Medical myths: All about heart disease

This week’s edition of Medical Myths will focus its beams on the many half-truths and misconceptions that surround heart disease. Among other topics, we cover smoking, coughing, exercising, supplements, and statins.

Globally, heart disease is the number one cause of death. It is responsible for 17.9 million deaths each year.

According to the Centers for Disease Control and Prevention (CDC), in the United States, one person dies every 36 seconds from cardiovascular disease. Heart disease accounts for 1 in 4 deaths in the U.S.

1. Young people do not need to worry about heart disease

It is true that heart disease is more likely to affect people over the age of 65, but 4–10% of heart attacks occur in people under the age of 45 years, mainly in men. In addition, it is how we live our lives as children, adolescents, and adults that lays the groundwork for heart health as we age.

For instance, eating a diet that is high in trans and saturated fats or smoking tobacco slowly increases the risk of heart disease as we age. Changes to lifestyle today build the foundation for a healthier heart in later life.

In the U.S. as a whole, heart disease mortality has slowly dropped since the 1970s , although the trend seems to be slowing. However, in some regions, rates have increased.

One study that investigated heart disease mortality in different age groups in the U.S. found that “over 50% of counties experienced increases in heart disease mortality from 2010 through 2015 among adults aged 35–64 years.”

2. People should avoid exercise if they have heart disease

This is a myth. Exercise helps strengthen the heart muscle and improve blood flow around the body.

In August 2020, the European Society of Cardiology published guidelines on exercise in patients with cardiovascular disease. Prof. Sanjay Sharma, who was involved in creating the guidelines, explains:

“The chance of exercise triggering a cardiac arrest or heart attack is extremely low.” However, he also adds a note of caution: “People who are completely inactive and those with advanced heart disease should consult their doctor before taking up sports.”

3. I take cholesterol-lowering drugs, so I can eat whatever I like

Some drugs, such as statins, reduce the level of cholesterol in the blood. However, this does not mean that a person who is taking statins can consume foods containing saturated fats with abandon.

Cholesterol is either consumed in the food that you eat or produced in the liver. Statins block an enzyme in the liver that is necessary for producing cholesterol, reducing overall blood cholesterol levels. However, this means that ingested cholesterol can still make it into the blood.

In short, statins may just be able to override the adverse effects of a poor diet, but a poor diet will increase risk of other independent risk factors for heart disease, such as obesity, hypertension, and diabetes.

4. Heart disease runs in my family, so there is nothing I can do to stop it

If close family members have experienced heart disease, it could mean that you have an increased risk. However, it is not set in stone, and there are a number of ways to reduce the risk, even for people with a genetic susceptibility.

These include eating a healthful diet, stopping smoking, managing blood pressure, and exercising regularly.

It is also worth noting that if heart disease runs in the family, it may not be a sign of genetic susceptibility. Families tend to share lifestyle factors, such as diet and exercise habits, both of which can impact the risk of heart disease.

5. Vitamins can prevent heart disease

Although most vitamins, taken at the recommended doses, are unlikely to be bad for heart health, there is no evidence that taking any vitamin supplements can reduce the risk of heart disease. And they certainly cannot replace a healthful diet and regular exercise.

For instance, a systematic review and meta-analysis looked for associations between multivitamin and mineral supplements and a number of cardiovascular outcomes, including coronary heart disease and stroke.

The analysis, published in 2018, took data from 18 existing studies, including 2,019,862 participants.

The authors concluded that multivitamin and mineral “supplementation does not improve cardiovascular outcomes in the general population.”

According to Victoria Taylor, the nutrition lead at the British Heart Foundation: “There are no shortcuts when it comes to nutrition — supplements are not a replacement for healthy food. You might be prescribed a vitamin or mineral supplement by a health professional for other reasons, but we do not recommend people take multivitamins to help prevent heart and circulatory diseases.”

6. I have smoked for years, there is no point stopping now

This is a myth. Smoking tobacco is a major cause of heart disease. As soon as a person stops smoking, the health benefits begin. The National Institute on Aging write:

“It doesn’t matter how old you are or how long you’ve been smoking, quitting smoking at any time improves your health. When you quit, you are likely to add years to your life, breathe more easily, have more energy, and save money.”

They also explain that you will lower the risk of heart attack and stroke and have better circulation.

