Health Headline: Diet and Hearing Loss

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Researchers examined nutrition data collected between 1991 and 2013 in the second Nurses Health Study to examine whether adherence to a healthier diet reduced the risk of hearing loss. They developed a scoring system for three dietary approaches: the Alternate Mediterranean Diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010). They also gave the subjects a hearing health questionnaire to ascertain hearing loss in 2009 and 2013. The researchers divided the diet scores into quintiles and examined the trend across increasing adherence to each of the three diets as determined by the scoring system.

Researchers reported that as the adherence to each diet increased, hearing loss decreased. Those subjects who adhered to their diet best reduced their hearing loss by as much as 30%.

Headline worthy? A split decision. I’m in favor of any reason for nurses or anyone else to eat a healthier diet with more vegetables and fruit.

Why not headline worthy? The first issue was use of the food frequency questionnaire, which relies on recall for the number of typical servings of over 150 items during the past year. Yes, you read that right; the questionnaire asks, for example, how many times you had chicken in the last year and how big was the serving. Maybe you could answer questions like that accurately, but I couldn’t. And as the old axiom about data goes: garbage in, garbage out.

Second, it used a poorly validated self-report of hearing loss from fewer than 700 subjects in just two studies. That’s good enough for a pilot study, but not good enough to make a recommendation.

Third was that when examining the median values for scores in the highest quintile across all three diet assessments, adherence was no better than 67% and as low as 50%. That means 33–50% of the time, the subjects ate foods that were not part of each diet. What made up the other half to a third? Maybe that was the secret to success.

So while these are promising results, they simply point the way to a bigger, better study to see if a better diet makes a significant difference in reducing hearing loss. However, if fear of hearing loss will motivate you to eat healthier, that’s a good outcome. But if I suspected hearing loss to be in my future, I’d take other steps in addition to eating better.

The Bottom Line

That’s my look at last week’s health headlines and the science behind them. In every case, the science did not merit the conclusions. The rush to publicize results gets headlines, but really? That’s all it does.

We can say that they provide interesting results that need further study. Even without complete info, you could take positive steps such as eating better to perhaps help avoid the conditions studied—you’ve got nothing to lose by eating more fruits and veggies.

What are you prepared to do today?

Dr. Chet

 

Reference: The Journal of Nutrition, nxy058, https://doi.org/10.1093/jn/nxy058.

 

Health Headline: Ketogenic Diet and Type 1 Diabetes

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Researchers wanted to examine the blood sugar control of type 1 diabetics who use a very low carbohydrate, high-protein, moderate fat ketogenic diet. The diet was developed by Dr. Richard Bernstein, himself a type 1 diabetic. They used a unique study design: they requested volunteers from a Facebook group of children and adults who adhere to the Bernstein Diet. Over 300 volunteers completed an online survey about their diagnosis and diet. The diagnosis of type 1 diabetes was confirmed from medical records from a follow-up survey of medical staff.

This was a rigid ketogenic diet with no more than 30 grams of carbohydrate allowed per day. The average intake was 36 grams carbohydrate per day. The better the control of carbohydrate intake, the better the HbA1c score, with a mean of 5.7%. Remember, these were type 1 diabetics; there are many type 2 diabetics who don’t control their HbA1c that well. I think this study illustrated the potential of nutrition in affecting a disease system. One interesting aside was the healthcare professionals treating the patients seemed indifferent to the dietary approach regardless of the results.

Headline worthy? Yes, in context. Close to half the subjects did not provide access to medical personnel so the researchers relied on the initial subject surveys for information. They also had no access to any dietary records to confirm the diet. Still this was a unique way to use social media to gather information. The study has to be confirmed using traditional research design to assess the variables. But this approach examined people who live this diet on their own or with their children. That can provide insights that might be missed if the study were conceived by a group of research professionals discussing the question around a table.

What are you prepared to do today?

Dr. Chet

 

Reference: Pediatrics. 2018. doi: 10.1542/peds.2017-3349.

 

Health Headline: Antibiotics and Kidney Stones

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For this week’s Memos, I picked three health headlines from the past week and examined the studies behind them to see if they were headline worthy. Let’s begin with the use of antibiotics and the risk of kidney stones.

