Tag Archive for: irritable bowel

Nutrition Research: Incomplete

/in /by

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

/in /by

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…

/in /by

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