New Research on Sucralose

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Everybody seems to be talking about sucralose. In the past week, I’ve gotten more emails about the artificial sweetener sucralose than I ever have before; I’ve also seen more commentaries on sucralose in health news feeds. The problem is that the issue really isn’t the sweetener itself—it’s a contaminant that may be found in the sweetener called sucralose-6-acetate. On top of all that, the primary author of the study is continually muddying the results of the study by using the term sucralose when she means sucralose-6-acetate.

The sweetener sucralose is as safe as it always has been. Some people are opposed to artificial sweeteners of all types, and that’s fine, but there’s nothing in this research update nor any of the other studies on sucralose that presents any type of major concern. That doesn’t mean it’s for everybody; genetic factors and microbiome issues may affect some people. But that aside, there’s nothing to be fearful of, so let’s check out the study that’s attracting so much attention.

Let’s start with what the researchers did. They attempted to examine six historical claims about sucralose:

  • Sucralose passes through the gut unchanged
  • It has no effect on the microbiome
  • It has no effect on intestinal tract
  • It doesn’t accumulate in human tissue
  • It has no effect on metabolism including blood glucose or insulin
  • It won’t disrupt the DNA

To say the tests to examine these questions were complicated is an understatement. I’ll give you my interpretation of the published results on Saturday. However, if you want to read the study yourself, click the link below.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1080/10937404.2023.2213903

Flavanols: The Real Brain Food

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As I suggested in the last memo, the researchers did not prove their hypothesis that there would be an increase in measures of memory in all participants of the clinical trial. While disappointing, the secondary hypothesis might have been even more important because it was statistically significant.

They found that those with the lowest intake of flavanols from foods and drinks had the most improvement in measures of memory function. Makes sense: people who did not eat enough fruits and other foods containing flavanols saw benefits by supplementing with a specific amount of flavanols every day.

Researchers didn’t test to see if eating little to no foods containing flavanol resulted in a decline in memory function; that would fall into the category of “first do no harm.” Understanding that flavanols are beneficial for more than just memory, it would not be responsible to have a person decrease intake of them.

They also did not find additional benefits of taking the supplement for those with the highest intake of flavanols from their diet. That means that a great diet has great benefits.

There are three points we can take from this study:

  • Regular intake of flavanols from supplements can compensate for weaknesses in the diet.
  • Eating flavanol-containing foods provides a wide variety of flavonoids including anthocyanidins, flavan-3-ols, flavanones, flavones, and isoflavones. In my opinion, eating and drinking plant-based substances is a better approach; using additional flavonoids from supplements is a great insurance policy.
  • The memory tests used in the study focused on one area of the brain: the hippocampal area. Supplementation did not appear to impact the prefrontal cortex component of cognitive aging.

If we want to age with a vengeance, I think we should look at it as though every little bit helps. I also think that the earlier we begin developing the habit of eating more fruits and vegetables, plus drinking teas, coffee, and cocoa drinks, the better our brains will be. And as a bonus, the rest of our body gets to enjoy the benefits as well.

What are you prepared to do today?

        Dr. Chet

Reference: PNAS May 2023. https://doi.org/10.1073/pnas.2216932120h

What’s Brain Food?

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If I ask what you think a good brain food would be, what would you answer? I think for most people, it would probably be fish, especially cold-water fish such as tuna and salmon. I don’t think we can discount how important omega-3 fatty acids are to the function of our bodies, especially our nervous system. But based on recent research, I don’t think we have to get quite as exotic as cold-water fish. I think we can find what we need in the produce section or at farmers markets. I’m talking about the phytonutrient class called flavanols.

Researchers recruited over 7,500 people—men over 60 and women over 65—as potential subjects. After meeting the criteria established for inclusion in this clinical trial, researchers ended up with just over 3,500 subjects. To test the theory that flavanols would improve memory, researchers used three different online memory tests. They used a form of the Healthy Eating Index to evaluate dietary intake of flavanols. They also used a test for the urinary excretion of flavanol by-products to confirm the amount of flavanols in the diet.

Half the subjects got a flavanol extract from cacao that contained at least 500 mg of cacao flavanols, including 80 mg of epicatechin; the remainder of the subjects received the placebo. Subjects were tested before the study began and then at the end of one, two, and three years.

