Yes, the Nutrients Are There

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My question is whether you get any nutrients besides sugar and fat from those marshmallow-covered yams or the green beans swimming in condensed mushroom soup and topped with fried onions from a can. The research on cooking techniques and retention of vitamins, minerals, and phytonutrients in vegetables and fruits is not extensive but overall, the answer is yes. Here’s a synopsis of what I found.

Cooking and Nutrients

The vitamin that seems to be lost regardless of whether it’s boiled, microwaved, or sauteed is vitamin C. Microwaving seems to preserve the most nutrients, but close to 90% of vitamin C is lost.

For some nutrients, such as beta-carotene and other carotenoids, starting with fresh vegetables as opposed to frozen seems to help retain nutrients. The amounts of carotenoids in carrots, sweet potatoes, pumpkins, and yams seem to increase when they are cooked. The same may be true in greens such as spinach and collard greens. Adding bacon doesn’t appear to cause any issues. Using nuts and fruit to make the veggies more attractive can add nutrients as well; for added color and texture, we added slivered almonds and pomegranate seeds to the brussels sprouts with parmesan—yum!

Casseroles may provide the best cooking style when appropriate. Whatever minerals leech out of the vegetables or fruits will be retained in the liquid of the casserole.

Surprise Finding

Cooking may reduce the amount of pesticide residues in vegetables. It’s nice to know that blanching, boiling and even stir frying may decrease residues by 10–80%. The research didn’t look at the liquid used for blanching or boiling, so we don’t know whether it’s a chemical change in the structure of the pesticide or it just leaches it out. Still, it was a welcome surprise.

The Bottom Line

Traditional holiday foods do retain beneficial nutrients. They can’t offset all the fat and sugar that were added, but we’re getting some of the vitamins, minerals, and phytonutrients the foods contain. To me, the real lesson is that the way the food is prepared may help you eat more vegetables and fruit. Steamed green beans? Yecch. But covered in a sauce? Maybe that will help get more vegetables into your picky eaters. As long as we control the amount and the frequency, we can feel good about eating holiday foods all year long.

What are you prepared to do today?

        Dr. Chet

References:
1. Food Sci Biotechnol. 2017 Dec 12;27(2):333-342
2. Nutr Bull. 2022 Dec;47(4):538-562.  doi: 10.1111/nbu.12584.
3. Foods. 2022 May 18;11(10):1463. 

Nutrients in Holiday Foods

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I hope you had a great Thanksgiving. With all the traditional and maybe not-so-traditional foods associated with the holidays, did you wonder how you fared from a nutrient perspective? We had a few of those foods that make you wonder: cheesy grits, corn pudding, and cranberry chutney to go along with the turkey. And don’t forget that pumpkin pie.

Never one to leave well enough alone, I wondered how much nutrition we actually get from traditional holiday foods that typically include more fat and involve more than just lightly steaming vegetables. How much butter and cream did you add to those mashed potatoes? How long did those greens beans cook? How about those marshmallows on the yams?

Do we end up with any nutrients—especially phytonutrients—from all those vegetables and fruit? Yes, you do, and how you cook the food makes a difference; in fact, one nutrient may increase with cooking! I’ll tell you what the research says on Saturday, but one thing’s for sure: Thanksgiving beats Halloween for nutrition.

What are you prepared to do today?

        Dr. Chet

Fiber: Food or Supplements?

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We don’t seem to eat enough whole or minimally processed plant foods, so the researchers were trying to discover whether getting fiber, especially insoluble fiber, was better from plant material or whether taking fiber in supplement form would suffice.

Researchers approached the question from the perspective of other beneficial nutrients that might be found in plants that might be processed out of fiber supplements. They conducted a literature search and found that just 44 studies that examined the phytonutrient content of many plant foods and met their criteria. They focused on insoluble fiber which would be found in the skin of apples and beans, seeds and nuts, and many other components of raw foods that are discarded in processing.

Bioactive Nutrients are Present

While the techniques are complicated and resulted in very long lists of various phytonutrients, insoluble fiber contains many of them. Part of the issue is that there are components we would never eat such as corn cobs or the peels of oranges. Fortunately, there are enough plants that we ordinarily eat that contain insoluble fiber.

That doesn’t mean that soluble fiber such as inulin and psyllium are not beneficial; they add bulk to the stool and help the digestive system in general. It also doesn’t mean that every source of insoluble fiber is beneficial; phytic acid found in the shells of beans can prevent minerals from being chelated and thus absorbed, but cooking the beans breaks down phytic acid without destroying the insoluble fiber. The good news is that the phytonutrients are there as we eat the foods.

Food or Supplements?

