Is There a Link Between Sugar and Cancer?

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Sugar has been in the news with the publishing of the latest results from the NutriNet-Santé study from France. The headlines of press releases suggest that drinking as little as four ounces of a sugary drink, including fruit juice, per day was related to an increased risk of getting cancer. Sugary drinks of all types except fruit juice were associated with an increased risk of getting breast cancer. These were all hazard ratio trend analyses; as the consumption increased, so did the risk of cancer.

If you read the Memos regularly, you know my approach is to always check how the data were collected. In this study, they used three 24-hour dietary records that included two weekdays and one weekend day. The diet records were done every six months throughout the duration of the follow-up, about five years. They subjects entered their data online; with over 100,000 subjects, that’s the only way this study could be done.

Of all the types of diet assessments, this is as close to the gold standard as I’ve seen. They had 97 different sugary drinks and 12 artificially sweetened drinks that were possible choices with very detailed descriptions and photos of drinks to help assess portion size. The only step they didn’t take was to have the records checked by a dietician before the subjects entered their data online. The methods in this study were solid compared to just about every other study I’ve talked about.

Should we avoid all sugary drinks at this point? More on Thursday. Tomorrow is the July Insider Conference call; this is your chance to learn more about nutrition and get your questions answers. You can still be included, so check out memberships right now.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.

MSG Is Safe, But Be Wary

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The controversy regarding MSG certainly won’t end with this Memo, but I want you to know what the research says so you can make an informed decision. There’s no question that some people have sensitivities to certain food additives, and I’m not diminishing that response in any way. My point in doing this series of Memos was to dispel myths that have grown around some food additives such as MSG.

Why was the early research wrong? The Chinese Restaurant Syndrome grew from a single physician who described how he felt after eating Chinese food. More case studies were published, then small trials that seemed to support the observation. As time went on, trials with better controls over subjects and their reactions were done to test those responses attributed to MSG.

Regarding the excitotoxic brain damage, for the most part, that research injected glutamate (and not MSG) directly under the skin or directly into the digestive system. Because of its importance in so many chemical reactions, glutamate is tightly regulated and does not cross the blood-brain barrier. In other words, the research could have been done better. When it was, the results of those studies could not be duplicated.

Where does that leave you? Reading labels, I hope. I just checked the label of smoked ham: no MSG but there were at least three different sources of sodium. Same was true for beef jerky. That contributes to the high sodium intake we all have if we eat those foods.

You can’t really get away from MSG anyway; it’s naturally found in so many foods such as meats, cheeses, and even in tomatoes. There could be a benefit to using MSG: it may lower your overall sodium intake because it takes a lot less MSG to give the umami flavor than salt does.

But be wary. Umami flavor can become addictive. You know those chips I like so much? Some have MSG added, and they’re tough to eat in reasonable amounts. It may be best to avoid them altogether unless you can control the quantity you eat. That was why MSG was thought to cause weight gain; by itself, it doesn’t but it can cause a person to overeat, and that for sure will increase body weight.

Like anything else, unless you’re allergic, MSG can be a part of a reasonable diet to add flavor to food. If it helps make people want to eat broccoli and cabbage, I’m all for that because the benefits of the vegetables far outweigh any harm from the sodium.

Don’t forget to let me know if you’ve ever had a negative reaction to MSG. I’ll give the results next week.

What are you prepared to do today?

        Dr. Chet

References:
1. Questions and Answers about MSGhttp://bit.ly/32tvELS.
2. N Engl J Med 1968; 278:796.
3. Science. 1969 May 9;164(3880):719-21.

Early Research on MSG

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People have been ranting against MSG for decades, but I never paid attention until I read a study on a group of subjects who said they had a negative response to eating Asian foods. The subjects were tested under four scenarios consecutively, dependent on their response to the prior test results. The study demonstrated that when exposed to massive amounts of MSG versus a placebo, there were no consistent responses from this sensitive group of subjects. That’s meaningful because it challenged common knowledge.

