Tag Archive for: digestive system

Nutrition Research: Incomplete

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In July and August, I wrote about recently published studies on multivitamins and mortality and fish oil and atrial fibrillation. My criticism of those observational studies was because the analyses of the data were incomplete, in my opinion. Here’s how the study we just finished on quercetin and irritable bowel did the correct analysis.

Researchers focused on the subjects with an irritable bowel condition and examined a single nutrient. They already knew that increased fruit and vegetable intake benefitted people with irritable bowels; they specifically examined the quercetin content of those vegetables and fruit to see if subjects who ate those foods needed fewer enterotomies and had lower mortality. They did. This is the way nutrition research should be done.

That’s exactly what they did not do in the multivitamin and fish oil studies. It isn’t like they didn’t have the data; one of the studies used the exact same database of subjects with the nutrition data already collected. They could have analyzed by nutrient, whether it was a macronutrient such as protein, carbohydrate, and fat; by the source of the protein, fat, and carbohydrate intake; or by specific nutrients such as calcium, beta-carotene, or type of fish oil. I could go on, but the point is they could have done more. But as I suggested, when physicians and statisticians are the only experts used—without nutritionists and dieticians—they apparently didn’t know the correct questions to ask.

As a result, we’re now stuck with physicians and other healthcare professionals questioning the use of multivitamins and fish oil. Experience tells me that will be hanging over our heads for years.

During the conclusion and recommendation section of every study, they always finish the observational studies with something like “This study doesn’t provide cause and effect; we need randomized controlled trials to test these findings.” I submit we need more thoughtful analysis of the data used in these studies. The way I see it, those studies were disasters, and there are more to come in the near future. Next week we’ll look at a study that condemns green tea extract and turmeric.

What are you prepared to do today?

        Dr. Chet

Quercetin and Irritable Bowel

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In the study I talked about on Saturday, the typical way of analyzing this data is to divide the group into segments by a specific variable and then compare the hazard ratios. In this case, the variable was quercetin and they chose to divide the subjects up by quartiles. During the follow-up time of nine years, there were 193 enterotomy events and 176 deaths. Compared with participants in the lowest quartile, those with irritable digestive conditions in the highest quartiles of quercetin intake were associated with a 54% lower risk of enterotomy and 47% decrease in all-cause mortality. In simpler terms, it cut the risk of a serious outcome by half. The relationship was the same regardless of the type of irritable bowel condition for both enterotomy and all-cause mortality with the exception of mortality of ulcerative colitis.

What does all this mean? There’s some type of positive relationship for people with serious digestive disorders who eat plant foods that contain quercetin. While interesting, this type of study doesn’t provide cause and effect—just a positive relationship. Stated simply, as people increase their quercetin-containing plant intake, the risk of having issues with serious outcomes from digestive disorders decreases. Quite correctly, the researchers recommend further research in clinical trials before the results can be confirmed.

The message: eat your vegetables and fruit. Here is a list of the top five vegetables and fruits containing quercetin. For vegetables:

  • Hot peppers (but please, no Carolina Reaper or anything that strong)
  • Broccoli and other cruciferous vegetables
  • Red onions
  • Herbs such as dill and cilantro
  • Capers

For fruit:

  • Apples
  • Tomatoes
  • Dark-skinned grapes
  • Green tea
  • Red wine if you drink alcohol

Maybe there is something to the old saying “an apple a day, keeps the doctor away.” If it keeps the heartburn away, that would do it for me.

You may think we’re done. Remember that Memo on making a single decision that has a long-term impact? I’ll tie that and this study together on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference:  The Journal of Nutrition. 2024;154(6):1861-1868

If You Have an Irritable Bowel…

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It seems many people experience digestive issues, from constipation, heartburn, and many types of irritation in their bowels. Many people are avoiding some food or ingredient—from gluten, most often found in wheat and bread products, to certain ingredients that are found in food, at least the foods that are available today. I have a slight hiatal hernia, a tear in the lining between my stomach and my lungs, and that can cause reflux; eat too much and I pay the price. Based on a recently published study, those of us who have any type of irritated digestive system just might find the answer in the produce section of our markets.

Researchers used the UK BioBank database to find subjects who had completed five of the 24-hour dietary recalls in a follow-up period of nine years. With that criterion met, subjects were recruited through electronic medical records as having conditions related to the digestive system under the umbrella term total irritable bowel. The researchers used the dietary history to identify all the foods the subjects ate that contained the phytonutrient quercetin; prior research had shown that the consumption of fruits and vegetables with that nutrient showed some benefit for people with digestive issues. The researchers wanted to confirm or refute those observations.

The researchers were able to identify 2,293 participants with serious digestive issues in the database. Diet information was collected using 24-hour dietary recalls; the researchers determined quercetin intake based on nutrient databases that estimated the amounts in the foods consumed.

The researchers were interested in two specific outcomes: enterotomy (the surgical opening of the digestive system to repair damage) and all-cause mortality. The researchers analyzed the data to estimate hazard ratios: the probability that someone will experience those outcomes over the follow-up time, which again, was over nine years. What did they find? I’ll let you know on Tuesday.