7. Heart disease only really affects men

This is a myth, as heart disease is the leading cause of death in both men and women. In 2017 in the U.S., 24.2% of men and 21.8% of women died from heart disease.

However, when strokes, which have similar risk factors, are added in, the figures are even more similar between men and women: 28.7% of men and 28% of women died from heart disease or stroke.

It is a common misconception that only men are affected by heart disease. It is true that men tend to develop cardiovascular disease at an earlier age than women and have a greater risk of coronary heart disease. However, women have a higher risk of stroke.

One paper explains, “Although the incidence of [cardiovascular disease] in women is usually lower than in men, women have a higher mortality and worse prognosis after acute cardiovascular events.”

8. Cardiac arrest and heart attack are the same

Heart attacks and cardiac arrests are not the same thing. A heart attack is a circulation problem. It occurs when the coronary artery, which carries oxygenated blood to the muscles of the heart, becomes blocked.

A cardiac arrest is an “electrical problem,” where the heart stops pumping blood around the body effectively. Cardiac arrests are often caused by a heart attack.

During a heart attack, an individual is likely to be conscious. During a cardiac arrest, they are almost always unconscious. Both are a medical emergency.

9. Coughing during a heart attack can save your life

According to some sources, coughing vigorously during a heart attack — so-called cough CPR — can save your life.

This is an internet distortion of a paper published over 40 years ago, which showed that patients who had a cardiac arrest during arteriography in hospital and who coughed every 1–3 seconds stayed conscious for an additional 39 seconds.

There is no evidence that this technique works in the community for heart attacks that are not induced by medical procedures.

According to Christopher Allen, a senior cardiac nurse:

“The absolute priority when you think you or someone else is having a heart attack is to call [the emergency services]. This way, paramedics can assess and aid you, and you’ll get to hospital as fast as possible. There is no medical evidence to support ‘cough CPR.’”

10. People with heart disease should avoid eating all fat

A person with cardiovascular disease certainly should reduce their intake of saturated fats — which are found in foods such as butter, biscuits, bacon, and sausages — and partially hydrogenated and trans fats, which are found in foods such as baked goods, frozen pizzas, and microwave popcorn.

However, unsaturated fats can provide benefits. For instance, there is some evidence that omega-3, which is a polyunsaturated fat, might protect heart health.

The American Heart Association recommend “that all adults eat fish (particularly fatty fish) at least 2 times a week. Fish is a good source of protein and is low in saturated fat. Fish, especially oily species like mackerel, lake trout, herring, sardines, albacore tuna, and salmon, provide significant amounts of the two kinds of omega-3 fatty acids shown to be cardioprotective, eicosapentaenoic acid and docosahexaenoic acid.”

They also recommend eating plant-derived omega-3 fatty acids. These can be found in tofu and other forms of soybeans; walnuts, flaxseeds, and their oils; and canola oil.

The take-home

Heart disease is common, but it is not inevitable. There are lifestyle changes that we can all implement to reduce the risk of developing cardiovascular problems, whatever our age.

What is music therapy, and how does it work?


Music therapy involves using a person’s responses and connections to music to encourage positive changes in mood and overall well-being. Music therapy can include creating music with instruments of all types, singing, moving to music, or just listening to it.

Music has powerful effects on the mind. Different styles of music can have a significant effect on a person’s mood very quickly, and it can help them experience and process a wide range of emotions, from happiness to excitement, as well as sadness, calmness, and thoughtfulness.

Making music can also be as beneficial as listening to music, and music therapy encourages people to actively create the music they find helpful to them.

This article explains what music therapy is, how it can help improve mental health, and its effects on different mental health conditions.

What is music therapy?

Music therapy uses the powerful abilities of music to improve a person’s well-being. It is an alternative to other types of therapy, such as counseling or cognitive behavioral therapy (CBT).

Music therapists use a person’s responses and connections to music to encourage positive changes in mood and overall mental mindset. Music therapy can include listening to music or creating music with instruments of all types. It may also involve singing or moving to music.

It can help improve confidence, communication skills, independence, self-awareness and awareness of others, and concentration and attention skills.

Live musical interaction between a person and their therapist is important during music therapy.

