Study Shows Hospital-Acquired Infections Kill 3 Times as Many Americans as HIV
Reviewed by Louise Chang, MD
WebMD.com, March 2, 2010, by Daniel J. DeNoon — Every year, 48,000 Americans die of infections they caught while in the hospital — and that’s a conservative estimate, a new study finds.
These aren’t infections people would have caught anyway. They are mistakes that cost lives, says study researcher Ramanan Laxminarayan, PhD, MPH, a senior fellow at the Washington, D.C. think tank Resources for the Future.
“It is a staggering number and one that does not have to be,” Laxminarayan tells WebMD. “When a patient goes to the hospital for another illness and dies of pneumonia, it does not always occur to the family that it was a mistake. But if that same patient went to the hospital and got blood tainted with HIV, the response would be quite different.”
Hospital acquired infections actually kill three times more Americans than HIV does. Yet we’re only beginning to get a handle on the size of the problem. That’s because it’s been very hard to separate out the costs — in terms of lives, suffering, and money — from the suffering caused by the illnesses and injuries that land people in the hospital in the first place.
Laxminarayan and colleagues analyzed administrative data from a huge national database of information on hospital records for 69 million U.S. residents in 40 states between 1998 and 2006. They focused only on infections acquired in the hospital, and not on infections picked up in the community.
Most of the infections come from using catheters and ventilators. Some of the germs causing the infections have been around for years; others are scary new bugs such as the MRSA staph “superbug.”
Johns Hopkins researcher Peter J. Pronovost, MD, PhD, is a world expert on hospital-acquired infections. He tells WebMD that the Laxminarayan study finally gives hard numbers to a problem that has vexed hospitals for decades.
“These deaths are invisible. The public doesn’t know. They are happening one at a time, silently, and patients think they are inevitable,” Pronovost tells WebMD. “But we know from our large patient studies this is not the case.”
In a study reported earlier this month, Pronovost and colleagues showed that by instituting simple safety checklists for hospital procedures — and by insisting on a team approach that includes the lowliest nurse assistants and the loftiest senior surgeons — hospital infection rates can be dropped nearly to zero.
But it’s not all up to hospital staff. You and your family can do a lot to prevent deadly hospital infections. Pronovost offers the following list. Note that some of these items may help you decide which hospital you should go to in the first place:
- Ask your doctor the hospital’s rate of bloodstream infections; it should be at or below one infection per 1,000 catheter days.
- Ask if the hospital is participating in the national effort to prevent these infections – it should be.
- Ask if they use the Pronovost checklist when inserting central line catheters.
- Ask if the clinicians wash their hands each time they enter your room.
- If you have a catheter, ask daily if you still need it. The catheter is a risk for infections
Pronovost says that while hospitals may have good intentions, it’s essential they keep track of their hospital infection rate. If a hospital can’t tell you its infection rate, it’s not doing enough.
“It’s like making a New Year’s resolution to diet — it doesn’t work unless you step on the scales throughout the year,” he says.
Now that the scale of the problem is known, Laxminarayan says that the U.S. should mount a prevention effort on the same scale as its anti-AIDS effort.
“People need to speak out,” he says. “Nobody can argue that patients going to the hospital should be at minimal risk. Many of these infections can be prevented, and there is no good reason not to do that.”
The Laxminarayan study appears in the Feb. 22 issue of Archives of Internal Medicine, as does an editorial by Pronovost. Pronovost’s study appears in the Feb. 4, 2010 online edition of BMJ.
Andrew Schafer MD
Image: Weill Cornell Medical College
The-Scientist.com, March 2, 2010, by Jeff Akst — Biomedical research needs practicing physicians — understanding the issues that arise in the clinic is arguably one of the best ways to inform the work done in the lab. But recently, there is evidence to suggest the numbers of physician-scientists — MDs who dedicate a significant amount of their time to medical research — may be dwindling, argues researcher and hematologist Andrew Schafer of Weill Cornell Medical College and New York-Presbyterian Hospital/Weill Cornell Medical Center.
Schafer expressed his concerns about this “disturbing” trend to The Scientist, described in a new book he edited, The Vanishing Physician-Scientist?.
TS: We do not have statistics on the numbers of physician-scientists so what makes you think that their role in the biomedical research community may be changing?
AS: There are several very disturbing trends that indicate that the career path of the physician-scientist really is in trouble. First, NIH grant applications have more than doubled in the past 15 years, but it turns out that virtually all of that doubling is attributable to PhD medical scientists. The number of pure MDs who are applying for NIH grants has been really flat for 20 or 30 years.
