What Causes Shingles?

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“What’s your opinion on getting the shingles vaccination? It’s expensive and my insurance doesn’t cover it. Is it worth it?”

A little background first. Shingles is a viral infection. One million people will get shingles this year, and one out of three people 60 and older will get shingles in their lifetime. It’s caused by the same virus that causes chicken pox; if you’ve had chicken pox, you’ve still got the virus lying dormant in your body. It hides in your nerve cells until for some unknown reason, it begins to multiply and cause the pain and blisters of shingles.

The virus manifests itself with burning and pain, even before a rash breaks out. Generally speaking, it lasts two to three weeks and goes away by itself. While it’s inconvenient, it’s not life threatening; itching and burning can be treated. However, what is much more serious is when shingles turns into postherpetic neuralgia. The pain and inflammation can last for weeks, even months, and sometimes years. It can be debilitating. We don’t know what makes some cases serious while others clear up on their own.

That brings us back to the vaccination—and I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: https://www.cdc.gov/vaccines/vpd/shingles/public/index.html

 

Why I’ll Keep Using Coconut Oil

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The research that the authors of the American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease, specifically on coconut oil, seems to be in conflict. The authors suggested coconut oil is bad for us, but the research studies they used didn’t really seem to confirm that conclusion. What gives?

The criteria that the Advisory’s panel used were limited in scope. There’s no evidence that the regular use of coconut oil contributes to CVD, even in cultures that regularly use coconut oil. They used a part-equals-whole logic. As they reported, there were significant increases in LDL-cholesterol when subjects increased coconut oil in their diet in the studies they cited. Because a high LDL-cholesterol level contributes to CVD, therefore coconut oil must contribute to CVD. That’s why the Panel does not recommend its use.

I understand what they said. The data they used supported their conclusion. However, they used a very narrow use of the data on coconut oil to support their recommendation.

They are correct when they state that coconut oil is high in saturated fat; in fact, it has the highest percentage of saturated fat of all fats and oils including lard and butter. But it also has a very high percentage of short- and medium-chain saturated fatty acids as opposed to longer chain fatty acids. The advantage is that short- and medium-chain fatty acids can by-pass the liver and be used directly to produce energy in most organs of the body, which makes coconut oil an option for getting energy quickly.

Let’s examine the statement that LDL cholesterol increased when subjects were taking coconut oil (1). In one study, LDL rose from 166 to 171 mg/dl in men and 155 to 156 in women (2). In another study, LDL rose from 118 to 128 mg/dl in a study of men and women (3). These were studies that lasted six weeks and five weeks respectively. There’s no evidence it would continue to rise had the subjects continued to use coconut oil. An increase of 3–6% in LDL-cholesterol wasn’t translated into a risk for CVD. Statistically significant? Yes. Meaningful in the real world? No.

The panel did not recommend coconut oil because it has saturated fat and has no other health benefits, but that point is debatable. Research on other benefits of coconut oil is really just beginning. Too many health gurus are overstating the benefits, especially when it comes to Alzheimer’s disease, and that creates the hype and most likely, the reason the Panel singled out coconut oil to examine more closely.

 

The Bottom Line

The Panel suggested we keep fat intake to no more than 30% of dietary intake; of that, only 10% should be saturated fat. They recommend that we substitute poly-unsaturated and mono-unsaturated fats and oils for saturated fat. That’s not really controversial and it’s a good idea.

What they did not say was that we couldn’t use coconut oil as one of our sources of saturated fat. If we eat 2,000 calories per day, that would mean up to 200 calories per day can come from saturated fat; that’s about two tablespoons per day, and that seems to be a reasonable source of saturated fat consistent with their recommendation.

Here’s the real bottom line: if you’re going to use a sat fat as a source of immediate energy, coconut oil is a healthier choice than lard or butter. And that’s why I use coconut oil; I don’t use a lot, but it works for me and makes sense to me as a scientist.

My recommendations never change. Eat less. Eat better. Move more. And in my opinion, using coconut oil is eating better.

