SFCA, Sodium Intake, and High Blood Pressure

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Researchers in the United Kingdom recruited people with elevated systolic and diastolic blood pressure for a randomized, placebo-controlled, crossover study on diet and blood pressure. The scientists put all 145 subjects on a low-sodium diet for six weeks. Half the subjects was given a placebo while the other half was given a slow-release sodium supplement. After six weeks, the subjects were crossed over to the other group for another six weeks. The objective was to see if sodium intake impacted the microbiome and short-chain fatty acids (SCFA) production to reduce blood pressure.

In a perfect world, researchers would take stool samples under all conditions to test for changes in microbe content, but that approach is expensive and time-consuming. Instead they chose to monitor changes in SCFA because they’ve been associated with blood pressure.

Researchers found that while taking the placebo, subjects on the low-sodium diet saw all SCFA increase; 2-methylbutyrate, butyrate, hexanoate, isobutyrate, and valerate were significantly increased. The increases in SCFA were associated with reductions in blood pressure and arterial-wall stretchability.

What does it mean? We’ve known for decades that sodium plays a role in blood pressure. This study demonstrated that sodium reduction directly increased the production of SCFA, which then lowered blood pressure. What we don’t know is the specific beneficial microbes affected or exactly how sodium negatively impacts them. Research continues and I’m sure we’ll find that out eventually.

The Bottom Line

On the other hand, it may not be necessary to find out. Scientists like me always want to know the specific bacteria and the mechanism by how it works. We know that fluid retention is involved somewhere. But we already know that if we reduce sodium, we’ll positively impact our blood pressure. We also know that fiber is the essential food for these SCFA-producing bacteria in our microbiome. If we focus on a more fiber-rich diet as well as take a fiber supplement, we may be able to increase our odds of reducing blood pressure without medication. If we need the meds, we take them, but if we can do it by feeding our microbiome, that’s even better.

What are you prepared to do today?

        Dr. Chet

References:
1. Hypertension. 2020;76:73–79.
2. Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.

Health Benefits of SCFA

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Let’s continue our look at short-chain fatty acids (SCFA) and what they do besides produce energy. Most of these are observational in nature; by that I mean when SCFA go up or down, effects are observed. What we don’t know at this point is why.

For example, when diabetic animals are given the SCFAs acetate and propionate, they maintain better glucose control. That means that adding SCFA to their diet can improve their ability to maintain blood sugar levels. Wait a second; is this the same acetate that’s found in vinegar? Yes. The problem is that the studies don’t provide consistent results.

The same is true for fat storage. When SCFA levels go up, fat storage appears to go down, but drinking vinegar doesn’t necessarily provide that benefit. Observational studies show that as SCFA levels made by the body go up, fat storage goes down. That can prevent weight gain, but we don’t know whether it causes weight loss. The same is true for cholesterol levels; SCFA are associated with lower cholesterol levels.

The problem is that we don’t know the precise mechanisms yet. In other words, what does making SCFA do to the metabolic systems in the body? To the genes? Or receptors for various functions? That’s what scientists are working on. Further, exactly what type of bacteria produce the right SCFA? There’s general agreement that Bifidobacteria produce acetate and propionate when fermenting fiber, but which Bifidobacterium? There are over 50 varieties. Maybe more than one—they may interact in sequence. We don’t know at this point.

What role do SCFA have in controlling blood pressure? Does sodium also have an impact on SCFA production? We’ll take a look at a recent study on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.
2. Front Microbiol. 2016; 7: 925. doi: 10.3389/fmicb.2016.00925

Short-Chain Fatty Acids: DIY Nutrition

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Short-chain fatty acids (SCFA) are critical to your health and well-being, yet you may not really know where they come from or what they do. In my opinion, the most interesting thing about SCFA is that they’re not generally found in our diet; we make them ourselves! We do that when bacteria in the microbiome work to ferment digestible fiber.

By definition, SCFA contain less than six carbon molecules. The three you may have heard about are acetate, propionate, and butyrate. SCFA can provide us with up to 10% of our energy needs. They’re especially important to colonocytes, a type of endothelial cells of the large intestine that need energy to digest and absorb food that we use to produce the rest of the energy we need.

I’ll cover what else SCFA do on Thursday. In the meantime, one way to increase the production of SCFA is to get more fiber, whether from foods or supplements. It’s especially important after a course of antibiotics; research has shown that after the microbiome is upset by antibiotics, the production of SCFA can be impaired, which impacts many biological processes.

The monthly Insider Conference Call is tomorrow night at 9 p.m. Eastern Time. You can still participate by becoming an Insider by 8 p.m. tomorrow night. If you have questions about COVID-19 or any other health topic, this is your chance to get answers. I hope to talk with you then.

What are you prepared to do today?

        Dr. Chet

Reference: Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.

Supplementing Your Diet: Supplement Info Now on MP3

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More than ever, we live in a digital age. Those of you who are in the supplement business have had to adapt your business to use more electronic tools to survive and thrive.