[Additionally], physicians drop out of research careers relatively early. At every point in the early life cycle of NIH funding, physician-scientists are more likely than PhD biomedical scientists to leave the NIH grant applicant pool. [This] is, to me, the most disturbing of all because it indicates that it’s not [just] that the so called pipeline of physician scientists hasn’t been expanding, but that this pipeline is actually leaking very badly.
TS: Why do you think there has been this shift?
AS: I think there are several things at play. First of all, I think that there are diminishing numbers of successful and happy physician-scientist role models and mentors, which one always needs to sustain one’s career. Secondly, if you’re an MD [who’s] started an academic career, there tend to be too many distractions that are competing with one’s full emersion into research — clinical responsibilities, increasing administrative responsibilities, teaching responsibilities, and all the other things that go along with the typical academic physician. And then probably the most important factor for the dropout is the increasing unpredictability of grant support. Now, with this roller coaster, boom-or-bust erratic cycling of NIH funding, physician-scientists are leaving the research arena because they do have other career options to make a living.
TS: What are the consequences if we continue in this direction?
AS: Physician-scientists [are] completely indispensible to the medical research enterprise because they bring to medical research the unique perspective of asking scientific questions based on their direct experience with patients. So I don’t think our society can afford to lose physician-scientists.
TS: So what is the future of physician-scientists?
AS: The message I [and other authors] try to convey is [that it’s] not as grim as this sounds. I don’t think they are vanishing. What is vanishing is our current or our old concepts of what a physician-scientist should look like. In the old days, we had the so-called triple-threat physician-scientists, who could allegedly, on any given day, move between the laboratory and the clinic and the classroom. That, if it ever existed, is definitely disappearing, if it hasn’t already disappeared. But in a different form, especially in the form of teams, I think the physician-scientist does have a very bright future.
The-Scientist.com, March 2, 2010, by Jeff Akst — Brian Fahey walked into Stanford University Hospital looking for problems. With nearly full access to the hospital’s departments and operating rooms, Fahey’s search seemed unbounded. During this time, he observed a number of patients on ventilators, some of whom succumbed to the potentially lethal problem of developing pneumonia—from the ventilator itself. The problem wasn’t unique to Stanford University Hospital, affecting roughly 60,000 people a year in the United States, with more than half a million patients at risk—a problem that can cost a hospital more than $40,000 per patient. A biomedical engineer by training, Fahey found this problem “particularly compelling,” he says. “People that are on the ventilator are, by definition, critically ill and fighting for their lives, and we have just made them sicker.”
During his 6-week-long stint at the hospital, through the Stanford Biodesign’s entrepreneur training program, Fahey and four of his classmates found about 350 problems, or unmet clinical needs. The program brings PhDs, engineers, and clinicians together for a crash course in entrepreneurship in the biomedical sciences. Over the course of 10 months, fellows identify problems and carefully whittle them down to those with marketable solutions. Some even succeed in starting their own company on the basis of projects initiated during the course.
While a researcher can apply for a spot in the Stanford program during a sabbatical year, Stanford only admits eight fellows per year; programs like it are similarly small and highly selective. Alternatively, scientists can try to train themselves how to think about their science from a more translational perspective. The first thing that fellows learn is that “the best way for your research to be valuable is to be working on the right thing, [which] starts with a disciplined process of understanding what the need is,” says Stanford Biodesign alumnus Ross Venook. Here are tips on finding the right clinical problems and testing your solution for market feasibility—two of the most important first steps for any entrepreneur.
Learn to identify an unmet need
“There is a tendency for scientists to mistake an observation for a need,” says Fahey. But observing a problem is only the first step—identifying the need takes defining the source of the problem. If a physician is struggling to insert a catheter, for example, an observer might conclude that the physician needs a better catheter, Fahey explains. However, the “need” in this case is a better way to access the vessel—a problem that could be solved by a different tool altogether. Henry Ford once said, “If I had asked my customers what they wanted, they would have said a faster horse,” Fahey quips.
Don’t try to solve the first need you find, make a list
The Stanford program and at least four other entrepreneurial programs ask their students to rack up a few hundred needs from which to start discussing potential projects. This process teaches students “to digest the observations that [they’ve] made [and turn them] into important clinical needs,” says Venook, who is currently a senior research and development engineer with the Neuromodulation business of Boston Scientific.
