degeneration?

Although it is not known for certain how fruit helps to protect against age-related macular degeneration, there is a theory that may offer an explanation. It is thought that the antioxidants in fruit may help protect macular cells in the retina by mopping up free radical molecules. These free radical molecules, which are produced by the body’s normal chemical reactions, are thought to attack cells and cause irreparable damage. By neutralising free radicals before they can attack macular cells, antioxidants can help to protect a person’s sight. However, because the antioxidant vitamins and carotenes did not contribute to the prevention in age-related macular degeneration, it is possible that other molecules in fruit may be playing a role.

Other constituents of fruits that may be beneficial to health include potassium, folic acid, fibre, flavonoids and other chemicals. At the moment it is not known how these may help prevent age-related macular degeneration.

Could the reduced risk be due to anything else?

Often, people who eat lots of fruit also lead more healthy lifestyles than people who don’t eat fruit. Another key factor is that fruit eaters tend not to smoke. It’s possible that the apparent benefits of fruit were due to not smoking. However, the researchers controlled for this and found that there was still a protective benefit in eating fruit.

How was the study conducted?

The study looked at the eating habits and lifestyles of 77,562 women and 40,866 men over the age of fifty. The participants were followed for up to 18 years for the women and 12 years for the men. They did not have macular degeneration at the start of the study.

During the course of the study 316 people developed age-related macular degeneration. The researchers looked at how much fruit these people ate. This was done by using up to five questionnaires to assess their diet, including the number of servings of fruit and vegetables they ate each day.

The study was published in the journal Archives of Opthalmology (Cho E, Seddon JM, Rosner B, Willett WC, Hankinson SE. Prospective Study of Intake of Fruits, Vegetables, Vitamins and Carotenoids and Age-related Maculopathy. Arch Ophthalmol. 2004; 122: 883-892).

What can I do to lower my risk of age-related macular degeneration?

You can reduce the risk of developing age-related macular degeneration by:3

  • eating at least five portions of fruit and vegetables a day, including three servings of fruit (preferably including bananas and oranges) (see what is a portion)
  • not smoking (see the smoking section)
  • eating a low fat diet
  • keeping physically active – the Government recommends at least 30 of moderate level physical minutes five times a week (see exercise section)
  • maintaining a healthy weight for you height (use our BMI calculator to find out your healthy weight range)

Acupuncture cuts migraines

British doctors have found that acupuncture can reduce the number of days of migraine a person has a year, as well as reducing the amount of medication they need and days off work. The results of their study are published on the website of the British Medical Journal.

How did the study work?

The study was designed to look at the use of acupuncture as an option for GPs prescribing treatment for migraines and tension-type headaches. GPs randomly offered their patients either standard treatment (medication and GP advice) or standard treatment plus acupuncture. Those who received acupuncture had up to 12 acupuncture sessions over the space of three months.

How many people were studied?

The doctors identified 401 people with chronic headache, most of them had migraines while the others had tension-type headaches. All the people were aged 18-65 years old and had an average of at least two headaches a month.

What were the results?

At the end of 12 months, people who had acupuncture in addition to standard treatment had 34 percent less severe headaches than people who only received standard treatment. Before treatment, the acupuncture group had a mean weekly headache score of 24.6 which fell to 16.2 after 12 months. The group that recieved only standard treatment had a weekly headache score of 26.7 before treatment and a score of 22.3 after 12 months.

During the 12-month study, people who had acupuncture in addition to standard treatment reported 15.6 days of headache during the four weeks before treatment and only 11.4 days of headache in four weeks at the end of the 12-month period. In contrast, those people who received standard treatment only reported 16.2 days of headache in the four weeks before treatment and 13.6 days of headache in four weeks at the end of the 12-month period.

These results mean that the people who recieved acupunture with standard treatment had 1.8 days less of headache every four weeks, when compared with those who did not have acupuncture. This works out as 21.6 days less of headache a year.

