Tuesday, January 26, 2010

American Heart Association drops the bottle on lifestyle recommendations

In a drastic lurch back to Victorian era temperance, the American Heart Association came out this month with lifestyle recommendations intended to promote “ideal cardiovascular health.” Their list of “Life’s Simple Seven” includes:
• Never smoked or quit more than one year ago;
• Body mass index less than 25 kg/m2 (I.e., not overweight)
• Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week;
• Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations;
• Total cholesterol of less than 200;
• Blood pressure below 120/80;
• Fasting blood glucose less than 100.

Not much to quibble with there it would seem, but as always the devil is in the details. Let’s look more closely at the “healthy diet” components:

• Vegetables and fruits are high in vitamins, minerals and fiber — and they’re low in calories. Eating a variety of fruits and vegetables may help you control your weight and your blood pressure.
• Unrefined whole-grain foods contain fiber that can help lower your blood cholesterol and help you feel full, which may help you manage your weight.
• Eat fish at least twice a week. Recent research shows that eating oily fish containing omega-3 fatty acids (for example, salmon, trout, and herring).

So far, so good, we have heard all that before. But as we approach the twentieth anniversary of the French Paradox, where does the AHA stand on wine?

• If you drink alcohol, drink in moderation. That means one drink per day if you’re a woman and two drinks per day if you’re a man.

That’s it? With the thousands of research paper attesting to the cardiovascular benefits of red wine consumption, nary a mention other than be careful not to drink too much? It’s not like there is a lack of data upon which to base a recommendation. According to the widely recognized expert Dr. R. Curtis Ellison, professor of Medicine and Public Health at Boston University, “ ... only stopping smoking would have a larger beneficial effect on heart disease than for a nondrinker to begin having a drink or two each day.” This recommendation is supported by the prestigious Framingham study, the bedrock of research on the lifestyle factors in cardiovascular disease. But the Framingham scientists have been studiously neglecting the data about drinking and health since the 1970’s when the role of alcohol was first evaluated. One of the scientists involved in the study, Dr. Carl Seltzer, revealed later that the senior staff at the National Institutes of Health demanded that the data be altered to remove any suggestion of a beneficial effect from alcohol, citing concerns that it would be “socially undesirable.” To this day the official Framingham website omits any reference to the alcohol studies. This is what they call science?

The thing is, most of know better and so the “updated” recommendations from the AHA lose credibility. It reinforces perceptions of the medical establishment as paternalistic. Time to start treating us like adults.

For more including detailed references check out my book Age Gets better with Wine.

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