The Bottom Line on Preschoolers, Probiotics, and Gastroenteritis

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“These studies are likely to have significant impact towards eliminating use of medications that don't seem to work.”

That’s a quote from a physician interviewed by NPR who wrote a commentary accompanying the two research papers on probiotic use for gastroenteritis or GE (1). I think it perfectly illustrates the fallacy of the pharmaceutical model of research on nutrition and its impact on health:

Nutrients are not medications.

They may come in pill form, they can be administered like medications, but they’re nutrients nonetheless.
Questions About the Studies
The . . .

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Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Winterize Yourself

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The official start to winter is quickly approaching, but for most of us the cold, wet, snowy, rainy weather has already begun. Today’s Memo contains some tips on how to winterize your body by focusing on basic nutritional supplementation.

Water: Make sure you increase fluid intake during the winter. The humidity is lower because the heat is on in your home, work, and school. You breathe out more water as a result. You have to replace those fluids. Every day drink one-half your body weight in ounces of water or any other fluid; if you weigh 150 pounds, drink 75 ounces of water daily.

Multivitamin-mineral (MVMM): If you haven’t been consistent in taking your MVMM, this is a good time to begin. Your immune system needs some basic nutrients and a MVMM is a good place to start, especially if it’s one that contains plant concentrates and extracts.

Probiotics: The immune system starts in the gut. Taking a probiotic every day can help your immune system function better. In addition, taking fiber with the probiotic can help feed all the good bacteria in your digestive system.

Vitamin D: Consider adding vitamin D to your regimen because we get a lot less sun during the winter. Ask your physician to test your vitamin D levels; if it’s below 30 ng/ml, add 2,000 IU vitamin D to your supplementation. There’s no real danger in taking vitamin D, so make sure you’re getting some even without a test.

Antioxidants: Help your immune system; add additional vitamins C, E, and beta-carotene to your supplementation.

Supplementation may or may not help you avoid getting a cold or the flu, but it may help reduce the severity and duration of a respiratory infection if you do get one. That’s worth the small expense of the supplements in my opinion.

 

Happy Thanksgiving!

Paula and I wish you all a Happy Thanksgiving. We are grateful for your support throughout the year. This week is one to spend with family and friends, so this will be the only Memo of the week. Thanks for being a member of the Dr. Chet family.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on the 2018 Cholesterol Guidelines

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In Thursday’s Memo, I talked about the 2018 Cholesterol Guidelines and evidence-based medicine, focusing on the physician side of the treatment discussion. But I believe that’s not the most important part of the discussion; I think the critical part is the patient side. Here’s why.

The Cholesterol Guidelines focus on lifestyle changes first: a healthier diet, exercise, quitting smoking, and weight loss. That’s supposed to be the initial part of the potential treatment plan—lifestyle first. In other words, what will the patients do for themselves before the discussion leads to medications, especially statins?

The guidelines aggressively focus on the use of statins and other medications to get the LDL-cholesterol to desirable levels, so we have a dilemma during the discussion of a treatment plan. Do the physicians assume, based on experience, that the patients won’t do what they’re supposed to do to lower their risk of CVD and immediately prescribe medications? Or do the patients take the lifestyle route seriously and do what’s necessary to change their health?

To be blunt, we patients haven’t done our part. We lose weight and gain it back. We start to eat healthier and don’t sustain it. We start to exercise, but we let life get in the way and stop, or we push too hard and get injured and stop, or the weather turns colder or hotter and we stop. When we agree to change our health habits and then don’t follow through, we make our health issues worse—they’re still in there eating away at our lifespan and not being treated.

Don’t make promises you know you won’t keep; notice I didn’t say can’t keep, I said won’t keep. If you know in your heart you’ll never change your diet or keep up with exercise, the best thing you can do for your health is don’t delay: start taking the meds and start taking care of the problem.

Although I disagree with it, I get why physicians jump to meds. There’s only one way to change that: we have to prove them wrong when they assume we won’t stick to a healthier lifestyle.

The Bottom Line

The 2018 Cholesterol Guidelines put the responsibility for lowering the risk of CVD without medications in our hands—the patients. Work out a timeline with some concrete goals for each lifestyle area with your physician. It won’t be easy: regular exercise for life, eating better from now on, quitting smoking, plus getting to a normal weight and staying there will all take time and consistent effort. That’s okay because even if your risk of CVD is high, it doesn’t mean you drop dead tomorrow. Even if you fall into an at-risk scenario, I know you can do it. There are many tools to help you keep at it: an app, a workout buddy, a Facebook group, and more.

Instead of looking at your health challenge as an obstacle, look at it as an opportunity for better health. If you say you don’t want to take medications, this is your chance to prove whether you really mean it. I can’t guarantee you’ll never need the meds, but you can work your way down to a smaller dosage with fewer side effects.

It all depends on your answer to one question: what are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

2018 Cholesterol Guidelines and Evidence-Based Medicine

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I was encouraged by the AHA’s new cholesterol guidelines for one reason: the promotion of a joint decision between patient and physician on a treatment plan if one was necessary. That’s the basic tenet of evidence-based medicine: any and all treatment plans should take into consideration the wishes and desires of the patient. Many factors can go into that—the age and current physical state of the patient, the financial cost of treatment, and the physical cost of treatment compared to the potential benefit.

