Author: Jeannie Collins Beaudin

A look at Canada’s new Low Risk Alcohol Guidelines…

So, have you been reading about the new Canadian Low Risk Drinking Guidelines too? The Canadian Centre on Substance Use and Addiction (CCSA) is telling us that any more than 2 drinks a week increases our risk of various diseases, with an emphasis on cancer – the disease many of us fear most – and that risk “increases radically” for each drink that is added beyond 7 drinks a week. This is quite a change from the previous guidelines that determined 1 to 2 drinks a day were low risk and up to 3 per occasion was considered moderate consumption, similar to guidelines in many other countries.

I must admit, having been bombarded with articles in the medical news since last November, I’ve felt guilty any time I’ve enjoyed a glass of red with a meal. But, something didn’t quite sit right. I’ve learned that the cause of cancer is known to be “multifactorial” — in other words, it’s generally accepted that it is a combination of factors that add up to cause cancer in most cases, and some of these causes are likely still unidentified, so why such strict limits? Shouldn’t we be looking at the overall picture more with a multifactorial disease?

For me, since I enjoy both the taste and the social side of moderate alcohol consumption, it’s important to separate and balance the cancer risk from alcohol from risk caused by other factors. And it would be useful to know how great a difference in risk there is between following the new Canadian guidelines and sticking with the old ones that are still followed in most other countries.

Once in a while researchers do identify one important cancer risk factor, as with lung cancer, where smoking stood out as a significant cause. But what about cancer in non-smokers? New research has identified that inhaling small particles (known as PM2.5, indicating Particulate Matter smaller than 2.5 microns in size) regardless of particle origin may be a major culprit. Cigarette smoke contains many chemicals, several of which are associated with cancer risk, but it also contains tiny the particulate matter that’s been identified as cancer-causing in non-smokers from various sources like dust and car exhoust, and other forms of smoke like cooking fires.. With cancer, it’s not simple… the cause(s) are too often not obvious, perhaps because it may require a poor immune response along with the cancer-causing agent to result in the disease. We’ve all heard of that person who smoked heavily until their death from natural causes at an elderly age!

So, having a risk factor for a particular type of cancer, like having inherited the breast cancer gene, doesn’t necessarily mean you will get the cancer. New research is examining how epigenetics, that control which genes are used (or “expressed”) are important in determining whether a person will get cancer or not.

Diet (avoiding processed foods), lifestyle (getting enough exercise, maintaining a healthy weight, and others), environmental exposures (avoiding pollution, toxins, and hormonally-active substances in the environment) and more are among the known causes of various cancers.

For breast cancer, just being a woman and being older are the two greatest risk factors, accounting for 70% of cases, according to one breast cancer information website. Genetics (inheriting a breast cancer gene) accounts for only 10% of cancers. Studies (not included in the references used to create the new Canadian guidelines) have found that the increased risk from moderate alcohol consumption of 4 to 6% translate into a small increase in actual risk numbers, and much less than the increased risk caused by poor diet or being overweight (see Harvard Health reference below).

As for cancer risks for alcohol, it’s well-known that heavy alcohol use is a major factor in the development of liver cancer. But the statistics within the report itself suggest that it’s a major risk factor in many diseases, including cardiovascular disease, although their chart indicates that up to 7 drinks per week actually lowers this risk (not mentioned in the recommendations). Among the criticisms of Canada’s new guidelines is that they use scary statistics for diseases like tuberculosis, citing a doubling of the risk of this disease without mentioning that it’s extremely rare. Doubling a risk of 2 cases per million people to 4 per million is a 100% risk increase, but the risk is still extremely low. The new guidelines have been criticized for manipulating statistics to make them appear more frightening.

One thing to be aware of, in any study (and I’ve seen this technique used all too often in drug studies sponsored by pharmaceutical companies), is to use “relative” numbers or ratios rather than “absolute” ones. Absolute numbers tell you exactly how much a measurement has changed, while relative ratios calculate the percentage of the change without telling you how big that number really is. This can make a very small actual number appear to be much more significant. In the esophageal cancer example in the last paragraph, the relative difference was 100% (sounds really scary), while the actual “absolute” number was only 2 per million or 0.0002% absolute risk increase (much less impressive, right?)