What are you prepared to do today?

        Dr. Chet

Reference: The Journal of Nutrition. 2024;154(6):1861-1868

Timing for Enzymes, Prebiotics, and Probiotics

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My digestive system has undergone changes—it doesn’t work like it used to work. Hence, I’ve been paying closer attention to digestive supplements. My voice had been getting raspy, and I had occasional reflux; I was concerned the two were related. I had an endoscopy and found I was correct. They also found a hiatal hernia.

When your body doesn’t work as well as it should, you look for something to help. In this case, digestive enzymes, probiotics, and prebiotics are where you begin.

Digestive Enzymes

These are products that contain pancreatic enzymes that will help digest proteins, fats, dairy, and several kinds of carbohydrates. For them to be most effective, take them just before or as you begin eating, about five to ten minutes before.

Here’s a change in my recommendations from the past: You can take the digestive enzymes up to an hour after you began to eat. They work all through your small intestine, and that takes hours. They’ll catch up to the food you’ve eaten.

Unless you are taking them only because you know that protein gives you excessive gas or you need them to digest a meal with cheese, take them before every meal. Even snacks? Yes, unless you know the specific food. How do you know? Trial and error.

Will using the supplement cause your body to stop making the enzymes naturally? Apparently your body already isn’t making them, so don’t be concerned. The only other thing to work on is the volume of food you eat. Maybe for you, the amount is the issue, not the enzymes you naturally produce. It’s really trial and error.

Prebiotics and Probiotics

The only real research that’s been done on timing of probiotics and the foods that feed them, the prebiotics, was done with models of the digestive system in test tubes. Based on that, the best time to take probiotics with prebiotics is just before or with meals. Personally, I take my probiotics with a fiber prebiotic any time because the right food for the probiotic is going with them. But if it helps you to remember to take them, take them before, during, or after a meal. Just take them and if it’s with some fruit and vegetables, that’s great—more food for them to eat.

The Bottom Line

Your digestive system changes at various stages of life. That’s not a bad thing; it’s normal. Digestive products can help adapt to changes in your gut, as they helped me.

I’ve tried to give you the best approach for maximum benefits from your supplements. While the timing may be important, nothing is as important as taking them consistently. We tend to stop when we feel better; don’t do that! Remember, these are supposed to be made by our body or obtained from the food we eat. Take digestive supplements consistently to get results.

What are you prepared to do today?

        Dr. Chet

Reference: Benef Microbes. 2011 Dec 1;2(4):295-303. doi: 10.3920/BM2011.0022

Resolving Gas Problems

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Whatever the cause, the question is how you can control any issues you have with intestinal gas. Once you realize how probiotics do what they do, and by that I mean via fermentation with the resultant gas, there are several strategies you can use to deal with it.

Strategies for Gas

Digestive enzymes can often help if the culprit is a specific food. For many people, beans cause gas while for others, excess protein can do it. With so many people doing keto these days, gas can be a substantial problem for them.

The solution may be to use a multi-purpose digestive enzyme before eating food you know causes you issues. Beans are obvious, as is protein. But for those who are lactose intolerant, milk and cheese can cause issues. Cellulases, proteases, and a lactase can help digest those macronutrients. For carbohydrates such as grains, amylases can be helpful.

The next question is whether taking digestive enzymes help with gas caused by supplements or pharmaceuticals. I can’t answer that because there’s no evidence one way or the other. Because your body naturally releases digestive enzymes, it’s doubtful they’ll interfere with the processing of the medication or supplement. It could be that your body isn’t making enough digestive enzymes to fully break down the substance, so adding or changing a digestive enzyme supplement is worth a try.

The second approach would be to identify which foods cause you problems, and it may not be as obvious as beans or dairy. It could actually be a spice that reacts with the microbes in your microbiome, and that’s not always easy to identify. Some foods such as sugar alcohols that are often used as sweeteners in processed food can cause gas. Once you’ve discovered which foods cause problems, sometimes the best policy is to limit them or avoid them entirely.

The third approach goes hand in glove with the second and that’s to change your diet. Research continues to show that people who eat more plant-based foods have different and perhaps better functioning microbiomes than those who do not. That’s a tough sell in this keto world we live in, but the carbs a person eats should lean toward vegetables with some fruit rather than starchy vegetables and grains.

Finally, if you take a probiotic supplement, stop it for a couple of weeks and see what happens. Remember in Tuesday’s Memo, the excess gas stopped when the person stopped taking the probiotic. It may be that a different probiotic blend might work better. There are over 6,500 different microbes that have been identified, and it may take trial and error as well as newly developed probiotic blends before you get it right.

The Bottom Line

There are a couple of other things that can contribute to gas such as drinking carbonated beverages and simply swallowing too much air. For most people, it’s still an issue of fermentation in the microbiome. The best approach is trial and error until you get the diet, prebiotic, and probiotic in balance.