That common knowledge began with a letter to the New England Journal of Medicine by a physician after reporting symptoms he felt after eating a meal of Asian foods; it wasn’t research, just a personal anecdote. At the same time, a researcher from Washington University in St. Louis began a series of studies on glutamate and other protein precursors that demonstrated the excitotoxicity affects on brain tissue; excitotoxicity (ex-SIGHT-o-tox-ISS-i-ty) refers to nerve cells being damaged or killed by excessive stimulation by the neurotransmitter glutamate. That was when the bulk of the negative research on MSG drew attention. However, over a period of years, other researchers attempted to duplicate those studies with unsuccessful results.

Where does that leave us? Other than a variety of conspiracy theories, MSG doesn’t seem to have the negative impact that has been attributed to it. I’ll finish this up on Saturday but my original question still stands: if you feel you respond negatively to MSG, reply to this email and I’ll let you know the results next week.

What are you prepared to do today?

        Dr. Chet

References:
1. N Engl J Med 1968; 278:796.
2. Science. 1969 May 9;164(3880):719-21.

A Closer Look at Monosodium Glutamate

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People these days love salty, and as I’ve said before many times, I especially love salty: nuts, chips of any kind, cured meats such as ham. I believe if bacon weren’t salty, it wouldn’t be as popular as it is. Mix salt with amino acids, especially glutamine, and it creates a taste called umami. It’s an almost irresistible flavor that some people, if not most, can’t stop eating.

Now what if I told you that monosodium glutamate (MSG) had been added to those specific foods to give it that umami taste? (It hasn’t, so don’t throw out the bacon or jerky just yet.) What would you think then? You might not be so enamored with those foods because MSG has been linked to headaches and brain dysfunctions. Some people attribute symptoms of allergic reactions to MSG that include breathing issues, the aforementioned headaches, and many other neurological-type issues.

Would you believe that MSG probably doesn’t cause those symptoms in most people? That the “research” showing that MSG is bad was poorly done, and to some degree, wasn’t even really research? For sure, you don’t want to miss Thursday’s Memo. Until then, let me know if you’ve responded negatively to MSG by replying to this Memo.

What are you prepared to do today?

        Dr. Chet

Reference: Questions and Answers about MSG http://bit.ly/32tvELS.

That Sugar Film: A Fantasy

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Let me clear up a few things right away. I’m not a fan of overeating sugar, whether pure cane sugar or high fructose corn syrup. But glucose is the perfect fuel because it burns completely with only carbon dioxide and water as the by-products. I think what everyone should do is respect glucose for what it can do and what overconsumption can do: make us fat—but no more than the other carbohydrates we over consume. With that in mind, let’s take a look at the filmmaker’s weight gain.

He claims to have eaten the equivalent of 40 teaspoons of sugar a day, keeping his calories the same as his regular diet, and gaining almost 20 pounds. My simple opinion is: bull. People in the movie spent some time suggesting that a calorie is not just a calorie, that somehow you can get more from sugar. I’ll address that in a moment. The real problem is that while he thinks he didn’t over eat, he absolutely must have to gain close to 20 pounds in two months. Period. I’m not suggesting he intentionally lied, but I watched him eat and he was not measuring much of anything. Unless you weigh or measure, you can’t say that you ate what you claimed you ate.

But let’s say that he was correct, that he ate 2,300 calories per day with 800 calories coming from sugar. What that would require was somehow more calories are extracted from sugar. My question is how? To go molecular for a second, the energy we get from food is the energy stored in the chemical bonds of the food; if we take in more fuel than we need, the body stores the extra energy as fat. If sugar has only so much energy stored in the chemical bonds, how can it release more? Glucose or fructose, doesn’t matter. That would require some form of unknown chemical reaction that could create energy. That doesn’t happen in any biochemistry of food I’ve ever studied. If it could, it would come at a cost, an energy cost somewhere.

The idea that a calorie is not a calorie has always been a foolish argument because there’s no chemistry to support it. We cannot make more energy than we begin with. The only way he gains 20 pounds is he overate. A lot.

