Don't blame Starbucks: Cops may have poorer health due to night shifts

Midnight shift workers often find it hard to get enough quality sleep on a consistent basis. Police officers are not exempt, often working late shifts and overtime as part of their job.

A new study finds that their schedule may cause cops to develop metabolic syndrome, a cluster of symptoms including high blood pressure, insulin resistance and high trigylcerides that advance development of such conditions such as stroke, cardiovascular disease, and type 2 diabetes.

The research, published in the current issue of Archives of Environmental & Occupational Health, focused on 98 police offers who were part of the Buffalo Cardio-Metabolic Occupational Police Stress study, which began in 2003. The participants had their blood pressure checked, took a blood test and had their waist circumference measured. They also filled out a questionnaire focusing on lifestyle choices such as sleep habits, physical activity, and smoking and alcohol use.

Researchers discovered that in general, those on afternoon and midnight shifts were younger than those working during the day, and predominately male. Overall, 30% of the police officers on the night shift had metabolic syndrome. In the general population, that number was 21%, taken from the National Health and Nutritional Examination Survey. The younger officers on the night shift (average 36.5 years) also had higher rates of metabolic syndrome than age-matched men and women in the general population, who came in at 24%.

Waist circumference was larger and HDL "good" cholesterol levels were lower among night shift cops compared to the general population and to officers working day and evening shifts. Officers working nights who got less than six hours of sleep had higher averages of metabolic syndrome factors than day shift workers.

"One potential explanation for this unusual finding is that midnight shift officers were most likely to be sleep deprived because of difficulties associated with day sleeping," said John Violanti, the study's lead author, in a news release. The research associate professor at the University of Buffalo's department of social and preventive medicine added, "Sleep debt has been shown to have a harmful impact on carbohydrate metabolism and endocrine function, which could contribute to metabolic disorders."

In the study, the authors wrote, "Information gained through this study may be useful to aid further investigation of not only police officer health, but also the health of those in other first-responder occupations."

--Jeannine Stein

Photo credit: Allen J. Schaben / Los Angeles Times

High-fat, high-sugar diet alters bacteria in the gut, making it easier to gain weight

A high-fat, high-sugar diet does more than just pump calories into your body. It also alters the composition of bacteria in your intestines, increasing the proportion of the little buggers that make it easier for you gain weight and harder to lose it, research in mice suggests. And the changeover can happen in as little as 24 hours, much faster than researchers had suspected, according to a report today in the new journal Science Translational Medicine.

Many different factors play a role in the propensity to gain weight, including genetics, physical activity and the environment, as well as food choices. But a growing body of evidence, much of it accumulated by Dr. Jeffrey I. Gordon of Washington University in St. Louis, shows that bacteria in the gut also play a key role. His findings could eventually lead to new ways to induce weight loss or to prevent weight gain in the first place.

Humans need bacteria in their gut to help convert otherwise indigestible foods into a form that is digestible. Human intestines contain trillions of bacteria, perhaps 10 of them for every cell in the body. Although hundreds of different types of bacteria are present, 90% of them fall into two major divisions, or phyla: the Firmicutes and the Bacteroidetes. Previous research had shown that obese mice had higher levels of Firmicutes, while their lean littermates had more Bacteroidetes. Analyzing the genomes of the bacteria, Gordon and graduate student Peter Turnbaugh concluded that the Firmicutes were more efficient at digesting food that the body can't, such as the complex sugars in grains, fruits and vegetables, breaking them down into simple sugars that can be used by the body.  Because these bacteria are more efficient, animals that have a higher proportion of Firmicutes in their guts convert a higher proportion of ingested food into calories that can be absorbed by the body, making it easier to gain weight. Over the course of a year, for example, a small increase in absorbed calories could lead to significant weight gain, Gordon said.

When the researchers transferred bacteria from the guts of obese mice into so-called gnotobiotic mice, which were raised in a sterile environment and had no bacteia in their guts, the mice gained more weight than did those receiving a similar amount of bacteria from lean mice, even though they were fed the same diet. But that was in mice. The question remained whether bacteria in the human gut could do the same thing.

In the new research reported today, Gordon, Turnbaugh and their colleagues found that they could transfer bacteria from human intestines into gnotobiotic mice, creating "humanized" mice that in themselves may prove to be a valauble research tool. The bacteria would colonize the mouse intestines even if they had been frozen and stored for long periods.