Camp out in a hospital
As part of the Stanford program, students spend 6 to 8 weeks at hospitals, speaking with clinicians. “It’s sort of pedestrian to say, ‘To do translation work, you should work with doctors,’ but I think that’s a big key,” Venook says. Getting full access to a hospital can be tough, but there are other options. Look at the literature for an MD that works in your particular area of interest, and introduce yourself. “You would be surprised how open people are to talk about their challenges every day,” says Brenda Jones of the University of Michigan Medical Innovation Center. “You might be turned down [at first], but more often than not, you’ll get someone who’s willing to talk to you,” agrees Fahey.
Visit other labs
Researchers tend to “fall in love” with their own techniques, says Fahey. “Instead of taking your skill set and trying to apply it to everything,” think broader, he says. Visiting other labs, such as diagnostics labs, where researchers are working day in and day out on a particular assay system, and learning about the tools they use can inspire you to think of new ways to solve a problem or improve the efficiency of a particular solution. “Find someone to collaborate with, [and] your likelihood to solve problems is really improved,” Fahey says.
Search the news
Other than talking to doctors, reading the news can reveal great problems in need of solving, says Marie Johnson,ﾠdirector of the Medical Devices Center Fellows Program at the University of Minnesota. “It’s just being a detective,” she says. For example, Medicare recently announced that it will stop covering hospital-acquired infections, Johnson says. That means the hospitals will have to cover the costs, and will likely look for products that effectively decrease the frequency of hospital-acquired infections.
Also, watch the news for adverse events relating to drugs or medical devices and diagnostics, and scan Medicare and insurance company Web sites for appeals, grievances, and issues they no longer cover.
Befriend industry scientists
Next time you’re at a conference, chat with folks from biotech or pharma companies. A great way to find unmet needs is to ask industry experts. “Companies tend to be looking to academia to find the solutions,” says Samara Freeman, a graduate of the UC Davis Business Development Certificate Program.
Ask for anecdotes
Clinicians or industry scientists are often unable to recognize problems or bottlenecks in their procedures and methods. They simply adapt an imperfect technique to get the job done. To identify such unseen needs, ask the clinician or industry professional “to tell stories,” Jones says, “and then listen for workarounds, accommodations, difficulties.”
Search a company’s “needs” lists
Some companies, such as General Mills, detail their specific needs on the Web, where you can view their innovation opportunities directly. For example, a need on the General Mills Website might read: “getting rid of salt” from food products, says Freeman. One possible solution would be to find a salt replacement. Currently, the company has 38 such needs listed on the General Mills Worldwide Innovation Network.
Check for market feasibility
Whittle down quick and dirty
The next step is to narrow your list of needs to a few worthy of more intense follow-up. Unfortunately, “it’s more of an art than a science,” Fahey says. Start by brainstorming solutions to the problems and shelf the ones that don’t inspire an immediate idea. Next, size up your potential market size. On the first pass, “you just have to use rough estimations,” he says. His team, for instance, decided to bucket market size into “small, medium, or large.” All else being equal, go for the product that will reach the largest markets first.
“The best way for your research to be valuable is to be working on the right thing.
Find your market size on PubMed
It’s not enough to identify people who will buy the technology; you need to have enough customers for the product to make money. To find out how big your market is, identify the prevalence and incidence of the problem your product seeks to solve by scouring the literature on PubMed for epidemiological studies as well as other databases, such as the Healthcare Cost and Utilization Project (HCUP) database, which provides statistics on hospital reports nationwide. Treatments for congestive heart failure, for example, exceed $38 billion dollars annually, affecting about 10% of people over the age of 75. “You can’t just design for one person,” Johnson says.
Make sure you’re worth at least $500 million
In addition to prevalence and incidence numbers, the HCUP database provides cost estimates, which can allow you to estimate how much the problem costs the system. Multiplying these costs by the prevalence numbers you already acquired can tell you how much money is spent on a problem each year. From a venture capitalist standpoint, Johnson says, your product must be worth “$500 million or more.” A viable product could have a small market—if it solves an expensive problem, it could be just as valuable.
Talk to 20 customers
For a solution to be a good one, somebody’s got to use it, says Andrew Hargadon of the UC Davis Business Development Program. In the last stage of the weeklong program, students call the customers in front of the entire class for a final check of their ideas. Hargadon recalls a group that found a way to cheaply measure different types of vitamin D in the blood. When they called a doctor, his “first response was, ‘That’s really interesting,’” Hargadon recounts. His “second response was, ‘You know, I’d never do that.’” Because vitamin D is so cheap, the doctor would rather prescribe a supplement than bother with a test. It’s the “rule of 20,” he says. You can’t “get started in your business until you’ve talked to at least 20 customers that tell you, ‘That’s what I’m looking for.’”