So, as soon as you realize these techniques are being used, you start to wonder what biases the writers of the report are hiding. Dan Malleck, a professor and specialist in alcohol regulation at Brock University in Ontario, points out this and other flaws in Canada’s new guidelines.

One he mentions is that, although they claim to have consulted 6000 studies on the harms of alcohol, they set up vague “exclusion parameters” that eliminated all but 16 studies, leaving a very narrow range of information on which they based their guidelines (and hiding the fact that they only used a few studies for their guidelines). Their document was also not peer reviewed… in other words they didn’t bother having other experts review their work before publishing (although apparently they did post it somewhere on the internet as a form of “consultation”).

Dan Malleck also points out that much of the language of the report is “inflammatory”, designed to create fear in readers, and that well-known benefits of alcohol were ignored, including only harms caused by alcohol (including violence and increased risk of accidents caused by alcohol intoxication from heavy drinking). Drinking to intoxication is one thing (known to be harmful on so many levels), while enjoying a pre-dinner cocktail or a nice glass of wine with a meal is another, in my opinion. It seems that all the harms were thrown into the pot when creating these guidelines, while the possibility of improved mental health, relaxation and beneficial socializing associated with alcohol use was left out of the calculation… not to mention the reduced risk of cardiovascular disease well-documented since many years ago in the Interheart Study and others from eating fruits and vegetables, exercising and consuming 3 or more alcoholic drinks per week.

So, I think the bottom line of “everything in moderation” is still the best advice. Each person should evaluate their personal level of risk versus potential benefit considering a wide range of health strategies (diet and lifestyle, as well as alcohol intake) and take action accordingly. Unless you are concerned about a single disease for some reason, I believe it’s best to focus on an overall healthy lifestyle that you can enjoy, and consider mental as well as physical health (both are important!)

It’s unfortunate that the new Canadian Low Risk Alcohol Guidelines document is not more open, balanced and inclusive, accounting for benefits as well as risks of alcohol and explaining the risks in a clear unbiased manner. Instead, it appears to advocate for abstinence (despite stating otherwise!), suggesting any alcohol consumption is risky with no possible benefits. They even went beyond their mandate of creating a guideline document and included advice for government to add health warning labels to all alcohol bottles based on their document.

PS: Image above is of drinks called “Sex on the Beach” and “White Russian”, taken by the author in España! (we had some laughs about those silly drink names, and especially that we’d ordered them together!)

PPS: It seems we’re much better about controlling our drinking than we used to be… Here’s an interesting history of alcohol use in the Canadian Maritime Provinces (where I live!) if you’re interested: https://backyardhistory.ca/f/drinking-in-the-maritimes?blogcategory=Moncton

References:

Canada’s Guidance on Alcohol and Health – Canadian Centre on Substance Use and Addiction (CCSA)

UK Low Risk Drinking Guidelines — Drinkaware

Study suggests scant increase in breast cancer risk from alcohol intake — Harvard Health

Alcohol Guidelines Misleading – Dan Malleck (specialist in alcohol regulation), The Hamilton Spectator

What are the main causes of breast cancer? — KnowBreastCancer.org

Is it safe to have an alcoholic drink before dinner? — Dr. W. Gifford-Jones, The Kelowna Daily Courier

LinkedIn post, Dan Malleck

Interheart Study– Medscape

Inhalable Particulate Matter and Health (PM2.5 and PM10) — California Air Resources Board

“The mind is like a parachute—it only works if it’s open”. Anthony J. D’Angelo.

I’m what you’d call a “lifelong learner”. But, you know, recently I almost feel like it might be time to stop reading health research—I’ve been finding so many articles and books that question beliefs I’ve held throughout my pharmacist career! But I always try to keep an open mind and it’s led me down some interesting rabbit-holes of research. One thing we need to remember about science is that it constantly advances. Accepted practices (like using leeches as a treatment in the days of Hippocrates and Galen) eventually are found to be not so great and are replaced with something better. I’m beginning to suspect people of the future may look back on some of our current practices and wonder why we weren’t smart enough to figure out where we went wrong…

One topic I’ve been reading about questions the effectiveness of antidepressants, that I recently wrote about HERE earlier this month.