Researchers in the United Kingdom examined the incidence of kidney stones in over 13 million children and adults between 1994 and 2015. They examined the medical records of over 25,000 subjects with stones and compared them with over 250,000 matched-control subjects. The researchers wanted to compare the use of antibiotics with the onset of kidney stones.

The researchers found that there was a relationship between the use of five different classes of antibiotics and the onset of kidney stones. The relationship appeared to be stronger with younger subjects and the risk lasted longer: up to five years.

Headline worthy? In the abstract, the researchers wrote about the relationship between changes in the microbiome and kidney stones. Antibiotics can cause changes to the microbiome, but they did not test the microbiome of any subjects. Therefore, there’s a statistical relationship but nothing more. On top of that, the risk of getting a kidney stone over 21 years was just 0.19%.

Conclusion: not headline worthy. It’s worth researching further to establish whether there’s a cause and effect relationship along with the role of the microbiome in the process.

What are you prepared to do today?

Dr. Chet

 

Reference: JASN. 2018. doi: 10.1681/ASN.2017111213.

 

Tracking Your Rate of Change

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The U.S. Preventive Services Task Force (USPSTF) just published new recommendations for prostate specific antigen (PSA) testing for men 55 and over. In effect, they don’t recommend PSA testing on a regular basis. I think that’s a mistake. I’ll cover the specifics for PSA testing during the Prostate Health webinar, but I think regular testing is important regardless of age for this reason: monitoring the rate of change.

Monitoring changes in medical tests does not just apply to PSA, it applies to just about every test: cholesterol levels, triglycerides, blood sugar, HbA1c, body weight, vitamin D. Even non-medical tests such as food intake. By monitoring changes, we can identify how each component of our health is changing, especially the rate at which they’re changing. It also tells us how well our lifestyle modifications are working. Those are valuable pieces of information.

No single number is important; it’s how that number fits in relation to other results of the same test that may be important. If it increases at a higher rate or at a faster rate, that may indicate a problem that needs to be addressed. Let’s say your PSA goes from 0.5 to 1.0 in a year. That’s a whole different story than if it went from 0.5 to 3.5 in a year; in that case, closer monitoring would be necessary. Same for your weight; if it went up two pounds in a year, your doctor probably wouldn’t be concerned. But if it went up 20 pounds in a year, something serious is happening and needs attention now.

I understand why the USPSTF took the position they did with PSA in those age groups: they want to prevent unnecessary tests and treatment. What they didn’t consider is that monitoring the rate of change could identify who needed to be treated now versus those who did not.

For those factors you can track for yourself, such as blood sugar if you’re prediabetic or a type 2 diabetic, fat intake, blood pressure, weight, and many others, you should make the effort. Those measurements can provide a lot of information for your health over time—information you can use to improve your health.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710.

 

I’m Alive V2.49

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When I opened my eyes this morning, I said the same thing I’ve said for the past 25 years: I’m alive! If I wake up this morning, it means I have at least one more year. It makes no sense in the real world, especially for a guy who talks about science so much, but I can’t change the way I think about this one thing.

The question is why? My dad died on this date 49 years ago at the age of 41. Ever since I opened my eyes on May 10th when I was 41, I believed I would live another year. Again, it makes no sense but it’s what I believe. For any new Memo subscribers, now you have a little insight into how I think. If you’re wondering “Why V2.49? My Dad died when I was 17; 17 plus 49 is 66—my current age. I am version 2.

What am I going to do with this year? Do what I feel I was created to do: teach. Make the complex simpler so you can understand it. Separate the fiction from the fact so you’re not deceived. Read more. Write more. Talk more. That’s what I’m here for, so that’s what I’m going to do. I’m glad you’re along for the journey.

What are you prepared to do today?

Dr. Chet

 

Sugar vs. Sweetener Research: Meaningless in the Real World

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I’m in a slight disadvantage in evaluating this study; I was able to read only the convention-session abstract and the press release. There were no recordings of the presentation that I could find, so there are details I don’t know. I have questions about the process, not the results, so here are my thoughts.

The In-Vitro Study

If you’re not familiar with the lingo, time to learn. In vitro is Latin, meaning literally “in glass.” An in-vitro study is conducted in a Petri dish, a test tube, or some location outside of an entire animal or human.

In this study, researchers exposed endothelial cells from the rats’ arteries to sugars and artificial sweeteners. We know there were changes in proteins; what we didn’t know is whether the change in protein genes that were activated in response to the artificial sweeteners mimicked a pattern we might see in a rat that’s diabetic. That’s an important question.

