Phytonutrients: Diet or Supplements?

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The study that we looked at this week demonstrated that flavonoid intake is related to socioeconomic status. It also demonstrated that most of that difference comes from the consumption of tea. All well and good.

What stood out to me was the lack of phytonutrient intake. While there were some small differences in the other flavonoids besides flavan-3-ols, the total intake of flavonoids was low. Even though we’re talking about just one class of phytonutrients, the total flavonoid intake minus the flavonoids from tea was about 140 milligrams per day. That’s reflective of a poor diet that does not include as many sources of phytonutrients as it should: not enough vegetables, fruit, beans, nuts, and others. And it hasn’t changed in the six years of the study. Most people still don’t eat enough plant-based foods to do themselves any good.

Supplements: An Insurance Plan

The study demonstrated the need for the regular use of supplements containing plant concentrates. A plant concentrate is the plant or its fruit or its root or its leaves, minus the water and the fiber. It should also have been harvested at the peak of nutrition, not the peak of flavor and taste. The plant concentrates contain all the phytonutrients that are contained within the plant, and that includes not only the flavonoids that were the subject of this study, but all of the other types of phytonutrients that we need on a regular basis.

The plant concentrates may be found in multivitamin-minerals, as part of a fruit-and-vegetable concentration, or maybe even as a stand-alone. We’re not talking about treating diseases with these supplements; we’re talking about getting the nutrition that you’re supposed to be getting from the foods that you eat (but you’re not). To me, this study pretty much proves that everyone needs to take supplements with plant concentrates every day. They provide good backup while you work on improving your diet.

The Bottom Line

If you want the best chance at preventing degenerative diseases, you need optimal nutrition. That starts with what you eat, including all those phytonutrient-containing vegetables, fruits, beans, grains, and aromatic herbs used to season your food. As a backup, take supplements that contain plant concentrates to complement your diet. It’s not either/or; it’s using them both to get to better health.

Paula and I will be taking some time off to work on more jobs around the house. We’ll be back after a short break.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:2147–2155.

Flavonoid Intake Varies by Demographic

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Besides the flavonoid intake, another purpose of this study was to find out if there were any socioeconomic differences between high and low flavonoid intake. Before I get to that, here are some of the results of this study.

The age group with the highest flavonoid intake was adults 51–70 with 293 mg/day. As education increased, so did flavonoid intake from 201 mg/day for those not completing high school to 251 mg/day for those with some college. Finally, the flavonoid intake remained the same throughout all three cycles of the study.

Socioeconomic status was correlated with flavonoid intake as well; the higher the status, the higher the flavonoid intake. Race, income, and education were all included in the analysis. But not all flavonoids—just flavan-3-ols. By nature of the analysis, flavan-3-ol intake was directly attributed to tea consumption. (If you want to try to increase your tea consumption, try making Paula’s Sugar-Free Sweet Tea; find the directions in the Recipe section of my Health Info page.)

The researchers were satisfied they had found a link to phytonutrient intake, specifically flavonoids, and non-nutritive factors. To me, it meant something entirely different and I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:2147–2155.

Getting Acquainted with Flavonoids

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Every vegetable, fruit, and spice we consume in the foods we eat and many substances that we drink contain phytonutrients. Just to make the subject even more complicated, there are different categories of phytonutrients including flavonoids, which are the most prevalent in our diet. Flavonoid intake is linked to reduction of diseases such as cardiovascular disease and cancer.

Here’s an example: turmeric is a spice and one of many plants that contain beneficial phytonutrients. Many of us use a turmeric supplement because it may help reduce pain and inflammation. Turmeric contains three major phytonutrients known as curcuminoids; curcumin is the most familiar.

Researchers wanted to check the flavonoid intake from subjects over nine years old who had completed two 24-hour recalls in two of three NHANES study cycles during 2011–16. Of all the dietary intake techniques in use, the 24-hour recall is the second most accurate available (food diaries are first). They used the dietary data to estimate the flavonoid intake of all subjects. The food or drink consumed with the most flavonoids: tea, although they found that nine year olds don’t drink much of it. But that’s not all they discovered, and I’ll cover that in Thursday’s Memo.

