Study Diet soda linked to heart risks
Mon, 23 Jul 2007 20:32:11 GMTBy JAY LINDSAY, Associated Press Writer
BOSTON - People who drank more than one diet soda each day developed the same risks for heart disease as those who downed sugary regular soda, suggests a large but inconclusive study.
The results surprised the researchers who expected to see a difference between regular and diet soda drinkers. It could be, they suggest, that even no-calorie sweet drinks increase the craving for more sweets, and that people who indulge in sodas probably have less healthy diets overall.
The study's senior author, Dr. Vasan Ramachandran, emphasized the findings don't show diet sodas are a cause of increased heart disease risks. But he said they show a surprising link that must be studied.
"It's intriguing and it begs an explanation by people who are qualified to do studies to understand this better," said Vasan, of Boston University School of Medicine.
However, a nutrition expert dismissed the study's findings on diet soda drinkers.
"There's too much contradictory evidence that shows that diet beverages are healthier for you in terms of losing weight that I would not put any credence to the result on the diet ," said Barry Popkin, of the University of North Carolina in Chapel Hill, who has called for cigarette-style surgeon general warnings about the negative health effects of soda.
Susan Neely, president of the American Beverage Association, said the notion that diet drinks are associated with bulging waistlines defies common sense.
"How can something with zero calories that's 99 percent water with a little flavoring in it ... cause weight gain?" she said.
The research comes from a massive, multi-generational heart study following residents of Framingham, Mass., a town about 25 miles west of Boston. The new study of 9,000 observations of middle-aged men and women was published Monday online in the journal Circulation.
The researchers found those who drank more than soda per day — diet or regular — had an increased risk of metabolic syndrome, compared to those who drank less than one soda. Metabolic syndrome is a cluster of symptoms that increase the risk for heart disease including large waistlines and higher levels of blood pressure, blood sugar, cholesterol and blood fats called triglycerides.
At the start of the study, those who reported drinking more than one soft drink a day had a 48 percent increased prevalence of metabolic syndrome compared to those who drank less soda.
Of participants who initially showed no signs of metabolic syndrome, those who drank more than one soda per day were at 44 percent higher risk of developing it four years later, they reported.
Researchers expected the results to differ when regular soda and diet soda drinkers were compared, and were surprised when they did not, Vasan said.
But Popkin said that result isn't that surprising. He said much of the market for diet sodas are people who have unhealthy lifestyles and know they need to lose weight — with the other portion being thin people who want to stay that way. That means many people drinking diet sodas have unhealthy habits that could lead to increased heart disease risks, whether they drink diet soda or not.
In studies in which some users were randomly given diet sodas and others were given regular soda, diet soda drinkers lost weight and regular soda drinkers gained weight, Popkin said.
In a statement, the American Heart Association said it supports dietary patterns that include low-calorie beverages.
"Diet soda can be a good option to replace caloric beverages that do not contain important vitamins and minerals," the association said, adding further study is needed before any association between diet soda and heart risk factors would lead to public recommendations.
Vasan also said poor overall health habits may be one reason diet soda drinkers did not show lower heart disease risks in the Framingham study, but there hasn't been enough research to say for sure.
Another possible reason is a controversial theory called "dietary compensation," which holds that if someone drinks a large amount of liquids at a meal, they aren't satisfied and will tend to eat more at the next meal, Vasan said.
Other theories, Vasan said, are that people who drink a large amount of sweetened drinks are prone to develop a taste for sweeter foods, or that the substance that gives soda its caramel color promotes resistance to insulin, which is needed to process calories.
Without a more definitive explanation, Vasan offers only this advice to diet soda drinkers: "consume in moderation and stayed tuned for more research."
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On the Net:
Framingham Heart Study: http://www.framinghamheartstudy.org/
American Heart Association: http://www.americanheart.org
Is chemo best before or after surgery
Mon, 23 Jul 2007 20:13:27 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - More breast cancer patients are being offered chemotherapy before surgery instead of afterward — amid much debate about how to do it right and when it's a good option. Doctors have long known that having chemo first sometimes shrinks an advanced tumor enough that a woman can undergo smaller surgery and keep her breast.
What's new is the hope that it may help more women with earlier-stage cancer in a different way: by letting doctors switch drugs if the tumor doesn't respond right away. Wait until after surgery, and there's no way to measure the drugs' effect.
Does it really work? There's the rub: Studies show it doesn't endanger a woman to have chemo before surgery — but so far, the hoped-for better survival hasn't been proven either.
That conundrum means whether a woman is offered pre-surgery chemo, and how, depends more on what doctor she chooses than on firm guidelines.
"I'm a fan of letting patients know what their choices are," says Dr. Minetta Liu of Georgetown University Hospital, a proponent who estimates that up to 10 percent of her patients who need chemo patients choose it pre-surgery. "You're not asking them to do something that's going to have a negative impact on their survival. It just may not help."
On the other side is Dr. Clifford Hudis of Memorial Sloan-Kettering Cancer Center, who wants more research to settle the issue before the fledgling trend becomes routine.
"It should not be used ... just because it exists," Hudis says.
With breast cancer deaths dropping since 1990, "the notion that we should move to a different strategy should be challenged, he adds. "We have uncharted territory."
More than 178,000 U.S. women will be diagnosed with breast cancer this year. Thanks to improvements in treatment and early detection, many will survive long-term. Still, breast cancer kills 40,000 a year.
Not every patient needs chemotherapy. It depends on the tumor's size and type, and whether the cancer has begun to spread, something determined with a check of lymph nodes under the arm.