Improvisation can also be a key part of music therapy. This involves making music up on the spot in response to a mood or a theme, such as making the sound of a storm using drums and a rainstick.

How does music therapy work?

The way that music affects the brain is very complex. All aspects of music — including pitch, tempo, and melody — are processed by different areas of the brain.

For instance, the cerebellum processes rhythm, the frontal lobes decode the emotional signals created by the music, and a small portion of the right temporal lobe helps understand pitch.

The reward center of the brain, called the nucleus accumbens, can even produce strong physical signs of pleasure, such as goosebumps, when it hears powerful music.

Music therapy can use these deep physical reactions the body has to music to help people with mental health conditions.

History and origins

Music has been a part of human life for thousands of years. Specifically, experts have found instruments dating back to over 40,000 years ago, suggesting that humans’ desire to express themselves or communicate through music is deep rooted.

The use of music for therapy and healing dates back to Ancient Greece, but its therapeutic use today began in the 20th century, after World War II had ended. The earliest reference to music therapy comes from a 1789 article called “Music physically considered.”

The 1800s saw medical research into the therapeutic nature of music grow, and by the 1940s, universities were offering music therapy programs. E. Thayer Gaston, one of three men who pioneered the use of music as a therapeutic tool, had organized and promoted the practice so that it would become an accepted type of therapy.

Now, there are many music therapy associations around the world, and music therapists work in private care, education, and social care.

Music therapy vs. other forms of therapy

Music therapy does not rely on verbal communication, so it can be better for people who struggle to communicate verbally. This could be due to a disability, a neurodegenerative condition such as dementia, an acquired brain injury, or a mental health condition.

As CBT and counseling are both talking therapies, they may not be suitable for people who find verbal communication difficult. This is where music therapy can be beneficial.

Additionally, mental health practitioners can bring music therapy directly to a person, such as if they cannot get out of bed or are unable to get to a therapist’s office. Enjoying music therapy at home can also benefit children who want to be in a familiar environment during their sessions.

This is not specific to music therapy, though, as many other types of psychotherapy can take place in the home.

The skills a person learns in music therapy can be useful in their everyday life, too. They may even take up learning an instrument as a new hobby, which they can use as a tool for improving their mental health and coping with difficult situations throughout their life.

Benefits

There are extra benefits to listening or creating music that talking therapies may not be able to offer.

For instance, learning and practicing a piece of music can improve memory skills, coordination, reading, comprehension, and math skills, and it can also give lessons in responsibility and perseverance.

People can also enjoy a great sense of achievement from creating a piece of music, which can help improve their mood and self-esteem.

Music therapy can also introduce people to many different cultures, as clients can explore any type and genre of music during therapy. Understanding the history behind a piece of music can help people connect with the music they are hearing or playing.

Although self-expression is a part of talking therapy, music therapy allows people to express themselves in a creative way, which can be a more enjoyable way of exploring difficult emotions.

Lyric analysis is another accessible way for people to explore and process difficult emotions, experiences, or memories through music.

For example, a person can find themes and meanings within lyrics and offer alternative lyrics that apply to their life and experiences, which can help them find the words that represent how they are feeling if they are finding it hard to express this themselves.

Some of the documented benefits of music therapy include:

  • improved self-esteem
  • decreased anxiety
  • increased motivation
  • successful and safe emotional release
  • increased verbalization
  • stronger connections with other people

How it helps with anxiety

Many studies suggest that music therapy can reduce feelings of anxiety, including in people with cancer, those undergoing surgery, and individuals going into intensive care units. Some studies also suggest that music can reduce blood pressure and the heartbeat, which can have a direct impact on how stressed a person feels.

There is also evidence to suggest that those undergoing music therapy experience reduced anxiety immediately after the session, which indicates that music therapy could be a convenient way to reduce symptoms quickly.

Music affects the amount of stress hormones, such as adrenaline and cortisol, that the body releases, and reducing these hormones can help relieve symptoms of anxiety.

Everything you need to know about inflammation

Inflammation is part of the body’s defense mechanism and plays a role in the healing process.

When the body detects an intruder, it launches a biological response to try to remove it.

The attacker could be a foreign body, such as a thorn, an irritant, or a pathogen. Pathogens include bacteria, viruses, and other organisms, which cause infections.

