Too Many Carbs vs. Too Few

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Yesterday I talked about a Lancet study that says too many carbs are bad and can kill you—but so can too few carbs. The logical question to ask is: what timeline are we talking about? Is it 10 years or 20 years or more? Based on the results of the study, let’s compare the extremes of carbohydrate intake with the mean intake of carbohydrate for a 50-year-old person.

If you ate fewer than 30% of your calories from carbohydrates, you might live up to 29 more years compared to the 33 years a person might live if they ate 50–55% from carbohydrates, so 79 vs. 83. What are four potential years worth to you? They’re only potential years because these are just hazard ratios; it could be as little as 2.5 years or as much as 5.5 years.

On the other hand, if you ate more than 65% of your calories from carbohydrates, you might live another 32 years compared to  33 years for someone who ate 50-55% from carbohydrates. At 82, do you care about one more year?

Only you can decide what those years are worth to you, and to compound the issue, we don’t know what our health will be like when we’re that age. But there may be a way to put the odds in your favor whether you want to eat more or less food high in carbohydrate. I’ll tell you about that tomorrow.

What are you prepared to do today?

Dr. Chet

 

Reference: http://dx.doi.org/10.1016/ S2468-2667(18)30135-X.

 

Huh?

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That’s exactly what I thought when I looked at my health news feed pictured above. Carbohydrates will kill you—maybe. Too many are bad. Too few are bad. It’s all referencing the same study published in Lancet Public Health. What the heck is going on? You’ve heard that beauty is in the eye of the beholder? Evidently, so are provocative headlines.

Researchers examined the mortality rate of participants in the Atherosclerosis Risk in Communities (ARIC) study. The subjects had been followed for 25 years. At the beginning of the study and periodically afterwards, they completed an abbreviated Food Frequency Questionnaire using food models to estimate serving sizes. Foods were analyzed using the Harvard food database to estimate protein, fat, and carbohydrates as well as sources of fats and protein.

What did they find? Just what the headlines said: too many or too few carbohydrates are related to an increase in death. As always, the details are found in the data. We’ll take a look in tomorrow’s Memo.

What are you prepared to do today?

Dr. Chet

 

Reference: http://dx.doi.org/10.1016/ S2468-2667(18)30135-X.

 

The Simplest Solution for Joint Pain

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Every joint in your body has a joint capsule and within the capsule is a liquid called synovial fluid. It’s made by the inner lining of the capsule and provides nutrients to the joint cartilage and other structures. It also provides cushioning to the joint. Even when we stand, the fluid in the knee joint prevents bone from touching bone—unless there isn’t enough fluid in the joint capsule.

You can probably guess where this is headed: the simplest solution for reducing joint pain is to drink more water. The less water and fluids we consume, the more likely cartilage, ligaments, tendons, and other structures will become brittle. In addition, there will be less fluid in the joints, which could allow nerves to be pinched in the spine and bone-on-bone contact in the hips and knees. And that does not feel good.

Joint pain is a complicated process, and inflammation has a significant role to play. The cumulative damage that we’ve done to our joints over the course of our lives has consequences; they may not heal as well or as completely as they should. There may be no permanent solution short of surgery to repair or replace structures.

The primary goal for any type of joint pain is to reduce pain levels. Drinking more fluids cannot repair the structures of a joint, but it can help improve the fluid levels within the joints so they get more nutrients and increase the natural fluid levels. That could decrease pain levels somewhat, allowing us to move more freely.

As I said when I begin this week, sometimes the simplest solution is the correct one. Drink up!

What are you prepared to do today?

Dr. Chet

 

The Simplest Solution for Migraines

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Let’s continue with the theme of the simplest solution often being the correct one. Migraines are a devastating form of headache. While most causes are unknown, people have identified triggers from chocolate to sounds to odors and more. My pretend daughter Jamie suffers from them on a regular basis.

As I researched how to deal with migraine headaches years ago, I found a pilot study that examined whether subjects could reduce the frequency and intensity of migraines by drinking more fluids. The researchers asked the subjects to drink 1.5 liters of water per day for 12 weeks. The subjects managed to increase their average intake to only one liter per day, but total hours with migraines and the intensity of those migraines decreased.

Will it work for everyone? Most likely not, but because there’s no harm in simply drinking more water every day, it will help those who were unaware that they were dehydrated; that’s not the first cause we think of when we think of migraines. It’s worth spending a month drinking more water to see if it has the same results for you or someone you know. For more potential solutions for migraines, see The Bottom Line on Migraines at the DrChet.com Store.