A second topic is the idea (first proposed by Nobel Prize-winning researcher Otto Warburg in the 1920s) that cancer is a disease caused by altered metabolism, rather than randomly damaged genes. In this theory, the energy factories of the cell (mitochondria) become damaged by chemicals, oxygen radicals, etc. and over-produce energy, leading to production of oxygen radicals that damage genes and a cell that constantly divides… what we know as cancer. I wrote about research into this alternate theory of the cause of cancer HERE in February 2021.

Another series of articles currently in the medical press is questioning the “lipid hypothesis” –the entire idea that fat is bad and increases the risk of heart disease. Open your mind and read on…

My current reading

I remember the first time I saw an article offering evidence that fat and cholesterol in our diet did not cause heart disease. I was sitting on a sunny balcony in Spain, six years ago, newly retired with time to finally catch up on reading pharmacy/medical articles. As I recall, I was reading the Medical Letter, a highly reputable summary of journal articles and research. My jaw dropped when I read that the risk of heart disease does not correspond with levels of LDL-Cholesterol in the blood for many people. For decades, lowering this number has been the goal of therapy using cholesterol drugs for almost everyone.

I read about entire populations who have extremely high blood cholesterol but zero risk of cardiovascular disease (the Masai in Africa, for example), and many people with low blood cholesterol who wind up in Emerg anyway with a heart attack. I saw critiques of the original cholesterol research that included only 7 countries that lined up with the proposed theory, while there were data available for over 20.

Although Statin cholesterol-lowering drugs are likely helpful for a segment of the population with inherited cholesterol problems (familial hypercholesterolemia), for most people these drugs quite likely are doing something else to show a reduction in heart disease in studies, as LDL-Cholesterol does not correlate with heart disease risk when the results of many studies are analyzed together in a “meta-analysis”.

As I dug further into the research, I realized there are plenty of studies that question the lipid hypothesis. Note that the definition of “hypothesis” is “an assumption, an idea that is proposed for the sake of argument so that it can be tested to see if it might be true.” Using the scientific method, any evidence that the hypothesis is not correct requires a re-evaluation of the assumption. For some strange reason (could it be the billions that these drugs generate??) this has not happened with cholesterol-lowering drugs. This is in spite of the observation of many “paradoxes” that supporters of the theory cannot explain (for example, the “French paradox”, with their diet high in saturated fats but a low rate of heart disease). Studies using newer methods of analyzing blood are also suggesting that LDL is less important to heart disease risk than HDL, triglycerides and a particular type of high-density LDL particles that couldn’t be measured before.

It turns out that statins also have anti-inflammatory, anti-clotting, and antioxidant activity, all of which help to prevent heart disease. As some doctors argue, if the drugs are working, what difference does it make what the mechanism is? But using the proper scientific method would require that an alternative hypothesis be tested: that one or more of these actions explain the success of drugs that also lower cholesterol, while drugs that only lower cholesterol (like fibrates and ezetimibe) don’t appear to actually save lives. Perhaps there are drugs with fewer side effects that could accomplish the same results.

I was unable to find any studies into this hypothesis, although I did see calls for further study into the issue. However, I have read that the drug, colchicine (used for many years to reduce inflammation caused by gout) is being tested for preventing the inflammation that many researchers now believe is at the root of heart disease risk. The results should help to clarify the issue.

Down another rabbit-hole

So, all of this has led me to another related topic… What causes chronic inflammation in the body? One alternative hypothesis being studied proposes that elevated insulin in the blood causes inflammation that is at the root of many chronic diseases, including cardiovascular disease. Diabetes and heart disease are known to occur together and diabetes is believed to be a risk factor for heart disease. But what if the process of diabetes, where more insulin is needed to handle blood sugar even before blood sugar increases (a condition known as “insulin resistance”), is actually the root cause of heart disease? Or, paddling further upstream, what if the excess refined sugar in our diet which stimulates increased insulin secretion is the real culprit?