There are no good statistics on how often women who need chemo choose it upfront. Most still have chemo after surgery, especially those treated in community hospitals.
But with more specialized cancer centers pushing upfront chemo for earlier-stage patients — and dozens of clinical trials testing different methods — the National Cancer Institute brought together experts last spring to debate the evidence behind what all agreed is a rising trend.
What's clear: If shrinking a tumor might save a woman's breast, or offer a markedly smaller lumpectomy, then pre-surgery chemo is a good option. Studies in the late 1990s proved that, and women with large tumors routinely are offered pre-surgery chemo — including Elizabeth Edwards, wife of Democratic presidential hopeful John Edwards, who entered a chemo-first clinical trial when her breast cancer was first diagnosed in 2004.
Where the NCI panel urged more study: Pre-surgery chemo in women with earlier-stage cancer, in case even small tumors have sent microscopic seedlings throughout the body.
Proponents contend that by using the intact breast tumor as a guide, they can tell when chemo's not working and try another drug — and learn more about what subtypes of cancer are most dangerous and how to fight them.
About 25 percent of women who get upfront chemo have their initial tumor actually disappear, says Dr. Patrick Borgen of Maimonides Medical Center in Brooklyn. They don't avoid surgery: Doctors mark the spot before the chemo, and then cut it out anyway in case any cancer cells still lurk.
But those women do have a lower chance of relapse than their counterparts who don't respond as well.
That leads to some tough questions:
_What to do with women who still have some tumor left to cut out after their chemo? There's no way to predict who will be fine and who will relapse, and no evidence that adding more chemo after surgery makes a difference. Doctors must make clear what to expect so these women don't feel like they flunked, stresses Georgetown's Liu.
_What if doctors switched pre-surgery chemo several times in hopes of better shrinkage? Hudis warns that such women may never undergo a full standard treatment, just bits and pieces that actually might mean a worse outcome. What to do when tumors don't shrink right away is under study now.
_How do doctors really know when a tumor's shrinking? Again, studies are tracking that. Surgeons sometimes find patients labeled hard-to-treat when scar tissue or a noninvasive type of cancer that doesn't respond to chemo in the first place was in the way.
Perhaps the biggest controversy: How to test and remove lymph nodes in women getting upfront chemo.
For now, specialists advise anyone considering pre-surgery chemo to get advanced testing, including a big enough biopsy, to make sure she's a good candidate.
Dr. Deborah Axelrod of New York University just had a woman seek pre-surgery chemo for a tumor way too small to need it. "The word is getting out," she says. "I'm not sure it's understood."
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Teen with meningitis on AirTran flights
Mon, 23 Jul 2007 18:00:37 GMTWICHITA, Kan. - A teenager who fell seriously ill on an AirTran Airways flight was diagnosed with bacterial meningitis, and the airline was contacting passengers who sat near her, a spokesman said.
The girl, whose identity wasn't released, was in critical condition Monday at Wesley Medical Center, a hospital spokeswoman said.
The teen had traveled Saturday from Orlando, Fla., to Atlanta on Flight 862 and then to Wichita on Flight 687, AirTran spokesman Dave Hirschman said. The crew called for an ambulance to meet the plane at the gate after the girl became sick on the second flight and unresponsive, he said. The airline notified the Centers for Disease Control and Prevention on Sunday.
Meningitis, a bacterial infection of the lining surrounding the brain and spinal cord, primarily affects children, killing about 10 percent of those infected. Symptoms include a stiff neck, high fever, headaches and vomiting.
It can be contracted by direct close contact with discharges from the nose or throat of an infected person, but not through casual contact or breathing the same air.
The planes the girl traveled on have been thoroughly cleaned and returned to service, and AirTran was notifying fewer than 20 people who sat in her immediate vicinity, Hirschman said. The airline is a subsidiary of AirTran Holdings Inc., based in Orlando, Fla.
New HIV infections outpace treatment
Mon, 23 Jul 2007 15:37:25 GMTBy MERAIAH FOLEY, Associated Press Writer
SYDNEY, Australia - Access to life-extending HIV/AIDS drugs in developing countries has improved during the past three years, but new infections still dramatically outpace efforts to bring treatment to patients, health officials said Monday.
Three years ago, fewer than 300,000 people in the developing world were receiving the anti-retroviral drugs that help treat the virus. Last year, 2.2 million people in developing countries received the drugs, according to Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.
"However, for every one person that you put in therapy, six new people get infected. So we're losing that game, the numbers game," Fauci told Australian Broadcasting Corp. radio.
In many parts of the developing world where the HIV/AIDS epidemic is still growing exponentially, effective prevention strategies — such as condom distribution, needle exchanges and basic education about the disease — reach less than 15 percent of the population.
"The proven prevention modalities are not accessible to any substantial proportion of the people who need them," said Fauci, one of the keynote speakers at the Fourth International AIDS Society Conference on HIV Pathogenesis and Treatment in Sydney, Australia, which runs through Wednesday.
"Although we are making major improvements in the access to drugs, clearly prevention must be addressed in a very forceful way," he added.
According to recent World Health Organization statistics, only 28 percent of the world's HIV/AIDS patients are receiving anti-retroviral drugs.
Dr. Brian Gazzard, chairman of the British HIV Association, said that while great advances have been made in extending access to anti-retrovirals, the disease is still running rampant in parts of Asia and Africa.
"The HIV epidemic is essentially uncontrolled, uncontrolled in Africa, uncontrolled completely in Asia right now," he told reporters at the conference, which has drawn 5,000 delegates from 133 countries. "The epidemic still is in an exponential growth phase ... and I think that is likely to continue."
