Tag Archive for: allergies

Obesity and Prenatal Omega-3s: Premature Conclusions

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Women frequently ask about prenatal supplementation, and omega-3 fatty acids are always part of prenatal recommendations; that’s why this study attracted my attention. Did they come to the right conclusions? I think the best place to begin is by reading the conclusion statement of the abstract, and then examine the data from the paper to see if it supports those conclusions.

Here we go:

“In this randomized clinical trial, children of mothers receiving omega-3 fatty acid supplementation had increased BMI at age 10 years, increased risk of being overweight, and a tendency of increased fat percentage and higher metabolic syndrome score. These findings suggest potential adverse health effects from n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and need to be replicated in future independent studies.”

Problems with the Conclusions

The difference in body weight was two pounds, with the fish oil group weighing more than the placebo group; neither group was classified as being overweight by international standards. With height being equal, that automatically meant that the BMI would be higher in the fish oil group. However, both groups would be classified as underweight based on standards for children five to ten years old. The implication was the omega-3 group might be overweight. They were not; in fact they were closer to normal weight than the lighter kids. The increased risk of being overweight isn’t supported by the data presented.

Related to the higher metabolic syndrome score, the researchers calculated the score using an algorithm that considered waist circumference, systolic BP, negative HDL cholesterol, the log of triglycerides, and the Homeostatic Model Assessment for Insulin Resistance or HOMA-IR for short. There was a difference of 3/10 of an inch in waist circumference, with the omega-3 group being slightly larger. There was no difference in triglyceride levels, and the omega-3 group had a higher HDL cholesterol level than the control group. There was no difference in systolic blood pressure between the groups. That leaves us with the HOMA-IR calculation.

Typically, serum insulin would be used in the calculation to determine the HOMA-IR number. They didn’t collect insulin data, so they used another indicator of insulin levels in calculating the HOMA-IR. The problem is that that algorithm was based on 21 adult subjects; it was never validated with a larger group or for use in children. I question its use, but for argument’s sake, let’s say it doesn’t matter.

The Real Problem

The real problem that I have is with the remark about a tendency towards increased percent body fat. When they assessed body composition at 10 years of age, they used bioelectrical impedance analysis (BIA). I worked on comparing methods of body composition analysis when I was a graduate student, so I can tell you from experience that underwater weighing is the gold standard for any group (and, yes, I’ve underwater weighed 10-year-olds). Specifically, there are two factors that are always concerning with BIA:

  • The algorithm is 95% dependent on height and weight. A two-pound difference in body weight in children could impact the calculation, even if the actual body composition was the same.
  • BIA is sensitive to fluid levels of the body. It assesses total body water and calculates fat mass by making an assumption about the water content of the remaining tissues. It’s not the best way to assess body fat in a major study such as this.

The Bottom Line

How?!!!

We hear that a lot when our grandson plays a videogame. When something happens that he doesn’t anticipate or understand, he yells “How?!!!” and that’s what I’m thinking right now. The most frustrating part of this research paper is their conclusion that omega-3 supplementation in the last trimester of pregnancy may result in adverse effects to the children.

How? How would supplementing with omega-3 fatty acids cause the offspring to have an increased risk of being overweight or obese? They did not provide any comment on how that could occur.

As it stands now, we really don’t know much more about omega-3 supplementation in the third trimester of pregnancy other than the kids whose mothers took omega-3 fatty acid had fewer serious asthma and allergy symptoms; because the incidence of asthma and allergies are rising steadily, that may be the most important observation from this study so far.

As for body composition? Not so much. This study will continue until the subjects are adults, so maybe further testing will yield more conclusive results.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Research Update on Probiotics and Adult Allergies

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Researchers recruited a total of 95 adults, ages 19 to 65, with allergic rhinitis for a double blind, randomized, placebo-controlled clinical trial; all the subjects were from two hospitals in South Korea. They were not allowed to take their usual medication to treat seasonal allergies.

In the experimental group, 47 subjects received the probiotics, and 48 subjects were in the placebo group. The probiotics used in the study was a novel blend called NVP-1703. The variables the researchers selected to track were markers associated with the immune response such as IgE and interleukins. They also tracked the symptoms of the subjects by having them complete daily diaries noting responses such as sneezing, itching, nasal congestion, runny nose, etc. The subjects also took standardized written allergy questionnaires.