The occurrence of heart disease started increasing dramatically back in the 60s when convenience foods were introduced to the market in North America. These highly-processed foods contained trans fats, now known to increase cardiovascular disease risk, along with increased salt, sugar, preservatives, colouring agents and more.

Governments and health organization were looking for strategies to reverse the dramatic increase in heart disease and, noting that the plaque that clogs arteries in heart disease patients contains fats and cholesterol, presumed that increased amounts of these substances in the typical North American diet must collect directly in the arteries when levels are elevated in the blood. The “answer” was to cut fat from the diet as much as possible and lower the amount of fats circulating in the blood.

However, reducing the fat content of food meant it lost much of its flavour. Adding extra sugar restored taste to products so, as food processors cut fat from products, the carbohydrate content steadily rose. Even “food pyramids” promoted by government organizations as the basis for a healthy diet, put strong emphasis on carbohydrate foods without initially distinguishing between processed and unprocessed forms, while recommending the avoidance of fats as much as possible.

Eventually, scientists realized we need fat in our diet, and added recommendations to consume what they called “healthy fats”—omega-3 oils found in fish, some seeds, and nuts. They continued to recommend substituting saturated fats with unsaturated fats from plant sources, mostly seeds. Unfortunately, many of these oils contain mostly omega-6 fats that promote inflammation (as opposed to omega-3s that reduce it), skewing the balance between these two. Newer research suggests that these huge diet changes, increased sugar and a shift in the types of fat, have contributed to the continuing rise of heart disease risk as well as obesity in North America. Eventually more emphasis has been placed on eating whole, non-processed foods.

New research

But what about the “evil” saturated fats? A new study on butter demonstrated that consuming it increases our HDL-Cholesterol, known as the “good cholesterol” that reduces risk of heart disease while also increasing LDL. Now, that was a surprise!

With newer cholesterol tests, researchers were able to see that a lack of “good” HDL-Cholesterol correlates much more strongly with cardiovascular disease risk than high “bad” LDL-Cholesterol does. Triglycerides seem to be more important than LDL too. And the ratio of triglycerides to HDL says a lot about your risk. Having a ratio of 2 (or not more than twice the amount of triglycerides as HDL), correlates with a reduced risk of heart attack. You can calculate this yourself from a routine blood lipid test if your doctor gives you a copy. Currently, emphasis is placed on having a ratio of total cholesterol to HDL of 4 or less (meaning that at least ¼ of blood cholesterol is in the HDL form), stressing the importance of having plenty of HDL.

And, guess what? Refined sugar in the diet raises triglycerides. There we go… sugar as the culprit again (not fat). Cutting sugar from the diet (i.e., eating a lower-carb diet) may turn out to be the most important action we could take to reduce the risk of heart attack and stroke. Research continues…

As for fat? Healthy fats just may include reasonable amounts of butter, cream, and tasty cuts of meat with the fat left on. It seems that we ran with a hypothesis that was never proven, while questioning scientists were hushed and reportedly lost funding grants if they voiced objections too loudly. The great diet experiment with low fat and high carbohydrates hasn’t worked to reduce heart disease, obesity or cancer. It’s time to pay attention to new research that questions old assumptions made decades ago that have not changed the course of heart disease (or cancer).

Reconsider your food choices

There’s a problem with the amount of sugar in the typical North American diet, much of which is hidden in processed foods. As well as contributing to cardiovascular disease risk, excess carbohydrate, particularly in the form of highly refined white sugar and white flour, where fiber and other nutrients have been removed, may contribute to increased risk of many chronic diseases.

But, don’t just take my word for it. Look up the references below, if you’d like to read the science. Join me down the rabbit-hole…

References:

Is there more to a healthy diet than cholesterol?—Nature

Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study—Diabetology and Metabolic Syndrome

The PURE Study Implications—European Heart Journal (2018)

The Great Cholesterol Myth, Revised and Expanded: Why Lowering Your Cholesterol Won’t Prevent Heart Disease (2022)—Jonny Bowden, PhD and Stephen Sinatra, MD

The Great Cholesterol Con—Malcolm Kendrick

The Cholesterol Myths (2000)—Uffe Ravnskov

This week, many are mourning the loss of Olivia Newton-John, talented actress and singer. But you may not know that she also worked tirelessly to bring awareness to breast and other cancers, publicly sharing her own breast cancer journey since her diagnosis in 1992 at age 44.

