Food or Supplements?

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One of the changes I’ve made in selecting topics to write about in these Memos is to read the table of contents of the scientific journals to which I subscribe, especially the nutrition journals. It’s easier to see what’s controversial by looking at news feeds, but they miss a lot of positive nutrition science. One question that’s ever-present is this: when it comes to nutrients, is getting nutrients from supplements as good as getting nutrients from food?

Researchers searched four databases of scientific journals to find randomized-controlled trials that examined the effect of either polyphenol-rich foods or polyphenol extracts on risk factors for cardiovascular disease (CVD). It’s estimated that there are more than 8,000 types of polyphenols, including flavonoids, polyphenolic amides, phenolic acids, resveratrol, and ellagic acid. You’ll find polyphenols in fruits, vegetables, spices, herbs, teas, nuts, and seeds.

They found over 1,100 studies that fit the profile. Using subject, statistical, and nutrient criteria, they whittled the number of studies down to 46. Then they conducted a meta-analysis of the impact of food and supplements on the following CVD risk-factors: systolic BP, diastolic BP, endothelial function, fasting blood glucose, total-, LDL-, and HDL-cholesterol, C-reactive protein, Il-6, and waist circumference.

Nutrition studies are usually messy, and this one was no exception. I spot-checked the 46 studies and found different foods for the polyphenol sources and different extracts for the supplements. Still, it was as well-done as such a study could be. I’ll give you the results on Saturday.

Tomorrow night is the Insider Conference call for March. The topic is the absorption of omega-3s, and I’ll also answer your questions. Become an Insider by 8 p.m., and you can participate in this live event.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.sciencedirect.com/science/article/pii/S2161831323000029

Erythritol: Reserve Judgment for Now

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The study published in Nature Medicine on erythritol is complex to say the least. I gave you three quarters of the results. There was one more part that I want to cover and then give you my primary issues with the study. As I said in Tuesday’s Memo, I’ve posted a Straight Talk on Health podcast for Members and Insiders that gives my complete thoughts on sugar alcohols, especially erythritol (remember to log in first).

Erythritol and Clotting

The final part of the study was actually a preliminary report on a much larger study. They had eight subjects drink 30 grams of erythritol mixed with 300 ml of water. That corresponds to estimates of what a high intake would be. Then they tracked serum erythritol levels in the subjects for seven days. They also tested for indicators of blood clotting factors and found that some were increased for a few days after consuming the erythritol drink. The implication is that high intake of erythritol might contribute to blood clots forming. The question is: who is at risk?

Primary Issues

My primary concern is the lack of adequate controls. This was an observational study, not a clinical trial, so no cause and effect can be determined. Researchers took measurements on several cohorts of subjects with diagnosed coronary artery disease (CAD). Those subjects had a host of risk factors including high blood pressure, type 2 diabetes, high LDL- cholesterol, and on and on. The ages in each cohort ranged from a median of 65 in the Discover cohort up to 75 in the European cohort.

They did not have a comparable cohort of apparently healthy controls in the same age group. They could have chosen a group of subjects who had blood drawn at their annual physical but no apparent diagnosis of CAD. While still not getting to cause and effect, it would have strengthened the basic observations if major adverse cardiovascular events (MACE) was seen or not seen in the controls.

The same is true for the study on the erythritol drink. Why not get a group with diagnosed CAD and see if the same clotting effect happened? If not that, why not just do a simple test that measures clotting time? That’s done for anyone who takes a blood thinner such as warfarin.

The Bottom Line

The researchers called for more research on erythritol to examine the increased adverse events in the present study, and I agree. Because erythritol is part of many low-carbohydrate foods and drinks designed for diabetics and those on a ketogenic diet, we need to know more about the risks. This was a good research paper but incomplete. The best we can say as to whether we should use sugar alcohols is that we must reserve judgment until a lot more research is done.

If you’re concerned about artificial sweeteners, try to cut back and use a variety of them to reduce the risks associated with any particular one. But for your health’s sake, don’t switch to sugar; the risks of high sugar consumption are even greater than those associated with artificial sweeteners. For ideas of asking the right questions in those future trials and more on sugar alcohols, check out the Straight Talk on Health just posted by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Is Erythritol Safe?