Let the competition guide your strategy
To figure out what you’re up against, check the IP databases on the United States Patent and Trademark Office Web site. If you find something similar to your product, Johnson says, it doesn’t mean you should scrap the idea, but it may affect how you should market it. You could overcome an infringement by paying royalties, or licensing the patent. Alternatively, you may want to contact those companies developing similar products to see if they would be interested in purchasing your idea. “You have to be aware [of what’s out there],” Johnson says. (Your local tech transfer office can likely help with this.)
Watch for up and coming technologies
It’s not enough to look at established technologies, says Youseph Yazdi, director of the Center for Bioengineering Innovation and Design at the Johns Hopkins University—you also have to look at what’s in the pipeline. Products under development represent your future competition, which will affect your marketing strategy. For current information, search the databases of public information on clinical research, such as uptodate.com and clinicaltrials.gov.
VentureXpert by Thomson Financial and VentureOne by Dow Jones Financial Information Services, “are very rich databases,” says Yazdi. They provide detailed information on what companies are currently working on and who’s funding them, but tend to be quite expensive. Check to see if your library has an institutional subscription.
Check the regulatory and reimbursement requirements
Determine which regulatory class your product falls into, says Jones, by checking the FDA Web site. It is important to understand the process of getting your product approved. That will influence your product’s timeline, and affect the overall development costs and potential revenue. Medical devices, for example, are divided into three classes that vary significantly in their regulatory requirements.
Also, check hospital billing codes, Jones adds. Your product may fall under a preexisting code if you are proposing a modification to an existing technology. A technology that requires a new code will be more time consuming and expensive for hospitals, says Jones, potentially making a it less attractive.
Medscape.com, March 2, 2010, by Lisa Nainggolan — (Stanford, California) — Adding more weight to the argument for a population-wide approach to reduce dietary sodium levels in the US is a new study that suggests such a move would save $32 billion in medical costs and avert almost one million MIs and strokes over the lifetime of adults aged 45 to 85, compared with the status quo . The findings are published online March 1, 2010 in the Annals of Internal Medicine.
“We wanted to discover whether small reductions in sodium intake, such as those achieved in the UK [around a 10% cut], would result in decreases in blood pressure and changes in cardiovascular disease that are worthwhile,” lead author Dr Crystal M Smith-Spangler (Stanford University, CA) explained to heartwire . “We created a mathematical model to look at the impact of reducing sodium intake and found that if you apply these population changes over the US, you do see substantial decreases, in both saving money and reducing the number of heart attacks and strokes.”
If you apply these population changes…….you do see substantial decreases, in both saving money and reducing heart attacks and strokes.
Smith-Spangler says the new paper builds on previous research in this area by including some sensitivity analyses, looking at whether there are any scenarios under which it would not be worthwhile to reduce sodium intake.
In an accompanying editorial , Drs Thomas R Frieden and Peter A Briss (Centers for Disease Control and Prevention, Atlanta, GA) say Smith-Spangler et al “provide compelling evidence that a policy-driven approach can reduce sodium intake, save money, and save lives.” This study “is consistent with previous work suggesting that this intervention could yield savings of $18 billion in direct healthcare costs,” they add.
Working With Manufacturers Better Than a Sodium “Tax”
Smith-Spangler and colleagues looked at two approaches to reducing population sodium intake: the first, modeled on the UK experience, involves the government working with food manufacturers to voluntarily cut sodium in processed foods. The second scenario would be to create a “sodium tax” on food. While they found that the latter method would also generate savings, of around $22 billion over the same time period, they discovered there are likely to be some problems with this approach.
“Based on our estimates, we thought the tax would be less effective than voluntarily working with industry to reduce salt intake,” Smith-Spangler commented.
They found only one scenario in which reduction of dietary sodium might not be worthwhile–if people noticed a significant change in the taste of food and deemed that it tasted “bad,” this “might mitigate any saving in quality-adjusted life-years, because so many people would be affected,” Smith-Spangler says. But in practice, this is unlikely to occur, she believes, because research suggests that most people do not notice modest reductions in salt intake, and their “preferred level of sodium intake resets after a few weeks.”
The editorialists agree, and they suggest following the UK example, whereby sodium reduction was performed on a stepwise basis, gradually reducing the salt content of foods.
US Poised to Join Other Nations in Salt-Reduction Policies?
Frieden and Briss go on to describe other countries that have implemented effective salt-reduction programs and the moves that are afoot in the US to institute similar policies, as discussed in detail in a recent heartwire feature.