What are you prepared to do today?

        Dr. Chet

References:
1. J Nutr 2020;150:2147–2155.
2. https://www.ars.usda.gov/ARSUserFiles/80400525/Data/Flav/Flav_R03-1.pdf

Exercise vs. Meditation? The Winner Is…

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As a trained exercise physiologist, if I were asked the question, “Which would prevent acute respiratory tract infections?” I would have picked exercise over meditation every time. The only reason I would choose meditation is that nagging voice in the back of my brain that says, “If they’re asking the question, maybe there were surprise results.” Science says to ask the question, so the researchers did; let’s take a look at the results.

When Meditation Tops Exercise

There were distinct differences between the exercise and stress-reduction groups versus the controls. When compared to the control group, the exercise group had fewer acute respiratory infections. The mindfulness-based stress reduction program also had fewer acute respiratory infections than did the controls, but when looking at other variables such as absenteeism and lost days of work, the stress-reduction program did slightly better than exercise.

When Exercise Beats Meditation

The researchers also examined the total number of infections, and the exercise group did better. In this study, which was completed well before the current pandemic, the exercise group had no coronavirus infections (the common cold) while the meditation and control groups both did; the difference was that the meditation-trained group handled the infections much better than did the controls.

It would have been great if they had one more group that both exercised and used the stress-reduction techniques. It would have been interesting to see if there were additive or even multiplicative benefits, or maybe there would have been no differences or even negative results. We can’t assume that it would have made the immune system function better; the “stress” of doing both might have compromised immune function.

The Bottom Line

Even though this study was done eight years ago, it’s the only study I could find that examined the benefits of exercise related to any type of upper respiratory infection. That the study also included stress reduction/meditative techniques was a bonus. What we know now, based on this study, is that moderate exercise as well as stress reduction will both reduce our risk of serious infection from many types of virus, and we may have milder symptoms if we do catch one. Whether this will serve us well during this pandemic is uncertain, but even a little protection to reduce the most severe symptoms would be worth the effort. That’s great news for people who don’t have the physical capacity to exercise and for those who don’t have the patience for meditation: either one will work. Just do something.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Immune System Training: Exercise vs. Meditation

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What’s going to work better to prevent acute respiratory infections: moderate exercise training or meditation training? Have you predicted which would be more effective without looking at the article? Or do you not have enough information yet? Let’s take a look at what each group did.

The moderate exercise group met for 2.5 hours each week with personnel trained in exercise physiology. The time was broken up into education about exercise and time practicing on different forms of equipment such as treadmills, exercise bikes, etc. The rest of the week, they exercised for 45 minutes per day. Most subjects used walking or jogging as their home modality of exercise. The subjects were trained to exercise at a moderate level based on the Borg perceived-exertion scale; once trained in assessing exertion, it matches up quite well with the effort people are actually performing during exercise.

The meditation group met with personnel trained in mindfulness-based stress reduction techniques for 2.5 hours a week. This program “is based on the idea that an increased awareness of physical, emotional, and cognitive manifestations of stress may lead to a healthier mind-body response to stress.” The subjects were also to practice the stress reduction techniques for 45 minutes every day at home.

The control group did not do either of the techniques. The training lasted for eight weeks. The variables I mentioned in Tuesday’s memo were collected before, during, and after completion of the eight weeks training. What were the results? I’ll give you a little more time to think about it and give you the answer on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Boosting Immune Function: Exercise vs. Meditation

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Every once in a while, I come across some research that’s just so interesting and unique, I have to share it with you. In this case, it’s directly related to boosting the immune system, which is what a lot of people are trying to do right now. In this case, researchers tested whether an eight-week program of either moderate exercise or meditation would reduce the variables associated with an acute respiratory infection such as time lost from work.