Over the 12-month period of the study, people who received acupuncture with standard treatment took a mean number of 12.6 days off from work (standard deviation of 18.9 days). In comparison, the standard treatment only group took 13.8 days off from work (standard deviation of 16.2 days). When these results were analysed statistically, the result is that the acupuncture group took 15 percent less days off work.

How were these results measured?

People filled in a headache diary for four weeks before their treatment started. They then repeated this at three months and one year after starting treatment. They were asked to assess the severity of their headache on a six-point scale four times a day. These scores were added together to give a daily headache score.

In addition, people filled in questionnaires that measured their use of headache treatments and days off sick from work.

What does this mean?

Most doctors agree that acupuncture can play a useful role in reducing pain from headaches but, up until now, the evidence has not been conclusive. This study provides further evidence for the benefits of acupuncture as a treatment for migraine. This is because the study was controlled, the people studied were randomly assigned to either standard treatment or standard treatment plus acupuncture, and the study involved a sizeable number of people.

In addition, the study also shows that acupuncture appears to offer long-lasting benefits. Most of the acupuncture group only received acupuncture for the first three months of treatment, yet their headache severity scores were significantly lower than those for standard-treament only when measured a full nine months after acupuncture treatment had stopped.

What do the study’s authors believe this study shows?

The authors of this study believe that the results show that the use acupuncture in addition to standard treatment leads to persisting, clinically useful benefits for people with chronic headache, particularly migraine. They argue that acupuncture should be used more widely to treat headaches.

Children’s blood pressure is rising

In the May 5 2004 issue of The Journal of the American Medical Association, a US study has found the rise in childhood obesity may also be partly responsible for a rise in children’s blood pressure. This may have a bearing on the children’s future health as high blood pressure increases the risk of heart disease and stroke in later life.

Below we look at the issue in more depth:

What did the study find?

The US study looked at 3,496 US children aged 8 to 17 years in 1988-1994 and compared their blood pressure to 2,086 US children of the same age in 1999-2000.

The researchers measured the children’s:

  • diastolic blood pressure – the pressure in the arteries when the heart is pumping blood
  • systolic blood pressure – the pressure in the arteries between heart beats when blood is not being pumped

The average systolic blood pressure for the children was 104.6mmHg in 1988-1994 and this rose to 106mmHg in 1999-2000.

The average diastolic blood pressure for children in 1988-1999 was 58.4mmHg and this rose to 61.7mmHg in 1999-2000.

In other words, children’s systolic blood pressure had risen by an average of 1.4 mmHg and their diastolic blood pressures had risen by an average of 3.3mmHg.

Why is this seen as important?

Having high blood pressure in later life raises the risk of developing heart disease and stroke. High blood pressure is defined as having a systolic blood presure of 140 or more and/or a diastolic blood pressure of 90 or more.

The children’s average blood pressure does not suggest that they will have high blood pressure soon. However, blood pressure rises with age and the fact that children have higher blood pressure than previous children means that they are at more at risk of developing the problem in the future. One of the study’s researchers, Dr Jeffrey Cutler, said: “The increases found by the study in children’s average blood pressures may seem small, but they can have serious consequences.”

Dr Cutler claimed that previous research suggests that every 1-2mmHg rise in children’s systolic blood pressure increases their risk of developing high blood pressure by 10 percent. Therefore, the children studied in 1999-2000 had an average increased risk of high blood pressure in later life of 14 percent when compared with those children studied in 1988-1994.

What is thought to be responsible for this rise in blood pressure?

The researchers believe that part of the rise in children’s blood pressure is partly due to the rise in the numbers of children who are overweight or obese. In fact, the researchers have calculated that 29 percent of the rise in systolic blood pressure and 12 percent in the rise in diastolic blood pressure could be attributed to the increase in children’s weights.

According to previous research, the percentage of boys who were overweight had risen from 11.3 percent in 1988-1994 to 15.5 percent in 1999-2000. While the percentage of girls who were overweight had risen even more dramatically from 9.7 percent in 1988-1994 to 15.5 percent in 1999-2000.

Apart from being overweight or obese, the other main lifestyle factors that contribute to increased blood pressure are not getting enough physical activity and eating too much salt in the diet.

