Sunday, 30 October 2011

Avoid alcohol 3 days a week

reposted from:
crabsallover highlightskey pointscomments / links.

NHS Choices Alcohol Tracker here.

Doctors have warned, “drinkers should have three alcohol-free days a week if they want to avoid the risk of liver disease,” the Daily Mail reported. It continued that the Royal College of Physicians (RCP) said that the current guidance must be rewritten as it implies that drinking every day is fine.
The new advice from the RCP is part of a submission to MPs on the House of Commons' Science and Technology Committee about current alcohol guidelines. This submission discusses their review of the evidence from 1995 as well as more recent research evidence and alcohol intake guidelines from other countries. The RCP concluded that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It adds that the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease.
To address what it sees as a problematic lack of emphasis on the frequency of drinking, the RCP suggests that the current advice on safe limits for alcohol intake should be stated in terms of weekly alcohol intake rather than daily unit limits, and that two or three days in the week should be completely alcohol freeIt says that men should consume no more than 21 units a week and women should have no more than 14 units, provided the total amount is not drunk in one or two sessions.
The Department of Health (DH) has reportedly said that it has no plans to change its guidance at present. It recommends that men should not regularly drink more than 3-4 units of alcohol a day, while women should not regularly drink more than 2-3 units. ‘Regularly’ is defined as drinking every day or most days of the week. People are also advised to not drink alcohol for 48 hours after a heavy session to let their bodies recover.
Alcohol abuse is associated with an increased risk of liver disease, cancer and other conditions. Read our Live Well pages on alcohol to find out more.

Where is the advice from?

The advice comes from a report by the Royal College of Physicians (RCP). The RCP submitted its report to MPs on the House of Commons' Science and Technology Committee. As such, the advice given is for the government about its policy on recommended alcohol intake limits, rather than being aimed directly at the public.
The RCP believes that government advice on sensible drinking limits can play an important role in dealing with alcohol misuse. It says that it is essential government advice is based on evidence and that it is regularly reviewed. It continues that the last systematic review of the evidence by the government, to which interested parties could submit their views, was in 1995.
The RCP believes that current government guidelines on alcohol consumption could be improved to better reflect the evidence in a number of areas, such as:
  • overall levels of consumption that are ‘safe’ or within ‘sensible limits’
  • frequency of alcohol consumption
  • the physiological effects of ageing
  • the balance of the health benefits of alcohol consumption for coronary heart disease against wider alcohol-related health harm
The RCP would also like a clear, independent evaluation of the government’s strategy for communicating its guidelines and the risks of alcohol intake to the public.

What does the RCP advise?

The RCP believes that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It says this is problematic, because the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease. The RCP cites various studies to support its argument.
It also notes that someone drinking four units a day (the current upper limit for men in the UK) would be classed as a hazardous or high-risk drinker on the WHO’s gold standard tool for identifying people at risk of alcohol-related harm.
The RCP says that these potential problems with the current guidelines could be remedied by moving to a weekly limit and adding the recommendation to three alcohol-free days a week.
It recommends that in order that people keep their alcohol consumption within ‘safe limits’, men should consume no more than 21 units a week and women should have no more than 14 units. It says that most individuals are unlikely to come to harm at these levels, provided the total amount is not drunk in one or two sessions, and that there are two to three alcohol-free days a week. It says that above this limit the risk of death from all causes increases as alcohol consumption increases.
The RCP also notes that these recommendations are a best judgement based on the evidence, and were reached after a number of areas of uncertainty and inaccuracy were taken into account.
The RCP also suggests that recommended limits for safe drinking by older people in the UK require further consideration, as older people may be particularly vulnerable to harm from alcohol due to biological changes associated with ageing. It says that current guidelines are based predominantly on evidence for younger age groups and there is concern they are not appropriate for older people.

40. The current guidelines are based predominantly on evidence for younger age groups and there is concern that current guidelines are not appropriate for older people. The recent report ‘Our invisible addicts’ published by the Royal College of Psychiatrists in 2011, suggests that a ‘safe limit’ for older people is 11 units per week for men, or seven units per week for women. [16]

What evidence is this based on?

