Consumption of spicy foods and total and cause specific mortality: population based cohort study
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3942 (Published 04 August 2015) Cite this as: BMJ 2015;351:h3942All rapid responses
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Re: Consumption of spicy foods and total and cause specific mortality: population based cohort study
Dear Editor:
I read with interest the provocative article published recently in BMJ(1)
I wish to offer the following comments:
1. The relationship between the consumption of spicy food and reduction in total and cause specific mortality could be "reverse causation". The healthier people enjoy spices more than than less healthy/sick people.
2.In Indian culture, more than 200 years ago, the spices and condiments were popularly called as herbal remedies (later on renamed as spices and condiments), and were/are used regularly during cooking. Apart from the taste and flavor they impart to food, because of their disease-preventing and health-promoting effects they were exported to and were used in many parts of the world. Many
natural spices and condiments have beneficial effects, like ginger has antiplatelet effects, turmeric has antiseptic properties etc.
It is highly likely that findings of the study (1) are true and the message has tremendous potential for community health and to dispel the misconceptions about natural spices and natural condiments. It is worth noting , these days spices and condiments are highly susceptible for adulteration (particularly in the less-advantaged countries) and of course, the excess of everything is bad.
References:
1.BMJ 2015;351:h 3942
2.http://www.eatingwell.com/nutrition_health/nutrition_news_information/8_...
Competing interests: No competing interests
I am very surprised not to have got an answer from the authors of this publication http://www.bmj.com/content/351/bmj.h3942/
My rapid response underlines the proximity of a scientific misconduct because the nutritional part of the study never ever was a prospective or follow-up-study as the authors say in their abstract ["Design - Population based prospective cohort study"] and in their original article ["During a median follow-up of 7.2 years (interquartile range 1.84 years; total person years 3 500 004)..."].
The "baseline questionnaire" only was controlled by "about 5% randomly chosen surviving participants in 10 survey sites [and] were resurveyed during August and October of 2008". The analysis of the total and cause specific mortality was conducted as the authors say by the "Linkage to local health insurance databases has been achieved for about 95% of the participants in 2013".
Nutritional habits of the participants of the study were not systematically re-analysed for at least 5 up to 9 years because they "were enrolled between 2004 and 2008".
Competing interests: No competing interests
I would like to underline and remind the extremely powerful broad spectrum fungicidal and bactericidal activity, many spices proved to exhibit, even against resistant strains, such as culinary enhancer oil of oregano.
References
http://www.bmj.com/content/317/7159/609/rr/634773
http://www.bmj.com/content/337/bmj.39357.558183.94/rr/630538
Competing interests: No competing interests
Dear Editor,
Re: Consumption of spicy foods and total and cause specific mortality: population based cohort study (1)
Although there are reasons to be cautious, the recent paper by Lv et al., in the latest edition of the BMJ is interesting and is suggestive of the potential health benefits of eating hot chilli peppers. This is perhaps not entirely unsurprising given the known antioxidant properties of this food. In addition to studying mortality, it could also have been interesting to look for potentially beneficial impact on morbidity. Topical capsaicin cream 0.025-0.075% is long established for the treatment of hypersensitive skin in chronic pain and more recently, capsaicin 8% patches have proven benefit for peripheral neuropathic pain (2). Previously, capsaicin was believed to work primarily on the TRPV1 receptor and cause it to desensitise and also to deplete Substance P. However, more recent studies (3) have revealed a direct effect on the mitochondria within peripheral nerve endings. i.e. the capsaicin triggers the release of large amounts of calcium, which in turn induces mitochondrial toxicity and can, in effect, ‘prune’ back the pathological nerve ending responsible for the hypersensitivity or in other words give them a ‘haircut’ (3). Perhaps future studies in this field may consider examining the impact of hot chilli peppers on morbidity including chronic pain?
Dr Stephen Humble
Consultant in Pain Medicine and Anaesthesia
Charing Cross Hospital
Imperial College Healthcare NHS Trust
1. BMJ 2015;351:h3942
2. Martini C, Yassen A, Olofsen E, Passier P, Stoker M, Dahan A. Pharmacodynamic analysis of the analgesic effect of capsaicin 8% patch (Qutenza™) in diabetic neuropathic pain patients: detection of distinct response groups. J Pain Res. 2012;5:51-9. doi: 10.2147/JPR.S30406. Epub 2012 Mar 15.
3. Anand P, Bley K. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth. 2011 Oct;107(4):490-502. doi: 10.1093/bja/aer260. Epub 2011 Aug 17.
Competing interests: No competing interests
To Dr. Stefler,
Thank you for the thoughtful comments. We acknowledge that the lack of accurate dietary information on salt intake in this study limited ours ability to adjust for this potential confounder. In Chinese cuisine, salt is one of the most important condiments for the cooking of chilli pepper and the production of chilli sauce. However, the data regarding the correlations between salt and spicy food intakes are sparse. We would like to clarify these dietary inter-relationships in future studies.