The researchers found significant positive changes in the questionnaire assessment from baseline through weeks one, three, and four between the probiotic group and the placebo group. The IgE levels and serum IL-10 levels were significantly improved between the probiotic and the placebo group.

The improvement in questionnaire results meant that the subjects that were taking the probiotics saw their allergy symptoms decrease. By assessing the immune responses, they saw that somehow the probiotics stimulated the production of IgE and IL-10. Both of those allow the immune system to control symptoms associated with allergic rhinitis.

The researchers concluded that this blend of probiotics could be beneficial to treat seasonal allergies; I’m not sure I would go that far since the study contained fewer than 100 subjects. I would say that it was nice progress, although there’s still more to do. But if you have allergies, taking your probiotics regularly may be helpful for your allergy symptoms as well as all the other benefits.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2020. 12: 1427-41.; doi:10.3390/nu1205142

Research Update on Probiotics for Infants

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Let’s begin this week’s research review with a study on the potential long-term benefits of probiotic use in infants. Researchers in Slovenia collected data on 316 healthy-weight newborns whose parents had test-confirmed allergies.

The families were divided into two groups: 115 infants were placed into a probiotic group and received probiotics every day between the ages of four weeks to twelve weeks while breastfeeding. The remaining 201 infants were put in the control group and breastfed without any supplements.

All children were followed by the same pediatrician through nine years of age to assess the children over the years to see who developed allergic rhinitis or allergic rhino conjunctivitis at some point. The results showed during the follow-up that 19.6% of the children had developed either form of allergy. They confirmed the diagnosis by examining the children for levels of IgE and skin prick tests.

Children in the probiotic group were three times less likely to develop allergic rhinitis than those in the control group, 4.3% versus 13.9%. When examining allergic rhinoconjunctivitis, the difference between the probiotic group and the control group was much lower although still statistically significant at 8.7% versus 9.5%.

I like this study because the children were tracked for an extended period of time. It may be that if the infants were tracked only through one year of age or if the study were terminated when they were four or five, there might not have been the same significant differences. Sometimes seeing the benefits can take longer than we expect.

You have to wonder what the results would be if the children were given probiotics beyond twelve weeks (some may have been; probiotics weren’t prohibited beyond the study.) We make sure Riley, who’s five, gets his probiotics every day.

Is that reduction in allergies worth the effort? Paula says any lessening of allergies is worth doing. Next month will be the 57th anniversary of her first allergy shots, and she’s been getting shots nearly continuously ever since—three at a time these days. If probiotics will spare some children years of shots or medications, let’s go for it.

What are you prepared to do today?

        Dr. Chet

Reference: EAACI Digital Congress 2020. Besednjak-Kocijančič, L. et al.

The Microbiome of Your Lungs

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When we think of the microbiome, it’s logical to think only of the digestive system and our skin. In reality, the microbiome includes every microbe in and on our entire body, including our lungs. At one time, the lungs were thought to be microbe free; that certainly seemed to be the case for newborns. As babies are exposed to various bacteria and other microbes, a microbiome develops in the lungs much as it does throughout the body. It seems to have the same balance of good and bad microbes, although not as extensive as the gut.

Research has shown that in serious lung conditions such as cystic fibrosis as well as chronic lung conditions such as asthma and allergies there’s a dysbiosis of the lung microbiome. In other words, the lung microbiome is out of balance.

What can be done to restore the balance? Nothing other than traditional treatments for now, but this is an area of great research interest. I believe that focusing on eating foods with probiotics as well as prebiotics can help our entire microbiome, not just our gut.

Vegetables, beans, yogurt, fermented foods, and fruit should still be the foundation of our diet. Whether it helps the lung microbiome is not known, but it will help the gut microbiome. As we know, what helps the gut microbiome can influence other parts of the body; it’s reasonable to believe that it just may help the lung microbiome as well.

What are you prepared to do today?

Dr. Chet
References:
1. JAMA. 2017;317(17):1713-1714. doi:10.1001/jama.2017.3023
2. http://www.news-medical.net/life-sciences/Lung-microbiome.aspx

 

Echinacea and the Immune System

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As I write this, there are 1,098 citations in the PubMed database for echinacea. I looked at every title to see if it was relevant to answering one question: should people who have an autoimmune disease use echinacea for allergies and colds? I examined at least 100 abstracts and downloaded five papers that seemed to be significant. Here’s what I found.