The study didn’t completely answer the question, mostly because of the paucity of research on insoluble fiber (or any type of fiber) and the beneficial nutrients it contains. They suggested that the challenges presented to the taste and textures of adding insoluble fiber to foods might be too challenging to be accepted by the public. While it’s easy to say “eat more plant-based foods,” getting people to do it is really difficult.

So if “Food or supplements?” is the question, my answer would be “Yes!” I think the convenience of having psyllium and inulin in powders is great because they mix well with water and can be put into drinks as long as they are consumed quickly. Adding a squeeze of lemon or a no-calorie flavor packet can make the drink more palatable.

For insoluble fiber, I think food is the way to go. Apples and pears with their peels, cooked red, black, chickpea, great northern, and other beans, root vegetables such as sweet potatoes and yams, carrots, oatmeal, flax seed, and bran as in bran flakes are excellent choices. They can be used in cooking, so be creative. Black bean salad, hummus, chili with beans, and many more sources can be eaten on a regular basis. We just have to seek them out.

The Bottom Line

The big benefit of insoluble fiber from foods is all the other phytonutrients you’ll also be getting. Just make sure you use spices to make them more palatable, including a little sugar if necessary. With Thanksgiving less than a week away, think of the sides you can create that could include root vegetables, beans, and other foods high in insoluble fiber. The old saying about an apple a day was more correct than we knew.

Speaking of Thanksgiving, Paula, Riley, Jamie, and I wish you all a Happy Thanksgiving. I hope you get to spend it with family and friends. The Memo will resume the following week. Be well and travel safely.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2023, 15, 4138. https://doi.org/10.3390/nu151941382.

Natural Fiber vs. Added Fiber

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In a recent paper, researchers reviewed the literature to see whether there are benefits to eating more plant foods or whether adding insoluble fiber to processed foods would be an adequate substitute. But first, a review.

The Recommended Dietary Intake of fiber is 25–35 grams per day; American adults eat only 10–15 grams per day. You see the problem. Besides the benefit to the digestive system, other benefits include a lower risk of diseases such as cardiovascular disease, type 2 diabetes, and certain cancers. Different fibers deliver different health benefits, depending on the chemical properties such as solubility, viscosity, and fermentability. That last one is an important one; the type of bacteria that proliferate in your gut is dependent on what you feed them.

Does insoluble fiber from vegetables, beans, nuts, and fruits, could provide better health benefits than getting fiber from processed foods or taken as a supplement? Many processed foods have their fiber removed, and then fiber is added to whatever food is made such as breads, pasta, and cereals. Turns out that plant foods may be better but not for the reason you might think. Isn’t fiber just fiber? I’ll tell you on Saturday.

Tomorrow night is the monthly Insider conference call. I’ll answer your Insider questions about conditions and products, and also expand on my recent take on vaccinations. Become an Insider by 8 p.m. Eastern tomorrow night and you can join in live!

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2023, 15, 4138. https://doi.org/10.3390/nu151941382.

How Can Vaccinations Reduce Alzheimer’s Disease?

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In reading possible explanations for the potential benefits of flu vaccinations for reducing the risk of Alzheimer’s disease (AD), it always comes back to reducing inflammation. Further, it isn’t just the flu vaccine that seems to have that effect. Pneumonia, DTAP booster, shingles, and others have also been studied with similar results: vaccinations seem to reduce the risk of AD. The question is still why? I’ll give you two possibilities.

Vaccines Stimulate the Immune System

Whenever you get a vaccination, the immune system is stimulated. It may be that the activated system addresses weaknesses in the immune system that should be protecting the nervous system. Some researchers speculate it may reduce the formation of amyloid bodies (sticky proteins that harm the brain) and prevent the progression of dementia.

One thing to remember is the population being studied. It might be that, in spite of lifestyle habits, inflammation increases as we age, specifically in the brain. Some people may have genetics that can help. However, it may not just be the nervous system in the brain that’s at risk from increased inflammation. There is an increase in cardiac arrythmias of all types, decreases in muscle function, and many other effects that we attribute to simple aging. It may not be as simple as working hard on a healthy lifestyle, and it may exceed our attempts at living healthier.

Viral Infections Cause Inflammation

“I never get sick!” I’ve heard that a time or two. My question is “How do you know?” Maybe you’re sick, but your immune system has fought off all the symptoms you expect. The assumption is that every virus you get exposed to will leave you with some form of physical manifestation: a cough or runny nose during a cold, vomiting or diarrhea with a food-borne pathogen, or a fever from the flu.

But how do you know that you’re not in a state of inflammation, wreaking havoc on your nervous system, your heart, or another organ? You think your immune system isn’t working even though you don’t “feel” it? It can be. If we’re not flat on our backs, we don’t think we are undergoing immune system challenges. That’s simply not reality, and the problem is that the challenges get worse as we get older.