I did Supplementing Your Diet as a CD with the idea that anyone could use it to help people understand why they need to supplement their diet, where they should begin, and how to select a quality manufacturer. You could lend it to someone, make an appointment to get it back, and maybe get an order. Because of the current state of social distancing, hose days are gone or at least on hiatus for a while. On top of that, CD players are becoming scarce. It’s time to enter the digital age with this product

Today we’re introducing Supplementing Your Diet as an MP3 download. How does that help your business? You can gift an audio to others so they can listen to it. All you have to do is put in their email address on the billing page when you buy it, and they will be notified and can download it (be sure to let them know it’s coming so they don’t mistake it for spam or malware). And you can send it anywhere in the world without a thought for postage.

The price of each download is $4.95, less your Member or Insider discount (remember to log in first). If you gift them to potential clients and customers, you’re taking a calculated risk but the information really helps people understand why supplementing is critical in this day and age. I can’t sell products for you, but I can explain the benefits. Then it’s up to you.

The Bottom Line

I created Supplementing Your Diet to help people understand the benefits of supplementation and to help business owners market their product with the best of scientific research. Add it to your repertoire of digital tools to increase your bottom line today.

What are you prepared to do today?

        Dr. Chet

Cost vs. Benefit for Saturated Fat

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In Tuesday’s Memo, I suggested that I don’t like speaking in absolutes when it comes to health recommendations; I’ve seen too many exceptions. What about our Michigan cardiologist? Was he correct? Yes and no, but mostly no.

He implied in the interview that the source of saturated fat is animal products. That isn’t true. In fact, someone could be a vegan and still over-consume saturated fats from using vegetable oils. Palm oil, vegetable oil, even almonds and other nuts that contain monounsaturated and polyunsaturated oils also contain saturated fats. My point is that even without any animal products such as cheese or milk, you can still get a lot of saturated fat in a vegan diet.

He was also overstating the positive effects of lowering saturated fat intake. I read the abstract; it said that it would take 56 people lowering their saturated fat intake for two years to prevent a single cardiac event. Further, the review did not show any reduction in mortality. To me, it raised a lot of questions that may have been answered but not reported.

Should we lower our saturated fat intake? Probably, but it’s going to take a lot more answers to swing the cost to benefit ratio in favor of giving up animal products for the potential benefits we may get.

What are you prepared to do today?

        Dr. Chet

Reference: Cochrane Library. https://doi.org/10.1002/14651858.CD011737.pub2

“Give Up Meat or Else!”

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“Animal Foods Conclusively Cause Heart Disease!” was the title in my news feed that attracted my attention. I had to check it out, because I’m not a fan of absolute statements in the health field; too often, some facts have to be ignored to make definitive statements such as that true. Was this any different?

A cardiologist from Michigan was interviewed in response to a recently published paper in the Cochrane Review. The review updated the information related to saturated fat intake and the rate of cardiovascular disease and mortality. After reading the paper, that’s the response the doctor gave to an interviewer from the Plant Based News. He suggested that the review conclusively shows that reducing saturated fat intake will result in a 21% decrease in CVD events. The implication is that most saturated fat comes from animal products: if we really buckle down and reduce our saturated fat consumption more, we can reduce events even further.

He makes the connection between animal products and saturated fat. But is that correct? It would mean that vegans, who consume no animal products, are protected from cardiovascular disease. Is that true? I’ll let you know on Thursday

What are you prepared to do today?

        Dr. Chet

Can Wearable Health Monitors Predict COVID-19?

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As of this writing, there are a minimum of five studies in the U.S. to determine whether wearable health-and-fitness monitors can predict the COVID-19 infection before noticeable symptoms actually occur. They’re looking at masses of data, rather than individual data points. Some are trying to predict how severe the infection will become using the data, which would allow a city, county, region, or even a state to move the necessary resources to the locations where outbreaks will occur. It would be a real step forward in the use of digital monitoring for tracking the potential outbreaks of disease.

While I hope they’re successful, there are two problems. The devices are expensive and only about 20% of the U.S. population actually owns them; how many use them is another whole question. Fitbits and Apple Watches are purchased by the type of people who are already interested in their health. This would limit the applicability to the general population.

The second problem is that it doesn’t do an individual any good at this point. Because the data are collected anonymously, no one could be informed if they’re at risk. As more treatments are discovered, early treatment may limit the severity of any long-term effects, but that doesn’t really help if you don’t know your data.

The issue is the right to privacy and especially health information privacy. I understand that and agree with it, but there should be some way an individual could be notified. Maybe this is the point where artificial intelligence could be used to keep human eyes out of it. And when we get to that point, odds are good that insurance will cover such devices because it always cost less to treat disease in its initial stages.

If you own such a device, such as a Fitbit, Apple Watch, Oura, Garmin, or other device, there’s a list of research studies at the end of this Memo along with the contact information I could find. Check them out. The more we know, the better prepared we can be for this or any other potential epidemic in the future.

What are you prepared to do today?