During her 30 years as a breast cancer survivor, she also promoted research into causes, treatment and cures of these diseases, setting up and funding a cancer research center in her home country, Australia. As well, she was a proponent of natural medicines that could be added to standard cancer treatment, including medical marijuana and other herbals medicines, and encouraged adoption of these into regular treatment programs.

She was the star of another film you may not have heard about…

There’s a good chance you’ve seen her box office hit films, Grease and Xanadu. But you may not be aware of her appearance (as host) in the 1997 documentary film, Exposure: Environmental Links to Breast Cancer, where she talks about her cancer journey and research into environmental causes of cancer. I was shocked at some of the facts I learned when I first saw the documentary and, sadly, many people have still not heard this information, even though the film was made 25 years ago. The connections to cancer they discuss are still relevant, and I’d encourage you to watch it… the full 50-minute documentary is available (for free) here (also posted in the references/links below).

I also wrote a blog on this subject in Sept, 2021: Environmental Links to Cancer. You can find it here. It includes some of the information I learned from Olivia Newton-John’s documentary, if you’re interested in reading it.

So, only a short blog this week… I think I just wanted to pass along Olivia Newton-John’s message: to learn all you can about preventing cancer, and that many risk factors are under your control. We just need to learn what they are, and work to make the needed changes in our environment and lifestyle.

Let’s celebrate the life of Olivia Newton-John by continuing the work she started to reduce our risk of developing cancer! Please pass these links along to others who might benefit from cancer prevention information…

References and links:

• Olivia Newton-John’s cancer-research legacy – BBC News
• Environmental Links to Cancer – J Collins Beaudin’s Health Blog
• Documentary film: Exposure: Environmental Links to Breast Cancer – Culture Unplugged

You may not know that art (drawing, painting, sculpture) and the arts (like music, drama and dance) can be therapeutic. While I didn’t think of it as a treatment, in the past I have reached for my classical guitar, even after months of not playing, when hit with one of life’s blows, but was never sure why. I’ve always found familiar music, whether listening or playing myself, has a calming almost meditative effect… especially if I sing the words in a really loud voice!

My cousin, who is a retired occupational therapist, would tell me stories of how doing art on a large canvas could help those with shoulder injuries overcome their pain (or fear of pain) and be able to exercise their recovering joint. But, although many of us (professionals or not) have realized some of the health benefits of art, there is actually a specialty in this area.

Professional Art Therapists

Art therapists are professionals who are trained in both psychology and art. There are 3 main ways that art therapy is used:

1. Analytic art therapy—Rather than rely only on words to share ideas, the client and therapist express themselves through drawing or painting.
2. Psychotherapy—The therapist focuses on verbally analyzing art produced by the client, initiating a discussion and analysis.
3. Art as a process—The focus is on the process of creating art itself as therapy, as my cousin described using in her work. The final product itself is unimportant, and is not analyzed.

So, art can be used to help motor function, self-esteem, self-awareness, and emotional resilience. It can also be used to help a client delve into their past, reaching into the subconscious mind, and aid in resolving conflicts and reducing stress.

But it’s also a wonderful and rewarding pastime. Learning new skills can provide a sense of achievement and can be a social outlet when learning in a group. I’ve found that artists love to help others improve, sharing what they’ve learned and additional sources of helpful information.

Art as an outlet

Art certainly helped me get through the worst of the pandemic, with its lockdowns and isolation. I had already delved back into art when I retired (neglected since my high school days, while busy with work and children). My hubby suggested that the flowers I was drawing with watercolour pencils were rather boring—why didn’t I try something more interesting, like faces? At first, I said, I can’t do that!