The gnotobiotic mice were fed a low-fat, plant-rich diet in the weeks before the bacteria were transplanted and for a month afterward. Analyzing the genomes of the bacteria, the team concluded that the bacterial colony in the mice was virtually identical to that of the human donor. After the bacteria were transplanted from a lean human donor, the colonies in the mice had a high proportion of Bacteroidetes and a low proportion of Firmicutes. But within 24 hours after the mice were switched to a high-sugar, high-fat diet, the proportions of the two phyla were reversed. With time, the mice also grew fatter than their littermates who did not receive the human bacteria. Furthermore, when the bacteria from these obese mice was transplanted into other gnotobiotic mice, those animals gained weight, even though they were kept on a low-fat diet. These findings suggest that the bacterial colonies can be passed from generation to generation, providing an explanation beyond genetics for why obesity runs in families.

The team is now studying bacterial colonies from malnourished children to see if the bacterial population can be altered to increase the children's ability to use food.

— Thomas H. Maugh II

 

Would you drink Coke or Pepsi for breakfast?

It appears that L.A. Times readers love their juice. Dozens of you wrote in to sound off about Sunday’s story “Nutrition Experts See Juice Glass as Half Empty.” The bottom line – that 100% fruit juice can be as unhealthy as soda – was not welcome news to many readers.

To recap, the story points out that fruit juice has comparable amounts of calories and sugar as soda on an ounce-per-ounce basis. Drinking excess soda will make you gain weight, and the same is true of juice. Health experts scratch their heads when schools remove soda from their vending machines and substitute juice instead. Though juice comes from fruit, it is not nutritionally comparable because it has more sugar and less fiber. As Dr. Charles Billington, an appetite researcher and endocrinologist at the University of Minnesota, put it: “It’s pretty much the same as sugar water.”

Juice drinkers wrote in with their complaints. Among them:

If [your butt] is super-glued to the couch, you can become obese eating celery. (I doubt it – that would mean eating a LOT of celery – but in principle, you could become obese if all you ate were apples and oranges.)

And:

My Dad lived to be 96 and drank more than one glass of orange juice, squeezed fresh every day. He hooked me, but I am only 80.

One reader pointed the finger at the way juice is packaged:

Just as with soda, having a big old half gallon in the fridge leads to pouring big old glasses of it any old time -- and a whole lot of calories.

But he added:

My father in his 60's was thinking that he was so healthy drinking his Tropicana orange juice every day -- a whole quart. Then suddenly, wham!! Diabetes hit him and he almost died. This is a Yale Medical School grad very aware of medical issues. In hindsight, he realized that he had been in sugar denial.

Several readers also wrote in to say that they’ve been on to juice for some time now. For instance:

I stopped drinking fruit juice several years ago when I realized I had high triglycerides, which can be a symptom of the body having trouble processing sugar and other carbohydrates. The large amount of sugar in orange juice even makes my teeth hurt now when I try some.

A researcher from the Harvard-affiliated Joslin Diabetes Center commented:

The "healthy halo" around juice has been in great need of a reevaluation.

He pointed to this study, published last week in the journal Cell Metabolism, that found that sugar consumption reduced the lifespan of worms. (I know, people are not worms, but they are useful models for studying aspects of human health.)

If you’d like to add your two cents, please feel free to post a comment here.

The problem of excess sugar consumption certainly raises the question (asked by one reader) of how much sugar one can consume each day without getting into trouble. The answer depends on how many total calories you’re shooting for each day. A helpful guide is available from LifeClinic.com. For instance, a 2,200-calorie diet can include up to 12 teaspoons (or 44 grams) of sugar each day.

I also got questions from many readers asking whether their beverage of choice (pomegranate juice, cranberry juice) was any healthier than orange or apple juice. You can look up almost anything at this website from the Agricultural Research Service’s Nutrient Data Laboratory, part of the U.S. Department of Agriculture. Be sure to check the 1-cup option to get an accurate read on calories, sugar and other components of an actual serving size (the program defaults to “100 grams”).

-- Karen Kaplan

Photo: Though it comes from real fruit, this glass of orange juice might was well be a Coke or Pepsi. Credit: Francine Orr / Los Angeles Times

Obesity drugs lumber toward marketplace

About this time last year, we were reporting on the failure of several investigational weight-loss medications. They included Sanofi-Aventis' rimonabant as well as two other drugs that aimed to work by blocking cannabinoid receptors in the brain.

However, one or more new weight-loss drugs may become available next year, based on research presented this week at the Obesity Society's annual meeting in Washington, D.C. Xenical was the last prescription weight-loss medication approved by the Food and Drug Administration, in 1999.