One more simple solution on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: Eur J Neurol. 2005 Sep;12(9):715-8.

 

The Simplest Solution for Fatigue

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One of the basic tenets of health and disease that I’ve learned is this: often the simplest solution is the correct one. Think of it this way. Whether we want to be the healthiest we can be or we have something that afflicts us, we think in terms of elaborate solutions. Instead, think of building a foundation to prevent or cure what ails us.

Let’s begin with something that can affect us all at times and that’s fatigue. The possibilities include an underactive thyroid, an adrenal issue, or pre-diabetes. But before we look at the complex, start with the obvious: drink more fluids. It may be a simple case of chronic dehydration. The lack of fluid can change the ionic balance inside cells, which can inhibit the production of energy by just about every cell including the brain and the muscles. Those two organ systems are most associated with fatigue.

Symptoms of dehydration vary. If an elderly parent seems unusually confused or a small child is drowsy and irritable when he or she is usually going full blast, try fluids first.

Before you try the elaborate solution, begin with the simplest. Drink more fluids, whether coffee, tea, plain water, or even eating more vegetables instead of refined carbohydrates. The simplest solution for fatigue may just be a glass away.

What are you prepared to do today?

Dr. Chet

 

More Reasons to Use Probiotics

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One of the most frequently asked questions I get is this: “Should I take probiotics when I take antibiotics? I don’t want to negate the benefits of the antibiotics.” Based on the summary of the Cochrane Review, I think there’s enough evidence to say that you should take probiotics any time you have to be on antibiotics. The research evidence is not perfect and the authors called for more and better research to confirm the results, but there appears to be no harm when taking probiotics during antibiotic use. If it doesn’t harm, then it’s a good idea to do it, even if the rate of C. diff is relatively low to begin with. But it’s a good idea to clear it with your doctor because reasons for taking antibiotics can be different.

There are a couple of things that we don’t know. What is the best type of probiotics to take? And how much should we take? In spite of those unknowns, when examining the data summary of all the studies, there was an overall benefit when probiotics were used. That means whether it was just one strain or several, in differing quantities, they all seemed to work. Whatever probiotic you typically use, take it during antibiotic use until we know more.

Another Review Paper

I’m currently going through a review paper on the brain-microbiome connection (3), and it’s one of the best reviews I’ve read in a long time. I’m still checking the background research; it’s complicated physiology and biochemistry. I can’t get it into the typical three Memos per week so it will be a new Bottom Line in the near future.

What I’ve taken away so far is that we should all be taking probiotics every day, unless there’s a reason you can’t. If you buy a quality product, they’re not inexpensive, but it’s still a good decision based on the potential benefits. In addition, it would be a good idea to add fermented foods to your diet every day: yogurt, especially Greek yogurt, kefir, sauerkraut, kim chi, and more. They all contain a variety of probiotics that can add to your microbiome.

You should also take a fiber supplement every day. Fiber supplements contain prebiotics that feed the probiotics—you’re feeding the good bacteria. In addition, eat foods with more fiber, and that means vegetables and fruits. Again, they can provide positive bacteria to help the microbiome if you eat them raw as well as the food the bacteria needs to thrive.

The Bottom Line

There is a long way to go until we have enough research that identifies the best strains and amounts of probiotics to take as well as the best sources. There’s always the possibility we’ll find a better way, such as eating specific varieties of fruit grown in a specific region of the world that has the right strains of bacteria. We just don’t know. But what we do know is that there are benefits to taking probiotics every day right now. I think that’s the path forward at this point for almost everyone.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.
3. Cell Mol Gastroenterol Hepatol 2018;6:133–148.

 

Probiotics Can Cut C. Diff Rates

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The authors reported that there were 39 studies included in the Cochrane review; 33 on adults and six on children. They included studies that were in-patient, out-patient, and using varying strains and quantities of probiotics. Here’s what they found.

There was moderate evidence that the use of probiotics together with the administration of antibiotics did reduce the occurrence of C. diff. The risk of getting the C. diff infection was reduced by 60% when compared to control subjects or those who were not treated; typically about 4% of the subjects got C. diff when treated by antibiotics, and it was reduced to 1.5% when probiotics were given concurrently. The phrase “moderate evidence” is one I haven’t used before. It’s generally specific to Cochrane Reviews and is assessed using various factors, ending with a number that reflects the quality of studies included in the analysis.

