Cleaning Up and Moving On

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I look around my desk, and what used to be a dumping ground for unopened mail, notes written on legal pads, sticky notes, and the backs of envelopes, is almost pristine. It was time to clean up and move on. I’m prepared to do the same thing with my Memo list of subscribers; next month I’ll be deleting those who haven’t opened emails in a year or more.

I know habits change. New email addresses are created without deleting the old account. People may not be interested in getting the Memo any more. The Memo may go directly into their spam folder. In some cases, the mailbox is full and the email gets bounced. In the email world, any of those actions show as red flags and can impact how email is treated by servers. Purging the list keeps my email address in good standing in the email world and helps keep me out of your spam folder.

You may notice that I sometimes put in links for you to click to save you time if you want further information. In some cases, that will send the Memo to your spam folder. If you don’t get two Memos per week, that’s a good place to look; you can also designate my email address as Safe or Not Spam.

Did you know that forwarding a Memo to someone can get you unsubscribed? If whomever you forwarded the Memo to clicks the Unsubscribe button at the very bottom, they unsubscribe your email address, not theirs, and there’s no way for me to know that’s not what was intended. If that happens, you’ll get an email from me saying you’ve been unsubscribed. I appreciate that you want people to read what I write, but be aware that can happen. It’s safer (although more cumbersome) to scroll down to the bottom of the Memo text and click the turquoise “Forward” icon. In most email systems, you can also forward the Memo after cutting off the large green box at the bottom where the Unsubscribe button appears. Of course, subscribing is free so you can always go to drchet.com and subscribe again if you’re no longer getting the Memo; if you subscribe and get the message that you’re already subscribed, then you definitely should check your spam folder.

Tuesday, we’re back to health news. Enjoy the rest of your weekend.

What are you prepared to do today?

        Dr. Chet

Purge Week

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An Insider sent me an interesting link about meat—more specifically, the red liquid that’s often at the bottom of the plastic bag when you bring home meat from the grocery store or the butcher. I’ll bet you thought it was blood because that’s what it looks like, but that would be incorrect. It’s called purge by butchers and meat scientists.

If you understand three things, purge will be easy to understand.

  • All the blood is drained immediately from animals after slaughtering; if not, it will coagulate quickly and cannot be removed.
  • Muscle in animals is about 73% water. Depending on several factors, including temperature, that water starts to drain from the meat.
  • Muscle has an iron-containing protein called myoglobin that can store oxygen; myoglobin is dark red.

When the protein degrades, myoglobin leaves with the water; it’s red and that’s why people think it’s blood. If you purchase your meat very cold, purge will be released as the temperature rises, depending on which muscle the cut of meat was from, how the meat has been handled and processed, and how long it takes you to shop and drive home. And if you like your steak “bloody,” I’m sorry to tell you that’s not blood; that’s purge.

To purge also means to eliminate. I’m going to do that to my email lists. If people haven’t opened an email in the past year, it’s time to remove them from my list. I don’t make that decision lightly, because there was a reason they subscribed in the first place. In Saturday’s email, I’ll explain why I’m going to trim my list in August.

What are you prepared to do today?

        Dr. Chet

Reference: American Meat Science Association. www.meatscience.org.

The Facts on Collagen Supplementation

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After covering collagen basics on Tuesday, two questions remain. Are collagen supplements absorbed or are they digested just like any other protein? Second, does research support the use of collagen supplementation to improve skin quality? Let’s take a look.

Collagen Absorption

The data on collagen absorption is sparse. In almost every study, dipeptides or tripeptides are used; then the change in serum peptides over several hours after ingestion is measured. There’s enough data to suggest that the tripeptides are absorbed as a whole without being broken into individual amino acids.

What hasn’t been tested yet is whether protein ingestion from a meal may interfere with the digestion and absorption process.

Is Collagen Supplementation Effective?