What are you prepared to do today?

Dr. Chet

 

Reference:
1. Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510
2. J Lipid Res. 1995;36:1787–1795.
3. Am J Clin Nutr. 2011;94:1451–1457

 

Coconut Oil Research vs. the AHA

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For this memo, I’ll print conclusions from the papers cited in the American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease and then print what the authors wrote about the research studies they used to assess coconut oil (1). I’ll confess, it’s hard to understand how they reached some of these conclusions.

The study:
The findings suggest that, in certain circumstances, coconut oil might be a useful alternative to butter and hydrogenated vegetable fats (2).

AHA:
“A carefully controlled experiment compared the effects of coconut oil, butter, and safflower oil supplying polyunsaturated linoleic acid. Both butter and coconut oil raised LDL cholesterol compared with safflower oil, butter more than coconut oil.”


The study:
In conclusion, the results of this study indicated that it may be premature to judge SFA-rich diets as contributing to CVD risk solely on the basis of their SFA (saturated fatty acid) content.

AHA:
“Another carefully controlled experiment found that coconut oil significantly increased LDL cholesterol compared with olive oil (3).”


The study:
There was no evidence that coconut oil acted consistently different from other saturated fats in terms of its effects on blood lipids and lipoproteins.

AHA:
“A recent systematic review found seven controlled trials, including the two just mentioned, that compared coconut oil with monounsaturated or polyunsaturated oils. Coconut oil raised LDL cholesterol in all seven of these trials, significantly in six of them.”

The Advisory’s conclusion: “Because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favorable effects, we advise against the use of coconut oil.”

Significantly. That’s a meaningful word in statistics but how about in the real world? I’ll finish this up in Saturday’s memo.

What are you prepared to do today?

Dr. Chet

 

References:
1. Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510
2. J Lipid Res. 1995;36:1787–1795.
3. Am J Clin Nutr. 2011;94:1451–1457
4. Nutr Rev. 2016;74:267–280.

 

Coconut Oil: Healthy or Not?

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The headlines screamed “Coconut Oil is Alarmingly High in Saturated Fats!” News post after news post talked about how Americans have been sold a bill of goods on the health benefits of coconut oil. Now the American Heart Association says it’s harmful. They published a Presidential Advisory on Dietary Fats and Cardiovascular Disease, a review paper to examine one issue: does saturated fat contribute to cardiovascular disease? They state that both the public and healthcare professionals are confused over this issue. The reasons are complex but primarily due to recent research publications that questioned the role saturated fat plays in the development of CVD.

The paper is 19 pages long with six pages of references. I’m not going to cover the entire paper because for the most part, there’s nothing new in what they’ve said. I’m only going to address a single issue: coconut oil. They begin the section by citing a New York Times survey that looked at which foods nutritionists consider healthy and what a group of registered voters consider healthy; nutritionists say coconut oil is not healthy while the public believes it is. The authors speculate that this is the result of the marketing of coconut oil in the popular press. Evidently they don’t spend much time on the Internet, because that’s where the bulk of claims for coconut oil are made.

I’m a fan of coconut oil for one primary reason (other than the fact that I love coconut): it contains short- and medium-chain fatty acids that can by-pass the liver and be used as energy for most organs. Is it still a saturated fat? Absolutely. Does it cause an increase in your risk of CVD? I’ll review their research on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510

 

The Big Fried-Potato Question

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During the eight-year study, only 236 of the 4,400 subjects died; fewer than 30 per year. We don’t know what caused their deaths; one would expect it to be heart attacks and strokes but that data was not examined. The researchers adjusted the analysis for a number of variables including age, but it would have been more valuable to know whether fried-potato consumption was related to early mortality. That would give us more of an indication that there really was an increased mortality from eating french fries three days a week.


The Big Question

The big question is simply this: why are researchers from Italy examining the relationship between potato intake and mortality in a study about osteoarthritis? On the surface, it doesn’t make any sense. There was no overall strategy outlined in the reasoning for the study.