The primary goal was not met; not all subjects saw an improvement in memory after the first year. The secondary goal was met, and it may prove to be even more important. I’ll finish this review on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference:   PNAS May 2023. https://doi.org/10.1073/pnas.2216932120

Diet: It Just Doesn’t Matter

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Long-time readers probably know I love using quotes from movies. One of my favorites is a Bill Murray line from the movie Meatballs. Although it’s part of a much longer rant, the key phrase is, “It just doesn’t matter!” That’s what I want you to remember from the study that examined the percentage of energy nutrients in the paleo diet. They found a significant difference in the range of nutrients, but the ranges are wide enough to incorporate the ketogenic diet as well as the Mediterranean diet.

Looking at the diets of hunter-gatherers in different parts of the world showed that the types of carbohydrates were dependent on what was available. In some cultures, digging up root vegetables and tubers was critical to the diet. But eventually, we learned to grow and process grains, and now we have an abundance of refined carbohydrates such as breads and pasta, often to our detriment.

What are the lessons?

Personalization

In one of the many commentaries I read on the merits and downfalls of the paleo diet, one researcher said this:

Ultimately, the best way to eat for your health is the change you can keep up with. Most people know what they need to do: limit calories, eat fruits, vegetables, whole grains, and lean proteins. The challenge is how to do it. There are lots of ways people can achieve this. The key is figuring out which is best for you as an individual that you can keep up with.

That uses a whole lot more words, but the message is the same as always: eat better.

When It Comes to Weight, It’s All About the Calories

Whichever way you decide to eat—and there are many ways to eat a healthy diet—losing weight is always going to be about how many calories you eat versus how many calories you expend. You can eat the carnivore diet, which is essentially all meat, although I wouldn’t recommend it. Or you can become a vegan. You can follow the DASH diet that I talked about a couple weeks ago, or you can eat the paleo diet. It just doesn’t matter. As long as you control the number of calories you eat, you can get to and maintain a normal body weight.

I believe you have to have vegetables and fruit as the foundation of your diet, but there’s a difference between maintaining a normal body weight and sustaining a healthy lifestyle. What we eat does matter. But quality aside, as always, it is and it will always be about the calories. Nothing else matters in controlling what you weigh. Eat less.

And if you can, eat better.

What are you prepared to do today?

        Dr. Chet

Reference:https://doi.org/10.1016/j.ajcnut.2022.12.003

Is Summer Paleo Diet Time?

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Now that we’re past Memorial Day, we’re officially in the summer season. For many people, that typically means they grill more than at other times of the year—I know that I do. It also seems like we favor more vegetables and fruit. In a way, it seems to mimic the paleo diet approach: we eat foods closer to nature before planned agriculture became common. I can’t say we’re hunter-gatherers because we mostly shop at the same grocery stores, but we may buy foods closer to the source due to the prevalence of roadside stands and farmers markets. With all the fresh food available, we also may eat fewer grains and starches, which also fits the paleo profile.

Or does it? Researchers at Simon Fraser University decided to examine the premise behind the paleo diet in terms of proportion of protein, carbohydrate, and fat. The current paleo diet approach consists of 19-35% protein, 22-40% carbohydrate, and 28-58% fat. While the range of percentages in each energy category are wide, it does focus on much higher protein and much lower carbohydrate, especially refined carbohydrates.

In a recently published paper, researchers at Simon Fraser University examined the percentage of energy nutrients in the diet of ten hunter-gatherer societies and in different locations. They derived the following percentage of energy nutrients: 14%–35% protein, 21%–55% carbohydrate, and 12%–58% fat. The percentages were significantly different—they incorporated a wider range in each nutrient category.

Are these differences meaningful in the real world? I’ll let you know on Saturday. Meanwhile, time to grill some burgers and veggies.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.ajcnut.2022.12.003

BE FAST for Stroke

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So what did the Society of NeuroInterventional Surgery (actual brain surgeons) add to the mix? They added the acronym BE, which then makes the entire acronym BE FAST.

What do the new letters stand for?

B: loss of balance. I didn’t see any details about how to test that. It may be self-evident that someone cannot stand upright without tilting to one side or the other. Or it may be the while holding their arms to test their arm strength, they can be moved side to side to see how they respond.

E: loss of eyesight in one eye or blurry vision.