Sometimes, the body mistakenly perceives its own cells or tissues as harmful. This reaction can lead to autoimmune diseases, such as type 1 diabetes.

Experts believe inflammation may contribute to a wide range of chronic diseases. Examples of these are metabolic syndrome, which includes type 2 diabetes, heart disease, and obesity.

People with these conditions often have higher levels of inflammatory markers in their bodies.

Types and symptoms

There are two main types of inflammation: acute and chronic.

Acute inflammation

An injury or illness can involve acute, or short-term, inflammation.

There are five key signs of acute inflammation:

  • Pain: This may occur continuously or only when a person touches the affected area.
  • Redness: This happens because of an increase in the blood supply to the capillaries in the area.
  • Loss of function: There may be difficulty moving a joint, breathing, sensing smell, and so on.
  • Swelling: A condition call edema can develop if fluid builds up.
  • Heat: Increased blood flow may leave the affected area warm to the touch.

These signs are not always present. Sometimes inflammation is “silent,” without symptoms. A person may also feel tired, generally unwell, and have a fever.

Symptoms of acute inflammation last a few days. Subacute inflammation lasts 2–6 weeks.

Chronic inflammation can continue for months or years. It either has or may have links to various diseases, such as:

  • diabetes
  • cardiovascular disease (CVD)
  • arthritis and other joint diseases
  • allergies
  • chronic obstructive pulmonary disease (COPD)
  • psoriasis
  • rheumatoid arthritis

The symptoms will depend on the disease, but they may include pain and fatigue.

Measuring inflammation

When inflammation is present in the body, there will be higher levels of substances known as biomarkers.

An example of a biomarker is C-reactive protein (CRP). If a doctor wants to test for inflammation, they may assess CRP levels.

CRP levels tend to be higher in older people and those with conditions such as cancer and obesity. Even diet and exercise may make a difference.

Causes

Inflammation happens when a physical factor triggers an immune reaction. Inflammation does not necessarily mean that there is an infection, but an infection can cause inflammation.

Acute inflammation

Acute inflammation can result from:

  • exposure to a substance, such as a bee sting or dust
  • an injury
  • an infection

When the body detects damage or pathogens, the immune system triggers a number of reactions:

  • Tissues accumulate plasma proteins, leading to a buildup of fluid that results in swelling.
  • The body releases neutrophils, a type of white blood cell, or leukocyte, which move toward the affected area. Leukocytes contain molecules that can help fight pathogens.
  • Small blood vessels enlarge to enable leukocytes and plasma proteins to reach the injury site more easily.

Signs of acute inflammation can appear within hours or days, depending on the cause. In some cases, they can rapidly become severe. How they develop and how long they last will depend on the cause, which part of the body they affect, and individual factors.

Some factors and infections that can lead to acute inflammation include:

  • acute bronchitis, appendicitis and other illnesses ending in “-itis”
  • an ingrown toenail
  • a sore throat from a cold or flu
  • physical trauma or wound

Chronic inflammation

Chronic inflammation can develop if a person has:

Sensitivity: Inflammation happens when the body senses something that should not be there. Hypersensitivity to an external trigger can result in an allergy.

Exposure: Sometimes, long-term, low-level exposure to an irritant, such as an industrial chemical, can result in chronic inflammation.

Autoimmune disorders: The immune system mistakenly attacks normal healthy tissue, as in psoriasis.

Autoinflammatory diseases: A genetic factor affects the way the immune system works, as in Behçet’s disease.

Persistent acute inflammation: In some cases, a person may not fully recover from acute inflammation. Sometimes, this can lead to chronic inflammation.

Factors that may increase the risk of chronic inflammation include:

  • older age
  • obesity
  • a diet that is rich in unhealthful fats and added sugar
  • smoking
  • low sex hormones
  • stress
  • sleep problems

Long-term diseases that doctors associate with inflammation include:

  • asthma
  • chronic peptic ulcer
  • tuberculosis
  • rheumatoid arthritis
  • periodontitis
  • ulcerative colitis and Crohn’s disease
  • sinusitis
  • active hepatitis

Inflammation plays a vital role in healing, but chronic inflammation may increase the risk of various diseases, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever.