“A coalition of national health organizations and major US cities led by New York City has called for reductions in Americans’ salt intake by 20% over the next five years, with a 10-year goal of a 40% reduction in population salt intake,” they note. “To achieve these reductions, the sodium content of processed and packaged foods will need to decrease by 25% in five years and by 50% in 10 years.”
The US Institute of Medicine is soon to issue a report, “Population-based strategies for reducing salt intake,” and it is widely predicted that it will recommend some kind of strategy to mirror that adopted in the UK. And Frieden and Briss note that the US National Salt Reduction Initiative has already developed voluntary two- and four-year interim targets for cutting sodium levels in restaurant and packaged foods.
“As we implement sodium-reduction strategies, the CDC is enhancing surveillance systems to monitor exposure and outcomes and is also monitoring progress reducing salt consumption and its health consequences,” they conclude.
The authors report no disclosures.
- Smith-Spangler CM, Juusola JL, Enns EA, et al. Population strategies to decrease sodium intake and the burden of CVD in the US, a cost-effectiveness analysis. Annals of Internal Medicine 2010; in press. Available at: http://www.annals.org.
- Frieden TR and Briss PA. We can reduce dietary sodium, save money, and save lives. Annals of Internal Medicine 2010; in press. Available at: http://www.annals.org.
Authors and Disclosures
Lisa Nainggolan is a journalist for theheart.org, part of the WebMD Professional Network. She has been with theheart.org since 2000. Previously, she was science editor of Scrip World Pharmaceutical News, covering news about research and development in the pharmaceutical industry, and a consultant editor of Scrip Magazine. Graduating in physiology from Sheffield University, UK, she began her career as a poisons information specialist at Guy’s Hospital before becoming a medical journalist in 1995. She can be reached at LNainggolan@webmd.net.
WashingtonPost.com, March 2, 2010, by Kari Lydersen — After receiving a diagnosis of aggressive breast cancer at age 43, Lisbeth Ceriani wanted to find out whether she had the BRCA gene mutation, which makes women much more likely to get breast and ovarian cancer. If she tested positive for the mutation, she decided, she would have her ovaries removed preemptively.
But Massachusetts, where Ceriani lives, is one of 24 states where Medicaid does not cover the $3,120 test, which is offered only by the Utah biotech company Myriad Genetics. Coordinator of a Boston au pair program where she does not get health insurance or earn enough to purchase it on her own, Ceriani said she could not afford the test. She is one of the plaintiffs in a lawsuit claiming that Myriad’s exclusive right to conduct tests for the mutation is unconstitutional.
The plaintiffs’ attorneys, from the American Civil Liberties Union and a nonprofit called the Public Patent Foundation, hope the case will redefine how patent law is applied to genetic testing and research. They say that Myriad’s patents on the isolated BRCA sequences impede research and women’s access to their own genetic information through testing.
Richard Marsh, Myriad’s executive vice president and general counsel, counters that the test might never have been developed and become widely available if it weren’t for the financial incentives offered by a patent. And he said the patents will expire in 2014 and 2015, at which point any company will be able to offer the test.
“It is an expensive test; affordability is a concern,” said Marsh. “But the whole patent system is to incentivize people to go out and develop a product and make it more accessible. We’ve literally spent hundreds of thousands if not millions to convince physicians and insurance companies that if you can diagnose someone with a predisposition [to cancer,] you’ll save more money by paying for the $3,000 test than hundreds of thousands on chemotherapy and surgeries.”
All Myriad tests are done at its lab in Salt Lake City. Doctors around the country send patients’ blood samples there and get results from Myriad: positive, negative or inconclusive. Doctors or genetic counselors then discuss the meaning of the findings and different options with their patients. Medicaid covers the test in Virginia and Maryland but not in the District.
‘A product of nature’?
Patents cover thousands of human genes, about 20 percent of the human genome, according to the ACLU. While it is illegal to patent products of nature, laws of nature or abstract ideas, federal courts have decided that a DNA sequence that has been extracted and isolated does not qualify as a product of nature.
Critics say these patents have a severe chilling effect on research because the patent-holder could claim ownership of any commercial applications that result. But Marsh points out that numerous papers have been published on BRCA genes since Myriad obtained the patent, and the company is also continuing to research the genes and refine its tests.
DNA sequences related to Alzheimer’s, spinal muscular atrophy and other diseases are among those covered by patents. ACLU staff attorney Chris Hansen said many were obtained by research institutions committed to keeping the genetic information in the public domain and away from companies that might seek exclusive use of it. He said that the parties behind the litigation chose to sue over the BRCA patents because Myriad has enforced them and because breast and ovarian cancer affect so many Americans.