Could UK children’s blood pressure also be higher than previous generations?

The levels of childhood overweight and obesity are increasing in the UK, so it is more than likely that UK children’s blood pressure are also higher than previous generations.

Both Professor Graham MacGregor, chairman of the Blood Pressure Association, and Belinda Linda, head of medical information at the British Heart Foundation agree that the rise in UK children’s weights will mean that their blood pressure will be higher too. They are concerned that will lead to higher rates of high blood pressure in later life.

What can be done to reduce childhood obesity and children’s blood pressures?

Reduce the amount of salt in the daily diet

Many children eat more than the recommended daily amount of salt in their diet (see table below). Two of the main contributors to this are the salt found in processed foods (for example ready meals and crisps) and salt that is added while cooking.

D A I L Y    S A L T    L E V E L S
The UK Government’s Scientific Advisory Committee on Nutrition (SACN) recommends the following daily salt intakes:
Baby aged up to six months oldless than 1g per day
Baby aged 7-12 months1g per day
Child aged 1-6 years2g per day
Child aged 7-14 years5g per day
Adult (aged 14+ years)a maximum of 6g per day

Make sure children get at least 60 minutes of physical activity every day

The UK Government now recommends that all children (up to teenage) should be physically active for at least 60 minutes per day, every day of the week. This activity can be built up through the day in bouts of 10 minutes or more, which means that it is possible to incorporate this activity more easily into daily life. For example, the Government suggests children could build this up by:

  • playing in break times at school
  • walking or cycling to and from school
  • taking part in organised activities such as PE, sports and swimming
  • playing with friends near home

However, it is also important for children to develop strong bones, it is vital that children engage in activities that build healthy bones at least twice a week. Activities such as running, jumping, ball games and gymnastics are ideal for strengthening bones. In addition, muscle strength and flexibility can be developed through activities such as carrying, climbing and rough and tumble.

This level of activity will also help children to keep their weight under control.

Parents can encourage healthy lifestyles in their children

If parents set good role models for their children, by eating healthily, not cooking with salt or adding it at the dinner table, and by being physically active in their daily lives, their children are more likely to adopt these lifestyle habits as well.

Passive smoking increases miscarriage risk

It is known that mothers who smoke are at a greater risk of miscarriage if they continue to smoking during pregancy. However, the effect of a partner smoking (passive smoking) during pregnancy on the risk of miscarriage has not been clearly resolved. A joint American and Chinese study, published in the May 15 2004 issue of the American Journal of Epidemiology, has found that if a woman’s partner smokes, the risk of miscarriage is raised. And if the partner smokes more than 20 cigarettes a day, the risk is significantly increased.

Below we look at the issue in more depth:

How was the study carried out?

The joint American and Chinese study looked at 526 newly married women who did not smoke or drink from 1996 to 1998. They were all textile workers in China and they were put into groups according to the number of cigarettes a day their husbands smoked: more than 20 cigarettes a day, less than 20 cigarettes a day and no cigarettes (nonsmoker).

The researchers tested the women’s urine every day to see whether or not they had become pregnant. When the women did become pregnant, their pregnancy was followed closely.

What did the study find?

There was little difference between the groups of women as to their likelihood to become pregnant. Therefore, in this study, the smoking habits of the father did not seem to affect the chance of pregnancy.

However, the number of cigarettes the father smoked did seem to have an effect on the risk of spontaneous miscarriage within the first six weeks:

  • of the women whose partners smoked more than 20 cigarettes a day, nearly one-third of the women lost their babies within six weeks of conceiving
  • of the women whose partners did not smoke at all, roughly one-fifth of the women had a miscarriage within the first six weeks of conceiving

Also, the number of cigarettes the father smoked seemed to have an effect on the likelihood of eventually becoming pregnant and giving birth:

  • of the women whose partners smoked more than 20 cigarettes a day, 76 percent became pregnant and gave birth
  • of the women whose partners did not smoke at all, 84 percent became pregnant and gave birth

What are the conclusions from these findings?