An update on the three leading candidates for approval:

• Lorcaserin, made by Arena Pharmaceuticals, reported Phase 3 study results of 4,008 patients who took the medication for one year. Almost half of the patients lost 5% or more of their body weight, and 22.6% lost 10%.
• Qnexa, made by Vivus Inc., is a combination of two drugs: phentermine and topiramate. In two Phase 3 studies of 3,750 patients, the average weight loss was 14.7% of body weight (37 pounds) after 56 weeks.
• Contrave, made by Orexigen Therapeutics Inc., is also a combination of two medications: buproprion SR and naltrexone SR. In a Phase 3 study, one-third of patients lost 10% of body weight.
  

 

The manufacturers all reported acceptable safety profiles, but the FDA will be looking closely at that issue. Rimonabant reached late-stage clinical trials before being abandoned because patients reported an increase in depression symptoms and suicidal thoughts.

"Safety is of paramount importance in treating patients who are overweight or have obesity," Dr. Lee Kaplan, an associate professor of medicine at Harvard who presented the data on lorcaserin, said in a news release. "We need new therapies that help patients reduce their weight and improve cardiovascular factors such as high blood pressure and cholesterol, while avoiding cardiac toxicity and symptoms of depression."

-- Shari Roan

 

Newer antipsychotics linked to kids' weight gain; all but one linked to metabolic changes

Children and adolescents who started on any one of four psychiatric drugs known as "atypical antipsychotics" packed on a significant amount of weight, new research has found. And three of the four psychiatric medications under study came with metabolic side effects that will dramatically boost a child's likelihood of developing cardiovascular disease, according to a study published Tuesday in the Journal of the American Medical Assn.

Patients taking their first-ever course of drugs marketed as Abilify, Risperdal, Seroquel and Zyprexa experienced weight gains ranging from about 9.7 pounds for Abilify to 18.7 pounds for Zyprexa. (Seroquel users gained about 13.2 pounds and Risperdal users gained about 11.7 pounds over 12 weeks. A comparison group of children with a diagnosis of severe mental illness but who were not on the medications gained less than a half-pound in the course of the study.)

Young patients on Risperdal, Seroquel and Zyprexa all experienced a significant increase in their triglycerides, and those taking Zyprexa and Seroquel had a surge in their overall cholesterol readings. Those taking Abilify registered dramatic changes in body composition, but no metabolic changes that reached the level of statistical significance accepted by medical researchers.

Among the 205 patients who completed the study, it was rare for researchers to see metabolic syndrome or diabetes develop in the 12 weeks of treatment they observed. But they took note of two kinds of changes in subjects that were ominous: first, they noted significant changes in the children's fat mass and waist circumference measures--which predict the development of heart disease in the general population and metabolic syndrome in adults taking antipsychotic medicines; and second, they recorded significant changes in many of the children's triglycerides and in the ratios of triglycerides to HDL cholesterol--both considered a reliable predictor of insulin resistance to come.

The latest study is the largest to date focusing on young patients taking one of the new-generation antipsychotics for the first time. Its results were hailed as "timely and sobering" in an editorial accompanying the study's publication. It comes against a backdrop of rapidly expanding use of these drugs, and their growing use among children as young as 5. The Food and Drug Administration is currently considering whether it to accept the recommendation of a panel of outside experts and approve three of the four drugs for use by children diagnosed with schizophrenia and/or bipolar disorder.

JAMA's editorial suggests that such a step might be ill-advised.

"These results challenge the widespread use of atypical antipsychotic medications in youth," wrote University of Washington, Seattle, child psychiatrists Christopher K. Varley and Jon McClellan.

The commenting physicians warned that the change in children's cholesterol levels and insulin resistance readings observed after only 12 weeks of treatment "portends severe long-term metabolic and cardiovascular sequelae." While physicians expanded their use of the drugs because they were "widely touted as being more effective and safer" than older psychiatric drugs, that belief "should be reconsidered," Varley and McClellan wrote.

Several earlier studies of these antipsychotic medications have documented weight gain, changes in body composition and measures of metabolic function. But this study's findings are the most dramatic so far to come to light. The researchers suggested that earlier studies--many of them conducted under the sponsorship of drug makers--may have understated children's weight gain on the drugs by including many subjects who had taken earlier courses of antipsychotic medicine, and thus already had experienced drug-connected weight gain. For all the subjects followed in this study, this was the first time they had taken any drug classified as an antipsychotic medication. 

Scattered in academic medical centers across New York state, all the researchers were sponsored by grants from the National Institutes of Health.

-- Melissa Healy

Obesity doctors urged to back off soda tax

The annual gathering of the Obesity Society is underway this week in Washington, D.C., and that means the debate over taxes on sodas and other junk food is back on center stage.