“Taking a gene out of the body doesn’t take it from being a product of nature to a creation of man,” said Hansen. “People have a common-sense reaction that it shouldn’t be right for some company to own a piece of my body.”
“It’s like saying I can’t look at my own blood,” said Ceriani.
Patent attorney and molecular biologist Kevin Noonan said “sound and fury” has obscured the legal realities of the case.
“Saying the consequence of these patents is that women may not be able to obtain the information is like saying I can’t call someone in New York because I don’t want to pay to use a telephone,” he said. “Free speech doesn’t mean something should be free, it just means the government can’t suppress it.”
Mark Stoler, president of the American Society for Clinical Pathology, a plaintiff in the suit, is concerned that Myriad’s monopoly on the test prevents patients from seeking a second opinion that might be available if other companies offered the same or similar tests.
Marsh said Myriad has licensed several universities to do tests that can confirm a positive finding.
“No test is perfect. No matter how many layers of quality control you put on something, there are still mistakes made,” said Stoler. “Our first question is, is it good lab practice to have a monopoly? The second question is, should genes be patented? Most of us agree the answer is no, genes should not be patented, and there should not be monopolies on lab tests.”
In December Ceriani tested positive for the BRCA mutation after Myriad donated free test kits to a local nonprofit. Marsh said the donation was driven largely by Ceriani’s advocacy.
Chicago filmmaker Joanna Rudnick tested positive in 2001 for the gene mutation, and later got a second opinion in Canada while she was there producing a documentary about BRCA. While Canadian doctors often send samples to Myriad for testing, some Canadian universities and researchers do a different type of test that can confirm mutations of the BRCA gene.
A second opinion is “an option most women don’t have,” Rudnick said, since insurance typically wouldn’t cover a second test. Her documentary argues that Myriad’s patents impede development of a more accurate and cheaper test.
“If they had a non-exclusive patent, they could still be testing and making money, they’d just have competition,” Rudnick said. “That’s American.”
LEF.org/news, March 2, 2010 — Derivatives of resveratrol — found in red wine grapes — may impede cancer cell development, U.S. researchers said. The National Cancer Institute has teamed with a biotech firm to examine the potential benefit of resveratrol among cancer patients. Dr. Bryan C. Donohue of the University of Pittsburgh Medical Center, Shadyside Hospital, says early-stage clinical trials now under way are examining resveratrol’s effectiveness among patients with heart disease, cancer, dementia and a host of other modern illnesses. In the meanwhile, some people simply looking for greater energy, enhanced clarity of thought and advanced overall well being are already benefiting from resveratrol supplementation, Donohue said. “I have had occasion to introduce hundreds of patients to daily resveratrol supplementation, ranging from healthy adults interested in health maintenance and prevention to more elderly individuals with specific health concerns,” Donohue said in a statement. “People have experienced greater energy, increased exercise tolerance, crispness and clarity of thought and a general bounce in their overall level of well-being.”
Although excessive alcohol consumption has adverse health effects, epidemiological studies have consistently demonstrated that moderate consumption of alcohol and wine is statistically associated with a decrease in death due to cardiovascular events such as heart failure. In the United States, a boom in red wine consumption was initiated in the 1990s by the TV show 60 Minutes, and additional news reports on the French Paradox. The French paradox refers to the comparatively lower incidence of coronary heart disease in France despite high levels of saturated fat in the traditional French diet. Some epidemiologists suspect that this difference is due to the higher consumption of wines by the French, but the scientific evidence for this theory is limited. The average moderate wine drinker is more likely to exercise more, to be more health conscious, and to be of a higher educational and socioeconomic class, evidence that the association between moderate wine drinking and health may be related to confounding factors.
Population studies have observed a J curve association between wine consumption and the risk of heart disease. This means that heavy drinkers have an elevated risk, while moderate drinkers (at most two five-ounce servings of wine per day) have a lower risk than non-drinkers. Studies have also found that moderate consumption of other alcoholic beverages may be cardioprotective, although the association is considerably stronger for wine. Also, some studies have found increased health benefits for red wine over white wine, though other studies have found no difference. Red wine contains more polyphenols than white wine, and these are thought to be particularly protective against cardiovascular disease.