He spends a lot of the movie talking about sugar spikes and falls that made him “addicted” to sugar. I’ve never seen anyone drink that much fruit juice, to the extent that it wasn’t reasonable. I asked on Facebook how sugar affects people who drink juice or any other form of sugar, but not sodas. The results were 1:3 against a sugar rush of any kind. I also included physicians and other healthcare professionals. Was it a formal study? No. And neither was what the author did to himself in this film.

To me, his film was a real work of fiction. Add it to your collection of fantasy films.

If you reduce the amount of sugar in your diet after watching this film, that’s great. You really can’t go wrong getting your calories from better nutritional choices. But don’t base your decision on this pretend research.

What are you prepared to do today?

        Dr. Chet

That Sugar Film: The Results

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I hope that this sunk in on Tuesday: Damon Gambeau, the filmmaker, was going to eat 40 teaspoons of sugar per day. The rest of the story was that he was not going to eat cakes and cookies or drink full-sugar soda. He was going to eat what might be considered health foods: low-fat yogurt, fruit juices, whole grain cereals with sugar added, and other things with Australian names I don’t recognize. By the end of each day, it had to equate to 40 teaspoons of sugar or about 168 grams, not counting all the other carbohydrates.

What happened after 60 days? One of his liver enzymes was off, up 20 points over the safety level, which was never really explained. His triglycerides were up significantly, from about 60 mg/dl to 132 mg/dl. While that’s up, it’s not really abnormal for a fasting triglyceride level.

The real change was in his weight. Based on weigh-ins, he gained 19.8 pounds in 60 days. He also gained 10 cm around his waist—that’s close to four inches. And here is the kicker: his estimated caloric intake before the self-study was around 2,300 calories per day. He claims that his caloric intake remained at 2,300 calories per day throughout the experiment. All the experts went nuts. Taubes said it’s got to be the sugar. Another said sugar has to be the problem.

Oh, really? I’ve got some comments on that on Saturday—and you won’t want to miss them.

What are you prepared to do today?

        Dr. Chet

Review: That Sugar Film

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Summer gives us a chance catch to up on reading or binge watch a television series, so I thought I’d watch some of the nutrition documentaries that I’ve been asked about. I’ve done some in the past such as Forks Over Knives. It gives me a chance to check the facts on what’s said and how true or relevant it is. That’s the case with the film titled That Sugar Film. It was written, directed, and starred in by an Australian filmmaker Damon Gambeau. Hugh Jackson even performed the opening scene.

The premise of the movie is that all sugar is bad. There was at least one anti-sugar and ketogenic diet proponent in Gary Taubes author of Good Calories, Bad Calories. The filmmaker also assembled a team of experts who were going to provide information and medical supervision during an experiment he wanted to conduct on himself. The experiment was to see how a high-sugar diet, one typical of the average Australian, would impact him. Based on what he claimed to eat, he was somewhere between the paleo diet and the ketogenic diet before that.

There was the requisite discussion of the cholesterol hypothesis and how fat was chosen as the demon to avoid instead of sugar as they relate to heart disease. The sugar industry conspiracy was also talked about in the same vein as the tobacco industry. But it’s what he did to himself that was by far the most interesting: switching to a diet that contained 40 teaspoons of sugar a day for 60 days. What happened to him? That’s coming on Thursday.

What are you prepared to do today?

        Dr. Chet

Making Burgers Leaner

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The series of Memos on meatless burgers generated many interesting comments. With the major holiday for grilling just two days away, I want to show you how to reduce calories in beef burgers.

First, use a leaner cut of meat for your burgers. Ground sirloin is often designated 90/10, ground round 85/15, ground chuck as 80/20, and hamburger meat as 70/30. The first number is the percentage of protein while the second is the percentage of fat by weight, but the grams of fat are vastly difference. A 4-ounce burger made of ground sirloin has eight grams of fat while the most commonly used cut for burgers at 80/20 has 21 grams of fat. That’s a difference of close to 120 calories, and those calories come from fat.