Quitting smoking may improve mental well-being

  • According to the results of a recent systematic review, quitting smoking may produce positive health effects in a matter of weeks.
  • The review found that people who quit smoking had a greater reduction in anxiety, depression, and symptoms of stress than people who did not.
  • If accurate, these findings could help motivate millions of people looking for more reasons to quit smoking or avoid stopping for fears of negative mental health or social effects.

Each year, smoking cigarettes claims the lives of more than 480,000 people in the United States and more than 8 million people around the world. And, according to the World Health Organization (WHO), smoking is the leading cause of preventable illness, impoverishment, and death worldwide.

Smoking rates have been falling substantially over the last 50 years, particularly in high income countries, with the rate of tobacco use now at 19.7% in the U.S in 2018. In contrast, this rate remains stubbornly high (36.7%) in people with mental health issues.

Some people believe smoking offers mental health benefits, such as reducing stress and anxiety. In one study, it was not just smokers who thought this but also mental health practitioners. Around 40–45% of mental health professionals assumed that smoking cessation would not be helpful to their patients.

Some also believe that mental health symptoms would worsen if they quit smoking. Many smokers worry that they will lose social relationships, either from the irritability that can occur early on during smoking cessation or because they view smoking as a central part of their social life.

According to the Centers for Disease Control and Prevention (CDC), nearly 40 million people in the U.S. continue to smoke cigarettes.

This is why a group of researchers set out to explore how smoking impacts mental health precisely. Their review appears in the Cochrane Library.

The mental benefits of quitting

“Smokers often believe that cigarettes are the crutch they need when they feel low, but there is good reason to think that smoking is actually making them feel worse,” said Dr. Gemma Taylor, the review’s lead author.

“The daily cycle of waking up with cravings, satisfying the cravings through smoking, only to be back wanting another cigarette within hours has an understandable impact on how people feel.

“But get past the withdrawal that many smokers feel when they stop, and better mental health is on the other side,” she continued. “From our evidence, we see that the link between smoking cessation and mood seem to be similar in a range of people. And most crucially, there is no evidence that people with mental health conditions will experience a worsening of their health if they stop smoking.”

If these findings are confirmed, they could offer hope to millions of people afraid to quit smoking for fears of experiencing worsened mental health symptoms.

Knowing that quitting smoking can improve mental and social well-being within weeks could also help keep individuals motivated during withdrawal.

Nicotine and dopamine

Nicotine, the primary active ingredient in tobacco cigarettes, can briefly improve mood.

When someone inhales smoke, it takes around 10–20 seconds for nicotine to reach the brain. Once there, it stimulates the release of dopamine.

Dopamine is a neurotransmitter associated with positive feelings. It tends to improve concentration and mood, relax muscles, and reduce stress. These properties give most people an almost immediate feeling of relaxation.

But the positive effects of nicotine wear off quickly.

Smoking and mental health

When someone smokes, it temporarily reduces withdrawal symptoms. This means they must keep smoking at the same rate to avoid withdrawal. This cycle of positive and negative symptoms helps drive nicotine addiction.

But smoking can not provide any long-term or meaningful positive benefits.

Scientists have identified links between mental health and smoking. For instance, one report found that people with mental health disorders smoke at two to four times the average rate of the general population.

Other studies have shown associations between depression and smoking, but the relationship between the two is likely to be complex, and scientists need to carry out more research to understand the details. Depression is a persistent risk factor for nicotine dependency across age groups.

Quitting improves mental well-being

In the recent review, researchers examined the findings of 102 studies. For inclusion in the review, each study had to last for at least 6 weeks and track whether participants quit smoking or not, plus any mental health changes. The studies either had to have a control group or be a long-term follow-up study of smokers, some of whom quit and some who did not.

In total, the review included data from more than 169,500 participants.

Most of the studies surveyed the general population, while several included people with mental health conditions. Some of the studies gathered information from participants with physical or chronic health conditions, pregnant people, or those who had recently undergone surgery.

Based on their analysis, the team concluded that, contrary to smokers and some practitioners’ fears, quitting smoking compared with not quitting did not worsen depression, anxiety, and symptoms of stress.

The review also found some evidence that quitting smoking promoted positive feelings and mental well-being. The team concluded that stopping may even have a small positive effect on social well-being.