The Bottom Line

I think this research causes a dilemma for some people: vaccinate or not? As we get older, our immune system doesn’t work as well. Let’s be honest: lots of things don’t work as well, but we’re still kicking, darn it! What we could ignore in our youth now demands our attention. Yes, we need a healthy lifestyle that includes a better diet, a little exercise, and some immune-boosting supplements such as vitamin D and C.

The challenge is the anti-science climate we now live in, and nothing is more controversial than talking about vaccinations. Opinions may be based on flawed science—or in some cases, no science, just opinion—and access to social media where people can say anything they want to say. For me, the science is pointing to benefits from vaccinations if you’re older than 65. Just spread them out over a few weeks or months to give your immune system a chance to adapt.

Whatever you decide to do, it’s your body. It’s your choice.

What are you prepared to do today?

        Dr. Chet

References:
1. J Alz Dis. 88 (2022). 1061–1074. DOI 10.3233/JAD-220361
2. Vaccine. 2021. https://doi.org/10.1016/j.vaccine.2021.08.046

Flu Shots and Alzheimer’s Disease

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One of the benefits of large cross-sectional studies, especially in the age of electronic medical records, is that medical tests and treatments can be examined while examining diagnoses at the same time. The Veterans Health Administration is one of many medical databases that can identify relationships between health factors and the onset of disease.

In a recent study, researchers used a large medical records database called Optum Clinformatics Data Mart. The methodology section was long, but essentially they divided potential subjects into those who did not get a flu vaccination at all and those who got at least one flu vaccination every year or more. They identified their potential subject list and then tracked them for four years to see if they received a diagnosis of Alzheimer’s disease (AD). In case you were wondering, people under 65 were excluded because AD does not manifest itself appreciably until after that age.

The results were more than a little interesting. Those who got at least one flu shot had a 40% reduced risk of getting diagnosed with AD. Before you even think, as I would have, “How many subjects were there?”–there were close to a million subjects in each group. The better question is how would a vaccination reduce the risk of getting AD? We’ll examine that question on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Alz Dis. 88 (2022). 1061–1074. DOI 10.3233/JAD-220361

Timing for Enzymes, Prebiotics, and Probiotics

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My digestive system has undergone changes—it doesn’t work like it used to work. Hence, I’ve been paying closer attention to digestive supplements. My voice had been getting raspy, and I had occasional reflux; I was concerned the two were related. I had an endoscopy and found I was correct. They also found a hiatal hernia.

When your body doesn’t work as well as it should, you look for something to help. In this case, digestive enzymes, probiotics, and prebiotics are where you begin.

Digestive Enzymes

These are products that contain pancreatic enzymes that will help digest proteins, fats, dairy, and several kinds of carbohydrates. For them to be most effective, take them just before or as you begin eating, about five to ten minutes before.

Here’s a change in my recommendations from the past: You can take the digestive enzymes up to an hour after you began to eat. They work all through your small intestine, and that takes hours. They’ll catch up to the food you’ve eaten.

Unless you are taking them only because you know that protein gives you excessive gas or you need them to digest a meal with cheese, take them before every meal. Even snacks? Yes, unless you know the specific food. How do you know? Trial and error.

Will using the supplement cause your body to stop making the enzymes naturally? Apparently your body already isn’t making them, so don’t be concerned. The only other thing to work on is the volume of food you eat. Maybe for you, the amount is the issue, not the enzymes you naturally produce. It’s really trial and error.

Prebiotics and Probiotics

The only real research that’s been done on timing of probiotics and the foods that feed them, the prebiotics, was done with models of the digestive system in test tubes. Based on that, the best time to take probiotics with prebiotics is just before or with meals. Personally, I take my probiotics with a fiber prebiotic any time because the right food for the probiotic is going with them. But if it helps you to remember to take them, take them before, during, or after a meal. Just take them and if it’s with some fruit and vegetables, that’s great—more food for them to eat.

The Bottom Line

Your digestive system changes at various stages of life. That’s not a bad thing; it’s normal. Digestive products can help adapt to changes in your gut, as they helped me.

I’ve tried to give you the best approach for maximum benefits from your supplements. While the timing may be important, nothing is as important as taking them consistently. We tend to stop when we feel better; don’t do that! Remember, these are supposed to be made by our body or obtained from the food we eat. Take digestive supplements consistently to get results.

What are you prepared to do today?

        Dr. Chet

Reference: Benef Microbes. 2011 Dec 1;2(4):295-303. doi: 10.3920/BM2011.0022

Timing May Be Everything

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I’ve recently gotten a few questions on the timing of dietary supplements. That means it’s time for a review.