The researchers from the study concluded that heavy smoking by the father increased the risk of early pregnancy loss. They suggest that this is either due to exposure of the male sperm to the effects of smoking, or due to the mother being exposed to the effects of passive smoking.

Why does smoking raise the risk of miscarriage?

The researchers believe that smoking by the father could damage the chromosomes in his sperm, making the sperm less likely to produce viable babies. Also the researchers think that the father’s cigarette smoke is inhaled passively by the mother and this can affect the developing fetus. It is thought that tobacco smoke may alter a pregnant woman’s levels of female sex hormones and that it may reduce the amount of blood that flows through the placenta and nourishes the baby.

What can be done to lower the risk of miscarriage?

It is worth remembering that miscarriage is a common event and many women experience two miscarriages, purely by chance. Often there is no underlying problem when a miscarriage occurs and there is every chance of a successful pregnancy in the future.

In over 60 percent of miscarriages, there is a problem with the way genetic material from the egg and sperm has combined and the resulting baby is unable to develop. There is no other reason for this than bad luck. Another cause is the embryo failing to implant into the lining of the womb. Doctors don’t full understood why this happens, but sometimes it can be due to a hormone imbalance.

Miscarriage is not thought to be caused by stress or lack of rest. However, it is helpful for both partners to stop smoking before trying to conceive and remain smoke-free once pregnancy has begun.

If you experience three consecutive miscarriages, it is advisable to visit your doctor to undergo tests to rule out any possible specific cause such as hormonal imbalances, abnormalities of the uterus or a problem with the immune system.

Strict diet lowers heart risk

A small-scale study in the US has shown that a stringent calorie-restricted diet may produce large reductions in heart disease and diabetes risk.

The researchers, from the Washington University School of Medicine, St Louis, studied the effects following a calorie-restricted diet of between 10-25 percent less calorie intake than the average western diet. The study appeared in the online version of the journal The Proceedings of the National Academy of Sciences on 19 April and will be published in the 27 April 2004 edition. It offers further support to idea that eating a varied, balanced diet and staying at a healthy weight by being physically active will help to lower your risk of developing heart disease.

What is a calorie-restricted diet?

A calorie-restricted diet is one where a person eats 10-25 percent less calories than an average western person. In this study, the calorie-restricted diet individuals ate 1,112-1,958 kcal/day of energy.

Because there is the danger that people following such a diet might not get the full range of vitamins and minerals they need, individuals following a calorie-restricted diet eat nutrient-dense foods. To do this they eat a wide variety of vegetables, fruits, nuts, dairy products, egg whites, wheat and soy proteins and meat. In this way, they ensure that they get more than 100 percent of their RDI (recommended daily intake) for all essential vitamins and minerals.

In addition to a restricted calorie intake, the people avoid all processed foods containing trans-fatty acids and refined carbohydrates in the form of desserts, snacks and soft drinks.

How does a calorie-restricted diet compare with a normal western diet?

The average american takes in almost twice as much energy as a calorie-restricted dieter: roughly 1,976-3,537 kcal/day.

Also, because the average american diet contains less fruit and vegetables and more processed foods than a calorie-restricted dieter, the composition of what an average american eats is different too.

Normal american diet:
Total energy intake – 18 percent protein, 32 percent fat, 50 percent carbohydrates.

Calorie-restricted diet:
Total energy intake – 26 percent protein, 28 percent fat, 46 percent complex carbohydrates.

Why do some people follow a reduced-calorie diet? What benefits do they believe they will gain?

Some people believe that calorie-restricted diets will confer a longer life-expectancy and help to counter the effects of ageing.

These beliefs are based on the results of animal studies that show that calorie reduction can increase life expectancy by up to 30 percent. So far, these studies have been carried out in rats, mice, fish, worms and various insects.

These findings also have support from an observation during the Second World War. During the war some of North European countries experienced a food shortage and this resulted in rationing. In some of these countries, rationing was accompanied with a sharp fall in mortality from coronary artery disease (heart disease). When the war ended, mortality from coronary artery disease rose sharply.