One reason they did it is because it’s open-access data: anyone can examine the data and use it for any type of analysis. All I had to do was register and I could download all the data related to any of their questionnaires including the FFQ. I’m not going to analyze the data, but I could.

The study was designed to examine osteoarthritis (OA) and the variables that are important to its prevention and treatment: “The purpose of this study is to examine people who have knee OA or are at high risk for knee OA; information will be used to better understand how to prevent and treat knee OA.” No mention of looking at potato intake and mortality.

The problem is that the authors of the study did not design the variables to examine; they had to use what was already in the study. The questions might have been different if they begin with a study to examine their research question: does potato intake affect mortality in North America? Here’s an example. The authors did not include data from potato chips in their analysis. To be fair, they couldn’t because all snacks were lumped together: potato chips, corn chips, pretzels, and other snack food. If you were starting from scratch, you would definitely include separate questions on the types of snack foods. But this is the type of problem that occurs when you don’t design the study; you take whatever is there, and maybe it works and maybe it doesn’t.


The Bottom Line

What can we gain from this research paper? Not much—it’s mostly meaningless in the real world. But we can do this: be realistic in how we prepare foods and what fast foods we choose to eat. Deep-fried foods can be a part of your diet; just make them a small, infrequent part of it. Every food can be a part of your diet as long as you control the amount and how often you eat it. Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

The Data Must Make Sense

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The data has to make sense before you do any type of statistical analysis; that’s why I always look at the mean and standard deviations. Let me explain what I found that seemed a little off in the Fried Potato Study.

The authors divided the data into quintiles based on potato consumption from less then once per month to greater than three days per week. The researchers reported 19 variables from age to calorie intake to the percentages of various diagnosed diseases in each quintile of potato intake.

I focused on the caloric intake and the Body Mass Index in each category of potato intake. As potato intake increased, the caloric intake increased 600 calories per day—from 1,150 calories per day to 1,750 calories per day. Keep in mind there are 3,600 calories in a pound, so that’s over a pound a week. In every quintile, as the potato intake increased, so did the caloric intake. That could make sense although we don’t know if the additional calories all came from potatoes.

What didn’t make sense was that the BMI for each quintile was about the same: 28.5. That makes no sense at all. If the calories increased, the BMI had to increase for each quintile. It did not. Physical activity could not explain it because those in the highest caloric intake were less active than those with the lowest potato intake. It would be wonderful if calories didn’t add up and we could eat all we want without gaining a pound. I’m sad to say it doesn’t work that way.

While the study leaves that question unanswered and many more, it still isn’t the single biggest question of all. Can you guess what it is—even without reading the study?

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

Fried Potatoes: Hazardous to Your Health

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The headline said: “Eating fried potatoes linked to higher risk of death.” My philosophy is that we can eat anything as long as we eat them in moderation, and I like French fries once in a while. My scientific curiosity tells me that I need to check this out. Let’s take a look at the study.

Researchers from Italy used data from the Osteoarthritis Initiative (OAI) to assess the relationship between potato intake and mortality. This is a multicenter study that recruited over 4,400 subjects from four medical centers in the North America. The eight-year study followed subjects who have osteoarthritis of the knee or are at high risk for developing it.

At the beginning of the study, data were collected on dietary intake using a Food Frequency Questionnaire. The dietary data were used to examine the relationship between potato intake and mortality rate. Non-fried potatoes were not related to increased mortality, but there was an increased risk of death for those subjects who ate fried potatoes. The risk was highest if someone ate fried potatoes more than three days per week.

Those are the results. But I have several questions of my own. I’ll cover that the rest of the week including the big question. Don’t forget: tomorrow night is the Fibromyalgia webinar; there’s still time to register.

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

How to Reduce Disease-Related Pain

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The first two memos on pain were relatively easy: joints and nerves. From that point forward, it can get very challenging: Lyme disease, irritable bowel syndrome, shingles—the list of diseases that lead to pain could go on and on. To complicate matters, with the concern over opioid addiction, many people in pain don’t want to even try those medications. What do you do?