The only concern I have is this: will that discussion actually take place as intended or will it be a one-sided conversation with the physician making the decision for the patient? Will the physician listen or ignore the patient’s views? Paula and I have a great primary care physician and specialists who always listen to us, but I know it’s not that way everywhere. It’s easy to say, “If he won’t listen, just find another doctor,” but that isn’t always an option in rural areas or if your health insurance limits your choice.

The physician side of evidence-based medicine is just half the story. I’ll give you my thoughts on the rest of the guidelines on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

AHA’s 2018 Guidelines on Cholesterol

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Here’s what the American Heart Association announced this past weekend: a 120-page research-based paper on new cholesterol guidelines and how the guidelines were developed. The paper was five years in the making, involved twelve medical and physician associations, and includes ten documents to explain and summarize what the guidelines say. For the foreseeable future, these will be the guidelines used by physicians trying to reduce the risk of cardiovascular disease.

The guidelines focus on control of LDL-cholesterol in combination with the state of the individual: those with and those without diagnosed disease. Primary prevention is for those who’ve not been diagnosed with atherosclerotic cardiovascular disease (ASCVD). Secondary prevention applies to those who have been diagnosed with ASCVD. The flow charts for treatment plans are complicated, even when isolated and presented on individual pages.

What I liked the most is that management of CV risk begins with a conversation between the physician and patient. The discussion revolves around risk factors, both lifestyle and the test results. The goal is to come to a consensus for treatment if a person’s CVD risk is high. What does that treatment involve? We’ll take a look on Thursday.

The Insiders Conference Call is tomorrow night. If you’re not an Insider yet, you still have time to join and take part in the call. I’ll be covering the latest research on omega-3s and vitamin D as well as answering your questions.

What are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

Research Update on Coffee and Alzheimer’s Disease

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I began drinking coffee when my mother put coffee with sugar and milk into my baby bottle—sounds shocking today, but that’s the way it was. Over 60 years later, I still love coffee, especially strong coffee. That’s why a health headline suggesting coffee may reduce Alzheimer’s and other neurological conditions caught my attention. I had to check it out.

Don’t rush off to the nearest coffee bar just yet, especially if you don’t drink coffee. This was a laboratory experiment to examine a by-product of coffee roasting called phenylindanes. The researchers examined whether these chemicals could prevent the aggregation of amyloid-beta and tau, the building blocks of the plaques and tangles of Alzheimer’s disease. Turns out, they can prevent those clusters and that’s great, but these are test-tube studies.

We’ve seen this many times before. Test-tube studies show beneficial effects of some nutrient and a product is rushed to market with no human trials. While that wasn’t the intent of the researchers, it probably will happen; you can still buy green coffee bean extract for weight loss even though the major clinical trial has been not just discounted but retracted.

I think it shows there’s power in plant nutrients. Eating or drinking a wide variety of all plants will help reduce inflammation, and thus the production of harmful chemicals in our bodies. The benefits are not just limited to raw vegetables or fruits. Cooking can have a beneficial impact on the phytonutrients just as the roasting of coffee beans may have. We don’t have to focus on a single nutrient for benefits.

The keys to health don’t change. Eat better. Eat Less. Move more. And have a cup of coffee or two along the way if you like it.

What are you prepared to do today?

Dr. Chet

 

Reference: Front. Neurosci., 10-2018 https://doi.org/10.3389/fnins.2018.00735

 

Genetics or Lifestyle?

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My dad died of a heart attack when he was 41. That fact has always been hanging over my head, especially when I had a heart blockage 16 years ago; the coronary artery was opened, I had a stent put in and have had no issues since. Was it my genes or was it lifestyle? Genotype or genes versus phenotype or lifestyle. I’ve always said genes, but not any more.

Researchers recently published an analysis of over 800 million individuals after examining births, deaths, and relationships between the individuals: in other words, who married whom, how many children they had, how long they lived. They found that a role for a genetic component of longevity was supported in family trees of people who were related. But here’s the interesting thing: they also found that there was a longevity relationship between non-blood relatives as well. In other words, the subjects’ in-laws shared similar traits for longevity.

What does that mean? Perhaps people unconsciously select mates with comparable traits. Because we don’t do that intentionally by genetics, it means that similar environments have a similar impact.

The actual role of genetics was estimated to be well below 10%. In other words, phenotype or lifestyle is more meaningful than your genes for how long you live. This was a very complicated mathematical analysis, so we should proceed with caution, but there’s little question that lifestyle has more to do with longevity than your genes.

Good genes give you a good start, but what you do after that matters most. What should you do? Eat better. Eat less. Move more.

Your body. Your choice. What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1534/genetics.118.301613

 

Vote!

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I wouldn’t normally recommend skipping your exercise, but I’m making an exception: if your exercise time is the only time you can go vote today, choose voting.

The health of our country is an important element of living a healthy life; we all need to be committed to keeping the U.S. system of government healthy.

What are you prepared to do today? If you’re in the U.S., I hope you’re voting. Readers in Canada, India, U.K., and elsewhere: stick to your exercise plan.

Dr. Chet