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Health writers have been talking pro and con about a new study that was published about erythritol, a commonly used sugar alcohol. The paper demonstrated an increased risk of major adverse cardiovascular events (MACE) if a person had too much of the sweetener in their bloodstream. In that sugar alcohols are found in more and more products, especially those geared toward the ketogenic diet, are people really at risk for a major cardiac event, or worse, death? Let’s take a look at the results of the study.

The researchers used data collected during consecutive heart catheterizations at the Cleveland Clinic, termed the Discovery cohort, a U.S. population extracted from a large genetic study conducted by the Cleveland Clinic, called U.S. validation cohort, and a European validation cohort similar to the one selected from the population in the Discovery cohort. The two key elements were that all subjects had blood samples drawn that could be studied and all were tracked for at least three years. Researchers developed tests to specifically identify the quantity of erythritol found in subjects’ blood.

The researchers separated the subjects into quartiles and compared those with the lowest levels of erythritol with those with the most. In all three cohorts, with blood samples taken in different parts of the U.S. and Europe and over different years, the highest quartile had a significant increased risk of MACE in over three years compared to the lowest quartile—two to three times as high.

In Saturday’s Memo, I’m going to review the major issue with the study. I’ll also post a Straight Talk on Health for Members and Insiders that takes a deeper dive into all the issues surrounding the study and whether this is something to be concerned about or not.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Protein Intake: Perspective Required

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The research paper that concluded that higher protein intake was associated with muscle loss and sarcopenia seems to offer more questions than answers. That’s actually a good thing, because future research can examine those questions. But there are questions that the researchers didn’t mention.

Researcher Observations

This is an observational study. Simply put, the subjects who completed all the tests were followed for several years, depending on when they joined the study. Therefore, no cause and effect can be inferred because the researchers were watching, not intervening.

The original number of subjects with sarcopenia was low at just 4.3%. With so many subjects over 72, the number should have been closer to 10%. The researchers acknowledged as much. If the study’s subjects had less sarcopenia than the general population, it’s hard to draw conclusions that are helpful to everyone.

My Observations

The single characteristic most closely associated with loss of muscle mass and sarcopenia was age. Protein intake was a covariate for sarcopenia but it was actually in the middle of the pack as a risk; a covariate is a separate attribute that can be measured alongside the primary variable being investigated.

The study included limited data on diet and exercise. I would expect that not very many subjects were exercising at levels high enough to sustain or increase muscle mass. That conflicts with the research data from clinical trials that show that increasing protein intake in older subjects on a weight training program increases strength and muscle mass.

What stood out more than anything was the limited amount of testing for sarcopenia and the mixed bag of testing procedures. If it’s such a problem, which every researcher in aging admits is the case, why aren’t there better diagnostic tools available to diagnose the condition? How can physicians treat a disease they aren’t diagnosing?

The Bottom Line

There is no reason to worry about protein intake as we get older based on this observational study. What we need to do is begin to retain muscle mass or reclaim our muscle through resistance training, better protein intake, and the strategic use of supplements. If you’re interested in a program to do just that, the Taking Back Your Muscle is still available on my website.

What are you prepared to do today?

        Dr. Chet

Reference: https://academic.oup.com/ageing/article/52/2/afad018/7036280

Is High Protein Intake Associated with Sarcopenia?

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If there’s one thing I’ve learned studying health, fitness, and nutrition for 35 years, it’s this: what we thought we knew yesterday may change based on what we learn today. Given that, I was still surprised to see an article in my news feed with a title “High Protein Intake Associated With Sarcopenia.” The Taking Back Your Muscle webinar uses strategies that research has shown help increase muscle strength, including eating more protein. What gives with this latest research?

Researchers selected as their subjects from the TwinsUK cohort. Subjects must be over 60 years old and have completed specific tests since 2010. Just over 3,300 men and women were selected to be included in the data analysis. Researchers examined a variety of variables including education, income, other diseases and conditions, strength, and muscle mass. Protein intake was measured. Researchers did find the opposite of what they expected: higher protein intake was associated with sarcopenia.

Did I get it wrong? I’ll talk about the rest of the study on Saturday. I wouldn’t change your protein intake just yet because there seems to be a larger problem that looms over us as we age. The article is open access, and you can read it at this link.

What are you prepared to do today?