It would have been more meaningful if they examined a pattern of protein responses that occurred in the endothelial cells of rodents that already had diabetes. Just because something is activated in response to a stimulus, in this case sugars or artificial sweeteners, that doesn’t necessarily mean it’s a bad thing. It just means it happened.

The In-Vivo Study

In vivo is also Latin and means within a live animal or human. I have several issues with the rodent part of the study. First they gave high levels of sugar to the rats as well as high levels of artificial sweeteners. It would seem to me that it would be beneficial to get an estimate of what humans actually consume on a daily basis, dose it down to the appropriate amount for a rat, and start with that. Then you can compare your test results to a “normal” level. Next you can begin increasing the amount to see when the negative effects begin.

Second they used the DR/BB rat; DR stands for diabetes resistant and BB stands for biobreeding. This type of rodent is often used for research on type 1 diabetes because although it’s diabetes resistant, it has an underdeveloped immune system. It will respond to environmental insults differently than normal rats. Excess levels of sugar and artificial sweeteners may create an insult to the immune system to cause type 1 diabetes in this breed of rat.

The reason for doing the study was to see if artificial sweeteners may be contributing to the obesity and diabetes epidemic—type 2 diabetes, not type 1. Using this breed of rat seems like it would muddy the results. The changes they found in the blood of these rats fed excessive amounts sugar and artificial sweeteners would have been expected. The question is whether this is related directly to the research hypothesis or not. In my opinion, no.

To make this study pertinent to humans, we would need a similar pattern found in humans. Perhaps people under excessive stress and whose immune systems were compromised might show some relationship. But we’re not talking about susceptibility to type 1 diabetes. We’re talking about type 2 diabetes, and although they share a name, they’re vastly different diseases.

What we have is a study in test tubes on protein genes that are activated in response to artificial sweeteners and a second study on rodents with some dysfunction in over 200 different protein genes in response to sugar and artificial sweeteners. We may have people who use excessive amounts of artificial sweeteners everyday. We may have specific but as yet unknown gene patterns that may make people more susceptible to type 2 diabetes, but we haven’t identified what those genetic patterns are at this point or even if they exist at all.

The Bottom Line

So what does this study mean? This basic research shows that there may be a pattern to protein synthesis that’s different in high-sugar versus artificial-sweetener intake. But that does not resemble in any way what the authors of the study suggested in the press release. This study is relatively meaningless in the real world. Maybe we’ll know more about how all this impacts humans in another 5–10 maybe even 20 years. But as of today, it’s just provocative headlines. And we get far too many of those already.

Use artificial sweeteners or do not; that’s your choice. But don’t change based on this study. Use the old adage: everything in moderation including moderation.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

What They Got Right in the Sugar and Artificial Sweetener Research

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Whether it’s a new form of treatment, a new medication, or even examining a phytonutrient for potential benefits, it all starts with basic research. That’s what the study I began talking about Tuesday is all about: basic research. I like it because this is the way all research has to begin. This is where test-tube studies are appropriate.

In this case they used epithelial cells from the vascular system of the rodents, exposed them to high amounts of sugars and artificial sweeteners, and then looked at specific changes in proteins that are involved in various types of cell action. In other words, they were looking for dysfunction in the way the genes for the proteins responded after exposure to the sugars and artificial sweeteners.

Were there differences? Yes. The important thing that they discovered was that the proteins inside these epithelial cells responded differently when exposed to sugar than when exposed to artificial sweeteners.

The question is this: was any of this meaningful in the real world? I’ll let you know what I think on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

Artificial Sweeteners, Obesity, and Diabetes

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Last week, you may have seen headlines that said something like “Artificial Sweeteners May Cause Obesity and Type 2 Diabetes!” Just about every news organization picked up a press release from the Experimental Biology meeting. In the press release, researchers gave some of the results of a paper that was presented at a scientific session, including comments by the lead author, Dr. Brian R. Hoffman.

The purpose for doing the study, he said, was because of the epidemic of obesity and diabetes in the U.S. While there’s little question that excessive sugar intake, combined with excess calories over years, does contribute to obesity and type 2 diabetes, no one has really examined the role artificial sweeteners may play.