The key is to work with your physician and specialists to develop a strategy for pain relief. That will vary by disease. A medication that benefits the nerves for shingles pain may be helped by NSAIDS or other pain relievers, but NSAIDS may not be beneficial for someone with IBS; the absorption of the pain reliever may cause more bowel pain.


Two Strategies to Help

There are two things you can try that may directly or indirectly help with pain. The first is to reduce inflammation and as I mentioned on Tuesday, the supplements that may help are omega-3s, turmeric, and glucosamine. They can help reduce inflammation in more than joints.

The second would be to strengthen the immune system. Lyme disease is bacterial, shingles is a virus, and IBS is an attack on the lining of the intestines. While strengthening the immune system is not directly involved, it may assist the body in dealing with the cause and reduce the pain. To me, that means using probiotics, antioxidants such as vitamin C and E, and using herbs such as echinacea and garlic. As I said, it may not directly affect pain but may indirectly help the body cope with the condition.


The Bottom Line

The two strategies won’t work for every disease. Every form of cancer can result in different pain. Some diseases such as type 2 diabetes can impact the extremities and eyes in ways that require professional guidance. But in general, strengthening the immune system may help over the long term. That also means increasing the intake of vegetables and fruit and getting some exercise within the limitations of the condition. That’s a topic for another time.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Nerve Pain

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Do you ever have pain that shoots down your leg? How about your hands getting numb or painful? Ever get a headache because you’ve clenched your neck muscles so tight due to stress? More than likely, you’re experiencing some form of pain caused by a firing nerve, and these three examples are the ones I’m asked about most often.

It’s always important to get an examination and diagnosis of the potential cause of the pain. If it’s mechanical, that’s one thing. If it’s neural, your approach will be slightly different. The cause of the pain may be a completely different location than where you feel the pain. In the first example, the probable cause is an impingement of the sciatic nerve somewhere; it could be in the spine where the nerve exits the spinal cord or it could be in the pelvic girdle. The second is the classic symptom of carpal tunnel syndrome; the nerves in the neck and shoulder are the primary cause even though the resulting pain is in the wrist and hands.

The critical part of dealing with nerve pain is to try to relieve the pressure on the nerve. Physical therapy and possibly massage that stretches and strengthens the appropriate joints are critical, but they must be done consistently. For some, pain relievers other than non-steroidal anti-inflammatories may be beneficial. Supplements that may help would be high-DHA omega-3s, gingko biloba, and magnesium. If you pushed me to say what’s the best approach, I would say take whatever you can to relieve the pain so you can do the physical therapy. Use the supplements for a longer term solution.

One more type of pain to look at Saturday.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Mechanical Pain

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Every morning, the process of getting my body moving is challenging. My back is stiff and my knee is tender, on the border of painful. The longer I’m up, the better I move. After about 30 minutes, I can get my workout. It takes my knee 10 minutes to warm-up once I start running.

I’m going to talk about pain this week—specifically, three types of pain and what may help. Today it’s mechanical pain. Remember the time you slipped and twisted your knee? Wrenched your shoulder when you picked up something you thought was a lot lighter? Broke your ankle skiing? Those are the types of injuries that can lead to mechanical changes that can result in pain; the injury heals but the tendons, ligaments, and cartilage are not quite the same. It can lead to pain, even many years later. That’s what happened to my right knee.

What can you do about it? Strengthen the supporting tissues to the extent you can. I went to a physical therapist, got an evaluation, was assigned some exercises and I do them regularly. It has strengthened the muscles that directly and indirectly impact the knee. While it’s still tender when I wake up, the swelling is gone and I can run if I choose. To me, that’s the most important thing. But I also take a timed release non-steroidal anti-inflammatory in the morning and use omega-3s, turmeric, and glucosamine twice a day. That works for me. You may need more pain relievers or you may need none.

That’s how you can deal with mechanically-induced pain. On to nerve-induced pain on Thursday and disease-related pain on Saturday.

What are you prepared to do today?

Dr. Chet