But my sister-in-law, a retired art teacher, suggested a wonderful reference book: The Big Book of Realistic Drawing Secrets, by Carrie Stuart Parks. Amongst the many tips and techniques, they recommended measuring to get everything the right size and in the right place. I’m sure you’ve seen images of artists, with one eye closed (to flatten the subject), holding up a pencil with arm outstretched. They are taking measurements! I also ordered a few of the suggested tools online to make it easier and more fun. Author, Carrie Parks, calls these “toys”… not really necessary but lots of fun to use.

And, gradually it worked! I challenged myself to do one portrait a week in graphite (pencil) and, while the early ones barely looked like the subject, I steadily improved. Each portrait was like a little puzzle, trying to figure what was “off”, preventing the drawing from looking like the person.

After our “Escape” from Europe just as the skies were closing to international air traffic, I sewed masks and gave them away. It was something to do during the lockdowns that was fun for me and helpful to others. A few people even compensated me for my work and that kept me in materials to continue. Eventually the artist in me surfaced, and I started painting designs on them using markers or acrylics, making each a tiny but useful work of art. When some people complained that the masks covered their facial expressions, I even made some with big smiles and funny faces. I could see people’s eyes crinkle with their own smile when they saw me wearing one of those…

Now that masks are readily available commercially, even the high quality N95 ones, I’ve returned to more standard art and my portraits. I’ve challenged myself to learn to do Portraits in colour, which is much more difficult than the black-and-white graphite on white paper. In addition to determining the light and dark areas of the face, I also need to analyze the colour tones—is it a more yellowy or pinkish beige? A reddish-brown vs a golden brown? It will take me a while to learn to recognize the colours that make up the skin tones I’m seeing.

The self-portrait at the top of this article is a recent example of my attempts to learn to use colour pastels. I think it looks like me, but I still have lots to learn… (I won’t point out my mistakes!! Haha!)

Many benefits to doing art

While this certainly not true “art therapy”, I find my art has its mental health benefits: it gives me goals to strive for, it continually challenges my brain to learn something new (or find and fix the problem on the page!), and it’s a relaxing meditation. Art makes a special original personalized gift too! I give most of my art away, although my hubby hangs some of it in my sunroom/art room/art gallery.

Can anyone do art?

Yes! Art teachers will tell you that “natural talent” is not necessary. Most art techniques and talents are learned, not inherited. The author of the book I found so helpful (see References, below) teaches a 5-day course in forensic art (how to draw composites for police work) to police force members, FBI, Secret Service personnel, and others, This course is part of the basis for the book I found so useful when I first began drawing portraits and includes basic techniques to get started.

An easy way to begin doing art, though, is by trying out adult colouring books. Pictures suitable for colouring are available in art, stationery and some large department stores or online, along with simple colouring pencils or fine-tipped markers. You can also find pictures to colour that you can download and print for free. While they don’t qualify as therapy, they are a fun and relaxing form of meditation that can be a step toward more complex art as a lifelong hobby.

So, whether you want to seek a certified Art Therapist for serious therapy, use art to relax and/or challenge yourself, or simply enjoy the art of others, art certainly deserves a place in our society. Sadly, art is sometimes an early victim of cutbacks in education and treated as a frivolous “extra” in the education system. And some never continue art into adulthood, even though they enjoyed it as a child. Art is closely tied to the culture of a society. Producing and enjoying art lifts us up, makes us think, relaxes, and energizes us.

Did you enjoy art as a child? Can you remember the joy of opening a new box of crayons? All those delicious colours! Tell us about it in the comments.

Doing art as an adult can give you the same feeling… You should see the beautiful box of crayons (aka water colour pencils) I bought myself this week! 😊

References:

The big book of Realistic Drawing Secrets – Carrie Stuart Parks Available on Amazon or your local book store.

Art Therapy – Wikipedia

Psychological Benefits of Art Therapy – Canadian Counselling and Psychotherapy Association

About Art Therapy – Art Therapy Association

Paint Basket Art Classes (online) Getting Started Learn to Draw – How to Draw – Pencil Drawing Basics (Note: I’ve watched quite a few of Paint Basket’s instructional videos. This free series helps beginners get started. He also offers many advanced lessons for a small fee.)