A chemical in red wine called resveratrol has been shown to have both cardioprotective and chemoprotective effects in animal studies. Low doses of resveratrol in the diet of middle-aged mice has a widespread influence on the genetic levers of aging and may confer special protection on the heart. Specifically, low doses of resveratrol mimic the effects of what is known as caloric restriction – diets with 20-30 percent fewer calories than a typical diet. Resveratrol is produced naturally by grape skins in response to fungal infection, including exposure to yeast during fermentation. As white wine has minimal contact with grape skins during this process, it generally contains lower levels of the chemical. Other beneficial compounds in wine include other polyphenols, antioxidants, and flavonoids.
To fully get the benefits of resveratrol in wines, it is recommended to sip slowly when drinking wines. Due to inactivation in the gut and liver, most of the resveratrol in imbibed red wine does not reach the blood circulation. However, when sipping slowing, absorption via the mucous membranes in the mouth can result in up to around 100 times the blood levels of resveratrol.
Red wines from the south of France and from Sardinia in Italy have been found to have the highest levels of procyanidins, which are compounds in grape seeds suspected to be responsible for red wine’s heart benefits. Red wines from these areas have between two and four times as much procyanidins as other red wines. Procyanidins suppress the synthesis of a peptide called endothelin-1 that constricts blood vessels.
A 2007 study found that both red and white wines are effective anti-bacterial agents against strains of Streptococcus. Also, a report in the October 2008 issue of Cancer Epidemiology, Biomarkers and Prevention, posits that moderate consumption of red wine may decrease the risk of lung cancer in men.
While evidence from laboratory and epidemiological (observational) studies suggest a cardioprotective effect, no controlled studies have been completed on the effect of alcoholic drinks on the risk of developing heart disease or stroke. Excessive consumption of alcohol can cause cirrhosis of the liver and alcoholism; the American Heart Association cautions people to “consult your doctor on the benefits and risks of consuming alcohol in moderation.”
Wine’s effect on the brain is also under study. One study concluded that wine made from the Cabernet Sauvignon grape reduces the risk of Alzheimer’s Disease. Another study concluded that among alcoholics, wine damages the hippocampus to a greater degree than other alcoholic beverages.
Sulphites are present in all wines and are formed as a natural product of the fermentation process, and many wine producers add sulfur dioxide in order to help preserve wine. Sulfur dioxide is also added to foods such as dried apricots and orange juice. The level of added sulfites varies, and some wines have been marketed with low sulfite content. Sulphites in wine can cause some people, particularly those with asthma, to have adverse reactions.
Foods to keep your heart, brain, and bones healthy
Reviewed by Brunilda Nazario, MD
WebMD.com, March 2, 2010, by Peter Jaret — Is there such a thing as a longevity diet? Increasingly, studies suggest the answer is yes.
Around the world, certain groups of people enjoy exceptionally long lives. Consider the lucky people of Okinawa: These Pacific Islanders have an average life expectancy of more than 81 years, compared to 78 in the United States and a worldwide average of just 67. Closer to home, members of the Seventh Day Adventists, who typically eat vegetarian diets, outlive their neighbors by four to seven years on average.
The residents of the San Blas islands, meanwhile, off the coast of Panama, very rarely suffer from high blood pressure and heart disease. Indeed, research shows that their rate of heart disease is only nine per 100,000 people, compared to 83 per 100,000 among nearby mainland Panamanians.
What makes these groups so fortunate? A growing body of findings suggests that diet is one of the important contributors to longevity and a healthy life. WebMD examined the research and talked to the experts. Here’s what’s on the menu of people who enjoy long and healthy lives.
Foods for a Healthy Heart
Most of us know to go easy on saturated fat, the kind found in meat and high-fat dairy products. Saturated fats have been shown to raise blood cholesterol levels into the danger zone. Just as important is what you should be eating. For heart health and longevity, you should eat:
Plenty of fruits and vegetables: Plant-based foods are abundant in fiber and many vitamins and minerals. Packed with nutrients, they’re also relatively low in calories. Studies consistently show that diets plentiful in fruits and vegetables help people maintain a healthy weight and protect against cardiovascular disease.
Whole grains: Like fruits and vegetables, whole grains pack a lot of nutrition into a low-calorie package. Grains like oats and barley are also rich in a long list of disease-fighting compounds.
In findings from the Multi-Ethnic Study of Atherosclerosis published in 2009, researchers at the University of Texas Health Sciences Center in Houston reported that participants whose diets included plenty of whole grains and fruit cut their heart disease risk by almost half compared to those whose diets favored meat and fatty foods. Findings from more than 161,000 nurses enrolled in the Nurses’ Health Study also show that whole grains protect against type 2 diabetes, a disease that in turn increases the danger of heart disease.