        Dr. Chet

Reference:https://academic.oup.com/ageing/article/52/2/afad018/7036280

Exploding Gallbladders: Just the Facts

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Let’s take a look at the actual case study on the exploding gallbladder and figure out what’s relevant and what’s conjecture—by all parties.

The Case Study

The paper was the result of a close examination of the medical information gathered when a 69-year-old man went to the emergency room at SUNY Brooklyn Medical Center with a perforated gallbladder. There were three parts to the paper:

  • The introduction focused on curcumin and its potential for causing issues in people with gallbladder disease.
  • The second described the treatment plan for the patient, mostly antibiotics and pain relievers.
  • Finally, a review laid the groundwork for why curcumin caused the perforation in the gallbladder.

The reason? Curcumin may increase the strength of the contractions in the gallbladder duct as it moves bile. A large stone was blocking the duct, so curcumin caused the pressure to buildup in the gallbladder and boom: explosion! Well, perforation, but you get the idea.

The Problem

There was no evidence to show that curcumin directly contributed to the gallbladder issues. What was also in the case study but not considered was that the patient had a history of gallstones. He was also taking five medications for hypertension, high cholesterol, and an enlarged prostate.

The writers of the case study were a medical student and a nephrologist (a kidney specialist). Based on published information, neither was an expert in the digestive system. It appears to have been conjecture on their part as to the cause of the gallbladder perforation. The comments on food and supplement oversight, while referenced, did not demonstrate any understanding of the FDA’s oversight of food and supplements; they’re not controlled as pharmaceuticals are, but both the FDA and FTC have control over the claims they can make. The amount of curcumin used by the patient was within the standard range for use of the supplement.

The Bottom Line

I can’t fault the writer for the Daily Mail; writers sometimes tend toward the sensational, and an exploding gallbladder is a perfect fit. The physicians and the article reviewers should have realized the faults in the analysis. Could a gallbladder explosion have been possible? Yes, but without accounting for the current status of the patient’s disease and considering pharmaceutical interactions of the meds the patient was taking, they used the “Ready, Fire, Aim” approach to assess what might have happened. We might expect that from reporters with no health background but not from medical professionals.

They were right about one thing. More research on interactions between food, herbs, and pharmaceuticals is necessary—but that isn’t news.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Exploding Gallbladders!

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Health Memo readers frequently forward health-related articles to me to ask my opinion; I read them all and respond to the sender if asked. Combined with my health news feeds, I read a lot about health—opinions about health, that is. I’m going to share a couple with you in the next few Memos and—wait for it—give you my opinion about whether what is being said is accurate, and more important, meaningful.

Let’s begin with curcumin, a very popular dietary supplement and a component of the herb turmeric used in cooking. It’s generally used as an anti-inflammatory for a variety of conditions, including joint health. The health headline in the Daily Mail implied that a 69-year-old man’s gallbladder exploded due to the interaction of the gallstones in his gallbladder with the high doses of curcumin he was taking. The Daily Mail seems to focus on celebrity news more than other types of news, but that doesn’t mean we can ignore the story.

The Daily Mail article was based on a case report published in a journal focused on just such case studies. The reporter took language from the paper that suggested that supplements avoid the regulatory process, creating a set of circumstances that could be potentially dangerous, as in this case. It also suggested that adverse reports with supplements are not reported. Is that all true? More importantly, what are the implications of such an article? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Another Buffalo Bill’s Cardiac Arrest

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I hope that you took 60 seconds to watch the video from Tuesday’s Memo and learn CPR. As I said, it’s simpler than when I taught it, and it may just save someone’s life—someone you love or maybe a stranger.

In the close, I mentioned another Buffalo Bill who suffered a cardiac arrest several months before Damar Hamlin’s on-field experience. The owners of the Bills and Buffalo Sabres and CEO of the Buffalo professional sports teams are Kim Pegula and her husband Terry. One night last June, Terry was awakened by Kim going into cardiac arrest. One of her grown daughters happened to be staying with her parents and performed CPR until emergency services arrived. She saved her mother’s life.

In an open letter in The Players Tribune, Kim’s daughter Jessica, a top-ranked tennis player, told the story of her mom. This time, without the immediate attention from a couple dozen experts, Kim’s brain was without oxygen for longer. While she continues to improve every day, she suffers from expressive aphasia. She can probably understand almost everything, but she sometimes can’t get the correct words to communicate well. No one knows whether she’ll regain lost function, but she’s alive to make that journey because of CPR. It’s a very moving story and I urge you to read it.

