Resolving Gas Problems

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Whatever the cause, the question is how you can control any issues you have with intestinal gas. Once you realize how probiotics do what they do, and by that I mean via fermentation with the resultant gas, there are several strategies you can use to deal with it.

Strategies for Gas

Digestive enzymes can often help if the culprit is a specific food. For many people, beans cause gas while for others, excess protein can do it. With so many people doing keto these days, gas can be a substantial problem for them.

The solution may be to use a multi-purpose digestive enzyme before eating food you know causes you issues. Beans are obvious, as is protein. But for those who are lactose intolerant, milk and cheese can cause issues. Cellulases, proteases, and a lactase can help digest those macronutrients. For carbohydrates such as grains, amylases can be helpful.

The next question is whether taking digestive enzymes help with gas caused by supplements or pharmaceuticals. I can’t answer that because there’s no evidence one way or the other. Because your body naturally releases digestive enzymes, it’s doubtful they’ll interfere with the processing of the medication or supplement. It could be that your body isn’t making enough digestive enzymes to fully break down the substance, so adding or changing a digestive enzyme supplement is worth a try.

The second approach would be to identify which foods cause you problems, and it may not be as obvious as beans or dairy. It could actually be a spice that reacts with the microbes in your microbiome, and that’s not always easy to identify. Some foods such as sugar alcohols that are often used as sweeteners in processed food can cause gas. Once you’ve discovered which foods cause problems, sometimes the best policy is to limit them or avoid them entirely.

The third approach goes hand in glove with the second and that’s to change your diet. Research continues to show that people who eat more plant-based foods have different and perhaps better functioning microbiomes than those who do not. That’s a tough sell in this keto world we live in, but the carbs a person eats should lean toward vegetables with some fruit rather than starchy vegetables and grains.

Finally, if you take a probiotic supplement, stop it for a couple of weeks and see what happens. Remember in Tuesday’s Memo, the excess gas stopped when the person stopped taking the probiotic. It may be that a different probiotic blend might work better. There are over 6,500 different microbes that have been identified, and it may take trial and error as well as newly developed probiotic blends before you get it right.

The Bottom Line

There are a couple of other things that can contribute to gas such as drinking carbonated beverages and simply swallowing too much air. For most people, it’s still an issue of fermentation in the microbiome. The best approach is trial and error until you get the diet, prebiotic, and probiotic in balance.

Unlike other health issues, excess gas can be uncomfortable and can result in embarrassing situations, but as long as you’re not standing next to a flame, shouldn’t be fatal.

What are you prepared to do today?

        Dr. Chet

What Causes Increased Gas?

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Over the years, I’ve learned this about people as it relates to their health: they notice every change in their digestive system. They have their own bathroom habits, and they don’t like anything that changes their pattern. If they make a change in their nutritional intake—whether it’s a food, a supplement, or a medication—and it impacts their pattern, they really don’t like it. What’s not as noticeable immediately is another digestive change, and that’s an increase in gas.

In one case, a person developed an increase in gas production—and not in a good way; she stopped taking a probiotic (after regular use for a couple of years) and the problem stopped. Another person noticed an increase in gas after adding an amino acid blend. Yet another noticed an increase in gas after starting a medication. What gives?

The microbiome consists of the bacteria and other microbes that reside in the digestive system. The primary way they do what they do is by fermentation; the result is the production of gas, and that’s perfectly normal. Any change that impacts the microbiome can change the production of gas. Other than stopping the food, supplement, or medication, what can we do about it? I’ll give you some ideas on Saturday.

What are you prepared to do today?

        Dr. Chet

RSV in Infants

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Our daughter-in-law, Kerri, is a pediatric respiratory therapist with 32 years of experience, so she was an obvious choice to talk to about RSV, especially in babies. You need to know more about RSV (respiratory syncytial virus), especially if you’re parents or grandparents of infants less than six months old. The CDC reference at the end has more information for all age groups.

RSV is very common, and most of the time it seems like a common cold; the CDC estimates virtually all children will have RSV by the time they’re two. But with higher infection rates this year, there will be more severe cases than normal. Treating the symptoms, especially the inflammation of the lungs and the potential for pneumonia, is critical if the infection progresses.

How Bad Is It?

How bad is RSV this year? This is the worst year my daughter-in-law has seen. In Charleston where Kerri works, they’ve got beds in the hallway of the NICU because of overflow cases. Her mentor in Virginia has been an RT for 40 years, and it’s the worst she’s ever seen. Cases are up in Grand Rapids, and we’re not even in the critical part of the season yet, which is winter and spring. So it’s serious.