Unlike other health issues, excess gas can be uncomfortable and can result in embarrassing situations, but as long as you’re not standing next to a flame, shouldn’t be fatal.

What are you prepared to do today?

        Dr. Chet

What Causes Increased Gas?

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Over the years, I’ve learned this about people as it relates to their health: they notice every change in their digestive system. They have their own bathroom habits, and they don’t like anything that changes their pattern. If they make a change in their nutritional intake—whether it’s a food, a supplement, or a medication—and it impacts their pattern, they really don’t like it. What’s not as noticeable immediately is another digestive change, and that’s an increase in gas.

In one case, a person developed an increase in gas production—and not in a good way; she stopped taking a probiotic (after regular use for a couple of years) and the problem stopped. Another person noticed an increase in gas after adding an amino acid blend. Yet another noticed an increase in gas after starting a medication. What gives?

The microbiome consists of the bacteria and other microbes that reside in the digestive system. The primary way they do what they do is by fermentation; the result is the production of gas, and that’s perfectly normal. Any change that impacts the microbiome can change the production of gas. Other than stopping the food, supplement, or medication, what can we do about it? I’ll give you some ideas on Saturday.

What are you prepared to do today?

        Dr. Chet

Artificial Sweeteners and Your Digestive System

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Before I address the concerns of the study on artificial sweeteners I talked about on Tuesday, be assured that I’m bringing you the facts as I interpret them. If you don’t use artificial sweeteners, I’m not trying to convert you, but I’m not going to let slide inflammatory headlines that only seek to raise fear where none should exist. The problem with the artificial sweeteners study is that it didn’t use a systems approach.

Bench Science

What the researchers did would be considered bench science. It’s basic in its approach: create a medium where the bacteria will grow, throw in various quantities of the artificial sweeteners, and see what happens. That’s a good first step in any type of research to see an impact on an entire organism. The same is true for examining the effect of the artificial sweeteners on the bacteria in the cancer cell medium. They established that chronic exposure to artificial sweeteners cause two probiotics to become pathogenic.

However, that’s where it ends. Trying to explain an increase in the obesity and diabetic epidemics because of how artificial sweeteners may impact a couple of gut bacteria doesn’t make any sense. It’s stretching things way too far with no evidence that what they’re describing happens at all. In effect, they’re trying to explain a health issue by looking at potential causes. Fine, good start—but now there’s a whole lot of animal and human clinical research that has to take place in order to prove whether it’s true, because what happens in a lab is often not what happens in a human.

Bench science has its place for sure, but it has serious limitations. In our headline-a-minute world, everyone is too eager to claim credit for something that hasn’t been proved.

The Digestive System

The human body is made up of various systems; the digestive system is one of them, but it doesn’t begin and end with the epithelial cells of the intestine. Food (including artificial sweetener) starts in the mouth with its salivary glands, goes down the esophagus, enters the stomach with its specialized fluids, travels the 20 to 30 feet of small intestine where more unique fluids do their jobs, and then the 10 to 15 feet of large intestine before it exits the body. The digestive system doesn’t act alone; it requires input from other organs and systems along the way: the pancreas, the liver, and so on. Every one of those could have an impact on the metabolism and elimination of artificial sweeteners and could impact how bacteria behave in the digestive system.

I could write a book on this subject, but let me just point out one thing that should be obvious: they tested two probiotic lines. Two. As of the last count, there are at least 6,500 different microbes that coexist within our digestive system. There are also trillions of them, each with a role to play, and we still don’t know what each and every one does. As I said, it’s complicated.

The Bottom Line

This study illustrates where good research begins: in bench science. There’s a lot more science that has to happen before we become alarmed about whether or not artificial sweeteners directly impact our microbiome, but their approach does raise a question that I’ll talk about next week: a systems approach to Aging with a Vengeance. We look at pain or other conditions as something that stands alone, but in reality, we may need a systems approach to deal with it.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

COVID-19 and the Small Intestine

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With the ACE2 receptor implicated in the long-term side effects of COVID-19, let’s begin with the digestive system. The gastrointestinal distress such as cramping, pain, and diarrhea are obvious, but there are reports that some people have had to have their entire small intestine removed due to damage from the COVID-19 virus. How could that happen?

One of the characteristics of these specific cells that contain the ACE2 receptor is that they function to absorb nutrients. If the virus interferes with absorption of nutrients by cells, the first cells that will be impacted are in the small intestine; it could literally starve to death. Second, a significant blood supply goes to the digestive system. We know that the COVID-19 infection can cause unusual clotting; if the blood flow is restricted to the small intestine, that could also cause cell death.

While we’re not done with this topic yet, I think it should be clear that we don’t know as much as we need to about the long-term effects of COVID-19. That’s why it’s so important for research to continue and for all of us to be vigilant in protecting our own health and the health of everyone we encounter.

Because of the holiday weekend, we’ll complete this tomorrow, but the discussion is far from being over as more research reveals more issues from exposure to this virus.

What are you prepared to do today?

        Dr. Chet

References: www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified