Recent Study Questions the Safety of Prescription Sleeping Pills

A recent study published in the British Medical Journal has found that prescription sleeping pills, such as Ambien and Restoril, are associated with increased risks for cancer and death.1 In the study, individuals who were prescribed 1 to 18 doses of insomnia drugs per year were 3.6 times more likely to die during the study period of 2.5 years than individuals who did not use these drugs. The risk of death was 4.4 times higher for individuals who were prescribed 18-132 doses and 5.3 times higher for individuals prescribed >132 doses per year. Individuals who were prescribed more than 132 doses per year were also found to have 1.4 times more risk of developing cancer.
While the study does not prove these drugs cause death or cancer, it serves as a caution on their use and highlights the need for individuals to explore other remedies for insomnia before resorting to drug therapy. For example, any underlying conditions that can contribute to insomnia, such as depression, restless leg syndrome and hyperthyroidism, should be treated first. Other non-drug based treatments should also be explored before turning to prescription sleeping pills. These include: eliminating caffeine and nicotine 4-6 hours before bedtime; avoiding alcohol as a sleep aid; avoiding exercise within 3 hours of bedtime; creating a comfortable environment with noise, light and extreme temperatures controlled; maintaining a regular time to wake up each day; getting out of bed and going to another room if unable to fall asleep or fall back to sleep within 15-20 minutes; and avoiding daytime napping. For those who have tried all other available treatments and still suffer from significant insomnia, prescription medications may still be beneficial as untreated insomnia has significant mental and physical health consequences. However, given the results of this study, we should all think twice before taking these medications.

Nate Kelly, MPH, RD, LDN

1. Kripke DF et al. Hypnotics’ association with mortality or cancer: A matched cohort study. BMJ Open 2012 Feb 27; 2:e000850.

Is consuming too much red meat a red flag?

Recent research has shown that consuming too much red meat (beef, pork, and lamb) may significantly increase the risk of early death, especially from heart disease and cancer.1 According to the results of the study, substituting one serving of red meat per day with other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) decreases the risk of early death from all causes by 7-19%. This decrease in risk may be even higher in men. Overall, the study suggests that individuals should try to limit red meat consumption to less than 4 servings per week. One serving of unprocessed red meat such as steak or pork chops is approximately equal in size to a deck of cards. For processed red meats the serving size is smaller (2 slices of bacon, 1 hotdog, 1 slice of salami/bologna).

Nate Kelly MPH, RD

1. Pan A, Sun Q, Bernstein AM; et al. Red meat consumption and mortality: results from 2 prospective cohort studies [published online March 12, 2012]. Arch Intern Med. doi:10.1001/archinternmed.2011.2287.

U.S. Preventive Services Task Force Report on Screening of Breast Cancer

The revised USPSTF recommendations — which were reviewed by the Academy’s Commission on Health of the Public and Science — call for biennial screening mammography for women ages 50-74 years and state that the decision to start regular, biennial screening mammography before the age of 50 should be an individual one that takes patient context into account, including the patient’s values regarding specific benefits and harms.

“It enables family physicians in particular to know the patient, know their history and help patients make decisions for themselves guided by a thoughtful discussion.”

The U.S. Preventive Services Task Force, or USPSTF, recently released new recommendations for the screening of breast cancer. These new recommendations have generated a large amount of criticism and concern among women, physicians, and other research groups. What exactly is so controversial about these recommendations and what do they mean for you? Let’s first take a closer look at the recommendations themselves.

Summary of Recommendations:

1. The USPSTF recommends screening mammography for women aged 50 to 74 years every other year.
2. The decision to start regular, biennial screening mammography before the age of 50 years should be an
individual one and take patient context into account, including the patient’s values regarding specific
benefits and harms.
3. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of screening mammography in women 75 years or older.
4. The USPSTF recommends against teaching breast self-examination (BSE).
5. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
6. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as
screening modalities for breast cancer.

The first two recommendations represent a significant shift from the recommendations issued in 2002 and are where most of the controversy is centered. Previously, the USPSTF recommended screening mammography, with or without clinical breast examination, every one to two years for women ages 40 and older. The new recommendations also differ from what is currently recommended by the American Cancer Society, American College of Obstetricians and Gynecologists, American College of Radiology (ACR), and the Society of Breast Imaging (SBI) who all recommend annual screening mammography starting at age 40 for most women, and even earlier in those with high risk. So, what does this mean if you are a woman in your 40s or over 75? The decision about whether mammography is right for you should be based on your family history, general health, and personal values. There are risks associated with screening mammography such as over treatment and exposing the breast to radiation, so careful consideration of what is right for you is warranted. Perhaps, the only thing that the recommendations and the controversy surrounding them make clear is that there is a need for further research in breast cancer prevention. We at Kernersville Primary Care encourage you to discuss the risks and benefits of screening mammography with your doctor and decide what measures are best for you.

Are Artificially Sweetened Beverages a Cause for Concern?

A recent article in the Journal of the American Medical Association questions the health benefits of artificially sweetened beverages, such as diet soft drinks. While a myriad of health problems from overconsuming refined sugars, such as those found in regular sodas is well documented, their calorie free diet counterparts may also pose some health problems.

The problem lies in their sweetness and its effect on the complex pathways that regulate body weight. Overconsumption of hyper-intense artificial sweeteners may cause taste preferences to revert to an infantile state and decrease tolerance of complex flavors such as those found in vegetables. Also, since diet beverages contain no calories they may cause dissociation between sweet tastes and calorie content which could disrupt the pathways regulating hunger.

In rodent studies, artificial sweeteners when compared to glucose caused diminished calorie compensation ability, increased caloric intake, and increased body weight. Rodents also preferred saccharin solutions over cocaine, highlighting the potentially addictive nature of these sweeteners. Some studies in humans have also shown relationships between diet drink consumption and obesity, metabolic syndrome, and type-2 diabetes. However, further research needs to be conducted before these relationships can be considered causal.

Although further research is need to confirm the long term health effects of artificially sweetened beverages, their potential health hazards warrant reconsidering their consumption. The authors of the JAMA article conclude that for now diet drinks may best be considered an aid to transition from high-calorie sugar sweetened beverages, such as regular soda, to minimally sweetened beverages such as water, mineral waters, teas, and coffee (with out sugar of course).

Can exercise improve your quality of life?

A recent study on the effect of exercise on quality of life, published in the Archives of Internal Medicine, found that among sedentary postmenopausal women with high blood pressure, exercise significantly improved quality of life. The study also found that the improvement was dose dependent, meaning that the more the women exercised the greater their improvement in quality of life. Furthermore, the study found that the improvement was independent of weight change. So whether or not you end up losing weight, exercising is still an effective method of improving your quality of life. The study examined eight aspects of quality of life including measures of both physical and mental health such as bodily pain, vitality, and mental health. We would all like to improve our quality of life and exercising an affordable and even enjoyable way of doing so. Current physical activity recommendations advise at least 8 kilocalories/kilogram/week of exercise. For a person weighing 155 lbs, this translates into a little less than two and half hours of walking at a moderate pace per week, or about 20 minutes a day.

Unhealthy lifestyles responsible for 9 of 10 new cases of diabetes

A recent study published in the Archives of Internal Medicine found that unhealthy lifestyles could be responsible for nine out of ten new cases of diabetes mellitus among older US adults. Specifically, the study suggested that if all men and women aged 65 or older exercised more, stopped smoking (or never started), ate a healthy diet, drank moderately, and had a body mass index of less than 25 the incidence of drug dependent diabetes in this age group would fall by 89%. The study also found that the risk of diabetes fell in a stepwise fashion with each extra healthy lifestyle factor. This study highlights the enormous importance of having a healthy lifestyle even if you are over 65. Seemingly small changes in lifestyle can have a big effect whether it’s taking a daily walk, cutting back on junk food, or losing a few pounds.

Happy 27th Birthday KPC!

Kernersville Primary Care will be celebrating it’s 33rd anniversary on July 16th,2017. Thank you, to the wonderful Kernersville Primary Care community, especially our patients, you rock!