The RCP’s advice appears to be based on their review of evidence from 1995, and updated with other research evidence published since 1995.

What is current UK government advice?

Official UK government guidance recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. 'Regularly' is defined as drinking every day or most days of the week. It is also recommended that people not drink alcohol for 48 hours after a heavy session to let their bodies recover.
Pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink alcohol, they are advised to not drink more than 1-2 units of alcohol once or twice a week and not to get drunk, to minimise the risk to the baby. The National Institute for Health and Clinical Excellence (NICE), advises women to avoid alcohol in the first three months of their pregnancy in particular, because of the increased risk of miscarriage.

How do the UK guidelines compare to other countries?

The RCP notes that comparing alcohol guidelines between different countries is difficult, as there are differences in the size of standard drinks and units. It reports that a recent analysis by the Australian government found that 15 countries recommended lower limits than the UK for men, and 12 countries recommended lower limits than the UK for women. Six countries recommended higher limits than the UK for men and six countries recommended higher limits than there are for UK women.
The RCP notes that although looking at the guidelines from other countries may be of interest, it is important that UK government guidelines are a considered and expert judgement on the risks of alcohol consumption, based on the scientific and medical evidence.

Where can I get more information?

More information on the effects of alcohol is available from the NHS Choices alcohol pages.

Links to the headlines

Avoid alcohol three days a week, doctors warn. The Daily Telegraph, October 23 2011
New guide for safe drinking. The Independent, October 23 2011

Further reading

Royal College of Physicians. The evidence base for alcohol guidelines.
Department of Health Alcohol Advice

Saturday, 29 October 2011

OU MSc in Medicinal Chemistry 2011-2013

In February 2011 I started the MSc in Medicinal Chemistry. I've just taken the first year exam. That's why I've only blogged here a few times since February - a bit busy on the course!

First randomised trial specifically for aspirin in cancer

Prof. Sir John Burn
Crabsallover has followed the link between taking aspirin and reducation in Cancer since Peter Rothwell research results in 2010.

reposted from:
crabsallover highlightskey pointscomments / links.

Other studies over the past two decades have suggested Aspirin reduced cancer risk, but this was the first randomised control trial, specifically for aspirin in cancer, to prove it.

Aspirin cuts the risk of bowel cancer in people with inherited susceptibility to the disease,The Guardian has today reported. The newspaper said that a study of long-term aspirin use found it cut the risk of bowel cancer by more than 60% in these individuals.

Prof Sir John Burns (wikipedia) (won a Knighthood 2009) from Newcastle Uni (full list of John Burn publications) on the Today programme (2 min interview with Evan Davis) said 

 Burns mentioned very good research of Peter Rothwell looking at effect on aspirin on heart attack trials. Burns trial results:Out of 250 in trial group 23 cancers occurred in the placebo group but only 10 in the aspirin group.  63% fewer cancers!  In some way aspirin knocks off the cells that are going to be cancerous in a few years time. One theory is that inflammation is involved in cancer progression, aspirins inhibit prostaglandin production. John Burns personal theory is that it is driving programmed cell death (apoptosis). Plants make salicylates (cf aspirin is a salicylate derived from white willow bark) which drive programmed cell death and protects the bark from infection.

Prof Sir John Burn, from Newcastle University, said there were 30,000 adults in the UK with Lynch syndrome.
If all were given the treatment he said it would prevent 10,000 cancers over 30 years and he speculated that this could possibly prevent 1,000 deaths from the disease.
However, there would also be side effects.
"If we can prevent 10,000 cancers in return for 1,000 ulcers and 100 strokes, in most people's minds that's a good deal," he said.
"People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition."

One of the questions asked by the research into aspirin was whether healthy people with no family risks should take the drug.
The lower the risk of heart attack or cancer, the lower the benefit of taking aspirin, yet there are still potentially deadly side effects.
Sir John said that it was a "finely balanced argument" and that he decided the risks were worth it for him.
"I think where we're headed for is people that are in their 50s and 60s would look very seriously at adding a low dose aspirin to their daily routine because it's giving protection against cancer, heart attack and stroke.
"But if they do that they've got to have their eyes wide open. They will increase their risk of ulcers and gastrointestinal bleeds and very rarely they will have a stroke caused by the aspirin."