A number of health organizations support a soda or junk food tax  -- raising the price on high-calorie, nonnutritious products -- to discourage people from buying them, as was reported here in Booster Shots last month. On Monday, however, the Obesity Society meeting was barely underway when the group Center for Consumer Freedom issued a statement urging health experts to view the obesity epidemic as an issue of personal responsibility that does not require government action.

In case you have forgotten, 33.3% of men and 35.3% of women are obese, according to the U.S. Centers for Disease Control and Prevention.

The statement from J. Justin Wilson, of the Center for Consumer Freedom, said: "The public health community seems dead-set on ever more regulation of our lives. The push for taxes on sugar-sweetened beverages is just the latest example of the disdainful belief that when it comes to matters of personal choices, the regulators know best. Government taxation should not be a tool for social engineering. Nor should it be used to penalize individuals for their personal food choices."

Social engineering?

Leaders of the Obesity Society, meanwhile, believe that having 72 million Americans overweight or obese with an associated $140 billion a year in extra medical costs requires some action beyond personal choice. The society's position statement on the epidemic does not mention a soda tax, but it addresses the issue of personal responsibility, saying obesity is not a character flaw but a complex disease involving genes, behavior and environment.

"While personal willpower and healthy lifestyle choices are part of the solution, a lack of willpower is not the cause, and personal responsibility alone is not enough to solve the problem," they say.

We'll have more news from the Obesity Society in Booster Shots this week.

-- Shari Roan

Photo credit: David McNew / Getty Images

Photo: Obesity prevalence among adults by state. Credit: Centers for Disease Control and Prevention

Heart attack rates up in women

Rates of heart attacks, as well as risk factors for cardiovascular disease, have dropped in middle-aged men over the last 20 years while women’s rates and risk factors have increased, according to a study published Monday. The research suggests that risk factors for heart disease, such as high blood pressure and high cholesterol, are not assessed or treated as aggressively in women as they are in men.

The study, published in the Archives of Internal Medicine, examined data from national surveys taken from 1988 to 1994 and a second time period, from 1999 to 2004. More than 4,000 men and women age 35 to 54, completed the surveys. Researchers looked at how often men and women had heart attacks and compared their scores on a tool that measures the risk of having a cardiovascular event over 10 years. The measurement, called the Framingham coronary risk score, takes into account age, cholesterol levels, blood pressure and smoking history.

In both time periods, men had more heart attacks than women. But the rates in men improved from 2.5% in the first time frame to 2.2% in the second time frame while women’s rates increased from 0.7% to 1%.

Men’s cardiovascular risk factors improved or remained stable over the two study periods while the only risk factor that improved among women was high-density lipoprotein levels. Diabetes prevalence increased among men and women, most likely due to the obesity epidemic, the authors said.

Traditionally, women have been thought to be largely protected from heart attacks and stroke before menopause due to hormonal influences, said the lead author of the study, Dr. Amytis Towfighi, an assistant professor of neurology at USC. But heart attacks and strokes are increasing in middle-aged women.

“People didn’t think that women in that age group were at high risk for heart disease and stroke,” she said. “But I suspect that with growing rates of obesity, women aren’t as protected as much as they have been in the past.”

The news isn’t all bleak for women, however. A second study in the same journal found that in-hospital survival rates after a heart attack have improved more for women than men.

-- Shari Roan

Photo: A woman undergoes an ultrasound test to look for atherosclerosis. Credit: Karen Tapia  /  Los Angeles Times

Investigational drug may promote weight loss

A medication that is under review by the Food and Drug Administration for the treatment of Type 2 diabetes may also promote weight loss, according to a study published online today in the Lancet. The drug, liraglutide, was approved earlier this year in Europe for the treatment of diabetes. It is marketed under the brand name Victoza.

Liraglutide is an injected drug that stimulates the release of insulin when glucose levels become too high. It also helps curb appetite. In the new study, researchers in Denmark assigned 564 obese individuals to one of four liraglutide doses, a placebo or the weight-loss drug orlistat. All the participants followed a diet of about 500 less calories than they normally consumed. They also increased their physical activity levels.

After 20 weeks, those on liraglutide lost more weight than those on the placebo. Participants on the highest dose of liraglutide lost 15 pounds compared with 6 pounds on the placebo and 9 pounds on orlistat. Three-quarters of the subjects on the two highest doses of liraglutide lost 5% or more of their body weight. The medication also reduced blood pressure and symptoms of pre-diabetes.

Side effects were nausea and vomiting but no serious adverse events were reported. Patients did not seem to mind injecting the drug, the authors noted. However, longer studies are needed on the drug, said in an accompanying editorial by Dr. George A. Bray of the Pennington Biomedical Research Center at Louisiana State University.