Second, you can consider the amount of fat lost while grilling. For 80/20 it can be up to seven grams of fat or about 60 calories while 90/10 only loses about one gram of fat or just 10 calories. However, the difference in shrinkage would be significant. The four ounces can drop to 2.6 ounces with the 80/20, but you lose just under one ounce in the 90/10. That means the ground sirloin will give you a bigger burger with a lot less fat.

How do you decide? It depends on whether burgers are a staple of your diet. If you have a burger or two only on outdoor-grilling holidays, who cares? If you grill burgers a couple times of week, the fat and calories begin to add up. Add lots of veggies——tomato, lettuce, onion, pickle—and use a whole wheat bun; check the calories in the buns because they can vary greatly.

You can have your burger, meatless or beef, and enjoy it, too. Of course, there are a whole lot more options for grilling, but to me there’s nothing like a good burger grilled outdoors.

Have a Happy 4th of July and enjoy your Independence Day celebration. I’ll be back next week with another health topic to discuss in detail. If you’re not in the U.S., I hope you’ll grill along with us.

What are you prepared to do today?

        Dr. Chet

Something Greater than Yourself

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Who’s going to analyze all of this data when data collection is complete? A better question might be who couldn’t analyze this data. The answer: anyone who has a good research question and agrees to abide by the guidelines of data usage can run an analysis. That could even be you. That’s correct; if you have a question and the ability to analyze the data, you could do it.

The goal is personalized medicine, and not just a pitch by a practice that’s talking about typical healthcare. The goal is to be able to identify the subgroups that will respond best to preventive health practices or to specific disease treatments. In that way, a profile of the best techniques based on genetics, environment, and lifestyle can be developed.

The only disappointment I have is that they didn’t include the microbiome. That would require a stool sample and add a greater degree of complexity to a data collection procedure that’s already very complicated. Maybe they’ll add that in the future.

If you go to the All of Us website, you’ll be able to find the local healthcare system in your area that’s responsible for data collection. In Grand Rapids, it’s Spectrum Health. I did the surveys online and scheduled an appointment for the physical data collection; that was it. In our area, we get a $25 gift card to a large grocery store chain, so I’m planning to get the whole family involved; Riley’s off the hook because you must be 18 and able to give consent. Whether you’re healthy or not doesn’t play a part in it; in fact, the info from people with current health conditions may be even more important.

The Bottom Line

The opportunity to become a part of something significant doesn’t happen all the time and almost never in preventive healthcare. This is time to do something greater than yourself, I can’t tell you whether it will benefit you personally, but it will benefit humanity. Maybe, just maybe, it will benefit a friend or relative. Check it out and check in to All of Us.

What are you prepared to do today?

        Dr. Chet

Reference: https://allofus.nih.gov/

All of Us: The Details

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Before I go further, I want you to consider this. For every variable, there will be a million data points. Height: one million. Weight: one million. Hip circumference: one million. You get the idea—and this is the simple stuff. The blood work alone could have 100 variables. Then we get into the DNA. Every gene has to be mapped to examine specific areas of DNA to see similarities or differences between healthy people and those with diseases.

If you volunteer, you will be called a partner instead of a subject. You’ll be giving the study plenty of information, but the information doesn’t just go one way. In the future, when there’s something that can benefit your health, you may be given information critical to preventing or treating a disease. The data collection includes giving Informed Consent and HIPAA for electronic data collection. Then there are several surveys and perhaps more in the future. There will also be blood and urine specimens as well as some baseline anthropomorphic data.

One thing that’s on everyone’s mind is information security. The researchers go into great detail to protect your identity. Data will be posted only with a number instead of a name, and the highest level of encryption available today will be used to protect your identity. I take security seriously, and I’m comfortable with it.

Check out the link in the Reference to find out more, and if you choose, to get started now yourself.

What are you prepared to do today?

        Dr. Chet

Reference: https://allofus.nih.gov/