The Systems Theory of Health

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When we consider Aging with a Vengeance, a systems approach to health is critical. We cannot consider one issue such as high blood pressure or arthritis without understanding that it’s not just a single organ or parts of organs that are involved in improving if not completely fixing a health problem. As Aging with a Vengeance progresses, a systems approach will be a critical component of the process.

The concept of a systems approach to biology and subsequently healthcare originated in 1969 with an Austrian biologist, Karl Ludwig von Bertalanffy. He described what has since become known as General Systems Theory. This is the concept that “systems cannot be reduced to a series of parts functioning in isolation, but that in order to understand a system as a whole, one must understand the interrelations between its parts.”

It seems obvious when you read it, but that’s not how we approach health and disease today. Blood pressure involves the heart and blood vessels, but also the renal system and the nervous system, to name just two others. Our health is reliant on multiple organs working as part of a system and interacting with other systems. That also means that disease does as well. More about that on Saturday.

Tomorrow night is the monthly Insider conference call. I’m going to talk about a review study of the metabolism of artificial sweeteners you don’t want to miss. I’ll also answer Insider questions. Isn’t it time you became an Insider?

What are you prepared to do today?

        Dr. Chet

Reference: J Thorac Cardiovasc Surg. 2016 August ; 152(2): 593–594.

Artificial Sweeteners and Your Digestive System

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Before I address the concerns of the study on artificial sweeteners I talked about on Tuesday, be assured that I’m bringing you the facts as I interpret them. If you don’t use artificial sweeteners, I’m not trying to convert you, but I’m not going to let slide inflammatory headlines that only seek to raise fear where none should exist. The problem with the artificial sweeteners study is that it didn’t use a systems approach.

Bench Science

What the researchers did would be considered bench science. It’s basic in its approach: create a medium where the bacteria will grow, throw in various quantities of the artificial sweeteners, and see what happens. That’s a good first step in any type of research to see an impact on an entire organism. The same is true for examining the effect of the artificial sweeteners on the bacteria in the cancer cell medium. They established that chronic exposure to artificial sweeteners cause two probiotics to become pathogenic.

However, that’s where it ends. Trying to explain an increase in the obesity and diabetic epidemics because of how artificial sweeteners may impact a couple of gut bacteria doesn’t make any sense. It’s stretching things way too far with no evidence that what they’re describing happens at all. In effect, they’re trying to explain a health issue by looking at potential causes. Fine, good start—but now there’s a whole lot of animal and human clinical research that has to take place in order to prove whether it’s true, because what happens in a lab is often not what happens in a human.

Bench science has its place for sure, but it has serious limitations. In our headline-a-minute world, everyone is too eager to claim credit for something that hasn’t been proved.

The Digestive System

The human body is made up of various systems; the digestive system is one of them, but it doesn’t begin and end with the epithelial cells of the intestine. Food (including artificial sweetener) starts in the mouth with its salivary glands, goes down the esophagus, enters the stomach with its specialized fluids, travels the 20 to 30 feet of small intestine where more unique fluids do their jobs, and then the 10 to 15 feet of large intestine before it exits the body. The digestive system doesn’t act alone; it requires input from other organs and systems along the way: the pancreas, the liver, and so on. Every one of those could have an impact on the metabolism and elimination of artificial sweeteners and could impact how bacteria behave in the digestive system.

I could write a book on this subject, but let me just point out one thing that should be obvious: they tested two probiotic lines. Two. As of the last count, there are at least 6,500 different microbes that coexist within our digestive system. There are also trillions of them, each with a role to play, and we still don’t know what each and every one does. As I said, it’s complicated.

The Bottom Line

This study illustrates where good research begins: in bench science. There’s a lot more science that has to happen before we become alarmed about whether or not artificial sweeteners directly impact our microbiome, but their approach does raise a question that I’ll talk about next week: a systems approach to Aging with a Vengeance. We look at pain or other conditions as something that stands alone, but in reality, we may need a systems approach to deal with it.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Are Artificial Sweeteners Toxic to the Microbiome?