For these reasons, a small number of individuals have been following calorie-restricted diets for a number of years to try to extend their lifespans beyond the usual range.

What were the researchers aiming to achieve with this study of calorie-restricted dieting?

The researchers wanted to conduct the first human study into the effects of a calorie-restricted diet. They were particularly interested in finding out whether or not such a diet really did have an effect on a person’s risk of developing heart disease.

One of the main causes of heart disease (and strokes) is the narrowing of a person’s arteries through a process called atherosclerosis. Atherosclerosis is the plaque build up on the arterial walls that can impair blood flow and leads to formation of a clot, which can cause a heart attack or a stroke. It is the leading cause of death in the western world.

For this reason, the researchers decided to measure the individual’s risk of developing atherosclerosis. To do this, they measured a person’s risk factors for this condition.

What are the risk factors for developing atherosclerosis?

Link between drinking alcohol and gout

There are a number of risk factors for atherosclerosis, and many of them can be reduced by eating a healthy, balanced diet and being physically active.

The risk factors for developing atherosclerosis are:

  • being overweight or obese (having a body mass index – BMI – of more than 25)
  • high total cholesterol levels
  • high levels of LDL (bad) cholesterol
  • low levels of HDL (good) cholesterol
  • high ratio of total cholesterol to HDL cholesterol
  • high triglyceride levels
  • high blood pressure

How was the study carried out?

The researchers decided to measure the risk factors for atherosclerosis in people who had been following a calorie-restricted diet for a number of years and compare them with those of people following a normal american (or western) diet. The researchers were interested to see if the people following a calorie-restricted diet had lower levels (and hence lower risk of atherosclerosis) than healthy people who ate a normal western diet.

Who was studied?

The study followed 18 individuals from Caloric Restriction Optimal Nutrition Society who were following calorie-restricted diets. They were aged 35-82 years old, with an average age of 50 years. They had been following calorie-restricted diets for 3-15 years, the average length of time was 6 years. None of them were smokers and none were taking medicines that would affect their blood pressure or cholesterol levels.

To compare the calorie-restricted dieters to people eating a normal western diet, the researchers used a comparison group of 18 healthy americans. These 18 people were matched against the 18 calorie-restricted dieters for age and socioeconomic status.

Could the effect of starting a calorie-restricted diet on an individual be followed?

Another interesting part to this research was that the effect of starting and then following a calorie-restricted diet could be studied. The researchers discovered that 12 of the calorie-restricted diet individuals had medical data for their blood pressure, serum lipid levels and lipoprotein levels from the time before they started calorie restriction. These levels could be compared with the results of starting and then maintaining a calorie-restricted diet.

All 12 individuals had levels that were similar to normal americans before starting calorie-restricted diets. After starting a calorie-restricted diet, all 12 experienced their greatest changes in blood pressure, serum lipid levels, lipoprotein levels and weight loss in the first year of dieting. These levels were then maintained or decreased further with continued calorie restriction.

How did calorie restriction affect body mass index (BMI)?

Body mass index (BMI) was significantly lower in the calorie-restricted group when compared with the matched group; 19.6 compared with 25.9. The BMI values for the comparison group are similar to the mean BMI values for middle-aged people in the US.

All those on calorie-restricted diets experienced reductions in BMI after starting their diet. Their BMIs decreased from an average of 24 (range of 29.6 to 19.4) to an average of 19.5 (range of 22.8 to 16.5) over the course of their dieting (3-15 years). Nearly all the decrease in BMI occurred in the first year of dieting.

How did calorie-restriction affect cholesterol and triglyceride levels?

It was found that the average total cholesterol and LDL (bad) cholesterol levels for calorie-restricted individuals were the equivalent of those found in the lowest 10% of normal people in their age group.

It was found that the average HDL (good) cholesterol levels for calorie-restricted individuals were very high – in the 85th to 90th percentile range for normal middle-aged US men.