In these studies, he and his research team examined the effect of high levels of sugars, aspartame, and acesulfame potassium on epithelial cells taken from rodents in a test-tube study. Then using another group of rodents, they overfed them sugars and the same artificial sweeteners for three weeks. The objective was to see what changes occurred in proteins and metabolites that were produced in cardiovascular epithelial cells in the test-tube study and the blood of the rodents.

They found that there were modifications in proteins under both conditions, which may have led to changes in the products they produced. But is this meaningful research or not? I’ll tell you what I liked about the study in Thursday’s memo.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

“My Doctor Told Me”

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I get asked health questions all the time about weight loss, fitness, diet, and more. If a physician told the questioners something they should or should not do, they will let me know, and then I know my job just got harder. That’s why “my doctor told me” are four of the most powerful words I ever hear.

The problem when it comes to nutritional recommendations, which can include both diet and supplements, is that physicians are not trained in the basics of nutrition. They may have read a summary about a high-fat diet or a multivitamin and tell their patients not to try this or take that, but they have no basis of training to know whether the study was well done or not. Even when they get the training, the specter of evidenced-based medicine (EBM) raises its head.
 

The Problem with Evidence-Based Nutrition

I decided to check out the Gaples Institute website. There’s general information about a healthy diet for patients. There’s also a course that healthcare professionals can take online to learn about nutrition. I read the brochure that’s available for physicians to find out what they will learn in the four modules of the course.

It’s nowhere near enough. Four 45-minute modules? I’ve been studying nutrition for 30 years, and there’s still so much I don’t know; it’s impossible for them to learn enough in three hours to reliably counsel their patients. In addition to that, the Gaples Institute uses the same low-fat approach to reducing the risk of heart disease that has been used for the past 50 years. And how has that worked for us? We have the highest obesity rate we’ve ever had.

Yes, physicians should understand there are better fats than others. Yes, physicians should understand that refined carbohydrates and deep-fried foods should be limited. But because the materials use data from large epidemiological studies that fit the EBM criteria, this is not real nutrition training. It provides them a single way to teach their patients, and that’s not providing any real nutrition training.

To say I was disappointed would be an understatement. Physicians need in-depth nutrition training, not a course that teaches a specific dietary approach to disease prevention. That doesn’t mean the Gaples approach won’t help some patients, but it ignores alternative approaches that might also help patients. While I said that “my doctor told me” were the most powerful words I hear from people, I also know that if they hear something they don’t like, they won’t do it, evidence based or not. Knowing what to do next requires real training in nutrition. That won’t happen in a three-hour course.
 

The Bottom Line

We’ll just have to wait and see what happens with nutrition training for physicians. It’s not really their fault; there’s so much to learn about treating disease, it leaves little to no time to teach prevention. For now, that’s left up to us as patients. While nutrition is complicated, you can always count on these six words to help you prevent degenerative disease:

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Online. 4/11/2018.
2. Arch Intern Med. 2011;171(14):1244-50.

 

Physicians as Teachers

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As the interview in JAMA continued, Dr. Devries continued talking about the lack of training and why it was a problem in his mind. He cited a study published in 2013 by the U.S. Burden of Disease Collaborators which concluded that the leading risk factor for degenerative disease and mortality was a poor diet. A poor diet! He suggests that because physicians are so poorly trained in nutrition—meaning not at all—their patients are suffering the consequences.

Dr. Devries became frustrated and together with others formed the Gaples Institute for Integrative Cardiology, a non-profit that aims to teach the public and physicians about diet, exercise, and the mind-body approach to heart health.

For the rest, it’s not just giving a patient a couple of handouts with healthy diet guidelines. Physicians have to somehow become the teachers. For that, they need training. But even before training can be addressed, insurance companies must be willing to pay for this type of physician-patient time—or any time beyond the 15-minute consultation limit imposed by many healthcare businesses. While the insurance companies may provide websites and materials and even some training with dieticians, it doesn’t carry the power the physician would have.

No real nutrition training of physicians, no hands-on nutrition training by physicians, yet what physicians say resonates with their patients in ways they don’t realize. On Saturday I’ll tell you the four most powerful words I hear about health.

What are you prepared to do today?

Dr. Chet

P.S. The fiber drink recipe I talked about last week is now available on the Health Info page at DrChet.com.

 

References:
1. Arch Intern Med. 2011;171(14):1251-57.
2. JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805.