Who can do CPR? Almost anyone. The American Heart Association has no minimum age for learning CPR. They say, “The ability to perform CPR is based more on body strength than age. Studies have shown that children as young as nine years old can learn and retain CPR skills.” Now—are you going to take the time to learn CPR in 60 seconds? Just click this link.

Aging with a Vengeance

After the Super Bowl Webinar on Taking Back Your Muscle last Sunday, I had inquiries about the prior Super Bowl Webinar Reclaiming Your Power. I’m happy to let you know you can purchase both replays in the Store at drchet.com. If you order one or both, make sure you use the correct email address; it’s the only way you can get the link to listen to the replay. And if you want to gift the replay to someone, you can; when you’re checking out and get to the billing details page, enter their email address instead of your own.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge
2. https://www.theplayerstribune.com/posts/jessica-pegula-tennis

Happy Heart Health Month!

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Happy Valentine’s Day to everyone! February is American Heart Month; it also has an emphasis on women’s heart health with Go Red for Women. That’s symbolized by wearing red as often as you can during February. I can’t think of a better day to do that than today—Valentine’s Day. There’s a lot that we can do for our hearts with diet, exercise, and more, but that’s not what this memo is about. It’s about responding to a challenge.

Whether you’re a football fan or not, you’ve probably heard about Damar Hamlin, the Buffalo Bills safety who had a cardiac arrest on the field in January. He has recovered and is doing well, and he hopes to get back to playing football. But he’s alive only because the immediate training staff responded by doing CPR on the field.

Damar is part of American Heart Month with #3forHeartTM CPR Challenge. The first part, and probably most important, is to learn how to do CPR in 60 seconds; follow the link to watch the video. Even though I’ve taught CPR, it was a good refresher and, wow, it’s a lot simpler than it used to be. Take a minute today to be prepared in case your Valentine or anyone else has a problem.

There is another part to this story about another Buffalo Bill who had a cardiac arrest. I’ll tell you about her on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge

What Your Body Needs for Bone Repair

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When it comes to broken bones, especially in adults, what can be done to help the healing process? Pain management is always paramount because of the second reason: joint rehabilitation. If any movement is too painful, no one wants to rehab the muscles and tendons surrounding the joint, especially with a dislocation that stretches them beyond their normal capacity. Putting the bone in place is one thing, but getting the tendons and muscles to repair is another. There’s no being brave or gutting it out; rehab is necessary to restore complete joint function.

That raises the question: are there any supplements that can help with the healing process? The research is virtually non-existent, as outlined in a recent article, but there are some nutrients that make sense:

  • Vitamin C: an additional 1,000 to 2,000 mg per day. Vitamin C is involved in building connective tissues; bone, tendon, and ligaments are all connective tissue.
  • Vitamin D: an additional 50 to 100 mcg per day. Vitamin D is known for helping build bone, so it makes sense to increase the amount.
  • Glucosamine: 1,200 to 2,400 mg per day in total. Glucosamine, like vitamin C, is used in making all connective tissue. This appears to be important within the first two weeks after the injury, based on animal studies.
  • Calcium: 500 to 1,000 mg/day in total. The formation of the callus and conversion to bone requires calcium. Taking an extra amount, providing stone formation is not an issue, is important.

The final part of bone repair is patience. We all progress at our own pace. If ever there was a time to be consistent, this is the time.

Manage the pain, perform the rehab once you’ve been given a program, take some nutrients that can benefit bone growth, and don’t stop until you have full function. That’s the bottom line on broken bones.

Super Bowl Webinar Tomorrow!

The research is done, the presentation is ready, and I’ve practiced as much as I can. At this point, I can’t guarantee you’ll be on the live webinar, but if you’re not, you will still get the opportunity to watch it later in the day or whenever it’s convenient. Taking Back Your Muscle is the kick-off for Aging with a Vengeance 2023. I also think it’s the one that can benefit us the most. Hope to see you tomorrow!

What are you prepared to do today?

        Dr. Chet

Reference: J Orthop Res 38:695–707, 2020.