The research on echinacea is a mess. There’s no consistency in the preparations used in research, the subjects included in the studies, the outcome variables that were examined, or the combination of herbs, vitamins, or minerals used in the preparations with echinacea. That’s just to find out if echinacea has any effect on catching or treating a cold. Beyond that outcome, the research is even less clear.

I found two studies that give some perspective on whether echinacea is safe for anyone to use including those who have an autoimmune disease. The first paper is a case study on a patient who suffered a breakdown in the myelin sheath after taking an herbal preparation (1). The paper reviewed all similar cases of echinacea causing similar symptoms. Based on their conclusions, boosting the immune system with echinacea could have negative effects.

There are several problems with this case study and the conclusions the authors made. While they assigned blame to echinacea, none of the subjects used echinacea alone nor were they administered the same way. Some were given orally while two others were injections. They did not examine any measures of immune function in the patients. They did not test for metabolites of echinacea nor any other herb in the blood of the subjects. They deduced that echinacea had to be to blame because of its reputation as an immune booster. One more thing: with the millions of uses of echinacea every day around the world, there were just four cases in 16 years. You read that correctly: four in 16 years. Those are pretty good odds.

In another paper, researchers examined the safety of oral preparations of echinacea (2). This was an old-school approach: instead of selecting research papers to include in a meta-analysis, they examined all the pertinent research one article at a time. They used their knowledge of how drugs are metabolized by the body, how they interact with other medications, and many other indications related to the safety of medications including herbals. They concluded that echinacea does not interact with medications to any degree. While it may change how the medication is metabolized, echinacea doesn’t change how effective the medication is.

More important, they concluded that there’s no indication in the science that echinacea is harmful to those with autoimmune diseases. They explain the reasons why physicians have believed echinacea could have consequences, but there was no evidence it was harmful. There was also no time restriction for the use of echinacea. If you have an autoimmune disease, I urge you to download and read the second reference for yourself. It’s open access and while it’s tough reading, it’s the best resource I’ve found on the issue.

 

The Bottom Line

If you have an autoimmune disease, you must check with your physician before using echinacea; he or she knows the specifics of your condition. Based on my review of the research, there’s no reason you cannot use echinacea to help your immune system when it’s under attack from a virus or allergens for a few days. But that’s not my call to make; there’s always the possibility of an abnormal response or of an allergic reaction to the plant material itself. It’s something you need to talk with your healthcare professional about, but it should be a discussion, not a lecture.

I know you want clear answers, but that’s just not completely possible in this case. What you have now is information with which to make an informed decision.

What are you prepared to do today?

Dr. Chet
References:
1. Balkan Med J 2016;33:366-9.
2. Planta Med 2016; 82: 17–31.

 

Immune Boost 1-2-3 Cautions

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Someone recently asked an excellent question: “Is there any risk in taking higher amounts of echinacea?” I’ll extend that to include vitamin C, garlic, and probiotics. The answer is possibly. I’m not hedging, but it’s complicated. Let me give you some examples.

One factor that can apply to any supplement is allergies. Echinacea and garlic are plants, and you may be allergic to one of the components of the plant. Instead of reducing your allergic response, it may heighten the response, causing the watery eyes and runny nose you’re trying to avoid. There’s no way to know for sure other than trial and error. If something makes you feel worse, it goes without question that you’ll stop it immediately.

Another potential issue is your genetics; you may process a phytochemical from these plants faster or slower than typical. That means it could be metabolized out of your system before it really has a positive effect or it could take longer to metabolize and stay in your system longer. There are no genetic tests for how you’ll react to any supplement—it’s trial and error.

One other aspect that’s important is whether you take medications. No surprise that there’s incomplete research on the interaction of every plant with every medication, so there’s no way to know how an herb or nutrient will interact with your meds. Garlic may reduce the coagulation of your blood; if you’re on blood thinners, you may not be able to take garlic because it could thin your blood too much. Or you might be able to take it because of your genetics and how you metabolize it. See how complicated it gets?

What you should know is that most people will not have a problem using the 1-2-3 immune boost. If you do, do what any reasonable person would do and stop taking it. On Saturday, I’ll cover the issue of using echinacea if you have an autoimmune disease.

What are you prepared to do today?

Dr. Chet