The first category would be multivitamins-multiminerals (MVMM) and other single- or multi-nutrient vitamin-mineral combinations such as calcium plus magnesium and vitamin D. The best time to take them is during or after a meal. The reason is that food has chelators for minerals and nutrients that can help with absorption.

What if you take a MVMM and want extra calcium? It depends on your objective. If you take them separately, you’ll get better absorption of the calcium and other minerals. As I said, there are substances in food that help absorption. But if you want to take them together, some will pass through but most will be absorbed.

The question is maximal absorption versus convenience. It won’t make a major difference, but consider what would be easier for you to remember; if you consistently forget to take them at separate times, you won’t absorb anything!

Consistency. The body adapts to what you do on a consistent basis. Timing for enzymes and microbes on Saturday.

What are you prepared to do today?

        Dr. Chet

Another Theory of Obesity

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It’s been a while since someone has proposed a new theory of obesity. I’m still a believer in “a calorie is a calorie” but it’s always good to find out what may be driving us to overeat.

The latest addition is the Fructose Survival Hypothesis for Obesity. The diagram above was taken from an article published in the journal Obesity. The authors claim that their new theory explains and is consistent with the other theories that include the energy-balance hypothesis, the carbohydrate-insulin model, the protein-leverage hypothesis, and the seed-oil hypothesis. They’re depicted in the large red circles and also include genetics and the microbiome. It all seems complicated, to say the least.

Fructose Survival Theory Simplified

Let’s just focus on the fructose in the blue box and follow those arrows. The arrow that goes up simply suggests that people who eat more fructose-containing food and drinks increase their food intake and gain weight. Simple.

The arrow that angles down to mitochondrial stress leads to a whole host of metabolic changes, all of which result in the decrease or blockage of production of ATP and the increase in fat storage. The result is obesity, altered blood lipids, and a fatty liver.

This pathway is apparently related to getting ready for hibernation, but one gene with the ability to store fat to protect against starvation kicks in and we just gain weight. Of course, it’s more complicated with multiple enzymes involved, but in reality it just goes back to one thing: eating and drinking too much of, in this case, refined carbohydrates.

Questions about the Fructose Theory

We know how this potential theory of obesity involving fructose metabolism seems to work. There are at least three questions:

1. Does the source of fructose matter? In other words, is high-fructose corn syrup (HFCS) more likely to impact weight more than the fructose in grapes or watermelon? The research in animals and a human trial involved eating and drinking the calories in prepared mixtures, but what about real food?

2. They suggest a pathway where glucose can be made into fructose by being exposed to salt, umami, and dehydration. In the animal trial, I couldn’t find total body water ascertained nor what type of sodium might be more hazardous: table salt? MSG? Pink salt?

3. Would the theory apply to normal weight people eating just enough to maintain their weight as it is, regardless of diet composition? Or would people gain weight even while not overeating, regardless of diet? They tested for outcomes in animals and people who were overweight to begin with, but there’s no evidence that people couldn’t lose weight if they cut calories even while eating a high-fructose diet.

Chemical drivers of food behavior such as those proposed must be studied, if for no other reason than to see if there are negative effects for people who don’t follow the mainstream dietary recommendations and yet maintain a healthy body weight. All this research has led to the research group being awarded a patent on a pharmaceutical that would interfere with a specific enzyme called fructokinase. We’re interfering with what they claim to be a natural process against starvation. Is that safe?

The Bottom Line

The researchers and drug developers have spent over a decade researching the fructose theory of obesity and spent millions of research dollars. They have a patented pharmaceutical that may address the issue. But the one question that they must answer, besides discovering any harms in clinical trials, is this: would someone who ate a diet high in fructose and sodium be able maintain a normal body weight? Is a calorie a calorie? Until then, I’m not convinced.

What are you prepared to do today?

        Dr. Chet

References:
1. Obesity. 2023. https://doi.org/10.1002/oby.23920
2. Phil.Trans. R. Soc. B 378:20220230. https://doi.org/10.1098/rstb.2022.0230

Your BMI and Shrinkage

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I received several interesting questions regarding the loss of height and its impact on BMI: should you use your current height or your tallest height? I checked the research and found some interesting ideas, but there’s no direct answer.

While it may change slightly over time, your current height should be used to estimate BMI. You’re measuring shorter than you were when you were younger not because you’re stooping (or melting like the Wicked Witch of the West), but because the vertebrae lose bone mass and the disks between them lose fluid and get smaller. You’ve also probably lost muscle mass, but that can be regained; when bones and discs degrade, it’s not reversible as far as we know. That may mean that a person, including yours truly, has a lower target to get to normal weight for his current height.

A new theory of obesity on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Am Geriatr Soc. 2012. https://doi.org/10.1111/j.1532-5415.2011.03832.x