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If you use artificial sweeteners and you saw the words “danger,” “artificial sweeteners,” and “serious health issues” all in the same headline, you’d probably be concerned. The headline recently appeared in my newsfeed, and because many of us use artificial sweeteners, I had to check it out. Here’s what researchers found in a study published in the International Journal of Molecular Sciences.

The researchers examined the impact of three artificial sweeteners (aspartame, sucralose, and saccharin) on two strains of probiotics and one form of tissue from the digestive system. First, they tested whether the artificial sweeteners at various concentrations impacted the growth of the bacteria in a typical medium. They didn’t (with the exception of saccharin at the highest concentration.)

Then they tested whether the sweeteners affected the ability of the bacteria to produce a biofilm, something that’s important to our intestinal health. They didn’t.

Finally, they examined whether exposure to artificial sweeteners would cause changes in the bacteria to make them pathogenic; that can happen, for example, with E. coli. Using cell lines drawn from an established line of colon cancer in this experiment, they demonstrated that the bacteria could potentially become pathogenic and enter the cell walls of the epithelium. That means they could theoretically enter the bloodstream and impact our health.

That sounds pretty bad, right? It certainly seems to merit the use of the words “artificial sweeteners,” “dangers,” and “serious health issues” in a headline. But is it of any real concern to you and me? I’ll let you know in Saturday’s memo as we talk about an important topic related to Aging with a Vengeance.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Want Fewer Medications? Change Your Lifestyle

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The study that we examined on Tuesday showed that a regular exercise program can help reduce the number of medications related to cardiovascular disease and type 2 diabetes. We’re not talking about youngsters; 51 subjects completed the study with an initial mean age of 54. There were some outcomes that were likely unexpected; for example, waist circumference did not change between the experimental group and control group over the five years. There was a significant decrease in body fat in the exercise group that explained the difference in body weight. Still, the control group lost about two pounds in five years while the exercise group lost about six pounds. That actually turns out to be a good thing, as I’ll explain a little later.

The Exercise Program

The high-intensity interval training was just as advertised: intense. It included a 10-minute warm up, followed by four 4-minute intervals at 90% of maximum heart rate (HRMax) interspersed with 3 minutes of active recovery. They finished with a 5-minute cooldown. They used percentage of HRMax as assessed in the exercise test, because that’s an intense level. The focus is on the 4 minutes but those 4 are brutal. You do get to rest, but then you have to do it over again, and that’s a significant challenge to the cardiovascular system. As people got fitter, the intensity would be changed to sustain the 90% level.

What surprised me was that there was no organized exercise activity in the other eight months of the year; they just kept track of activity levels using the activity monitors. There were no differences between the control group and the exercise group in the eight months with no organized activity. That’s interesting.

Most Variables Didn’t Change

This probably surprised the researchers, but it was a desirable outcome. There were no significant differences in body fat, waist circumference, BMI, or overall percentage of body fat. While the subjects probably would have liked to have lost more weight, the fact that they didn’t shows that the changes that occurred in the risk factors for cardiovascular disease, such as high blood pressure and low HDL cholesterol as well as a lower insulin levels, showed that the difference was the actual exercise program itself. The differences in distribution of nutrients in the diet and in the total caloric intake were insignificant. As I mentioned earlier, the number of steps per day and other activities were still even. That means, again, the changes could be attributed to the exercise program alone.

The Bottom Line

What is abundantly clear is that if you really want to reduce medications, you have to pay the price by changing your lifestyle. In this study they focused on one variable: exercise. If you add a change in dietary intake, and or a change in the distribution nutrients, you may get even more benefits. But for me, it answers the question that I started with. You want to reduce medications? Change your lifestyle.

Is it worth it? That’s your call. But that’s what Aging with a Vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.

Can You Reduce Your Medications?

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One of the questions that I get asked frequently goes something like this: “Dr. Chet, how can I reduce the medications I’m taking?” Along with that question is, “I don’t want to have to take medications for blood pressure or cholesterol or diabetes. What can I do?” As we proceed with a focus on Aging with a Vengeance, a recently published study illustrated at least a partial answer to these questions.

