Research Update on Colon Health

/in /by

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

/in /by

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?

/in /by

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

/in /by

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?

/in /by

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

How to Gain Weight Without Magic Pills

/in /by

How many of you took the time to look up the phytonutrient I gave you in Tuesday’s Memo? If you did, you know that it was one of the many phytonutrients in one of my favorite herbs: echinacea. The company that manufactures the weight gain pill called CB-1 claimed one of the ingredients was tested in a clinical trials and helped increase calorie intake for up to two hours.

I searched PubMed for every ingredient on the label, and the only studies I could find showed that some phytonutrients help add finishing weight to cows. There were no human trials related to body weight. Most of the research, especially on the phytonutrients, was related to improving the immune function in humans and animals.

My guess is that the 24-page booklet accompanying the supplement explains how to eat to gain weight: it comes with the purchase of a one-month supply of the product for just $70 plus shipping. So that’s it: no real research and booklet on how to eat. Such a deal!

Gaining Weight

There are some people who really want to gain weight, such as teen athletes and endurance athletes or people who’ve lost too much weight due to illness. Then there are those rare people who’ve always been thinner than they want to be. You might think my response would be to eat more and move less, but no. That course of action may help you get fatter, but it probably won’t be healthy. And the extra pounds may not go where you’d like them to go; how many of us wish for a bigger belly?

Here is the simplest approach. I’ll preface this by saying that anyone who has helped people gain weight probably has a different view, but after 35 years as an exercise physiologist, here’s my approach.

  • Increase protein intake by 20 to 40 grams per day. You can use food such as cooked chicken breast with about 10 grams protein per ounce or canned tuna in water at seven grams per ounce. That’s what we did before there were all the protein powders available today. You can measure the powders precisely and mix them in a smoothie or with milk for even more protein.
  • Use 10 to 30 grams of branch-chain amino acids (BCAA) and/or essential amino acids (EAA) every day, preferably after exercise. EAAs contain the BCAAs as well, so it’s your preference; both have shown an increase in muscle mass and strength when used in combination with a weight training program.
  • Incorporate weight training into your exercise program. There are a hundred different training regimens using everything from exercise tubes to weight training machines. The approach you use depends on your age and fitness level, but if you want to gain weight, you want to increase muscle as well as adding some fat.

That’s it. You already know how to get results based on the recent Memos: be consistent, week in, week out.

The Bottom Line

The focus in health always seems to be on losing weight and with 70% of the population overweight, there’s a reason for that. But if you need to add some weight, the simplest solution is often the correct one. Reasonably increase protein intake together with some of the right amino acids and start a weight training program. No need for magic pills because it’s the effort that gets results.

What are you prepared to do today?

        Dr. Chet

The Weight-Gain Pill

/in /by

I’m a self-proclaimed channel flipper—I always want to see what else is on when I have the remote. That’s why I did a double take when I saw the beginning of a commercial for weight gain. It wasn’t the typical approach, such as the product contains some formulation of branched chain amino acid, creatine, and other herbs that are supposedly associated with gaining muscle faster. Not this time.

The featured testimonial was a woman who was always “skinny” her entire life. The “before” picture was a very thin woman. Then she begins using this product with an herbal blend and some vitamins in it. She managed to gain 53 pounds! But it went with the product’s Facebook tag line: Curves are in—and we can help!

What was in this magnificent supplement? Vitamin D and zinc and the herbal blend. I’ll give you just one ingredient to give you a clue: dodeca-2E,4E,8Z,10Z-tetraenoic acid isobutylamide. I’ll tell you what I found in the research as well as describe a legitimate weight-gain program for those who might need it in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Why Are You Napping?

/in /by

I think people get frustrated with research because, just like I’ve described this week, one study says one thing while another comes to different conclusions. I hope that if you’ve been reading the Memo long enough you won’t be frustrated. In this case, why might studies that seem similar on the surface come up with different results?

First, while the studies seemed to ask the same questions, the studies actually had different objectives. In the Swedish study that showed a reduction in cardiovascular disease (CVD) events for those napping once or twice a week, the subjects were selected because they had not had any cardiac events or diagnosis of CVD. That means that any CVD that took place in the follow-up period was a primary event. In the other two studies, high-risk CVD events were excluded in one but other CVD factors were allowed such as hypertension.

Second, the purpose of the Swedish was designed to look at the development of CVD. The other two studies from Switzerland and the U.K. recruited over 500,000 subjects, but the research questions appeared to be decided after the studies began. There’s nothing wrong with that, but just because you have collected data on many variables, including genetics, doesn’t mean the data collected answer the research questions that were asked.

For example, the premise was that daytime napping causes CVD and hypertension. It seems likely that those conditions could cause fatigue, which would require daytime napping. Even if that were not the case, the subjects appeared to already have problems sleeping, which would impact hormone levels that contribute to CVD such as cortisol levels and many others.

The Bottom Line

These large studies attempted to make sense out of prior research that showed a link between daytime napping and CVD. What I think these studies demonstrate is that the cause of the nap is important. If it’s a planned nap designed to allow digestion or a pause in a long work day, it may not be hazardous to your heart health. However, if a person doesn’t sleep well or has sleep apnea and is fatigued because of that, being forced to nap during the day to recover can indicate a higher risk of developing CVD and hypertension.

Diet, body mass, lack of exercise, and other factors all have a role to play in sleep quality and CVD as well. If you plan your nap, you’re in control. If you’re forced to nap, time to look at your lifestyle and see what you can change.

What are you prepared to do today?

        Dr. Chet

P.S. Just for fun, these are a few of Riley’s more inventive napping positions. Oh, to be that flexible! Maybe the monkey blanket helps.

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

To Nap or Not to Nap

/in /by

About 16 years ago, Paula and I spent several weeks (spread out from March to October) helping our son Matthew build his boat-building shop. The daily routine went something like this: start early, break for lunch, take a 30- to 45-minute nap, then work the rest of the day. Matthew and Kerri live near Charleston, SC, where summer temperatures aren’t really conducive to construction work, so napping during the hottest part of the day made a lot of sense, but we also found we got a lot more accomplished every day.

I’ve used that approach off and on ever since. Recently, a couple studies were published that called into question whether naps were a good idea as they might be related to cardiovascular disease (CVD).

The research news caught my attention because the last time I read a research paper about sleep and napping showed that there was no relationship between napping and cardiovascular disease. In fact, the risk over five years of follow-up was a 42% decrease in CVD events when a person took a nap once or twice a week and no risk if a person napped every day (1).

In the most recent research, there was a relationship between napping and hypertension and napping and CVD in two separate studies with thousands of subjects (2, 3). Why? We’ll delve into why there were different results on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

The Secret to Prevention

/in /by

Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275