Researchers recruited subjects who did not get a flu vaccination and also did not exercise or meditate; they used just about every survey related to health that was available. They also took samples from nasal rinses after subjects had acquired an acute respiratory infection of any type and tested for markers of immune function in the rinses.

The mean age of the subjects was 59 years old. The subjects were randomly assigned to one of three groups: the control group who agreed to do nothing during the eight weeks; a group who would exercise at a moderate level; and a group who would participate in a specific type of meditation.

On Thursday, I’ll talk about the training programs. Looking ahead, short of looking up the paper itself, what do you think will be more effective: exercise or meditation to boost the immune system?

Insider Conference Call

Tomorrow night is the August Insider conference call. I’m going to do a COVID-19 update focusing on the recent spate of doctors plugging hydroxychloroquine as well as answering Insider questions. If you become an Insider by 8 p.m. ET, you can participate live!

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Practice Makes Perfect

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Have you ever looked at new health habits as a series of tasks you need to perfect? There are many different habits that are part of a healthy lifestyle such as eating more vegetables, exercising five days a week, taking your supplements regularly, and dozens more. Losing weight is not just eating fewer calories; it’s a process that involves many different tasks in order for you to be able to do that.

  • What are you going to eat?
  • Who is going to buy the food?
  • Who is going to prepare the food?
  • How are you going to measure the food?
  • When are you going to eat it?

Think about all the decisions that have to be made in order for you to simply eat breakfast—not just any breakfast, but one that fits with your overall meal plan and caloric goal for that particular day.

Let’s say you want to start with a protein smoothie in the morning. Do you have the right kind of blender or juicer to be able to do that? Have you purchased all the fruit, vegetables, and protein powder that you’re going to need? How much time will you need to add to your morning routine in order to do it?

There are probably dozens more nitty-gritty things you need to perfect. The point of this memo is to have you recognize the types of changes that you’re going to have to think about, and remind you that you probably won’t get it right the first time that you try. You’re going to have to practice these new tasks. Hence the title of this memo: Practice Makes Perfect.

Fitness: An Example

If you take any tasks related to the overall goal of getting fit, there are elements of it that you’re going to have to complete. It’s not just the exercise itself. That’s something you can do. Where this idea comes into play is in preparing to exercise.

Are you going to exercise in the morning? Set your alarm at least 15 minutes before you want to begin. For some of you it may have to be an hour earlier because you have certain rituals you perform in the morning before you start your day.

When your alarm rings, get up and get out of bed. You can go back to bed if you want to, but you have to get out of the bed. Do that for one week, weekdays, or weekend. Get good at it. Get used to it. You’re practicing to get up on time in order to be able to exercise. You may find out right then that getting up early is not going to work—maybe mornings just aren’t your time and you’re going to have to figure out some other time to exercise.

Then the following week, the night before you start, lay out your exercise gear. When the alarm goes off, get up get out of bed and put on your workout gear. Do that for a week. Laying out your clothes the night before. Getting up on time. And getting dressed on time. Again, you can go back to bed if you want. When you’ve got that mastered, again weekday or weekend, then you can start your workout routine.

Seems a little silly, I know. But you have to practice being successful at the things that precede exercise before you can be successful at exercising itself. You’re going to run into obstacles, and you don’t yet know what they are. It may be that your wife will want to get up at the same time. It may be that your kids, if you have them, will hear you and want to get up as well. You have to be able to deal with all of those issues and anticipate that they may happen at varying times before your workout. Think of it as getting prepared for a game-time situation. Once you’ve experienced it, you’ll know how to react better than you would if you leave it to chance.

We could do this approach for every task related to any health or fitness goal. The degree to which you have to cut up that elephant to consume the parts depends on you. Some tasks may be easy to manage while others will not. But unless you perfect the component tasks, it will be too easy to quit when an obstacle appears.

The Bottom Line

In this summer of coronavirus, improving everyone’s health has never been more important; if the virus tracks you down six months from now, you can be better prepared to fight it off. This week I’ve written about ways to help you prepare to change your health from where it is to where you want it to be.

