A Case for Fasting

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During the food poisoning episode last week, I didn’t eat for 30 hours. Of course, I had slept most of that time and eating was the last thing I wanted to do. Even though I could have started eating again, I decided to continue the fast to at least 60 hours. I continued to drink fluids—I’m not going to live without coffee—but no food or drinks with calories.

Why do this? I had just scanned a research paper written by a Japanese research group who had four volunteers fast for that long. They observed interesting changes in metabolism by measuring by-products of metabolism in blood. They took blood samples before the study and then at 10 hours, 34 hours, and 58 hours. In prior research, they had discovered 14 changes in metabolites, but this time there were 30 more changes that occurred during the 58-hour fast.

It’s difficult to establish a time-course of events as they didn’t collect blood every two or four hours, but we can compare baseline numbers with the results of the other times blood was collected and analyzed. Initially the body relies on stored sugar in the form of glycogen, but eventually sugar gets used up and the body has to rely on fat stores. Here’s observation Number One: blood sugar was consistently maintained varying only 10 mg/dl over the observed times. Surprised? I’ll tell you why that happened on Thursday.

What are you prepared to do today?

        Dr. Chet

Report Food Poisoning

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What should you do if you get food poisoning? Report it. The procedure may vary state to state, county to county, and even city to city, but here’s what we did.

The first thing: Paula called the restaurant where we ate and told the manager what happened, what we ate, and when. We can’t be sure their food was the culprit, but that’s the only time Paula and I ate the same things for the prior 24 hours. What we had to eat before then we shared with Riley, and he never had any digestive issues. It doesn’t have to be an accusatory conversation, but they should know—think of all the people that may have eaten at the same place. The manager was grateful for the information and said she’d check their stock of the food we ate.

Then I looked up the procedures for the county. They had an online form to fill out that asked about the symptoms, the timing in relation to meals, and what we’ve eaten over the past 72 hours. I filled it out on Sunday and they called Monday to check on some details. The forms were very detailed, and that’s probably why most food poisoning isn’t reported. By the time we feel better, which is just usually a couple of days, we think it won’t make any difference. But remember that no one can count the incidences if we don’t report it and let the health department do its job. Every time we see on the news that romaine lettuce or whatever has been recalled, that’s all the health departments working together to do their jobs—but they can’t help us if we don’t help them.

Paula and I have recovered from our bout with food poisoning. It was a very unpleasant 48 hours, but we made it; Paula adds that vomiting hard every 60 to 90 minutes is a great core workout. Most cases of food poisoning are not going to be fatal; only 450 deaths were reported per year out of the 1.2 million reported cases of salmonella poisoning. We don’t know how many could have been prevented with better info from the public.

We can never be sure our food supply and our home cooking techniques are perfect, but we can strive to make them better. So if you suspect you’ve gotten food poisoning, tell your doctor, your health department, and the store or restaurant as soon as possible. It’s the right thing to do, and it could save many other people from a miserable day or two. It might even save a life.

What are you prepared to do today?

        Dr. Chet

The Most Likely Culprit: Salmonella

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Food poisoning happens more often than we think it does. Most often, we throw up once or have a single bout of diarrhea with no fever and no fatigue and it’s over. The question is how we know which type of bacteria was at fault. There’s no way to know for certain unless stool samples are tested, and that only happens if the case is severe enough that a person requires hospitalization. While I can’t be certain, my best guess is that Paula and I encountered salmonella, the most common form of food poisoning.

I base that on the length of time from the onset of symptoms and the type of symptoms. Salmonella may or may not cause a fever, but it can cause vomiting and diarrhea. The Centers for Disease Control estimate that 1.2 million people get salmonella infections per year but as I suggested, it could be much higher; only 23,000 people per year are hospitalized with food poisoning. Most people get over salmonella within a few days with no lasting effects.

How do you know when to seek medical assistance? When the symptoms are very severe and last longer than is reasonable: 36–48 hours would be my guess. An inability to keep anything down or severe diarrhea can cause dehydration and that’s definitely not good. Children under five and people over 65 are the most at risk for hospitalizations because their immune systems are most likely to be compromised and dehydration is a greater risk.

What should you do if you suspect food poisoning? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Is It Food Poisoning?

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It all began Saturday evening. Paula and I had gone out to dinner to celebrate the 31st anniversary of our first date and were watching a little television. After finishing a show, she said she felt like throwing up. She decided to get ready for bed while I channel flipped for awhile. I found out later she had thrown up almost hourly all night long. It continued all the way through most of the next day. The vomiting skipped me, but I had diarrhea the rest of the night and throughout the next day. Neither of us had a fever, but the symptoms continued. I’ve never slept so much in 24 hours ever.