What You Need to Know

Infants will have symptoms, but they can’t tell you directly. A decrease in energy level, decrease in appetite, irritability, runny nose, and coughing are common. The child may or may not have a fever.

This info from my daughter-in-law was surprising to me: infants are nose breathers. The most important thing adults can do is suction the mucus from the nose to keep their breathing pathway open. Yes, you’ll hear the wheezing in the lungs, but the pathway goes through the nose. Use saline drops to keep the tissues moist and a suction bulb to keep the nasal passages open.

More tips from Kerri:

  • Keep a humidifier going; that helps with maintaining the mucus’s fluidity.
  • If the infant has a fever, keep her cool. Don’t pile on a lot of blankets, although that’s seems counter-intuitive. The baby’s breathing rate is higher to dissipate heat, so keep her cool—not cold, just cool.
  • Finally, watch the baby. If he’s really struggling to breathe, especially though his mouth, seek medical attention immediately.

The Bottom Line

Let me repeat: for most people of all ages, RSV seems like a cold. A weakened immune response can cause serious illness, so we have to be cautious. That’s especially true for infants, but also applies to elderly people and anyone with a chronic health condition. As with a cold, you’ll want to manage fever and pain; keep the liquids coming to avoid dehydration.

If there was one good thing that came out of the COVID pandemic, it was that the general public is more knowledgeable about dealing with viruses: wash your hands, keep surfaces clean, don’t touch your face, and cover your coughs and sneezes. RSV is especially communicable, so wearing masks can be beneficial.

Remember, there’s no RSV vaccine yet so prevention is the best option. We want to keep those who can’t speak for themselves as safe as possible, so always pay attention.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/rsv/high-risk/infants-young-children.html

Virus Update: RSV

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We have a viral uptick going on right now, and it’s not COVID. My health news feed has been sending warnings about an unusually high number of cases of respiratory syncytial virus (RSV), a very common respiratory virus that’s usually not problematic. It generally causes mild, cold-like symptoms, and most people recover in a week or two. However, that isn’t true for everyone; RSV can be very serious for infants under six months and preemies as well as older adults.

Why is it so serious? RSV is the most common cause of bronchiolitis, an inflammation of the small airways in the lung called the bronchia, and pneumonia infection of the lungs in children younger than one in the U.S. If you’re a numbers person, each year in the U.S., an estimated 58,000 children younger than five are hospitalized with RSV infection resulting in 100 to 500 deaths per year.

The elderly are also at high risk, especially those with compromised immune systems. You want more numbers? It’s estimated that more than 177,000 older adults are hospitalized and 14,000 of them die in the U.S. due to RSV infection every year.

One more complication: there’s no vaccine for RSV. What can we do? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Protect Your Colon Health: Do a Test

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Continuing with our examination of the study on invited colonoscopies versus usual care, what could the researchers have said to cause any controversy? Remember, the comparative rates of diagnosing colorectal cancer were slightly lower in the invited group. The controversy came when they stated that there was no difference in mortality over the course of 10 years. That suggests that it doesn’t matter whether you’re specifically asked to have a colonoscopy or get one as part of your usual care—your risk of dying from colorectal cancer, the second leading cause of cancer deaths in the U.S., is no different. As you might expect, nothing is quite as simple as it appears to be.

Invitations Don’t Mean You’ll Accept

The stunning part to me was that only 42% of the people in the invitation group accepted and had the colonoscopy. This is where going back to ask why the subjects did or did not have the colonoscopy is important. The people were not identified by name but by a randomly generated number. In order for the data to be meaningful, we need to know why the potential subjects chose not to participate.

What About Other Diagnostic Tests?

The most common test at this point is the fecal occult blood test (FOBT). This test looks at a sample of your stool to check for blood; the key is that it’s blood that’s not visible to the eye (that’s what occult means in this case). Blood in the stool can be a symptom of several conditions including anemia and colorectal cancer; the test can also be used to identify genetic risk factors for colorectal cancer.

What the test can’t do is identify those people who have adenomas, a precancerous growth. Not all adenomas become cancerous, but they can be removed during a colonoscopy and tested for cancer. The fecal occult blood test can’t detect adenomas that are not bleeding.

The Bottom Line

The thing to remember is that testing is important, whichever way you do it. Colonoscopies require the marvelous “colon cleansing preparation” that may be too hard on elderly people or those with poor health; it’s no walk in the park for anyone. The cost may also be prohibitive depending on the type of insurance coverage one has. Protecting your colon health calls for a serious discussion with your healthcare provider to find out what the best course of action is for you. Family and personal history both have a role to play and need to be considered.