  • Setting realistic goals allows you to break up any big goal into manageable parts.
  • Changing directions is critical, or you’ll end up where you don’t want to be.
  • Finally, you have to practice to get the tasks that contribute to your goal just right. You can do it with enough practice. One bite at a time.

What are you prepared to do today?

        Dr. Chet

Eating the Elephant

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I’m sure you’ve heard the question, “How do you eat an elephant?” The answer: “One bite at a time!”

Paula and I took off last week to try to organize a couple areas of our house. I thought we could get two or three different tasks done. I was wrong; we’re still finishing the very first task. Granted, it’s been at least 10 years, probably more, since we tried to clean out our clothes closet completely, but I felt that it was doable. Turns out it was one enormous elephant, and we didn’t finish. Yet.

When it comes to improving your health, it’s just like eating that elephant: most of us are too optimistic about what we can do within specific periods of time.

  • “Three months until the wedding? I could lose 40 pounds.”
  • “My HbA1c is 6.8? I can get it down to normal in a month or two.”
  • “My blood pressure has sky-rocketed to 195/110? I could handle that in probably a few weeks by getting some exercise and eating better.”

Is it possible to achieve those goals? Maybe. Most likely not, at least not in that time frame, because you’d have to consume too much of the elephant too often. The likelihood is that you’re going to get tired of the taste of elephant and quit before you get there.

Setting realistic goals is difficult when it comes to your health. What’s even more difficult is to understand that you have to make a commitment to take long-term control of your health; short-term plans rarely get the results you want. That means you’re going to have to commit to eating a little better. Eating a little less. And moving a little more.

What are you prepared to do today?

        Dr. Chet

The Magic of Chicory

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Because this is my birthday week, I thought I would indulge myself and talk about some personal research I recently did. Today it’s all about chicory—it’s everywhere. The little purple flowers can be found alongside just about every road in Michigan. I’m pretty sure it’s probably that way across the U.S. where the climate is similar at this latitude. Those little lavender-purple flowers are chicory, officially known as Cichorium intybus, a member of the Aster family. This absolutely phenomenal lavender-flowered plant is one of those plants that are classified as weeds in some areas, but in others are cultivated for their nutritious parts.

Chicory as a Fiber Source

I first became aware of chicory when I found out the root is the source of one of my favorite types of fiber called inulin. The reason that I like that particular type of fiber so much is that it can act as a prebiotic and feed many of the bacteria of the microbiome. But first, it acts like any other type of soluble fiber: it absorbs fluid to help food move through the small intestine. Then when it gets to the large intestine, it can supply the thousands of microbes with food.

Chicory is not the only source of inulin, but it’s the greatest source. Here are some of the other major sources of inulin if you wanted to get it by eating plants; all of these amounts are per 100 grams of a serving; that works out to about 3.3 ounces:

  • Chicory root contains about 40 grams
  • Jerusalem artichoke has 16–20 grams
  • Garlic has 9–16 grams
  • Raw asparagus has 2–3 grams

It might be relatively easy to eat 3.3 ounces of artichokes or asparagus. But I’m not sure many people are going to want to be around you if you eat 3.3 ounces of raw garlic every day, although it could be a big assist in social distancing. Just a thought.

Chicory as Food

I was surprised to find out that almost the entire chicory plant can be eaten; it has been cultivated as food in Europe since the 1600s. Depending on the age of the plant, as well as the time within the growing season, the leaves of the plant can be considered a salad delicacy. I don’t usually stop and eat or even nibble when I’m out for a walk/run, but chicory is in the endive family and the flavor is supposed to be somewhat bitter and crunchy like endive. That’s if eaten raw. When cooked, the flavor mellows out quite a bit, as it does for dandelion greens, another relative. When used in foods, it appears that chicory is often eaten like celery. The leaves, the roots, and the leaf buds are boiled and added to foods. Chicory seems to get more intriguing as a potential food all the time.