Several review articles have summarized the absorption of collagen. Eleven studies with just over 800 subjects were included in the latest review; eight of those studies used collagen hydrolysate, 2.5 to 10 grams per day, for eight to 24 weeks. They tested whether the supplemental collagen benefitted people with pressure ulcers, dry skin, aging skin, and cellulite, with generally positive results. Two studies used collagen tripeptides, three grams per day for four to twelve weeks, with notable improvement in skin elasticity and hydration. Again, positive results.

I was disappointed to find no research on whether collagen may benefit other connective tissue such as tendons and ligaments. That may help the recovery from rotator cuff or Achilles tendon surgery, among many other conditions.

Practical Application

Based on the data, it appears that collagen tripeptides are absorbed intact to some degree, although I’m still concerned about the absorption in relation to meals. I’m already recommending that essential amino acids be taken at least 15 minutes or longer before a meal. But I think to help with absorption, take collagen tripeptides, usually collagen I and III, about 15 minutes before a meal if it contains protein or a couple of hours afterward. Giving the digestive system a head start may increase absorption. I put mine in my second cup of coffee because it has no flavor and the heat doesn’t impact the tripeptides.

The Bottom Line

Although the evidence is not overwhelming, there are positive results using collagen supplements to benefit your skin. Research shows that it will be absorbed in a form that can help the body make structural collagen for the skin. While the studies I cited used differing amounts of collagen for varying amounts of time, I would try 5 to 10 grams per day for at least 90 days to see results. And pay attention to your muscles and joints; you may find they benefit as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Biol Pharm Bull. 2016;39(3):428-34.
2. StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531
3. J Drugs Dermatol. 2019;18(1):9-16.

Are Collagen Supplements Effective?

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I spent the past weekend with a few thousand of my closest friends, some in person and others via live broadcast; that always means I get some good questions, including one about collagen I couldn’t answer.

A healthcare professional had told one attendee that collagen supplements were broken down into individual amino acids before being absorbed, as proteins are from any source, thus he was wasting his money buying collagen supplements. I decided that the answer could benefit everyone, so this week we’ll cover collagen basics.

Collagen is a protein and therefore is made up of amino acids. We can manufacture it, but just like other characteristics of aging, we make less as we get older. Collagen provides structure to all connective tissue such as skin, tendons, bones, and ligaments. We notice it most in our skin. Crepe skin? Smile lines around the eyes? Those come courtesy of reduced collagen. There are close to 30 types of collagen that have been discovered, but the most prevalent are types I–IV. Of that, over 90% are type I.

Collagen is made of repeating sequences of tripeptides or three amino acid blocks; they form three chains that twist to make a triple helix. The primary amino acid sequence of collagen is glycine-proline-X or glycine-X-hydroxyproline where X can be any of the other 17 amino acids. Glycine is the amino acid with the smallest structure; that allows the collagen triple helix to twist tightly and thus adds strength to the structure wherever it’s used, including the skin.

That’s the structure of collagen. On Saturday, we’ll answer the absorption question and look at how to use collagen most effectively. In tomorrow night’s Insider conference call, I’ll cover collagen more in depth as well as comment on the recent United States Preventive Services Taskforce on vitamin supplementation. If you become an Insider before 8 p.m. Eastern Time tomorrow, you can join me live to get your questions answered.

In the meantime, maybe you should just be proud of those smile lines—you’ve earned them, after all.

What are you prepared to do today?

        Dr. Chet

Reference: StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531

It’s Still All About the Calories

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The keto vs. Mediterranean diet study was interesting for a variety of reasons. The researchers deserve a lot of credit for even attempting to try a study of this magnitude; 40 subjects may not seem like a lot, but to provide food via delivery together with instructions on preparation is very expensive and labor intensive. It should be noted that a portion of the study took place during the lockdown phase of COVID-19; that delayed some testing, but to their credit, the subjects affected continued the particular diet they were on for the two weeks until testing could be scheduled. Here are my thoughts on the results.