The purpose of research such as this is to help you find what your path should be. But once you know it, follow it. Ignoring it may bring undesired outcomes—and the last time I checked, death is permanent.

What are you prepared to do today?

        Dr. Chet

Reference: New England Journal of Medicine. 2022. DOI: 10.1056/NEJMoa2208375

Research Update on Colon Health

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If I were to take a poll, I’d wager that most people would skip a colonoscopy if there were an alternative that provided the same information on the health of your colon. The key words are “same information”—not only that, but provided the same diagnostic outcomes. Will the alternative test tell you whether you have colorectal cancer? Will it give information on the health of your colon? A recent research paper called that into question. Let’s take a look at the study published in the New England Journal of Medicine.

Researchers from several European countries (Poland, Norway, Sweden, and the Netherlands) wanted to examine the difference in outcomes between two groups. The first were a group who were invited to have a colonoscopy. The second was a group that received usual care. Simply put, the second group relied on physicals and doctor discussions to decide whether to have a colonoscopy or not. They recruited over 28,000 people from 55 to 64 years old for the invited colonoscopy and compared them with over 56,000 people who received the usual care.

After following the subjects for 10 years, they found the risk of colorectal cancer diagnosis was 0.98% in the invited group versus 1.2% in the typical treatment group. That looked pretty good for colonoscopies. But it’s what the researchers suggested in the discussion portion of the article that raised questions. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: New England Journal of Medicine. 2022. DOI: 10.1056/NEJMoa2208375

Yes, Fiber Is Healthy

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Almost all Americans need to increase their fiber intake by eating foods containing fiber as well as using supplemental fiber if needed. I do and will continue to do so with one caveat, which I’ll talk about later. Let’s get into the research that caused the headline about fiber and cancer.

Genetic Defects Were the Underlying Problem

Based on observational studies, researchers examined the role of soluble fiber on metabolic syndrome (MetS) in mice—not just any mice but mice that had a specific defective gene called Toll-like receptor 5 (TLR5). These mice develop MetS when fed a modern diet. Researchers used several types of soluble fiber, including inulin and pectin. While the symptoms associated with MetS were decreased, they discovered that close to half the TLR5 mice developed liver cancer while the normal controls did not. Why? One thing they noted was that the TLR5 mice became jaundiced due to bile acids in their blood.

Based on prior research, researchers suspected that something was causing bile acids to enter the blood stream. There’s a strain of mice, C57BL/6 mice, that has a defect which causes portosystemic shunt (an abnormal vein connecting the blood supply returning from the intestines to the vein returning blood to the heart, bypassing the liver). That allows bile acids to build up in the blood stream, damaging the liver, and causing liver cancer. The use of high soluble-fiber diets speeds up that process because of the fermentation of the fiber by probiotics. Hence that’s why the results associated fiber with cancer. But is it an issue in humans?

Soluble Fiber and Liver Cancer in Humans

I think the risk to humans is negligible for two reasons. Based on the latest data, the risk for portosystemic shunt in humans is about one in 30,000. The researchers suggest it may be higher, but we don’t test for it. The caveat I mentioned? Bile acids can be detected by a simple blood test; if you want to be sure you don’t have an issue, just request that test to eliminate the shunt or any other cause of bile acids in your blood.

The second reason is that the researchers fed the mice 10% of their diet as fiber. In one trial the inulin content was 2.5% while in another it was 7.5% of the mice’s dietary intake. The Daily Value for humans eating 2,000 calories per day is 1.4% or 28 grams, and that’s mixed fibers. We currently average 0.7%. It doesn’t seem likely that even people who supplement their food with fiber supplements will reach a comparably high level of intake.

The Bottom Line

Don’t for a minute think that this research isn’t important because it is. We live in a society that believes if some is good, more must be better. What they’ve shown is that some soluble fiber is good for weight loss and the symptoms of MetS, as well as keeping your bowels moving smoothly. We don’t need to overdo anything; we just need to do the average. Try to get about 25 to 35 grams of fiber daily from foods and supplements, get the blood bile test to be extra cautious, and you’ll be fine.

What are you prepared to do today?

        Dr. Chet

References:
1. https://doi.org/10.1016/j.cell.2018.09.004
2. https://doi.org/10.1053/j.gastro.2022.08.033

Does Fiber Cause Liver Cancer?

