Do Artificial Sweeteners Increase Cancer Risk?

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Last week, my health news feed filled up with headlines that almost all sounded like this: “Artificial Sweeteners Linked to Higher Cancer Risk!” This isn’t the first study to suggest that relationship and it won’t be the last. This French epidemiological study of over 100,000 subjects collected data for more than seven years. One of the things I almost always criticize is data collection using food frequency questionnaires. Not this time.

The subjects completed at least two food diaries per year. Portions were assessed by comparing with pictures of portions sizes. What they did particularly well is to list all the foods that contained artificial sweeteners, including all brand names; then they tested most of the foods in the lab to verify the presence of artificial sweeteners. Researchers collected as many confounding variables as they could to account for everything that contributes to cancer.

After the statistical analysis, the overall hazard ratio demonstrated a 13% increase in the risk of cancer. Aspartame and acesulfame potassium were the artificial sweeteners with the highest hazard ratio among all those tested. Based on this information, do we need to avoid artificial sweeteners or at least lower the amounts we consume? I’ll talk about that Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1371/journal.pmed.1003950

Do You Need a Fruit-and-Vegetable Concentrate?

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Vegetable-concentrate and fruit-concentrate products are popular now, judging by the number of ads on TV and the web; the implication is that they can replace real fruits and vegetables in the diet.

For the fruit concentrate, manufacturers remove all the fiber and water, yielding concentrates from various fruits and phytonutrient blends plus aloe vera. The supplements include 2,000 mg per serving with 17 ingredients; that works out to 120 mg per ingredient if equally divided. Are those amounts significant, especially after removing the fiber and water? Hard to say without a lot of research on each nutrient to find the effective amount, both individually and combined; for example, we don’t know if there’s an interaction between the nutrients that affects absorption and utilization.

One more type of concentrate would be single-nutrient supplements, such as a specific type of curcuminoids from a certain species of turmeric. Manufacturing is not my area; it takes some hard-core chemistry to figure out how to get the nutrient you want.

Here’s an example: curcumin is extracted from the dried root of the rhizome Curcuma longa. After drying, the process of extraction requires the raw material to be ground into powder and washed with a solvent that selectively extracts coloring matter, the curcuminoids, which then can be put into supplement form. Might there be some vitamins and minerals remaining? Probably, but that isn’t the point of the supplement. The curcuminoids are.

The Bottom Line

At the end of the day, our bodies need the fiber and water from plants to feed our microbiome. That’s why these types of products complement the vegetables and fruits you’re supposed to be eating—they don’t replace them.

I think the best way to get the best of both worlds is eating the five to ten servings of fruits and vegetables you’re supposed to eat, plus taking a multivitamin-multimineral with plant concentrates as insurance to make sure you get all the basic nutrients. If you know you’re not going to be eating as you should for a while, like an accountant working 14-hour days at tax time or a student cramming for finals, a fruit-and-vegetable concentrate might be a good addition. Then add specific concentrate-phytonutrient blends you may be missing in your diet; for example, if you hate mushrooms, take a mushroom-blend supplement. Now you’ve got all your bases covered.

What are you prepared to do today?

        Dr. Chet

Reference: www.fao.org/fileadmin/templates/agns/pdf/jecfa/cta/61/Curcumin.pdf

Vitamins and Minerals in Supplements

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I got an interesting question last week about a supplement that contained a blend of fruit and vegetable concentrates: vitamins and minerals aren’t included on the label, so are they in there? The answer is probably. It all comes down to the purpose of the supplement.

A concentrate is typically the entire vegetable or fruit with the water removed by a dehydration process; whatever is in the plant will be in the concentrate. You could liken this to drying a fresh herb to use as a spice. A more sophisticated process is to remove some of the fiber as well; that would remove solids, but some vitamins and minerals could remain.

Another variation is if a company were to focus on a phytonutrient blend, such as the polyphenols and hesperidin from citrus fruit. They would standardize the supplement to the amounts of those phytonutrients but wouldn’t be concerned about vitamins or minerals unless they met a percentage of the RDA.

There is still more precision in concentrate and phytonutrient supplements, and we’ll talk about them on Saturday.

What are you prepared to do today?

        Dr. Chet

Wait a Minute!

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It was a beautiful day in Grand Rapids on Thursday: 65 degrees, hazy sunshine, no wind, and a perfect day to take a kid to the park. Riley likes basketball (as is required of all children in the Midwest); he can’t hit the rim with the net at 10 feet, but that didn’t stop him and three other kids his size. Attempts were many, but baskets were few, and they didn’t seem to care.

Naturally I had to give it a try. I tried from 10 feet to the right of the basket, but my shot fell two feet short. Whoa! Tried again, and watched the ball sail under the basket. So in spite of having a three-month old knee, I tried a jumpshot—and stumbled a little as I landed. Yikes. My balance, spatial awareness, equilibrium, and power all seem to have left me in the past few months.