A sub-analysis of three studies showed a pooled reduced likelihood of 24% in developing mixed anxiety and depression in the future and, based on two studies, a 44% reduced chance of developing anxiety alone. The studies on future diagnoses of depression were too dissimilar to calculate a summary result.

Limitations

It is worth noting that the team had high confidence in the overall finding that quitting tobacco does not worsen mental health symptoms.

However, they were less confident in their results regarding the mental health benefits of stopping smoking — the calculated likelihood of these findings was very low to moderate.

Their confidence in the link between quitting smoking and improvement in mental health symptoms was very low for depression and low for anxiety.

This is because the studies included in the review used different methods and ways of assessing mental health symptoms, making it harder to combine the results. The authors also note that certain studies had limitations and design flaws.

The research duration also varied drastically between studies, ranging from 6 weeks to 6 years.

More robust, uniform research is needed to understand the true relationship between mental health, mental health symptoms, and smoking.

During a pandemic may not seem like the time to quit smoking. But now may just be the right time, according to Deborah Arnott, Chief Executive of Action on Smoking and Health.

“After the year we’ve all had, some smokers might feel now is not the time to stop. The opposite is true — put smoking behind you, and a brighter future beckons. Using nicotine replacement, whether patches, gum, or vapes, can help deal with any withdrawal symptoms, which last at most a matter of weeks,” says Arnott.

“Be confident that once you’ve put smoking behind you, not only will you be healthier and wealthier, but you will feel happier too.”

The American Lung Association offer tips for cutting down and quitting smoking successfully. They say that every smoker can quit, and they will help find the technique that works for every individual smoker.

The Key to a longer life

  • Findings from a new observational study support most of the current dietary guidelines on fruits and vegetables.
  • Daily intake of 5 servings of fruits and vegetables was associated with a lower risk of death related to cancer, cardiovascular disease, or respiratory disease.
  • Starchy vegetables and fruit juices, however, did not appear to contribute to the reduction in risk.

For many decades, nutritionists have recommended a balanced diet to provide the body with the proper nutrients to stay healthy. The core components of this diet include vegetables, fruits, grains, proteins, and dairy.

A recent study by researchers at the Harvard T. H. Chan School of Public Health in Boston, MA, provides further evidence for current dietary guidelines and expands on them, finding that consuming at least 2 fruit and 3 vegetable servings on a daily basis may lower the risk of both disease-related death and death from all causes.

Current dietary guidelines

“While groups like the American Heart Association recommend 4–5 servings each of fruits and vegetables daily, consumers likely get inconsistent messages about the recommended amount and which foods to include and avoid,” says Dr. Dong D. Wang, M.D., Sc.D., an epidemiologist and nutritionist at Harvard Medical School and lead author of the study.

The Department of Health and Human Services and the Department of Agriculture published their recommendations in the form of the 2020–2025 Dietary Guidelines for Americans.

According to this set of guidelines, half of the plate for every meal should contain fruits and vegetables.

However, the guidelines also note that more than 80% of people in the United States do not meet this recommendation and should aim to increase their consumption of nutrient-dense foods.

Participant dietary information

The researchers collected self-reported dietary information from two large cohort studies: the Nurses’ Health Study (NHS) and the Health Professionals’ Follow-up Study (HPFS).

The NHS cohort included registered female nurses between the ages of 30 and 55 years, while the HPFS cohort included males aged 40–75 years with occupations in the health profession. These studies included follow-ups with the participants every 2–4 years to accumulate dietary information over a span of approximately 30 years.

The researchers excluded participants with baseline heart disease, cancer, or diabetes, leaving them with data from 66,719 females and 42,016 males.

They also incorporated data from an additional 26 studies involving a total of 1.9 million participants, which examined the relationship between fruit and vegetable intake and death rates.

The high participant numbers and continuous longitudinal assessments provided the team with an extensive collection of data for analysis.

However, it is important to note that the criteria of the two cohorts — occupation and corresponding education — suggest a similar socioeconomic status across the participants, who may have been more likely than other members of the population to have access to a healthy diet. The study does not address the realities and effects of food insecurity.

Nutritional values of fruits and vegetables lower risk of death

The study outcomes showed that an increased intake of fruits and vegetables is associated with a lower risk of death, including death due to cancer, heart disease, or respiratory disease.

Additionally, the researchers saw the lowest risk of death at a threshold of a combined 5 servings, beyond which there was no apparent benefit on risk.

