Wednesday, June 20, 2007

Left Behind

There's an interesting correlation between a couple of news stories out today.

The first is the results of three large national database studies showing that between 1971 and 2000 the death rate of men with diabetes has dropped significantly and is in line with the overall rate of decline in death rate among all Americans. The same is not true, however, of women with diabetes, whose death rate did not decline at all.

One of the researchers concluded: "The improvements seen in men suggest that the improvements in diabetes care are working on longevity as well. But the finding in women is concerning and means we may need to explore whether different approaches are needed to improve health outcomes for women with diabetes."

One answer -- one very big, systemic answer -- might be found by reading between the lines of health guidelines being given to women. Take, for example, the recent eating guidelines from the American Heart Association, which one of my favorite blogs, Junkfood Science, rips apart at the seams. Go and read author Sandy Szwarc's breakdown of the AHA recommendations.

In short, though, she points out that:

1) The AHA Guidelines state that to prevent heart disease and premature death, women should maintain or lose weight and maintain a BMI between 18.5 and 24.9 with a waist circumference of 35 inches. However, when the studies to support this recommendation are examined, there are ZERO clinical studies cited to support that women who lose weight live longer or decrease their chances of cardiac disease.

2) The AHA recommends that women consume no more than one alcoholic drink daily. However, an examination of their 54 pieces of "evidence" shows that few were actually clinical trials, and most were conducted only on men. And the AHA expert committee even noted that the results "are not applicable to women."

3) The AHA says to prevent heart disease and increase longevity, women should consume ample fruits and vegetables; eat whole-grain, high-fiber foods; consume fish at least twice a week; limit saturated fat to less than 10% of calories (7% is preferred), and limit sodium to approximately 1 teaspoon of salt a day. Trans fats should make up less than 1% of calories.

To support these recommendations, the AHA cites a whopping 94 studies. However, as Sandy of Junkfood Science discovered, 36 of the studies included no women and the AHA committee noted they were not applicable to women. Another 8 studies were not applicable because they were studies of previous cardiac patients, not prevention studies related to the guidelines. Forty-eight of the studies were observational and could not point conclusively to causal relationships between diet and disease. Only one study was a clinical intervention trial.

Sandy's conclusion: "Not one observational study was able to credibly support the AHA heart healthy eating recommendations for women to prevent heart disease or premature death. The only observational study specifically looking at Healthy Eating in accordance with our government’s dietary guidelines found no benefit. And finally, the strongest evidence — an actual clinical trial of the heart healthy diet on the primary prevention of heart disease in women, that went on for more than 8 years — found it had no effect on heart disease."

So, let's go back to the first data about how women with diabetes aren't experiencing the decline in mortality enjoyed by their male counterparts and non-diabetic Americans as a whole. Is it apples and oranges? I really don't think so. Until and unless we develop a body of clinical work specifically studying the effects of diet and disease on women, we're going to lag behind on more than just pay rates.

Okay. Off the soapbox now. Jeez. I sound like a feminazi. I'm not. Really.

No comments:

Post a Comment