I sat down on a bench and pondered, “How do I get back from this far down?” I never expected things to get this bad so quickly; or has it really been even longer? I haven’t attempted anything like a jumpshot in a while. Then a phrase Riley likes to say popped into my head: “Wait a minute!” I already know the answers: Eat less. Eat better. Move more.

Moving more may mean going back to working on balance movements; spatial awareness may mean standing tall, closing my eyes, and touching my nose with my index finger. Neural pathways have to be awakened. They’re still there, just dormant.

There may be no NBA in my future, but I’ll get back to hitting that 15-foot baseline jumper this summer. Lucky for me, I have a built in practice buddy who’s always ready to play. Grandkids are the best!

What are you prepared to do today?

        Dr. Chet

The Default Is Always Exercise

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Ever have one of those days? For no particular reason at all, you don’t really want to bother watching what you eat or doing any exercise. What do you do?

Get on the floor and do five or ten push-ups or sit-ups, or get on your exercise bike and get your legs going for one minute. Then re-assess: what’s next? Maybe you stick with floor exercise. Maybe you put on some walking shoes and walk around the yard. Then you decide it’s a nice day so you’ll go for a longer walk. Or bike ride.

Or maybe you’ll just stop. That’s okay as well. Exercise is always the default to get yourself moving in the right direction. Maybe you’ll find out you can do more sit-ups than you thought.

It’s important that you think about why you didn’t care about your exercise or meal plan. Are you coming down with something? I’m currently battling a Supercold, so I know how that can sap your good intentions. Are you feeling down about something? Is it a small setback? Or is depression slipping up on you? Whatever the reason, being active beats sitting and thinking you’re not worth anything. When it’s one of those days, getting the blood moving is the way to get going.

What are you prepared to do today?

        Dr. Chet

Lessons from the Starvation Study

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The analysis of data in the Minnesota Starvation Study was immense—1,385 pages in two volumes—but I found two fascinating quotes from interviews with the subjects and lead author Dr. Ancel Keys. Let’s begin with a quote from one of the subjects in an interview 40 years later.

Lesson 1: How You Know You’re Restricting Food Too Much

“I don’t know many other things in my life that I looked forward to being over with any more than this experiment. And it wasn’t so much . . . because of the physical discomfort, but because it made food the most important thing in one’s life. . . food became the one central and only thing really in one’s life. And life is pretty dull if that’s the only thing. I mean, if you went to a movie, you weren’t particularly interested in the love scenes, but you noticed every time they ate and what they ate.”
Harold Blickenstaff, Study Subject

If you try to restrict calories, and you’re obsessed with food all day long, you’re restricting calories too much. For most of us, lowering our intake 10% to 15% by making better choices should not be that noticeable. Yes, it takes a little time to get used to eating a different way, but it shouldn’t create an obsession with food.

Lesson 2: Post-Weight Loss Honeymoon Period

“Enough food must be supplied to allow tissues destroyed during starvation to be rebuilt . . . our experiments have shown that in an adult man, no appreciable rehabilitation can take place on a diet of 2,000 calories a day. The proper level is more like 4,000 calories daily for some months. The character of the rehabilitation diet is important also, but unless calories are abundant, then extra proteins, vitamins, and minerals are of little value.”
Dr. Ancel Keys, Lead Scientist

Caloric restriction is used to lose weight as well as to try and attain the many benefits of long-term caloric restriction. Eventually you reach a point of unity; you achieve your goal weight and that’s where you maintain.

But if you’ve ever reached a weight loss goal, chances are you’ve tempted fate: you experiment to find out if you can eat a little more of your favorite foods. You add little at a time, and you don’t see the scale move—at first. But eventually, the honeymoon period ends and you begin to gain back the weight. It’s happened to me several times. Be aware that it will happen to you. Remember, it’s always about the calories. Keep that in mind and you’ll abandon that weight permanently.

The Bottom Line

One more item from those interviews 40 years later: to a man, the subjects all said they’d do it again. In spite of the deprivation they went through, they knew the knowledge gained was important. I think it speaks to their character to know they would make those sacrifices again.

These two quotes provide us with guidelines. Keep them in mind so you know when you may be overdoing restricting or eating. We’re after the long-term benefits, so keep adjusting until you make it your way of life.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

The Right Meal Plan for You

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“On Day 1 of semistarvation, February 12, 1945, the men sat down to a meal that included a small bowl of farina, two slices of toast, a dish of fried potatoes, a dish of jello, a small portion of jam, and a small glass of milk.”

This was a quote from the Minnesota Starvation Experiment to give an example of the meals the subjects ate during the six-month study. In our carbs-obsessed society, that’s just about the worst meal imaginable. Remember, the purpose was to lose 25% of their body weight in six months. They could eat only the foods that would be available during WWII; the non-combatants in the areas where the war was fought had been semi-starved for years, and we had to know how to begin to feed them so they didn’t get sick from overconsumption.