As I write this, we both feel better. I still feel 10 cents short of a dollar, but that raises a more important set of questions. What is the most likely culprit? What should you do if you get these symptoms? More important, what should we do to let others know? I didn’t choose this topic—it chose me—but that’s going to be the focus of this week’s Memos.

Tomorrow night is the Insiders Conference Call. The primary topic is probiotics and then I’ll answer your questions. You can still participate by becoming an Insider today.

What are you prepared to do today?

        Dr. Chet

Vaping: Better Than Tobacco

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Today’s final look at vaping and quitting smoking considers the following question: Does the use of vaping to quit smoking result in eliminating the dependence on nicotine? Based on the research, the answer is no, because there’s no research that attempts to answer that question that I could find. Knowing the powerful addictive qualities of nicotine, the only assumption we can make is that vaping does not result in breaking away from nicotine. Therefore when it comes to that question, vaping transfers the nicotine addiction from one delivery system, tobacco, to another delivery system, electronic nicotine-delivery devices. The addiction remains.

But we can still say vaping is better than smoking or chewing tobacco simply for the reduction in chemical exposure.

Maybe the assumption is that nicotine is benign. It isn’t. It has powerful effects on the cardiovascular and nervous systems as well as the adrenal and pancreatic glands. But that isn’t the only issue.

Research Questions

Besides the long-term effects of vaping on the body as well as the question I posed above, there are still several questions that have to be answered.

  • What is the effect of the incineration of the flavors used in vaping juices? The assumption is that because they come from fruit and other juices, they’re natural and won’t have any negative effect on the teeth, the trachea, and the lungs. We know that cooking changes the chemicals in the fruits and vegetables we eat; we also know that when eaten, they have no negative impact on the digestive system, but there’s concern that some of the by-products may be harmful to the lungs. We have no idea what incineration of the juices at high temperature will create. Remember that tobacco is a plant, too—it’s not that different.
  • What is the effect of the smoke or vapors on other people? Vaping generates second-hand smoke just as smoking does, but there’s no research on that.
  • Will childhood vaping lead to nicotine experimentation and addiction? Vaping devices have been marketed like candy to children for their taste. Nicotine cannot be advertised to children, hence the warning in the television ad that began this series, but the concern is that once using the same type of e-cigarette delivery system with fruit juices, it will be a small step for the kids to try the nicotine forms when they’re old enough, if not before.

The Bottom Line

At this time, vaping is better than smoking or chewing tobacco due to the reduction in exposure to toxic chemicals. However, it’s not correct to suggest that vaping is safe until the above research has been done. Until research demonstrates that vaping will lead to helping smokers break their addiction to nicotine, it’s the best route available to help people quit smoking and probably to quit chewing tobacco, although that’s not been tested. But that still doesn’t make it healthy.

If you want to know more about nicotine, the business of vaping and my personal experience with cigarette smoking become a Member or Insider at drchet.com. I cover those issues in the latest episode of Straight Talk on Health.

What are you prepared to do today?

        Dr. Chet

Reference: Ther Adv Respir Dis. 2018 .doi: 10.1177/1753465817744960.

Do Vapes Help People Quit Smoking?

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The only answer at this point is maybe. In the most recent review of the literature, population-based studies that rely on surveys and questionnaires suggest that vaping helps; the problem is that while they tells us something about the population as a whole, it tells us nothing about an individual. We’re still missing randomized placebo-controlled trials. The placebos wouldn’t have to have zero nicotine but should have a variety of doses to assess the best dose of nicotine for quitting; after all, nicotine patches and nicotine gum have been available for decades and have proven to be only 7% effective over a year.

The premise of vaping is that it’s healthier than smoking cigarettes. Is it? When you consider the hundreds if not thousands of chemicals released from tobacco cigarettes, the answer would be yes. Switching from cigarettes to vapes is better from that perspective. But does vaping really help people quit smoking?

One of the characteristics of recent electronic nicotine-delivery systems is the use of liquids with higher doses of nicotine, close to what is found in cigarettes. It may take these higher doses to help people quit smoking.

What are you prepared to do today?

After they quit smoking cigarettes, how long does it last? Research from the United Kingdom suggests that vaping help smokers quit with the use of traditional quit-smoking programs. The long-term effectiveness remains unknown. Which raises the second question: are people able to get off nicotine altogether? I’ll talk about that on Saturday.