Researchers in Spain recruited 64 subjects for an exercise program. The exercise program was a high-intensity interval training (HIIT) program, three days a week, that ran for four months under staff supervision. The rest of the year these subjects were given activity monitors that automatically uploaded data on activity, sleep, etc. The researchers also took a variety of blood samples for testing metabolic variables, tested the subjects’ fitness levels, assessed anthropomorphic measures such as body weight and waist circumference, and recorded medications related to blood pressure, cholesterol, triglycerides, and blood sugars. The subjects were retested after two years and again after five years.

Over the period of five years, an amazing 51 subjects completed the exercise sessions and all the testing required. That, in and of itself, is remarkable—I’ve done this type of study, and holding on to the subjects is one of the main challenges.

The primary question was answered: those who exercised as the study required took fewer medications for blood pressure, cholesterol, and blood sugar control. As you might expect, that isn’t the entire story, so we’ll wrap this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.

Four Tips for the 4th!

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We are fast approaching the three-day holiday weekend to celebrate the 4th of July here in the U.S. It got me to thinking: just because it’s a holiday, it doesn’t mean we should completely abandon some of our health habits that might be strained a little bit, given the celebrations associated with Independence Day. This is going to be a time to be outside, most likely in the heat and humidity given the advanced forecasts, with plenty of foods that may not be typical of our normal diet. So I decided to give you four tips for your health this holiday weekend.

Protect Your Eyes

I’ve been watching barbecue competitions on the Food Network, and I’ve noticed the master chefs squinting because the sun is constantly in their eyes. Don’t do that. Wear a hat with a brim to shield your eyes from direct sunlight, then add sunglasses to your ensemble. While there’s no direct evidence that a single exposure creates critical damage to the eyes, there’s no point in exposing your eyes to the most powerful and strongest sunshine of the year. Don’t forget that this applies to kids as well; keeping kids in good-quality sunglasses isn’t easy, but we have to protect those little eyes—or maybe opt for a cool hat. It’s also important if spending time in a pool or lake; the glare of the sun off the water can be just as damaging.

Protect Your Skin

I recently spent a significant amount of time researching the potential benefits of taking collagen for skin health, and the single most damaging factor to skin as we age is exposure to the sun. If you’re going to be outside for parades, family gatherings, in the pool, etc, make sure that you use sunblock to protect your skin. It will require re-application as the day goes on, but it’s worth it. If you want to avoid the problems of aging skin, protect it now, and again, don’t forget about protecting the skin of your children and grandchildren. A bad burn early in life may have consequences later on.

Drink!

When you spend hours and hours in outdoor activities, you have to maintain your fluid intake and then some. The general recommendation is half your body weight in ounces per day; if you weigh 150 pounds, drink 75 ounces of fluids every day. If it’s a hot, humid day, it should be four to eight ounces about every 15 minutes. The only fluid that doesn’t count is alcoholic beverages; alcohol is a diuretic which means you will lose more fluid than you take in. So you have to make sure that you focus on other types of fluid as well. This might be a good time to check out Paula’s Sugar-Free Sweet Tea recipe on the Health Info page of drchet.com; she spent weeks researching and testing to find a way to have Southern-style sweet tea without the calories, and I think she came as close as possible. Contrary to widespread belief, caffeine is not a diuretic; tea, coffee, energy drinks, and other caffeinated drinks add to your total the same as non-caffeinated.

Red, White, and Blue

Hot dogs, hamburgers, ribs, and other grilled meats seem to dominate our diet during the July 4th cookouts. I wouldn’t think of changing that, but I would add some red, white, and blue to it. The vitamins and phytonutrients in fruit can offset some of those high fat foods we may eat. Look for strawberries, watermelon, raspberries, and tomatoes for the red. Apples, pears, and bananas for the white. Blueberries, blackberries, and Concord grapes for the blue. Emphasize fruit snacks instead of salty, and get a cup or two with every meal for the healthy nutrients and great tastes.