Blood Lipids

  • Subjects on the keto diet showed a greater decrease in triglycerides (TG) than those on the Mediterranean diet.
  • On the other hand, those on the Mediterranean showed a greater decrease in LDL-cholesterol than did the keto diet subjects.

While the researchers discussed it at length, I don’t think it was relevant. All subjects began with average fasting TG in the normal range. While both diets decreased TG, that the keto diet reduced it slightly more isn’t earth shattering when you start at a normal reading.

The same holds true for the LDL-cholesterol. Yes, the Mediterranean diet reduced it while the keto diet increased it, but the net was 6 mg/dl over the initial readings. What could have been concluded was that neither diet reduced LDL-cholesterol by an amount that was clinically meaningful.

The Microbiome

There were no tests of the changes in the microbiome under each diet reported—at least not yet. Subjects had a definite decline in fiber intake, especially when they provided their own food in the keto diet. The Mediterranean diet saw an increase in fiber intake when subjects provided their own food.

Why mention this at all? The microbiome controls the initial processing of nutrients. In addition, the immune function begins in the gut. While the keto diet may have provided some benefit related to HbA1c, at what cost? We simply don’t know. What we do know based on other research is that the lack of fiber changes the probiotic content of the microbiome.

The Bottom Line

The data showed that the subjects averaged 200 to 300 fewer calories per day regardless of diet and maintained the reduction over both diets. They ate better, they ate less, and they lost weight.

I think this study was important because it leaves us with better questions to ask in the future, such as: how would health measures be affected if subjects reduced calories another way? It also proves what I’ve been saying for years. The average weight loss after the study was 13 to 17 pounds, and that was maintained during the follow-up period. This was not a weight loss study, yet regardless of the initial diet, the subjects lost weight. I’ve said it before and I’ll say it again: regardless of the type of diet, it’s still all about the calories.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Face-Off: Mediterranean vs. Keto

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Last week ended with the publication of an interesting study on two popular diets, Mediterranean and ketogenic, and their potential benefits for people with elevated HbA1c levels; HbA1c is a blood test that measures your average blood sugar levels over the past three months. I use the word “diet” as a description of the type of foods eaten, not as a weight loss program.

The researchers constructed what they termed the Well-Formulated Ketogenic Diet plan to compare with a Mediterranean diet. Both approaches reduced sugar, refined carbohydrates, and starchy vegetables; the Mediterranean diet added unprocessed whole grains, beans, and fruit. The subjects had either prediabetes or type 2 diabetes. The primary goal of the 36-week program was to monitor changes in HbA1c along with a variety of secondary measures including blood lipids.

The 40 subjects were randomly assigned to using the keto diet for 12 weeks and then switching to the Mediterranean diet for 12 weeks or vice versa. Food was delivered to all subjects for the first four weeks of both phases, which I think is brilliant—one of the hardest parts of learning a new way of eating is discovering how the foods can be combined and prepared, along with getting used to the different tastes. After those four weeks, they provided their own food that fit within the particular diet they were on at the time. The final 12 weeks were left up to the subjects.

The results demonstrated both dietary approaches reduced HbA1c about the same amount, and the decrease was maintained regardless of which diet they began with. However, there were some differences as well. I’ll give you those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Citric Acid: Stone Killer?

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Increasing fluid intake can reduce the risk of developing stones of all types: kidney stones, gall stones, bladder stones, or uric acid crystals. But there’s one more thing you could do to reduce the risk—add some citric acid to the fluids you drink. While the research on using a form of pharmaceutical is not clear yet, this is one thing we can do with diet.

We expect electrolytes such as sodium, potassium, magnesium, and calcium in sport drinks, but adding citric acid can help your blood’s pH as well as reduce the formation of stones. The simplest approach would be to drink limeade or lemonade; fresh squeezed or a manufactured drink, citric acid makes the drink tart and sour. The food with the highest amount of citric acid is lime, with lemon a close second. I typically use sugar-free lemonade and add the juice from one lime in a 16-ounce container. It’s very tart but not inedible.

