Posts by Holly Strawbridge
After being confined to health-food stores for years, gluten-free foods have become the latest food fad. Supermarket aisles abound with products proudly labeled “Gluten free,” and many restaurants now offer gluten-free options. For people who can’t tolerate gluten, a protein found in wheat, rye, and barley, this abundance is a blessing. But lately it’s become hip to go gluten-free. Based on little or no evidence other than testimonials in the media, people have been switching to gluten-free diets to lose weight, boost energy, treat autism, or generally feel healthier. People who are sensitive to gluten may feel better doing this, but most won’t get a significant benefit from the practice—and will pay more for food because gluten-free products are expensive. It’s important to know that it can set you up for nutritional deficiencies such as a dearth of B vitamins and fiber.
If you take good care of yourself, you just might end up avoiding cardiovascular disease (CVD), the most common killer in this country. That’s the bottom line from a study published this week in JAMA. Researchers from Northwestern University’s Feinberg School of Medicine analyzed five long-term studies which documented cardiovascular risk factors for 120,000 individuals at ages 45, 55, 65, and 75. This time they cast a broader net and tallied up all cardiovascular events—nonfatal and fatal heart attack and stroke, angina, the need for angioplasty or bypass surgery, heart failure, and death due to cardiovascular disease. The percentages of people who experienced one of these “events” was huge, above 50% at all four ages. However, those with an optimal risk factor profile—non-smoker, no diabetes, blood pressure less than 120/80 mm Hg, and total cholesterol less than 180 mg/dL—had a much lower lifetime risk of cardiovascular disease. For example, men and women with optimal profiles at age 55 were 30% to almost 50% less likely to develop cardiovascular disease than those with two or more major risk factors. They also lived an average of 14 years longer free of cardiovascular disease.
It’s natural to assume that all OTC drugs are safe for just about everyone. But that’s a mistake. A recent report in JAMA by Harvard-affiliated physicians found that when a prescription drug moves to OTC status, balanced advertising tends to fly out the window. Of the four drugs randomly selected for the study—omeprazole (Prilosec, Nexium), orlistat (Alli), loratadine (Claritin), and cetirizine (Zyrtec), only Alli mentioned any potential harmful effects at all. One reason for this is that the Food and Drug Administration (FDA), which oversees the advertising of prescription drugs, insists that every side effect and interaction found in clinical trials of the medication be included in every ad. But OTC advertising is overseen by the Federal Trade Commission, which requires only that ads meet a “reasonable consumer” standard of truthfulness. Does this mean drugs should not be sold OTC? Of course not. But you can avoid potential pitfalls by asking a pharmacist whether the drug is okay for you to take.
By offering the taste of sweetness without any calories, artificial sweeteners seem like they could be one answer to effective weight loss. The American Heart Association (AHA) and American Diabetes Association (ADA) have given a cautious nod to the use of artificial sweeteners in place of sugar to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease. As with everything, there’s more to the artificial sweetener story than their effect on weight. One concern is that people who use artificial sweeteners may replace the lost calories through other sources, possibly offsetting weight loss or health benefits. It’s also possible that these products change the way we taste food. Research also suggests they may prevent us from associating sweetness with caloric intake. In addition, the long-term effects of artificial sweeteners on health have not been fully determined.
We usually think of post-traumatic stress disorder (PTSD) as an aftermath of military combat or terrible trauma. It can also strike heart attack survivors. By the latest account, 1 in 8 people who live through a heart attack experiences a PTSD-like reaction that might be called post-traumatic stress disorder (PTSD). They experience the same key symptoms: flashbacks that occur as nightmares or intrusive thoughts. They try to avoid being reminded of the event and become hypervigilant worrying that it will happen again. As treatments for heart attack continue to improve, 1.4 million people a year are now surviving the event long enough to be discharged home. If the study is correct, 168,000 of them will be diagnosed with PTSD every year. It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.
Millions of people depend on the blood thinner warfarin to prevent clots from forming in their blood. It’s an important drug, but tricky to use. One problem with warfarin (Coumadin, Jantoven, generic) is that it interacts in potentially harmful ways with other medications. Two problematic types are antibiotics and antifungal agents. As we write in the June issue of the Harvard Heart Letter, this isn’t just a problem with pills, but can also happen with ointments, creams, and suppositories. Adding an antibiotic such as cotrimoxazole, cephalexin, or penicillin, or an antifungal medicine such as itraconazole or ketoconazole on top of warfarin can heighten warfarin’s blood-thinning ability. This raises the risk of internal bleeding or sustained bleeding after an injury.
Calcium supplements are being called on the carpet after new research showed they significantly increased risk of heart attack among women getting extra calcium from pills, but not among those who got their calcium from food. What’s the connection? Over time, calcium can accumulate in arteries. It also builds up in plaque, the cholesterol-filled pockets that can cause angina or a heart attack. Three Harvard professors say the new study doesn’t prove that calcium supplements cause heart disease, but advocate that it’s almost always best to get vitamins and minerals from food, not pills.
Millions of people with heart disease who take the blood thinner clopidogrel (Plavix) can now look forward to having fatter wallets. Plavix lost its patent protection this month, and on May 17 the Food and Drug Administration gave several companies the okay to sell its generic form. Clopidogrel users can now buy brand-name Plavix for a premium price, or equally effective generic clopidogrel in a 75-mg dose at a much lower cost. The change may also save lives. “We have seen more than a few patients have heart attacks because they had stopped taking clopidogrel due to the expense,” said Dr. Thomas Lee, professor of medicine at Harvard Medical School and Co-Editor in Chief of the Harvard Heart Letter. “I think the lower price is going to save some lives.” Before a company can sell a generic version of a drug, it must prove to the FDA that the drug is as effective and safe as the original.