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What? Okay, that isn’t exactly what the health headline said. An article published in SciTechDaily last week said Diets High in Processed Fiber May Increase Cancer Risk. It appears they published the press release about a study from the University of Toledo. What piqued my interest was that it focused on my favorite fiber, inulin. That’s one of the soluble fibers I use together with psyllium husks every day.

What made this particularly disturbing was that the processed fiber appeared to contribute to a particularly nasty type of liver cancer called hepatocellular carcinoma. As you know, headlines are meant to grab your attention, but everything isn’t always as portrayed.

Let’s begin with some facts. In the U.S., 28,600 men and 12,660 women will be diagnosed with all forms of liver cancer in 2022. While it’s in the top 10 types of cancer, the U.S. has a population of 330 million, so that’s still not a huge number; rates are higher in less developed countries.

Typical intake of all types of fiber is about 14 grams on average, less than half of what the fiber intake should be. Depending on diet, fiber intake should be about 1.4% of the dietary intake by volume.

On Saturday, I’ll talk about the studies and put things in perspective. I’ll also be taking my fiber every day as well.

Tomorrow night is the monthly Insider Conference Call. I’ll be covering several health topics in the news as well as the 3/7 weight training program. Become and Insider before 8 p.m. Wednesday and you can join the call at 9 p.m.

What are you prepared to do today?

        Dr. Chet

Reference: SciTechDaily. 10/10/2022. Diets High in Processed Fiber May Increase Cancer Risk

Dealing with Delayed-Onset Muscle Soreness

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Muscle soreness generally occurs after a new workout routine, especially weight training. It generally involves eccentric contractions: the simplest way to explain it is the resistance to a movement. During a bicep curl, eccentric contractions would be resisting the lowering of the weight as you return to the starting position. But that’s not exactly what I mean. This is an overall fatigue and soreness that affects more than muscle. Let’s call it delayed-onset body soreness.

What Causes Delayed-Onset Body Soreness?

Movements that are repetitive, that last for hours, that aren’t part of your normal routine—those are the likely causes of delayed-onset soreness. It doesn’t matter how fit you are or how strong you are. While fitness and strength will help, it’s still going to happen occasionally. When you perform movements, even if they’re as simple as standing and answering questions like I did, there are stresses on the ligaments, tendons, and joints as well as the muscles, minute after minute, hour after hour. Micro-tears can occur in multiple types of tissue, and that can cause inflammation and pain.

What you feel the next day is actually the repair process in progress.

Can You Prevent DOBS?

Probably not because it’s caused by something you do infrequently: rake leaves, walk up and down arena steps, shovel snow, or help someone move. But stretching on a regular basis probably helps. Ever stand up, take a deep breath, and reach over your head to stretch just about every muscle in your body? Something as simple as that a few times a day will help keep you limber. Yoga would be great but whatever it is, it has to be consistent to be effective.

The Bottom Line

Infrequent events with repetitive movements are going to happen. I don’t think there’s a need to specifically train for them other than stretching on a regular basis. Taking nutrients such as glucosamine and vitamin C may help the repair process; you can take them in the days leading up to the event as well as after, along with whatever pain meds work best for you. No question that regular aerobic exercise and strength training will help, but most likely won’t prevent soreness. The good news is that this is a problem that should resolve itself quickly.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.acsm.org/docs/default-source/files-for-resource-library/delayed-onset-muscle-soreness-(doms).pdf?sfvrsn=8f430e18_2

What Did I Do?

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Fall is here and those wonderful multi-colored leaves everyone seems to love are making their appearance here in Michigan. While they can be stunning to look at, they will need to be raked and recycled. That’s going to lead to people waking up the next day (or days because they all don’t drop on the same day) feeling like they’ve been run over by a truck. Sore. Fatigued. Hard to move.

Recently Paula was on a mission to find a specific item so we went to six different big box stores in one afternoon, which is something we hadn’t done since before covid. She felt fine and made it through the day but was wiped out the next day. I just spent the weekend in St. Louis with a few thousand of my closest friends talking and answering questions. Both days I was wiped out and went to bed early. Ever help someone move? Remember how you felt the next day? You ask yourself, “What did I do?”

The technical term is delayed-onset muscle soreness. I think it’s really more than just muscles involved. The question is why? Raking leaves and walking through stores isn’t strenuous. Neither is standing and talking. What gives? Any time a task requires repetitive movements you’re not used to doing, you’re at risk for delayed-onset muscle soreness. I’ll talk about how to deal with it on Saturday.

What are you prepared to do today?

        Dr. Chet