These results point to the nutritional value of these foods. For example, higher consumption of fruits and vegetables increases the intake of potassium and antioxidant activity, which link to lower blood pressure and improved lung function, respectively.

As the data are fully self-reported, there may be discrepancies between the actual and reported intakes. Participants with higher intake, in particular, may have tended to overestimate how many servings they consumed.

This margin of error may blur the defined threshold of 5 servings, so the study authors acknowledge that slightly higher servings (up to 10) could also lead to lowered risk.

This study also expands beyond current guidelines by differentiating among specific groups of fruits and vegetables.

The researchers observed trends with a lowered risk of death for leafy greens and foods rich in vitamin C and beta carotene. Fruits and vegetables that fall into these categories include spinach, kale, carrots, and citrus fruits.

Conversely, they did not identify any trends for fruit juices or starchy vegetables, such as potatoes and peas. One possible reason for the latter is the prominence of canned foods. The canning process may deprive starchy vegetables of their antioxidant properties.

Compared with whole fruits, the fluid form of juices may cause a more rapid elevation of blood glucose and insulin levels, which can increase the risk of disease.

In contrast to the existing guidelines, which include canned foods and juices among the recommended foods and drinks, this study calls for further research on the effects of these items on health.

Continued support for ‘5-a-day’ serving recommendation

Rather than being an interventional study, in which researchers directly implement variables and analyze the effects, this study was observational. As a result, it is not possible to conclude that the trends present in this study indicate a causal relationship.

Regardless, there is plentiful evidence that highlights the benefits of a balanced diet containing plenty of fruits and vegetables. The present conclusions also correspond to findings from similar observational studies on the associations between fruit and vegetable intake and disease.

The findings of this study conform to the overall current dietary guidelines to eat at least 5 servings of fruits and vegetables a day. Additionally, it provides further insight into the specificities and benefits of fruit and vegetable intake.

fresh fruits and vegetables isolated on white background

ALL ABOUT SUGAR (Medical Myth)

Over the centuries, this crystalline sweetener has invaded everyone’s snacks, drinks, guts, and minds. It has caused its fair share of controversy, too.

Although everyone is familiar with sugar as a concept, we’ll start with a brief explainer.

What is sugar?

Sugar is a soluble carbohydrate — a biological molecule consisting of carbon, hydrogen, and oxygen atoms. Other carbohydrates include starch and cellulose, which is a structural component of plant cell walls.

Simple sugars, or monosaccharides, include glucose and fructose. Granulated sugar is a compound sugar, or disaccharide, known as sucrose, which consists of glucose and fructose. During digestion, the body breaks down disaccharides into monosaccharides.

Still, the chemistry of sugar does not explain its infamy. The substance gained its dastardly reputation because it tastes delicious and, if consumed too freely, is bad for our health.

1. Sugar is addictive

Some experts believe sugar is an addictive substance. For instance, the authors of a controversial narrative review in 2017 write:

“Animal data has shown significant overlap between the consumption of added sugars and drug-like effects, including bingeing, craving, tolerance, withdrawal, cross-sensitization, cross-tolerance, cross-dependence, and reward and opioid effects.”

However, this review focuses on animal studies. As the authors of another review explain, “there is a methodological challenge in translating this work because humans rarely consume sugar in isolation.”

Dr. Dominic M. Dwyer from Cardiff University’s School of Psychology explains, “Although certainly present in some people, addiction-like behaviors toward sugar and other foods are present only in a minority of obese individuals. However, we should remember that sugar can drive the overconsumption of foods alongside its addiction-like potential.”

Along similar lines, Prof. David Nutt, Chair of the Independent Scientific Committee on Drugs and head of the Department of Neuropsychopharmacology and Molecular Imaging at Imperial College London, writes:

“There is not currently scientific evidence that sugar is addictive, although we know that sugar has psychological effects, including producing pleasure, and these are almost certainly mediated via brain reward systems.”

It is worth noting that even though health experts do not class sugar as an addictive substance, that does not make it healthful.

2. Sugar makes kids hyperactive

This is perhaps the most common myth associated with sugar: eating candy causes children to run wild. In fact, there is no scientific evidence that sugar increases hyperactivity in the vast majority of children.