"Whether long-term use of an injectable drug is palatable as a treatment for obesity is yet to be established," he said.

The FDA has also raised questions about whether the medication can cause thyroid tumors, said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York.

"As a weight loss drug, liraglutide faces many hurdles," Roslin said in a statement. But, "drugs that can control diabetes, without causing weight gain, have huge potential. Furthermore, this group of patients is used to injections of insulin and Byetta. For a primary obesity drug to require injections would require blockbuster data."

- Shari Roan 

Photo credit: Tim Sloan  /  AFP  /  Getty Images.

Looking for health advice? Dr. Coca-Cola will see you now

When the American Academy of Family Physicians announced it had received a substantial grant to enhance educational information about nutrition on its FamilyDoctor.org site, you’d think health experts would have been happy.

But the money was earmarked to focus on the role of beverages and sweeteners in a healthy diet. And it came from the world’s largest beverage maker, the Coca-Cola Co.

No, “happy” isn’t exactly the word to describe the way some health experts feel about this deal. “Distressed” and “disappointed” are more like it, according to a sharply worded letter sent Wednesday to Dr. Douglas E. Henley, the academy’s chief executive.

“We urge the AAFP to regain its credibility by rejecting the deal with Coca-Cola,” the letter stated. “If the AAFP declines to do that, we urge your organization to reassert its support for the public health (and its own independence) by supporting a warning label on caloric sugar-sweetened beverages and a federal tax on soft drinks to support health promotion or health insurance programs.”

The letter was signed by 22 doctors, nutritionists and health advocates, including obesity experts Dr. George Bray of Louisiana State University’s Pennington Biomedical Research Center, Dr. Matthew Gillman of Harvard Medical School, and Barry Popkin, director of the University of North Carolina's Interdisciplinary Obesity Center. It asks Henley to respond to Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest, a leading proponent of a soda tax.

The letter noted that soda is “the only food or beverage that has been demonstrated to promote overweight and obesity.” (Click here for an L.A. Times story on the scientific studies that support this claim.) But the signatories warned that the six-figure grant from Coca-Cola will prevent the doctors group from “criticizing sugar-sweetened beverages in the strongest language.”

In its own statement, Jacobson's group noted that Coca-Cola – which sells 1.6 billion servings of beverages each day – has a track record of partnering with health groups:

“In 2003, the American Academy of Pediatric Dentists took a $1 million payment from Coca-Cola. Before the payment, the dentists' group acknowledged the connection between sugary drinks and dental disease. But after the payment, the president of the AAPD told reporters that the ‘scientific evidence is certainly not clear’ on the role soft drinks play.”

American Family Physician, the academy's journal, published an article last year recommending that children and teens “consume no more than one serving of sweetened beverages (e.g., fruit juice, fruit drink, regular-calorie soft drink, sports drink, energy drink, sweetened or flavored milk, sweetened iced tea) per day.”

But today, FamilyDoctor.org advises parents of overweight children only to cut down on fast food and dessert. It makes no mention of soda or other sweetened drinks.

Henley told Food Navigator-USA.com that the academy was aware of the letter. But he stood by the partnership with Coke.

“We will move forward with this commitment together by providing educational materials on sweeteners and how to maintain a healthy, active lifestyle while still enjoying many of the foods and beverages consumers love,” he said in a statement.

Celeste Bottorff, Coca-Cola North America’s vice president of living well (yes, that’s actual her title), told FoodNavigatorUSA.com that the company has a long history of philanthropy that includes “many health organizations.”

-- Karen Kaplan

Photo: Would you trust health advice from the makers of this drink? Credit: Amy Sancetta / Associated Press

Extra pounds, and attitudes about them, can affect doctor-patient relationships

Doctors can be fairly significant, one would think, in helping people combat obesity-related health problems. But a good working relationship usually begins with respect. And that might be a stumbling block.

In a new study, researchers at Johns Hopkins University School of Medicine report on their questioning of  238 patients -- and their physicians -- from 14 medical offices about their encounters. The patients for whom doctors said they had little respect just happened to have higher body-mass index scores. 

Here's the news release. The study is to appear in the November issue of the Journal of General Internal Medicine.

And here's a recent L.A. Times column from Dr. Valerie Ulene suggesting that doctors might be at least partly to blame for those weight problems: What the doc doesn't say: You're overweight

Plus, an article exploring the effect of a physician's excess weight on patients: Does a doctor's weight matter?

Apparently, attitudes about weight can affect both sides of the doctor-patient relationship.

-- Tami Dennis

Photo: Daniel Acker / Bloomberg