        Dr. Chet

Wearable Device Study Information:
Duke Covidentify: https://bit.ly/2XXTAp6
Scripps Detect Study: https://bit.ly/3gWkMNy
Stanford Covid-19 Detection Study: https://stanford.io/2XuTGWa
RNI Wearable Devices for Covid Monitoring: https://bit.ly/37022IB

Heart Rate and Viral Infections

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What might we gain by collecting and analyzing data from fitness and health devices? In a recently published study, researchers collected data from over 200,000 different Fitbit users. They selected users from the top five states of Fitbit users and collected data on height, weight, and age as well as heart rate and sleep data. It’s important to note that the data were collected anonymously so there was no invasion of privacy.

They ended up with data sets on over 47,000 people. That’s where this study became mathematical in nature. They correlated heart rate and sleep data with the rate of flu-like cases reported in each state by the Centers for Disease Control. They found changes in heart rate and sleep time correlated with the increase in reported cases of the flu. It helped improve the prediction model between 6.3% and 32.9%.

This is important for a couple of reasons. First, they were able to handle billions of data points; that seems so easy to say, but think about what that involves in terms of data storage. Second, they were able to show some predictive use for the data.

Although they were improving the ability of the CDC to predict the number of cases in general, it requires a lot more to actually predict who has a viral infection. More about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:https://doi.org/10.1016/S2589-7500(19)30222-5.

Health Monitors and COVID-19

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Do you have a Fitbit that you use regularly? Does it track your heart rate? How about an Apple Watch? Can it track your temperature? Blood pressure? Millions of people use those types of devices. Think of the potential for collecting data. It could be millions of data points per second.

I recently wrote about a study that integrated data collected from smartphones with health reminders and recommendations to see whether texts and emails could impact behavior. I didn’t believe they could, based on the limited data used by the computer to send recommendations. That was really an issue of total numbers of subjects; they had 300 and they needed 300,000 or better yet, 3,000,000.

These new studies overcome the problem of limited subjects. Several research groups are collecting data anonymously from fitness devices to find out if they can predict when someone has the COVID-19 virus. What could those devices track that might predict a viral infection? Heart rate, for one. I’ll talk about that study on Thursday.

What are you prepared to do today?

        Dr. Chet

Researching GOLO’s Claims

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Before I get into the rest of the research on the claims made by GOLO, I want to be clear that I have nothing against any products or programs in the market. I’m not assessing the entire program for any company. But having worked for a couple of decades with companies that follow the FDA and FTC Guidelines for dietary supplements very closely, it’s more than frustrating when companies play loose with the research. If they make a structure-function claim, they should be able to substantiate those claims according to the guidelines.

Published Studies

The GOLO website refers to two studies that were published in journals. In the first study, a researcher assessed the effectiveness of the GOLO program on measures of weight and glycemic control. The study lasted 13 weeks; 16 out of 26 subjects completed the trial. There were significant reductions in body weight and insulin levels.

In a second study, the same researcher compared the subjects who used the GOLO weight loss program. The control group was given a placebo and the experimental group was given the program’s dietary supplement. The treatment group lost more body weight than the controls; there were also positive changes in serum insulin and a score of insulin resistance.

The implication is that in all studies, published or not, the dietary supplement made the difference in the results. There’s no way to tell. While every study talked about caloric intake, they did not report comparative data, either within subjects when there was no control group, or between groups when there was. This is simply poor research methodology and statistical analysis.

Does the Research Prove the Claim?

As I said on Thursday, while the company makes many claims on the website, I stuck to the one that said the product was “clinically proven to reduce insulin resistance.” They did not prove that the dietary supplement helped reduce insulin levels, blood glucose levels, or HOMA-IR, a measure of insulin resistance. There were just too many confounding variables they did not examine. I already made mention of the caloric intake. The program evolved over time from one where they planned a 500-calorie deficient diet for the subjects to one where they were advised on how to construct a diet from certain food selections. That’s why caloric intake is so important; we need to know that to find out how well the subjects met the dietary guidelines. The best they could claim is that the supplement may have assisted some subjects to lose weight.

In each study, the changes in HbA1c were relatively meaningless in the real world; reducing HbA1c by 0.18% and 0.61% is within the error of the method. As for the use of HOMA-IR, the researcher who developed the algorithm has said that it was not suitable for these types of clinical trials, just for large epidemiologic studies. Finally, the reduction in blood sugar in every trial where it was measured could be explained by exercise, which they also did not account for in the analysis; many people don’t realize exercise can modify insulin resistance by the third workout.

The Bottom Line

There were many more issues with the selection of data used in the multiple analyses and in the choice of statistics themselves. Most importantly, the significant loss of subjects—all four lost up to 40% of all subjects—was acknowledged by the authors, but they didn’t explain its impact. I could go on with errors, but it’s unnecessary. For the claims made, the level of substantiation is simply not sufficient to exhibit the dietary supplement’s benefit for insulin resistance. The weight loss program may be beneficial, but it can’t be verified by any of the studies they completed or by the materials provided on their website.

Eat less. Eat better. Move more. Do those long enough and you will be able to lose weight, get fit, and improve your metabolism as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Diabetes Updates, 2019 doi: 10.15761/DU.1000125.
2. Trends Diabetes Metab, 2019 doi: 10.15761/TDM.1000109.