The Bottom Line

Enjoy Independence Day to the fullest, but take a couple of minutes to take care of your health while you celebrate. You’ll reap the benefits by keeping your body independent of the potential challenges celebrations can bring. Paula and I will do the same. Enjoy the holiday weekend and we’ll see you next Tuesday.

What are you prepared to do today?

        Dr. Chet

Should People with CVD Take Omega-3s?

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Last time, I talked about some research that hasn’t been done to definitively know whether DHA contributes to arrhythmias or not, but I implied that there may be one issue that may have contributed to this latest study. Let’s talk about research bias.

Research Bias

Some of the researchers who examined the data from the longitudinal study I talked about on Tuesday were also involved in at least one of the clinical trials on Vascepa, the pharmaceutical form of EPA-only omega-3s. I know what you’re thinking: somehow they intentionally manipulated data so that it seemed DHA was bad. I wouldn’t assume that, because these are good scientists. However, there has to be an inherent bias—beliefs that set up space in your brain and affect your actions without you realizing it. Another way of stating this would be that you find what you look for. It would be very difficult to examine any data involving EPA, DHA, and cardiovascular disease and withhold bias. I don’t believe it was intentional, but I also believe that it could have influenced the results to some degree.

The INtermountain Healthcare Biological Samples Collection Project and Investigational Registry (INSPIRE for short) is not a randomized clinical trial; it’s an observational study. I’ve already talked about the data that are missing on diet, supplementation, and exercise. In addition, it’s a big stretch to suggest that 10 years after samples were taken during an angiographic procedure that the same distribution of EPA-DHA was maintained.

Prior Research

Let’s think about the studies from last week: they were test-tube studies. Those are the foundation you must build before you start doing animal testing; only after that do you get to human testing. One research group also did a study on rodents which demonstrated proof of possible benefit. Have we had that type of research on EPA and DHA as it relates to cardiovascular disease? I did find some.

There have been studies examining how omega-3s may positively affect heart rhythms. In studies on rodents and dogs, DHA but not EPA showed clear benefits on reducing atrial fibrillation and other forms of cardiovascular disease.

But when you examine research on humans, the data are conflicting. By that I mean that some studies show that higher DHA intake and/or levels are associated with the reduction of arrhythmias. Other more recent research shows that it may not. There’s simply not enough information to make a decision.

The Bottom Line

At this point, you have to be thinking “What the heck am I supposed to do?” I think that we stand in an area of research where we have to “reserve judgment,” or maybe it would be better to say to “reserve condemnation.” We just don’t have enough data to make an informed decision either way. I’ve illustrated some of the things that need to be answered as it relates to omega-3 intake, but there are many more questions.

So I’ll leave you with this. If you have had no signs or symptoms of cardiovascular disease, no matter your age, you can most likely continue taking the same omega-3 supplements you always have been. If you have had a heart attack with damage to the muscle tissue, that seems to be where the problem lies, but it isn’t the same for every person. I would have a discussion with your cardiologist before deciding whether to take just EPA or to continue taking combinations of EPA and DHA; that’s the prudent thing to do.

But as you make that decision, consider all the other benefits of omega-3s. A search for “omega-3” at drchet.com yields several pages of results. Very rarely in life do we have simple decisions to make; it’s always a balancing act between competing objectives and imperfect information, and this is another one of those situations.

What are you prepared to do today?

        Dr. Chet

References:
1. J Am Coll Cardiol. 2021 May, 77 (18_Supplement_1) 1453.
2. Vascul Pharmacol. 2016 Jul;82:11-9. doi: 10.1016/j.vph.2016.03.007.
3. Can J Physiol Pharmacol. 2016 Mar;94(3):309-23. doi: 10.1139/cjpp-2015-0300.
4. Circulation: Arrhythmia and Electrophysiology. 2012;5:978–983.

Omega-3s and Heart Disease

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In addition to the research papers on omega-3s I talked about last week, another paper was presented at the American College of Cardiology in May that suggests EPA seems to reduce cardiovascular disease (CVD), while DHA seems to neutralize the benefits. Let’s take a look at this recent study to see what they found.

