Why Alcohol Might Be Good for Diabetics

Several studies over the years have found that diabetics who regularly drink a little—and we do mean alcohol—tend to live longer and keep their glucose under better control. For instance, I reported in 1999 that "diabetes sufferers who enjoy an occasional libation, compared with those who eschew alcohol, have just half the risk of dying from coronary artery disease. Those
who down a drink a day face only 20 percent of the teetotalers’ heart-disease mortality."

It's perplexed physicians as to why. And posed a dilemma. After all, doctors don't usually want to prescribe alcohol since it's basically empty calories, can addle thinking, and can contribute to the development of alcoholism in some individuals. So, particularly where a mechanism to explain the association remained murky, doctors generally ignored the link.

It may become a little harder to do so, now.

A study published in this month's American Journal of Clinical Nutrition finds that when people were served alcohol with a meal, their bodies more slowly converted the carbohydrates in the meal into blood sugar. And that's a good thing.

Australian researchers at the University of Sydney's Human Nutrition Unit fed a group of 10 men and women "meals"—usually amounting to no more than white bread with margarine or mashed potatoes. Why these carbs? Because ordinarily the body breaks them down into gluocse—blood sugar—so quickly that eating them is not much better than directly downing a teaspoon of table sugar.

However, when alcohol was consumed with the food—or even up to an hour beforehand—the body digested the food into glucose far more slowly. It parsed out the glucose into blood at a nice, steady pace, which is exactly what the doctor wants to see happen. Why? Because spikes in blood sugar can confuse the body's insulin-making machinery, leading to a spike in insulin, which is NOT good for the blood vessels.

Jennie C. Brand-Miller and her colleagues conclude that "under realistic conditions," moderate quantities of beer, wine, or gin—all three of which were tested in amounts equivalent to two predinner drinks—can lower blood-sugar values following a meal by up to 37 percent,. This, of course, is all relative to dining alcoholfree.

"These effects may provide a hitherto unreconized benefit of moderate alcohol consumption for cardiovascular health," the scientists say.

There is a caveat—isn't there always: The test subjects were all lean and healthy, i.e. not diabetic. However, there is the expectation that this may be one way for people who are at least prediabetic to stay that way.

Here's another caveat: In the new study, the scientists administered white wine in one round of the tests. In fact, red wines might have provided an even more robust advantage, based on data I reported 3 years ago. In that story, experiments—admittedly conducted in diabetic rats—showed that even without its alcohol, red wine's constituents could control their blood sugar after a meal as well as nondiabetic animals.

Hot Flash Newsflash III

Women of a certain age, as we like to say, find themselves prone to hot flashes—a sudden flush and drenching sweat. Not only are these episodes uncomfortable and potentially embarrassing, but they can also become a major distraction from any events at hand. Which is why they're not usually welcomed. However, a new study suggests that perhaps they should be in certain breast-cancer survivors—those taking the drug tamoxifen to ward off a cancer recurrence.

Joanne Mortimer of the Moores Cancer Center at the University of California, San Francisco School of Medicine led a study that followed 1,551 women. All had survived early-stage breast cancer and were taking part in a Women's Healthy Eating and Living study, which began in 1995. The study was designed to evaluate whether l0w-fat diets that were high in fiber, fruits, and vegetables might help limit the cancer's return. Slightly more than half of the recruits had been prescribed tamoxifen, and more than 75 percent of these women—674, to be exact—experienced hot flashes.

That's not surprising, since hot flashes are a common side effect of breast-cancer treatment, notes Mortimer. However, among tamoxifen users, hot flashes proved a strong predictor that a woman's cancer would not come back, Mortimer's team reported at the American Society of Clinical Oncology meeting, yesterday. Breast cancer returned in roughly 13 percent of the patients who'd experienced hot flashes, but in 21 percent of those who didn't.

These findings held for women at any age, and proved a better predictor of whether cancer would return than how advanced her cancer had been at diagnosis or whether the cancer was estrogen-receptor negative—the type most resistant to therapy with a synthetic hormone, such as tamoxifen.