There was also a reduction in abdominal cramping and diarrhea in those subjects who were given probiotics with their antibiotics compared to those who didn’t get probiotics. In this case, the quality of the research was considered of poor quality. Does that mean that the probiotics were ineffective? No. More than likely it was due to the subjective assessments of pain by individuals. You can test stool to see if C. diff is present, as would have been done in the other part of the research, but relying on people’s self-assessment of pain is less objective. (That’s why my website offers the pain scale developed by the Missoula Project; it has physical activity descriptors that make it easier to determine where you are on the scale. Look for it on the Health Info page.)

Where does that leave us? I’ll finish on Saturday with some recommendations for the use of probiotics.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Can Probiotics Prevent C. Diff?

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Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Digital Media and Relationships

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In observing the people at Paula’s high school reunion, the one thing that stood out was that the relationships the classmates had formed during their time together had endured. True, they had a small graduating class with fewer than 75 students, but even in bigger schools with hundreds of graduates, there are groups of students who still know each other well because of activities they participated in together.

What impact would digital media have had back then? Paula was asked to speak as a representative of her class and in looking back, she said this:

We didn’t have an amazing computer in our pockets that we use for vital things such as taking pictures of our food and watching cat videos and texting each other: “What do you want for dinner?” “I don’t know, what do you want?” But we had down time, free time to spend just being a teenager. No one stared at the phone—that would have been silly. We looked at the scenery and at each other.

How would social media have affected the class of 1967? They were a social network. They were involved in each other’s lives during school, sports, and other activities, live and in person. I’m sure it would have had an impact; I just don’t know if it would have been in a positive way. There would most likely have been less live social contact and instead a lack of human contact. There would have been less time to talk face to face because there would be so much more access to more people, even in a very impersonal way.

The irony of digital media today is that social media is how many members of the class reunion found each other; it certainly helped spread the word of the reunion itself. They had gotten reacquainted before they got together in person and had seen pictures of each other’s spouses and kids and grandkids on Facebook and Instagram. Digital media are just tools of communication, and that’s how the reunion class uses them.

Digital Media and the Class of 2018

Don’t for a minute think I’m a Luddite. After all, I’m communicating with you three times a week via email and many of you read this on your cell phones.

Whether the use of digital media contributes to ADHD is not certain, but it does contribute to one thing for sure: isolation. A 2016 article in Psychology Today said:

Humans are hardwired to interact with others, especially during times of stress. When we go through a trying ordeal alone, a lack of emotional support and friendship can increase our anxiety and hinder our coping ability … Other studies confirm that loneliness isn’t good for anyone’s health. It increases levels of stress hormones in the body while leading to poor sleep, a compromised immune system and, in the elderly, cognitive decline.

Texting and commenting on social media platforms cannot convey true emotion, no matter how many emojis you use. The only way that works is live social interaction where you can look someone in the eye when you talk to them or at the very least hear their tone when speaking on the phone.

When you think about health and what can impact it, the bonds we make with other humans is important. It can help our mental health in many ways and that can impact our physical health. To me, that’s what the class of 2018 might be missing: the social interaction and personal bonds that transcend decades. When they meet in 50 years, will they talk about the great text or Tweet someone sent or the excellent Instagram story someone put together? I doubt it. And that’s their loss.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. 2018;320(3):255-263. doi:10.1001/jama.2018.8931.
2. https://www.psychologytoday.com/us/blog/out-the-ooze/201611/the-perils-social-isolation

 

Is There a Link Between Digital Media and ADHD?

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Today it’s difficult to find teenagers who don’t have their eyes glued to a cell phone. They’re texting, checking social media, playing games, or doing just about anything other than talking to other teens—even if they’re sitting across the table from one another. Researchers from California universities wanted to find out if the digital media today has a measurable impact on the behavior of high school students. Here’s what they did.

The researchers recruited over 3,000 students in 10th grade to participate in a two-year study of digital media use and symptoms of attention deficit hyperactivity disorder. The teens reported their use of all forms of digital media including phones, computers, and gaming devices. They were tested every six months for symptoms related to ADHD using standardized tests.

Researchers found that as the use of digital media increased, so did the symptoms of ADHD. The type of activity didn’t matter: texting, checking social media, playing games, listening to music. The more time they spent on digital activities, the more ADHD symptoms. That doesn’t mean they had ADHD; they exhibited symptoms.

Before you take away your teen’s media devices, let me add that this was not a perfect study; studies that rely on surveys and questionnaires have their issues. Still, it does indicate that as reliance on digital devices increases, attention to the world may decrease, and that’s no surprise. How is this related to Paula’s high school reunion? I’ll wrap it up on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: JAMA. 2018;320(3):255-263. doi:10.1001/jama.2018.8931.