Chicory has also been used as an additive to or a substitute for coffee. Evidently when dried and roasted it has a very distinctive flavor that enhances coffee. In fact, after World War II, England and Germany roasted chicory root as a substitute for coffee beans. While I’ve never tasted it, I know that there are several brands of American coffee that contain roasted chicory root. What I don’t know is how that might impact the ability to act as a fiber and prebiotic. Because you’re trying to extract flavor from the root plus roasting the root, there may not be any of the desired digestive qualities available.

Chicory as a Nutrient

Because it’s a plant, you know that it must have phytonutrients. I’ve talked about the benefits as it relates to the microbiome, but there may be other benefits from consuming the plant or extracts from the plant. For example, in some of my background research on this, it seems that some people apply a paste of chicory leaves on the skin for swelling and inflammation. In another trial on rodents, chicory was used in combination with a variety of other herbs to see if it would lower blood pressure. It did, but it’s still a long way from a very small study on rats to developing natural ways of dealing with blood pressure.

One thing is for sure: using the parts of the plant that we know are the most effective for the digestive system is probably a good idea. We know that adults should be getting 25 to 30 grams of fiber per day, but most people seem to be able to hit only between 12 and 13 grams. So if taking this type of fiber known as inulin sourced from chicory root or eating more artichokes and asparagus is possible, you’ll get a lot of benefit from this plant. Maybe this will inspire you to taste the leaves of the plant with the little purple flowers on the side of the road in your next salad.

That’s exactly what I did on a trip to the store before writing this Memo. I noticed some chicory growing on the side of the road in an area that had a little bit of parking. So I stopped my car, got out, picked several different sized leaves, and then ate them. The plant had blossoms so that may have made a difference in the flavor. It was extraordinarily bitter but left no aftertaste. It would be interesting to be able to get some chicory that was specifically designed to be used in salads to see if it would taste similar. I would say this: if you can drink an IPA, I think you could eat salad with chicory in it. That’s my experience with eating chicory leaves to date. I’ll stick with inulin from the root for now.

New Info and Some Time Off

There’s a new Basic Health Info posted on the Health Info page at drchet.com about the myths and facts of face masks as described in actual scientific research. If you’re tired of people throwing fantastic tales of masks’ effects at you, here’s where you can go to get the facts: Cloth Masks: What the Research Says

We’re taking next week off to catch up on some big chores around the house, maybe even relax an hour or two, so expect to hear from me again on August 4.

What are you prepared to do today?

        Dr. Chet

Reference: BMC Complement Altern Med. 2017 (3) 7;17(1):142.

Research Update on Probiotics and Adult Allergies

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Researchers recruited a total of 95 adults, ages 19 to 65, with allergic rhinitis for a double blind, randomized, placebo-controlled clinical trial; all the subjects were from two hospitals in South Korea. They were not allowed to take their usual medication to treat seasonal allergies.

In the experimental group, 47 subjects received the probiotics, and 48 subjects were in the placebo group. The probiotics used in the study was a novel blend called NVP-1703. The variables the researchers selected to track were markers associated with the immune response such as IgE and interleukins. They also tracked the symptoms of the subjects by having them complete daily diaries noting responses such as sneezing, itching, nasal congestion, runny nose, etc. The subjects also took standardized written allergy questionnaires.

The researchers found significant positive changes in the questionnaire assessment from baseline through weeks one, three, and four between the probiotic group and the placebo group. The IgE levels and serum IL-10 levels were significantly improved between the probiotic and the placebo group.

The improvement in questionnaire results meant that the subjects that were taking the probiotics saw their allergy symptoms decrease. By assessing the immune responses, they saw that somehow the probiotics stimulated the production of IgE and IL-10. Both of those allow the immune system to control symptoms associated with allergic rhinitis.

The researchers concluded that this blend of probiotics could be beneficial to treat seasonal allergies; I’m not sure I would go that far since the study contained fewer than 100 subjects. I would say that it was nice progress, although there’s still more to do. But if you have allergies, taking your probiotics regularly may be helpful for your allergy symptoms as well as all the other benefits.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2020. 12: 1427-41.; doi:10.3390/nu1205142