Because of these very healthy results, calorie-restricted dieters had remarkably low total cholesterol to HDL cholesterol ratios, a very positive sign for lowering the risk of heart disease.

These positive changes in calorie-restricted individuals were found to occur mainly in the first year of dieting. When the levels of the 12 individuals who had information for their cholesterol levels before they began a calorie-restricted diet were studied, it was found that they had close to average levels for normal middle-aged americans. However, following the calorie-restricted diet brought about large improvements in cholesterol levels and most of this occurred in the first year of dieting.

And finally, it was found that the calorie-restricted group had remarkably low triglyceride levels. In fact, they were as low as lowest 5 percent of americans in their 20s. This is more remarkable when it is noted that the calorie-restricted individuals were actually aged between 35 and 82 years.

How did calorie-restriction affect blood pressure levels?

Both systolic and diastolic blood pressure levels in calorie-restricted group were remarkably low, about 100/60, values normally found in 10-year-old children. In contrast, the average blood pressure for the normal diet group was about 130/80 (which is standard for the typical american).

For the 12 individuals who had medical data concerning their blood pressure before they started calorie restriction, it was found that their starting blood pressures were similar to those of the comparison group. Their large decreases in systolic and diastolic blood pressures occurred during the first year of following a calorie-restricted diet with a further decrease to extremely low levels in the period after that.

How did calorie-restriction affect insulin and glucose levels?

Fasting plasma insulin concentration was 65% lower and fasting plasma glucose concentration was also significantly lower in the calorie-restricted group when compared with the comparison group.

What do all these findings mean?

This means that the results show that calorie restrictions results in large, sustained, beneficial changes to a person’s risk factors for atherosclerosis: total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride levels and blood pressure.

Calorie-restriction also provides a powerful protective effect against obesity and insulin resistance (a risk factor for developing type 2 diabetes).

Could the findings be due to vitamin supplements the people were taking?

It appears that taking vitamin supplements made little difference to the results of the study.

Many of the calorie-restricted individuals and comparison subjects took a wide range of supplements. While four calorie-restricted dieters and three comparison subjects did not take any supplements at all. The researchers found that serum lipid, lipoprotein and blood pressure levels of those not taking supplements showed no statistically significant difference from those who were taking supplements.

Can the results of the study be trusted?

While the results of the study appear to be compelling, it must be remembered that the results are based on a very small sample of people – only 18 people who followed the calorie-restricted diet. This means that it is difficult to be certain that these findings are definitely the result of calorie restriction and not some other factor. Much larger trials will be needed to confirm these findings and the study’s researchers are running a larger controlled, prospective study to do this.

Also, the current study only followed people on a calorie-restricted diet for an average of six years. This means that the long-term effects of calorie restriction are unknown and its long-term safety is still unclear. For this reason, the researchers will be running their new study for a longer period.

Is a calorie-restricted diet recommended?

Because there is still uncertainty surrounding the effects and safety of a calorie-restricted diet, the medical community is cautious about recommending this approach as a way of reducing heart disease and diabetes risk. However, the results of this study have been welcomed by UK doctors as further support of the health benefits of eating a healthy, balanced diet and maintaining a healthy weight by being physically active.

What can we do to reduce our risk of heart disease, stroke and type 2 diabetes?

The current advice is:

  • keep at a healthy weight or lose excess weight if necessary (you should aim for a BMI of 25 or less)
  • reduce the amount of salt you eat (to less than 6g a day)
  • eat five portions of fruit and vegetables a day
  • give up smoking
  • learn to relax and reduce stress
  • cut down on alcohol (Men should aim to drink no more than 3-4 units of alcohol per day with a maximum of 21 units a week. Women should aim for no more than 2-3 units per day with a maximum of 14 units a week.)
  • aim to be physically active for about 30 minutes on five or more days of the week

Gene linked to prostate cancer

Researchers have discovered a gene that appears to be associated with prostate cancer and how fast it grows. Overactivity of this gene appears to cause cells to divide uncontrollably – resulting in cancer. It is hoped that a test for this gene’s activity could be developed that could be used to identify prostate cancer and distinguish between slow-growing and fast-growing tumours.