I think adding balance and eyesight are a good idea for the lay public. A physician or other healthcare professional may know to look for balance and eyesight symptoms, but it may not be as obvious to you and me. Here’s the whole list:

BE FAST

B: loss of balance

E: loss of or blurry eyesight

F: face drooping

A: arm weakness

S: speech difficulty

T: time to call 911

Commit those to memory and if you feel that you or someone you care about might be having a stroke, assess those symptoms and most important, take action immediately if necessary. I can’t stress that enough because the sooner treatment begins, the less function a person loses.

Enjoy your holiday weekend, and safe travels if you’re hitting the road. We’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://getaheadofstroke.org/call911/

Suspect a Stroke? Act FAST

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The other day, for no particular reason at all, I got really dizzy for a moment. I wasn’t spinning in circles or doing anything else that might have caused it, so I did what I always do: I acted FAST and looked for signs and symptoms of a stroke. The American Heart Association (AHA) has taught that acronym for years, but recently a group of neurosurgeons added more to it. Today, we review the original acronym FAST. What does it mean?

F: face drooping. Does one side of your face seem to be pulled down? If you smile—a really, really big smile—are you smiling equally on both sides of your face?

A: arm weakness. Typically, you would stand with your arms raised out to the side and parallel to the ground. You can check to see if one arm does not quite make it to parallel with the ground or if it drifts back down. I also grabbed a stick and squeezed as hard as I could.

S: speech difficulty. Try repeating a simple phrase to see if you can remember it and if it sounds clear. For some reason I chose the old “How much wood could a woodchuck chuck…” Not the easiest thing to try to repeat a couple of times, but I did.

T: time to call 911. Do you call if you just have one sign or symptom? Yes! Do you still call if these symptoms seem to resolve themselves shortly? Yes! I didn’t have any symptoms, but I still told Paula. I was going to do a song and dance, but I never could in the first place, so it wouldn’t have gone well.

The reason time is so important is that with today’s medical technology, the sooner treatment begins, the better the outcome to regain all functions. AHA says, “stroke patients who are treated with the clot-busting drug IV r-tPA Alteplase within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability.”

What did the brain surgeons want to add? I’ll tell you on Thursday. It’s Memorial Day weekend and you may need the information if you’re attending any gatherings.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.stroke.org/en/about-the-american-stroke-association/stroke-awareness-month

Sucralose: A Treatment for Auto-Immune Disease?

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In test-tube and rodent research, researchers have found that sucralose given in high amounts may help reduce the immune response, thereby preventing the body from attacking itself, which is the essence of an auto-immune disease. How about that? For all the negative comments about sucralose, wouldn’t it be a kicker if it turns out that this artificial sweetener may actually help people?

But let’s take a closer look at what they found and what they didn’t find. The researchers made sure to point out that when the amount of sucralose necessary in rodents is translated to human amounts, they would be at the top end of the Acceptable Daily Intake (ADI).

In reality, humans don’t normally get that much sucralose. It would be logical to think that perhaps lower amounts of sucralose may be compromising the immune system for normal users, but researchers tested it and didn’t find any issue. They found the blunting of the immune response only in high amounts.

There is a lot of research to go before any clinical trials are done to eliminate or test other factors such as the microbiome. Still what has been cursed by many might be their treatment plan in the future.

The Bottom Line

I think these two studies on sucralose and eyedrops illustrate the unintended consequences of pharmaceuticals and artificial foods and that the consequences may be positive or negative. They just might have a function that can be beneficial to our health beyond what we know today. Of course, we may find out other substances may be more detrimental than we thought. We have to understand both are possible. In the meantime, we still must sustain a good diet and exercise program.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41586-023-05801-6 Received: 15 September 2021

Eyedrops for Alzheimer’s?

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A recent study is looking at eyedrops for glaucoma and the potential prevention or possible treatment for Alzheimer’s disease. I have a vested interest in that because I have glaucoma and use a form of the medication in question for it. The function of the medication is like a localized diuretic; the medication is absorbed into the blood stream and is carried throughout the body.

Researchers discovered that an enzyme inhibitor called a carbonic anhydrase inhibitor affect the formation of amyloid bodies in blood vessels. The medication may work inside the mitochondrion in some way to prevent formation of these proteins associated with Alzheimer’s disease. When they administered the medication to mice at about eight months of life forward, the mice didn’t demonstrate the cognitive decline found in untreated mice.

While the actual mechanism of action is not specifically understood yet, if it proves effective in clinical trials in humans, a pharmaceutical developed to help with one condition may benefit people in other ways. Not all intended consequences turn out to be negative. I’ll cover another interesting study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1002/alz.13063

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146