View John Burns interviewed by Dominic Hughes, BBC

Fergus Walsh, BBC Health Correspondent,  reports having taken aspirin daily for 11 months since the Peter Rothwell trial results.

Those on the John Burn trial took 600mg aspirin daily which is a much bigger dose than the 75 mg that many middle-aged people like me take to reduce their risk of cardiovascular disease. I wrote last year: "If I get an intestinal bleed in a few months time and am taken to hospital needing a blood transfusion, then it will be easy to argue that I got it wrong."
Well, so far so good.
John Burn also looked at other cancers eg womb and found a 50% reduction (Telegraph interview)

John Burn explains his trials and the biochemistry (8min 20s) of Aspirin mechanism to prevent cancers. It might be making faulty cells fall on their sword.

100,000 years ago we used to forage on plants that used salicylates to defend themselves. Now our diet is free of salicyates. Above paper in picture is

J. Burn, P. D. Chapman, D. T. Bishop and J. Mathers (1998). Diet and cancer prevention: the Concerted Action Polyp Prevention (CAPP) Studies. Proceedings of the Nutrition Society, 57 , pp 183-186 doi:10.1079/PNS19980030 (full pdf) 

Another 10 min video on mechanism of action of aspirin (technical)

another presentation by John Burn - trial results and biochem (5min 50s) "as in plants, salicylates initiate apoptosis (programmed cell death) among genetically abnormal stem cells that have yet to become cancer."

By: Johnson, A. S.; Arthur, H. M.; Burn, J.; Wilson, R. G.. Gut, Apr2004 Supplement 3, Vol. 53, pA21-A21, 
Conclusion: Both aspirin and celecoxib caused dose dependent reduction in cell viability, proliferation, and angiogenesis. Celecoxib produced these effects at levels in excess of normal serum levels when it is no longer COX-2 selective. Aspirin induces apoptosis via a COX-2 independent mechanism which may facilitate angiogenesis arrest and play a critical role in limiting tumour growth.

The Lancet Podcast of the 28th October 2011 press conference (20mins) - John Burn & Tim Bishop

taking 600mg / day aspirin gives 60% prevention of cancer - 75mg gives 25% prevention (13 mins) .. but a low dose will avoid a lot of ulcers.. (14 mins).. CaPP3 trials will give clue to best dose 75mg / 300mg / 600mg per day to offset cancer. CaPP3 website now launched!
 Press Release embargo 28th October 2011

The Lancet comments (subscription required)
'The long-term results of CAPP2 are also invaluable for the continued assessment of aspirin for prevention of sporadic colorectal cancer, which is not currently recommended mainly because of concerns about toxic effects and continuing uncertainty about dose and duration.10 With aspirin's well established vascular benefits and recent evidence of benefit for colorectal and other cancers in pooled cardiovascular randomised trials,11 Burn and colleagues' findings might at last tip the scales in favour of aspirin as the chemopreventive agent of choice for many individuals.

Does this long-term follow-up analysis allow a definitive conclusion, say for standard regulatory approval, about aspirin's ability to prevent colorectal cancer? In isolation, no, since the results of the primary analysis were not significant for the ITT (Intention-To-Treat) population. The data strongly support routine use of aspirin, however, for patients with Lynch syndrome as an adjunct to intensive cancer surveillance. As the first randomised trial of aspirin with colorectal cancer as the primary endpoint, CAPP2 also certainly moves us closer to a more definitive answer on aspirin's overall role in the prevention of colorectal cancer. Unfortunately, prohibitive logistics make a randomised trial of aspirin prevention with a colorectal cancer endpoint in a sporadic-risk population unlikely. Therefore, these results from CAPP2 and previous evidence arguably support more general recommendations to consider aspirin for prevention of colorectal cancer in the context of individualised risk-benefit assessments.

Cancer Research UK comment 'People with Lynch syndrome are about 10 times more likely that the general population to develop cancer, particularly of the bowel and womb, and often at a young age.'