The work was conducted by researchers at the Institute of Cancer Research Everyman centre and have been published in the journal Oncogene (Foster CS, Falconer A, Dodson AR. Transcription factor E2F3 overexpressed in prostate cancer independently predicts clinical outcome. Oncogene advance online publication, 7 June 2004).

What is prostate cancer?

The prostate is the gland that produces the liquid component of semen. It is only found in men and is located just below the bladder. Cancer of the prostate gland cause tumours to develop in the prostate, which becomes enlarged.

How many people are affected by prostate cancer each year?

According to Cancer Research UK, more than 27,000 men are diagnosed with prostate cancer every year.

According to the NHS Cancer Screening programmes, approximately 10,000 men die from the disease every year. This means that many men develop prostate cancer but do not die from it – in fact, only 1 in 25 men will die from the disease. This is because many forms of prostate cancer are slow-growing and the men can live out their lives without suffering any ill effects from the tumour.

What is the risk of developing prostate cancer?

The overall lifetime risk of developing prostate cancer for a man is one in 14. In other words 73 in every 1,000 men will develop prostate cancer in the whole of their lifetime.

However, age plays in important role: prostate cancer is largely a disease of older men. Men aged less than 50 years rarely develop prostate cancer, while half of all cases of prostate cancer are in men aged more than 75 years.

How is prostate cancer detected?

If it is suspected that there is a problem with your prostate, the following tests may be carried out.

Urine test – to look for blood in the urine or to see if the problems are due to an infection.

PSA blood test – a blood sample is tested for its level of prostate-specific antigen (PSA), a high level may suggest prostate cancer, however it may also be due to a less harmful cause.

Digital rectal examination – a urologist feels the prostate by inserting his or her finger into the back passage. The urologist can then feel for any abnormalities that may suggest prostate cancer.

However, none of these tests can confirm that a person has prostate cancer. For example, some men may have prostate cancer, but their PSA levels are normal. Meanwhile, two out of every three men who do have a raised PSA level do not have prostate cancer. Instead, their raised levels are due to either infection, exercise, sex or benign enlargement of the prostate (often known as BPH or benign prostatic hypertrophy).

The only way to confirm the presence of prostate cancer is to remove a section of the prostate and study it under the microscope – known as a biopsy. Even then it cannot be accurately known whether or not the cancer is slow-growing (and does not need treating) or is fast-growing (and should be treated).

For this reason, researchers are looking for a test that will accurately diagnose prostate cancer and show whether or not it is slow- or fast-growing.

What did the researchers find?

A gene, known as E2F3, plays an important role controlling cell division and growth. Overactivity of the E2F3 gene is thought to result in uncontrolled cell division and growth, leading to the development of a tumour. For this reason, the researchers decided to investigate whether or not E2F3 played a role in the development of prostate cancer.

The researchers found high levels of E2F3 activity in 98 out of 147 samples of prostate cancer (67 per cent). High levels of E2F3 activity are rarely found in samples of normal prostate tissue.

In addition, the researchers found that there was a significant association between high levels of E2F3 activity and the risk of death from prostate cancer. This suggests that increasing levels of E2F3 activity are associated with increasingly fast-growing cancers (also known as aggressive cancers).

Why is this important?

The findings suggest that it might be possible to develop a test for E2F3 activity that could help to diagnose whether or not a person has prostate cancer with greater accuracy than is currently possible.

Also, the findings suggest that such a test would be able to show whether or not the cancer was fast- or slow-growing.

Why is it important to find out how fast a prostate cancer is growing?

Because prostate cancer occurs in later life, many men with slow-growing prostate cancer can live out their natural lives without suffering any ill effects. They don’t need treatment. However, the aggressive form will shorten a man’s life and needs to be treated as soon as possible.

By being able to distinguish between the types of prostate cancer, many men will be spared treatment they did not need.

When will a test be available?

The researchers’ work is currently in the very early phases of development and it could be many years before a working test for the activity of E2F3 becomes available.