Tuesday, December 11, 2007

EtAOK: Journal Impact

So for you fans out there of my ramblings, you may have noticed I don't drink. I've actually blogged before about it. Multiple times.

Anyway, the other day I was driving to an interview somewhere and heard a radio ad that reminded me of the whole issue. They were selling a supplement that was "red wine extract pills with no alcohol." So it obviously peaked my interest as knowing what it is in red wine that isn't in vodka is obviously what gives red wine its FDA/AMA stamp of approval over, say, moonshine.

Now I call this update journal impact because I'm all too aware of what journal impact factor is and what it means. So if I were to, hypothethetically of course, cite a study published by FASEB (that's the Federation of American Societies for Experimental Biology) I already know that it doesn't carry the same weight as something in, for example, The New England Journal of Medicine.

That said, the FASEB came out just recently and talked about what exactly it is in red wine that makes the difference. Turns out it's "polyphenols". There's a decent summary you can read about it here. After being tortured through organic chemistry anything with the word "phenol" in it just sounds dangerous, but apparently there's an exception to every rule. You can now buy polyphenol supplements on eBay (not that I am in any way, shape, or form endorsing this product. I personally think most supplements are garbage even more overpriced than the proven pharmaceuticals they "replace" - all without that pesky FDA who is always trying to stamp out American ingenuity).

One thing that's helped me support the belief that alcohol is heart unhealthy is the fact that the mormon population overall has a lower rate of heart disease compared to non-mormon countparts. In the off chance you're reading this and aren't mormon and don't know anything about mormonism, mormons are pretty well known for their abstinence from, among other things, alcohol.

Well, it turns out that it's the abstinence from one of those other things that seems to play one of the biggest factors. While I know that Deseret News is also not exactly a high impact journal, the story actually was broken across the AP wire and showed up on most credible news sites today (i.e. MSNBC, CBC, The London Free Press, etc). The study showed that fasting may actually be more cardioprotective than all that other stuff. Traditionally the first Sunday of every month is "Fast Sunday" worldwide in the LDS church. On fast Sunday, those whose health permits abstain from a meal or two and are encouraged to donate the money saved from not eating those meals to the Church's Fast Offering fund, which is specifically used to to provide welfare to the poor. While the study certainl by no means proves that fasting is cardioprotective, it certainly is suggestive.

But I still think alcohol is not good for the heart.

5 comments:

Tiny Shrink said...

If I may, I've actually been wondering for a while (since the great EtAOK debates of 2007) if part of the problem is that we're recommending stuff to people based on one or two small studies. Hey, guys, drink 1-2 drinks per day to protect your heart! Oh, wait, is 2 drinks too much? is 1 drink enough? does that cause breast cancer? is it any drink, or only red wine? etc, etc. I compare this to the Women's Health Initiative that cause millions of women to be yanked off their HRT, and a successful lawsuit against the makers of Premarin (ladies alleged their breast cancer was caused by the drug). Now, we're in a gray zone about HRT: some studies have redone the data and found the risk to be even smaller, others have not found such a risk, etc. And how does one quantify the risk to an individual woman? "You'll have 0.01% increased risk of breast cancer, but a 0.002% decreased risk of colon cancer" (I made up those #'s)--how can anyone choose between these things? It's not like we have a calculator to accurately predict a person's risk of every poor outcome and then add in the risk/benefit ratio of every possible intervention.

So, while I continue to slightly disagree with you about the EtOH and the cardioprotection, I do agree that it's not really okay to go out and suggest to patients that they start drinking or increase their consumption of alcohol. And after all, how do we really know what the appropriate risk/benefit ratio is? Which patient will be cardioprotected without becoming an alcoholic, or getting oral cancer?

Tiny Shrink said...

Oh, and I have a question about the "polyphenols" from red wine thing. Are they really the ONLY thing in red wine that gives them a benefit, or is it a combination of factors? As in, we've isolated various antioxidants from different foods, but the best way to get the antioxidant effect is still to eat the food--the supplement (even assuming it's a good supplement) still isn't quite the same. Just curious!

The fasting thing is quite interesting. Do Mormons fast the whole day, or just skip 1-2 meals?

Gauderio said...

Of course the only way to know would be to do a head-to-head trial of 1 glass/day red wine vs. polyphenol supplementation, but then how would you ever possibly double blind it? Wouldn't it be pretty obvious which you are getting?

And the fasting thing traditionally is for two meals over a ~24 hour period. We're supposed to eat dinner Saturday night and then skip breakfast and lunch and resume again with dinner. Of course it must be done considering the conditions. When I was in South America, there were a few occasions that people came down with heat exhaustion from abstaining from all intake and being out in the sun all day working.

Tiny Shrink said...

That would be an interesting study indeed!

And I asked about the fasting thing because I know different religious groups fast for different amounts of time. I just wasn't sure what "you guys" do. Of course, there are people who probably shouldn't fast, and some situations when it could be harmful, but I've heard of benefits of fasting before, so it makes some sense to me. I was just wondering what length of fast and how strict the fast was in the study.

Dr.Jon said...

Then of course you have the europeans who drink like fish and have a lower incidence of heart disease. Recent too! European Heart Journal!

http://news.bbc.co.uk/2/hi/health/7177506.stm

(original = http://eurheartj.oxfordjournals.org/cgi/content/abstract/29/2/204
)