Nuts: For too long, nuts were banished from the list of healthy foods because they’re high in fat. They are. But the fat they contain is mostly unsaturated, which protects against heart disease.
Dark chocolate: Dark chocolate? That’s right. Researchers now think that high blood pressure and heart disease are exceedingly rare among residents of the San Blas islands because they eat chocolate, and lots of it. Components in dark chocolate called polyphenols are believed to lower blood pressure and improve the flexibility of blood vessels. In a 2008 study, researchers at the University of Aquila gave volunteers with hypertension 100 grams of dark chocolate daily. After 15 days, their blood pressure readings were significantly lower and their insulin sensitivity had improved.
Organic Dark Chocolate (70% or more)
Foods for a Vital Brain
The basic advice is simple: What’s good for your heart and blood vessels is also good for your brain. That means eating a diet centered on fruits and vegetables, with plenty of unsaturated oils such as olive oil, and plenty of whole grains. Foods that may add extra protection include:
Blueberries and other antioxidant-rich fruits: Ongoing research at the Jean Mayer Human Nutrition Research Center on Aging at Tufts University suggests that foods especially high in antioxidants, including blueberries, grape juice, and walnuts, protect against age-related changes in the brain that lead to memory loss and even dementia.
Fish: High in omega-3 fats, fish and shellfish have been shown to protect against irregular heart rhythms than can lead to heart failure. New evidence suggests that in addition to heart protection, the fatty acids such as DHA and EPA found in fish oil (and ALA found in flaxseed) may offer a defense against depression and age-related memory loss.
Low-salt foods: Researchers have known for years that less salt in the diet means lower blood pressure. Now new evidence suggests that keeping blood pressure down may also protect brain cells and decrease the risk of age-related memory loss and even dementia.
“High blood pressure can damage the vasculature that supplies the brain with oxygen and nutrients,” explains Tufts University neuroscientist Aron Troen, PhD. That may explain why people with chronic hypertension seem to be at higher risk of developing age-related cognitive impairments.
Coffee: A growing number of studies suggest that coffee has several surprising health benefits. Along with potentially lowering the risk of type 2 diabetes, consumption of coffee may reduce the risk of age-related mental decline.
The latest evidence, from a Finish study of 1,409 volunteers published in the Journal of Alzheimers Disease in 2009, found that people who regularly drank coffee during their middle-aged years were significantly less likely to suffer dementia and Alzheimer’s later in life. Those who drank three to five cups daily had a 65% reduction in risk.
Foods for Strong Bones
Bone loss and osteoporosis are among the leading reasons for disability in later life. And once seniors become disabled, their health often declines in many other ways. Although some bone loss is inevitable as we age, eating foods rich in calcium and vitamin D can slow the process and prevent disabling fractures. Among the top choices:
Low-fat dairy products: “The body needs vitamin D in order to absorb calcium,” says Robert P Heaney, MD, professor of medicine at Creighton University in Omaha, Neb., and a leading expert on osteoporosis. “But adequate levels of protein are also necessary to keep bones strong.” For that reason, he argues, dairy products like milk and yogurt are the best sources of calcium because they contain the full array of nutrients needed for healthy bones.
Dark green leafy vegetables: Collard greens, spinach, and broccoli are good sources of calcium.
Tofu: Look for brands made with calcium sulfate, which contain the highest levels of calcium. A half-cup contains about 250 milligrams of calcium. (Adult women should consume about 1500 milligrams a day, according to Heaney.)
Unfortunately, getting enough vitamin D turns out to be trickier than getting enough calcium. Although many foods are fortified with vitamin D, diet alone isn’t able to provide enough. Our skin converts sunlight to vitamin D; but with age, that process becomes less efficient. (During the winter months in most parts of the United States, the sun is too weak to generate vitamin D production.)
While experts continue to debate the optimal levels of vitamin D, Heaney recommends taking 1,000 to 2,000 international units (IU) a day in supplement form. Boosting vitamin D is particularly important as you get older, he points out, since the skin becomes less efficient at generating this crucial nutrient from sunlight.
Marinated, then Baked Tofu
Beyond Nutrients: The Joy of Eating
A diet abundant in nutrients is obviously important to longevity. So is enjoying what you eat– and especially finding joy in sitting down to meals with family and friends.
Studies of centenarians the world over suggest that social connections and finding meaning in life are both crucial to longevity. The long-lived people of Okinawa say one reason they enjoy long and healthy lives is something they call ikigai, or “finding your reason to live.”