Avoid the mentality of “if some is good, more must be better.” Research hasn’t shown that to be true, so let’s stick to what we know. And while citric acid is a weak acid, it may still give you an upset stomach if you have too much. One lime or lemon per day seems to reduce stone formation.

What are you prepared to do today?

        Dr. Chet

Reference: Korean J Urol. 2014 Dec; 55(12): 775–779.

Don’t Forget Fluids

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With the unseasonably warm weather many of us are experiencing, I thought it was time to remind you that it’s not all about water: the emphasis should be on fluids. Coffee, tea, milk, soda, sports drinks, soup—all of those count toward your daily fluid intake.

It’s true that some drinks are better than others. Sugary drinks take extra fluid to keep your blood osmotically balanced or to store the sugar as glycogen, but all drinks count as fluid. The only drinks that don’t count are alcoholic drinks because alcohol is a diuretic; caffeine isn’t a true diuretic, so worry about the caffeine only as it affects your sleep. But the rest? All good. Don’t forget that most vegetables and fruit are mostly water, so they count as fluid as well.

How much fluid do you need? One-half your body weight in ounces (if you weigh 200 pounds, make sure you’re getting at least 100 ounces of water every day), and more if you’re in the humid heat.

There’s one more thing you could add; I’ll let you know what on Saturday.

What are you prepared to do today?

        Dr. Chet

Taking Biotin? Tell Your Doctor

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Biotin is a B vitamin often used for skin health among other benefits; it’s involved in many metabolic processes in the body. Due to its chemical nature, it’s used as a coenzyme in several tests. One of those tests is for troponin, a protein released from the heart into the bloodstream during a heart attack. There are no large trials that have tested the effects of biotin on troponin testing, but a physician or lab tech needs to know if you’re taking extra biotin.

The amounts in multi-vitamins appear to cause no issues, but adding the biotin in products to improve hair, skin, and nails could be enough to impact the test. Did it in our subject’s case? Maybe. We don’t know for sure.

As we approach this long holiday weekend, take a minute to add up all the biotin you’re taking in supplements. If it’s more than one gram, and if you end up in the ER because of a suspected heart attack or stroke, tell the lab tech. It doesn’t impact your having a heart attack; it impacts the test as to whether you may have damage to your heart as a result of a heart attack. You don’t want that test to be inaccurate because it’s important to arriving at the correct diagnosis.

Enjoy the July Fourth holiday, check out the audios on sale for men and women, and I’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Still in Doubt? Check It Out Again

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In the last Memo, I said we weren’t done with the person who had waited three days. We spoke again after a couple of days, and she still had the same pain profile: back and chest, not as intense. She’d had a heart catheterization that came back clear: no blockages in any of her coronary arteries. Still the discomfort bothered her.

I’ve talked to many people over the years who were going through the same thing. I always recommend they go to the ER immediately. She had done that, albeit a couple of days later, and the diagnosis was indeterminate. She did have extremely high blood pressure which had come down with treatment in the hospital, but like most people, she disliked some of the side effects and didn’t want to take the meds. As we talked, she mentioned that she also had dizziness going up a flight of stairs and her vision was blurry. That was it—that’s a symptom of a stroke, so I recommended she go back to the ER if someone was there to drive her.

They ran more tests including and MRI of her head. No blockages or evidence of a stroke; her blood pressure was still way too high, but that could be managed at home. Still there was a diagnosis of a heart attack based on enzyme levels even though the ECG didn’t show it. She is working on lifestyle changes to get off blood pressure medications if possible.

But the enzyme level triggered something in my memory, and I’ll tell you about that on Thursday. Make sure you read it before the holiday weekend begins. Remember, the audios Dr. Chet’s Health Tips for Women with Dr. Pam and Health Tips for Men are still on sale through the Fourth of July.

What are you prepared to do today?

        Dr. Chet