When I said it’s all about the calories, I really meant it. If you’re ready to try calorie restriction, eat exactly what you’re eating now but reduce it by 11% to 15%. It’s also a great time to eat better with more vegetables and fruit and less fried food, but it’s not mandatory. The Right Meal Plan is one you’re willing to maintain for the rest of your life.

I’ll cover a couple more lessons from the Minnesota study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

Semifinal Thoughts on the CALERIE Study

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In case you’re thinking, “Wow, I can’t believe he’s still talking about this one study”—I know! I don’t typically spend this much time reviewing a single study, but this one answered a lot of questions about the benefits of cutting calories. Even with 60 publications so far from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) clinical trial, there’s still a lot more info to come and two big questions still to be answered.

More Results from the CALERIE Study

In this first controlled study of calorie restriction in healthy humans, researchers found that:

  • Fasting insulin decreased
  • Triglycerides, total cholesterol, and LDL-cholesterol decreased
  • HDL-cholesterol increased
  • Glucose tolerance increased
  • Working memory improved
  • Inflammation markers such as C-reactive protein and TNF-alpha decreased

As more data is examined and new analytics are discovered to test more variables, I’ll be bringing you more results that may help you be healthier.

What We Don’t Know

The most important thing we don’t know yet is whether calorie restriction is an effective way to lose weight and whether all those great benefits would still apply. By definition all diets restrict calories, but this is not a diet; this is changing your lifestyle to maintain a calorie restriction of 11% to 15% for a long time, preferably for life. If you want to maintain the benefits, such as better insulin control and reducing the risk of heart disease, you never stop.

The other question is whether one type of eating style would be more effective than others to sustain the diet and its effects. Mediterranean? Keto? Vegan? We still don’t know for sure, but my opinion is that it doesn’t matter—it should be one that you can live with long term using the healthiest foods you can afford.

The Bottom Line

The CALERIE Study has demonstrated specific health benefits for calorie restriction of 11% to 15% for normal weight people. I think it will apply to overweight people as well. In the next few weeks, I’m going to drop my caloric intake by 12.5%, and I’ll keep you posted on how you can do it as well.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrition Reviews 2020: Vol. 79(1):98–113.

How Calorie Restriction Affects Your Metabolism

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Resting metabolic rate (RMR) is the number of calories you use while at rest—just lying around doing nothing. It’s the calories your body uses to operate your internal organs and your brain, etc. From the second you open your eyes, the calories you burn are considered activity-related calories.

The concern in trying to restrict calories as in the CALERIE Study is how that will affect RMR. Will it be proportional or will RMR go down too much, leaving you feeling too tired to do anything?

Researchers examined the data in a subset of normal-weight subjects over a year, looking at tissue losses and metabolic adaptations that contributed to the reduction in RMR. In other words, which organs or systems were impacted the most to lower RMR? They calculated the differences before and after the secondary study to see what changed, and found that the RMR was reduced by only 101 calories per day.

There’s more to come from the CALERIE study. One thing for sure is that a small reduction of 12% to 15% in calories every day can do you a whole lot of good—no special diets necessary—without losing your get up and go.

What are you prepared to do today?

        Dr. Chet

Reference: Int J Obes (Lond). 2022 Feb 18. doi: 10.1038/s41366-022-01090-7.

Can Cutting Calories Improve Your Mood?

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In research like the CALERIE study, there’s a tendency to focus on physical changes but what about mood, depression, and quality of life (QOL)? Did researchers find changes in those variables as well? Let’s take a look. While the two-year span of the data analyzed varied slightly from other phases of the study, physiological results were virtually identical to the other phases I’ve talked about in previous Memos.

Testing Procedures

For those readers familiar with the assessment tools typically used in measuring psychological variables, here’s a list of the instruments they used.

Mood: Beck Depression Inventory-II [BDI-II] and the Profile of Mood States [POMS]

QOL: Rand 36-Item Short Form and Perceived Stress Scale

Sleep: Pittsburgh Sleep Quality Index [PSQI]

Sexual function: Derogatis Interview for Sexual Function Self-report

Results

For simplicity’s sake, I won’t use numbers to report the results, because unless one is familiar with the scale for each assessment it wouldn’t be meaningful. Every following relationship was statistically significant or correlated. Compared with the ad libitum (AL) group, the caloric restriction (CR) group had significantly improved mood, reduced tension, and improved general health and sexual drive at month 24. Sleep duration had improved by month 12 and was sustained through month 24.

Greater percent weight loss in the CR group at month 24 was associated with increased vigor and less mood disturbance, improved general health, and better sleep quality. The researchers concluded that there was no negative impact of CR on psychological variables in normal-weight people.

I have a tendency to put more faith in measurable variables such as blood pressure or heart rate than inventories and questionnaires, but the results demonstrated that all measures moved in a positive direction when restricting calories: better perception of mood, health, QOL, more and better sleep, and even sexual vigor. There are indications that CR may be beneficial even in people who are normal weight.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2016 Jun 1;176(6):743-52.