For instance, a 1995 meta-analysis in JAMA combined data from 23 experiments across 16 scientific papers. They concluded:

“This meta-analysis of the reported studies to date found that sugar (mainly sucrose) does not affect the behavior or cognitive performance of children.”

However, people with children may doubt the truth of this conclusion. 

3. Sugar causes diabetes

Another relatively common myth is that sugar directly causes diabetes. However, there is no direct link between the two. The confusion perhaps arises because there is an intrinsic association between blood sugar levels and diabetes.

The story is a little more complicated, though. Overweight and obesity are risk factors for type 2 diabetes, and consuming high levels of sugar does increase the likelihood of developing overweight or obesity. However, sugar is not the direct cause of type 2 diabetes.

As for type 1 diabetes, dietary and lifestyle factors do not play a part.

4. Avoid fruit when dieting

Fruits are delicious, partly because they are sweet, thanks to naturally occurring sugars. Because of their sugar content, some people believe that we should avoid eating fruit when maintaining a moderate weight.

This is a myth. Fruits contain a range of healthful compounds, including a variety of vitamins and minerals, and fiber.

Fruit consumption is associated with health benefits, including a reduced mortality rate.

One study concluded that freeze-dried mango “does not negatively impact body weight but provides a positive effect on fasting blood glucose.” Another study found that consuming blueberries enhanced insulin sensitivity.

However, it is worth noting that the two studies mentioned above received grants from the National Mango Board and the United States Highbush Blueberry Council, respectively.

Make of that what you will, but there is no doubt that consuming fruit benefits health. Removing it from our diet to reduce sugar intake would be a mistake.

5. We must eliminate sugar from our diet

Because we know consuming excess sugar is bad for health, it makes sense to reduce our intake. However, it is not necessary to remove it from our diet entirely.

As we noted above, fruits contain sugar, and they benefit health, so cutting it from our diet would be counter-productive.

As with everything in life, moderation is key. With that said, sweetened beverages, such as soda, have associations with several negative health consequences, including kidney damage, cellular aging, hip fractures, obesity, type 2 diabetes, and more.

Cutting soda from our diets would certainly  be a fantastic idea.

6. Sugar causes cancer

Despite the rumors, most experts do not believe sugar directly causes cancer or fuels its spread.

Cancer cells divide rapidly, meaning they require a great deal of energy, which sugar can provide. This, perhaps, is the root of this myth.

However, all cells need sugar, and cancer cells also require other nutrients to survive, such as amino acids and fats, so it’s not all about sugar. According to Cancer Research UK:

“There’s no evidence that following a sugar-free diet lowers the risk of getting cancer, or boosts the chances of surviving if you are diagnosed.”

As with diabetes, there is a twist — increased sugar intake has links with weight gain, while overweight and obesity are linked with increased cancer risk.

So, although sugar does not directly cause cancer and does not help it thrive, if someone consumes high levels of sugar and develops obesity, their risk increases.

Scientists are continuing to investigate the relationship between cancer and sugar intake. If there are links between the two, they are likely to be convoluted. For instance, the American Cancer Society write:

“There is evidence that a dietary pattern high in added sugars affects levels of insulin and related hormones in ways that may increase the risk of certain cancers.”

One study, which included data from 101,279 participants, concluded that “total sugar intake was associated with higher overall cancer risk,” even after controlling for multiple factors, including weight.

Other researchers have found links between sugar intake and specific cancers, such as endometrial cancer and colon cancer. However, for now, the link is not as solid as the rumor mill claims.

The take home

Sugar is a much-researched topic. Typing “sugar health” into Google Scholar brings up more than 78,000 results from 2020 alone. Navigating this amount of content is unwieldy, and, as with any scientific topic, there are disagreements.

Something to bear in mind is that many studies investigating the health impacts of sugar receive funding from the food industry. One review of research into soft drink consumption, nutrition, and health examined the results of 88 relevant studies.

They found “clear associations” between soft drink intake, body weight, and medical issues.” Tellingly, they also report that “studies funded by the food industry reported significantly smaller effects than did non-industry-funded studies.”

Although there are a number of misunderstandings surrounding sugar, some things are certain: although it might not directly cause diabetes or cancer, eating high levels of sugar is not healthful. Moderation, I am afraid, is the solution.