        Dr. Chet

References:

1. Ther Adv Respir Dis. 2018 .doi: 10.1177/1753465817744960.
2. Cochrane Database Syst Rev. 2016. doi: 10.1002/14651858.CD010216.pub3.

Warning: Vaping Update

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A couple of months ago, I happened to read a story about a couple of graduate students who came up with a business plan to replace cigarettes with vapes; they wanted the nicotine from the vapes but none of the harmful chemicals in tobacco products. Turns out, the company in the commercial was their company 15 years later after a major investment by a tobacco company.

With a DVR, you can pretty much skip all commercials if you want to. But as I hit the fast-forward recently, I saw something that made me rewind. It said something like “Warning: the following product contains nicotine.” The bulk of the commercial was a testimonial from someone who quit smoking cigarettes by switching to an electronic nicotine delivery system or vaping, for short. The commercial ended with the name of the product found in many vaping stores.

The health questions that vaping presents haven’t been answered, especially the question implied by the commercial: does vaping help people quit smoking cigarettes? Further, do people who smoked tobacco and switch to vaping ultimately quit nicotine all together?

I’ll answer the first question on Thursday. What are you prepared to do today?

        Dr. Chet

Do Your Job

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Physical preparation. Mental preparation. The final thing that’s drilled in to the Patriots is to do their job and do it to the best of their ability. Don’t take it upon yourself to do someone else’s job because you want to help. Take care of your space, do what you’re supposed to do, and you will be in position to make the right play at the right time.

I’ve been in meetings where people took it upon themselves to suck the oxygen out of the room by talking out of turn and about things not in their area. Those are the type of meetings that lead to less than optimal results.

How does that relate to your health? The doctor does what he or she is supposed to do. The nurse draws blood, the lab tech runs the samples, and the data entry personnel make sure the results are input correctly. The medical team does everything they’re supposed to do.

You’re the final member of that team. You have a role to play whether it’s to eat a specific diet, take your medications at the proper time, or go to cardiac rehab or physical therapy. That job continues when you’re back on your own. It doesn’t mean you’re set for life; it means that now you know your role in getting and staying healthy. In that way, you can train to peak exactly when you need to peak.

Do your job! All you have to do is look in the mirror every morning and ask yourself one question:

What am I prepared to do today?

        Dr. Chet

Peaking Mentally at the Right Time

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It’s not enough to perform your best physically; you also have to be able to peak mentally. While the physical does impact the mental, you can’t just wing it if the task is important to you. To me, that was the difference in the Super Bowl. But the Patriots in particular seem to be able to consistently peak at the right time, and that’s how they’ve won six Super Bowls.

In the lead up to the game, I watched a clip of the head coach Bill Belichick. I’m a long-time Bills fan, so he is definitely not my favorite person. The clip I viewed was Belichick talking with his defense, telling them to keep doing what they were supposed to do, and later in the game they would get the results they wanted. Defense is his specialty. Whatever the Patriots were doing on defense worked the entire game. Not so much on offense. Except for the touchdown drive. They used a formation they hadn’t used before, used it four plays in a row, and scored the touchdown that decided the game. They were ready to peak at exactly the correct moment, because it seemed like a different team on that drive.

No matter what you do, remember that physical training is just part of the story. You have to practice and prepare mentally to execute at exactly when you need to perform. The physical and the mental work in concert, and to ignore one puts the other at risk. There’s still one more thing you have to do and I’ll finish this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Peaking Physically at the Right Time

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The New England Patriots won the Super Bowl again. You can love them or hate them, but you have to respect what they’ve accomplished. In fact, you have to respect the physical preparation of both teams leading up to the game. No one seemed winded or gasping for air, and no one seemed to be cramping or suffering other physical issues.

Tom Brady’s physical preparation is well known; at 41, he’s the oldest quarterback to win a Super Bowl. But both teams were physically ready to play, and they peaked at exactly the right time.

Wouldn’t you like to be able to do that? There are many paths that can get you there. On Super Bowl Sunday in my Super Bowl Webinar, I showed one way for you to have the energy to peak at just the right time. You can purchase the replay for the rest of the week and watch it any time up to two weeks after that.

But physical peaking is just one part of the story. You have to be prepared mentally as well and that decided the difference in the game. I’ll tell you why on Thursday.

What are you prepared to do today?  

        Dr. Chet