I haven’t seen the data, just press releases of varying lengths; I’ve written the authors but haven’t heard back yet. The problem with this recent study is that it’s a retrospective examination of a large group of people. The data are part of an ongoing study (much like the All Of Us study in which I’m a volunteer) that secured blood and tissue samples of volunteers; the researchers use that data as well as access to the volunteers’ medical records. In this case, they assessed the EPA and DHA levels of the blood samples and the CVD events that occurred in a random sample of the volunteers over the years. That’s how they determined that the EPA was beneficial in reducing CVD and as DHA levels rose, the benefits were negated.

The primary problem is that the blood samples are a snapshot of one day in the life of the volunteers. We have no idea if they took dietary supplements or if they happened to eat a lot of fish or a lot of nuts and other foods with omega-3s. No other dietary data, no supplement data, no exercise data—all things that we know are related to the development of cardiovascular disease. I think there’s a significant factor at play in this data analysis, and I’ll give you that observation in Saturday’s memo.

What are you prepared to do today?

        Dr. Chet

Reference: Press Release: Warning: Combination of Omega-3s in Popular Supplements May Blunt Heart Benefits. Intermountain Medical Center May 17, 2021

Omega-3s May Kill Tumors

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As exciting as Tuesday’s Memo might have been on omega-3s and superbugs, today’s Memo probably tops that. Before we get too excited, it’s important to remember that this was another test-tube study. That’s fine; that’s how research into any topic begins, but it still has to be proven in human trials.

Researchers in Belgium exposed tumors to various types of polyunsaturated fatty acids including omega-3s and omega-6s. This is the important part: as they made the medium more acidic, the tumors preferentially used fatty acids as fuel. The tumor cells started to implode via a process called ferroptosis. Literally, it means “iron cell death.” What seems to happen is that as the tumor becomes more acidic, it can’t store the fat as well. That creates free radicals, and the tumor cells are destroyed from the inside out. The fish-oil DHA was the most effective at killing tumor cells.

What does this mean for us? Nothing yet, but in another study, when mice were given DHA, their tumors developed more slowly. Remember, what happens in tumors may not happen in the body because actual tumors may have developed a more sophisticated defense system. Then there’s the matter of causing acidity—not necessarily easy to do systemically or targeting just the cancer. But just as with the superbugs, it gives us a reason to take our fish oil with EPA and DHA. And of course, there are other potential benefits to the body as well. Fish burps seem a small price to pay for all this protection, right?

How about the recent research on DHA and atrial fibrillation? I’ll tackle that issue in next week’s Memos. It comes down to scientists asking the correct question.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Metabolism. https://doi.org/10.1016/j.cmet.2021.05.016.

Omega-3s: New Weapon Against Superbugs?

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One of the biggest concerns with hospitalization is catching an antibiotic-resistant bacterial infection. It happened to my father-in-law about 15 years ago, and it was a serious infection requiring over a week in the hospital. He survived, but more superbugs are still around and have gotten worse.

Researchers in Australia examined one such superbug to see how it responds to exposure to omega-3 fatty acids from fish oil. This was a test-tube study and the paper isn’t published online yet, so I can’t check the methodology. What they have reported is that one such superbug, Acinetobacter baumannii, doesn’t seem to discriminate between the fats that it consumes in the hosts’ body. The omega-3s seem to make the bacteria susceptible to a greater variety of antibiotics.

Remember, this is a test-tube study; not everything that works in a test tube works in a human body. Human trials will take some time if those scientists and others can replicate this research. What it means to us right now is that the fish oil we’ve been taking all these years may have benefits we never even considered. I’ll cover another such benefit on Saturday.

Wednesday night at 9 E.T. is the Insider Conference Call. Topics on the docket are more info on omega-3s and cardiovascular disease, plus collagen and skin health. You can still participate by becoming an Insider before 8 p.m. Wednesday.

What are you prepared to do today?

        Dr. Chet

Reference: mBio. DOI: 10.1128/mBio.01070-21