Hot Flash Newsflash II

Even people who don't cotton to tofu usually find soy nuts palatable. The hard, toasted seeds taste sort of like a cross between peanuts and pretzels. It now turns out that as snacks go, these may have an extra benefit--at least for women experiencing menopausal symptoms. Eating a handful of soy nuts at various times throughout the day cut the number of hot flashes they experienced by at least 40 percent.

The study recruited 60 heathy postmenopausal Boston-area women to take part in a pair of eight-week dietary sequences. In one, they ate a low-fat, high-carbohydrate diet rich in calcium and fish. In the other sequence, they ate this diet supplemented with a half-cup of soy nuts each day, with the "nuts" to be spread out in three or four portions several hours apart. Half started on the diet without soy nuts, the rest on the soy-supplemented one.

In addition to experiencing fewer hot-flash episodes while they were in the soy-nut phase of the trial, the recruits also reported fewer other physical and emotional symptoms of menopause. Francine K. Welty and her colleagues at Beth Israel Deaconess Medical Center in Boston report their team's findings in the April Journal of Women's Health.

The amount of soy and its consumption throughout the day were each intended to mimic, in part, the typical day-long intake of soy in many Asian cultures, where the prevalence of hot flashes is low. Indeed, Welty's group notes, an estimated 10 to 25 percent of Chinese and Indonesian women typically experience this menopausal symptom compared to some 60 to 90 percent of women in Western countries.

I happened onto this paper while I was taking advantage of a nice offer by the publisher of this journal. In honor of National Women’s Health Week, last week, it opened access to the contents of this issue and any other issue of the journal at no cost--but only through June 15. To do so, log in to http://www.liebertonline.com/jwh.

Hot Flash Newsflash

A recent report in the Journal of Women's Health suggests a way to limit the risk of developing hot flashes during menopause that is definitely not what the doctor ordered: Spend your 30s as a couch potato.

Brian W. Whitcomb and his colleagues at the University of Maryland School of Medicine, in Baltimore, suspected physical activity might limit menopausal symptoms, including the often embarassing and always-miserable hot flashes. So, they administered detailed questionnaires to 512 menopausal women, querying them on their activities between the ages of 35 and 40.

The disappointing findings: highly active women were 70 percent more likely to have experienced moderate to severe hot flashes, and 80 percent more likely to suffer hot flashes daily, than were women who had remained largely inactive.

With the epidemic of obesity ravaging populations worldwide, physicians increasingly implore their patients to eat only as much needed to sate hunger--and to exercise regularly. Because regular exercise also helps cut risks of many chronic diseases, from heart problems to diabetes, the researchers caution that "our study results should not serve as an admonishment against regular participation but rather contribute information to the understanding of hot flashes."

The data appear in the journal's January issue. Normally, papers in this journal are available only to subscribers. However, in support of National Women’s Health Week, last week, the publisher is offering free online access to all issues of this peer-reviewed publication through June 15. To see this paper or any other in the journal, go to: http://www.liebertonline.com/jwh.

Killer Stats

Today, cancer and heart disease are neck-and-neck leaders as the top causes of death throughout the world. Each claims about 8 million lives annually. Although infections and stroke used to kill roughly equal numbers of people each year at the turn of the millennium, their trajectories are veering in very different directions, with stroke rates climbing slowly and infectious diseases other than HIV/AIDS plummeting dramatically.

If the projections indicated by the World Health Organization data hold true through 2030, the fastest climbing disease killer will be HIV/AIDS. Its death toll in 2002 was 2.8 million people. By 2030, WHO projects mortality from this infectious disease will more than double--to 6.5 million. That wouldn't put it far behind stroke, which is projected to claim about 7 million lives a year by then. Both will still be well behind heart disease at more than 9 million deaths a year and cancer at more than 11 million annually.

One of the saddest stats: WHO projects that tobacco related deaths will reach reach about 8.3 million a year by 2030, which would account for about 10 percent of all deaths globally.

Source: World Health Statistics 2007, released May 18, by the World Health Organization, Geneva, Switzerland, p. 12.