Competing interests: No competing interests
Re: Consumption of spicy foods and total and cause specific mortality: population based cohort study
The inverse association between consumption of spicy foods and mortality, reported by Lv and colleagues, is clearly an interesting finding. However, the authors, as well as the corresponding editorial and previous rapid responses, acknowledge residual confounding as possible explanation for the results. In my opinion, one strong contender for the confounding role is salt intake. While it has strong relationship with hypertension and the consequent CVD mortality (1), it is also possible that those who eat spicy food frequently have a lower sodium intake as they might use chili or other spice instead of salt.
Because of the difficulties in measuring salt intake accurately, this dietary factor may be a potential unmeasured confounder in not just this study but many other nutritional epidemiological analyses. Regarding the high salt and spice intake in China, this population would be especially suitable to clarify these dietary inter-relationships in future studies.
References
1. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326.
Competing interests: No competing interests
Correction in response regarding references (http://www.bmj.com/content/351/bmj.h3942/rr-2
We read an interesting research article [BMJ 2015;351:h3942], not the [BMJ 2015;351:h3855] .
Reference 1 should be read as BMJ 2015;351:h3942
Other contents remain unchanged.
Competing interests: No competing interests
Thank you for the thoughtful comments. Indeed we have noted geographical variations and carefully controlled for the "center effect" due to multiple survey sites on the hazard function by stratifying on the survey site variable in the Cox model (stratified model). We have also adjusted the survey site variable in the model, and examined the association within each survey site and then pooled the results using meta-analysis. The results remained largely unchanged.
Competing interests: No competing interests
The scientific substance of the BMJ-article http://www.bmj.com/content/351/bmj.h3942/ could be summarized as follows: "Get chili resp. other hot spices or die trying" because it is not a prospective trial. It is more a modern fairy-tale combined with naive empiricism and a vague clinical correlation.
Once upon a time, between 2004 and 2008, a huge number of men and women of the People's Republic of China, participants from the China Kadoorie Biobank, were counted and asked only once whether they had had chili or other hot spices in their nutrition during the last single month. They were never asked about this afterwards.
In 2013 a group of Chinese scientists investigated the total and cause specific mortality in this population based cohort without further studying and investigating the nutritional habits of the participants.
The same results you would get when you ask from 2004 until 2008 if people have had caviar, oysters, lobsters, or saffron from the middle east in respect of using automobiles or washing machines and looking for their mortality some years later.
In the huge continent of China with its different meteorologic zones there are many regions where you cannot grow or afford Red Hot Chili Peppers. Many Chinese ethnic groups either have different nutritional habits or people are too poor to buy spices.
And this is the epidemiological truth about increased total and cause specific mortality: The poorer the people, the lower their standard of living and income, the higher is their total and cause specific morbidity and mortality.
This BMJ-publication is too spicy and indigestible.
Dr. med. Thomas G. Schaetzler (MD)
Family Medicine Unit
Public GP-medical office/Fachpraxis Allgemeinmedizin
Kleppingstr. 24 D 44135 Dortmund Germany
th.g.schaetzler@gmx.de
Competing interests: No competing interests
Competing interests: No competing interests
Re: Consumption of spicy foods and total and cause specific mortality: population based cohort study
Dear sir,
The effect shown certainly appears plausible: people eating Chili pepper die less. The mechanism is unclear but is very probably not related to systemic effects of capsaicin, which has thankfully no bioavailability: in an (unpublished) study in 6 healthy volunteers, the ingestion (oral) of up to 20 mg pure capsaicin did not result in any measurable plasma presence of capsaicin (HPLC-UV, 100 ng/ml detection threshold). Believe me, you do not want to go above. This is consistent wiith experimental studies finding a cancer preventive effect of injected but not oral capsaicin in animals. Since capsaicin is a potent neurotoxin, it is indeed a good thing that it has no systemic bioavailability. The reason for this was not explored: no intestinal resorption, complete liver first pass effect? My bet is on complete liver metabolization, since capsaicin is lipid soluble.
So the effects found may relate to interactions with the intestinal vanilloid receptors, changes in the intestinal microbiota, or other reasons, such as the antibiotic or antiseptic effect of chilli: non-ingestors of capsaicin maybe eating more toxic or contaminated foodstuffs. Since the study was done in a single region, with the same alimentation, it could well be a valid explanation. It might be interesting to compare the effect of capsaicin on survival across cultures: Would the French who use little capsaicin live shorter lives than those Chinese who use a lot? Among Chinese, do the Sichuan Chinese live longer than others? Do French from the Basque region around Espelette (a particularly delicious chili) live longer than those from Alsace or Brittany?
Competing interests: I tend to put a lot of chili pepper in food (especially Espelette chili) when I cook, and my family complains of it. I will now be able explain why it is Good to do so.