Sleepless Kids Stat

Sleep "is an important but underrecognized component of wellness in children," Columbia University researchers note in a recent supplement to the prestigious journal Pediatrics. That's why it's disturbing that their new nationally representative survey of U.S. children finds that "[a]pproximately 15 million American children are affected by inadequate sleep." Many of these children also had mood disorders--chiefly depression--headaches, and allergies. Moreover, the scientists found, contrary to many smaller studies, this one documented that childhood sleep deprivation "transcends all culture."

Source: Smaldone, A, J.C. Honig, and M.W. Byrne. 2007. Sleepless in America: Inadequate Sleep and Relationships to Health and Well-being of Our Nation's Children. Pediatrics 119, Supplement 1(February):S29.

Smoke and Wind

Pass by any major urban office building, these days, and you're likely to see at least a few souls commiserating outside the entrance about their forced eviction from smokefree offices whenever they feel an urge to light up. However, such nicotine addicts may find their lives constrained even more, if regulators get wind of new research published this month in the Journal of the Air & Waste Management Association.

Stanford University scientists wondered whether exiling smokers to the outdoor environment actually contributed substantially to pollution there. So, they set up continuous particle sensors to tally the tiny smoke particles in areas frequented by cigarette and cigar smokers--these were typically parks, outdoor cafes, sidewalks, and restaurant patios.

The bottom line: Sitting or standing downwind of a smoker could fill your breathing space with substantial amounts of smoke. How much? Within 1.5 feet of smokers, one could encounter upwards of 1,000 micrograms per cubic meter in air of fine particles. These are the type that can be inhaled deeply into lungs.

Admittedly, that was a maximum value. More typical ones were 200 to 500 micrograms per cubic meter of air. Still, Neil E. Klepeis and his colleagues report, concentrations at 1.5 feet downwind of an outdoor smoker were comparable to indoor concentrations found in smokers' homes. The big difference: Once an outdoor smoker puts out his or her cigarette, nearby air concentrations plummet to virtually zero. In homes, however, air isn't diluted as effectively as outdoors, so smoke remains aloft within rooms for hours after stubbing out a cigarette.

This is the first peer-reviewed data on systematic measurements of outdoor tobacco smoke. The study's authors conclude: "these data--that outdoor tobacco smoke levels can be substantial under certain conditions--[are] vital to the development of outdoor tobacco-control policy."

Of course, they're only telling us nonsmokers what we have been observing anecdotally: that outdoor air all too often fails to effectively dilute tobacco pollution. I'd say these data should begin discussions about whether even outdoor cafes need to consider offering us--especially patrons with small children--access to truly smokefree zones.

Health Promotions?

James O. Hill is president-elect of the American Society of Nutrition and director of human nutrition at the University of Colorado. Today, at his society's annual meeting--part of EB '07--Hill floated an interesting idea: Find ways to reward people for moving toward a healthier weight.

Two-thirds of Americans can afford to lose a little--or a lot--of weight, he noted. Clinics can treat the excessively heavy, but don't do much for the simply pudgy. Moreover, even people who successfully shed extra pounds usually put them back on again in the next few months or years. The trouble, Hill said, was society hasn't really crafted effective positive feedbacks, incentive structures that encourage exercise and discourage overeating. At least no feedbacks that were stronger than our biology's innate craving to eat and avoid labor.

One proposal he offered was to have people rewarded in the workplace for staying healthy, such as at a near-optimum weight. He noted that many jobs had a dress code. That's based only as aesthetics. How much better, he suggested, to link career advancement or bonus pay to maintaining health, not just pressed shirts and shined shoes.

An intriguing idea.

But not one, I suspect, that will win much favor.

I can imagine all sorts of lawsuits from people who suffer genetic conditions that affect weight or other health issues. Or who have jobs that compromise health at the same time they're being threatened with reduced compensation for poor health. And who decides what constitutes health...or even the ideal weight for any individual?

Although I support Hill's basic thesis, I guess I'd prefer to see society work out carrots to promote health by individuals--not a battery of sticks.