Tag Archive for: microbiome

No More Showers!

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If you saw a book called Clean, you probably wouldn’t think the author decided not to take any more showers. But you would be wrong, because that’s exactly what Dr. James Hamblin announced he would do about five years ago in a magazine article. Over time and a whole lot of research, the article became the basis for his book. In an interview I read with the author, he’s constantly irritated because the most frequent question he gets when people find out he hasn’t taken a shower in five years is “Do you stink?” My thought is if that you’re close enough to ask the question, you probably should know the answer, even with social distancing.

His primary concern over taking showers is our addiction to cleanliness, which is something I’ve thought about as well. (Never fear, I’m not going to quit taking showers.) His concern is with the microbiome of the skin. We all hear research on the microbiome within the digestive system just about every day, but the microbiome of our skin is actually the first line of defense in our immune system. Whatever we do to our skin affects the microbiome of our skin. With all the various soaps, detergents, and shampoos, as well as the chlorine that’s in most water treatment systems, that has to have some impact. Is the impact good or bad?

That’s what we’re going to take a look at in this week’s memos. Could how we treat our skin microbiome impact our immune system? We’ll look at the state of research to date.

What are you prepared to do today?

        Dr. Chet

Reference: Clean The New Science of Skin. James Hamblin. Penguin Random House. 2020.

The Magic of Chicory

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Because this is my birthday week, I thought I would indulge myself and talk about some personal research I recently did. Today it’s all about chicory—it’s everywhere. The little purple flowers can be found alongside just about every road in Michigan. I’m pretty sure it’s probably that way across the U.S. where the climate is similar at this latitude. Those little lavender-purple flowers are chicory, officially known as Cichorium intybus, a member of the Aster family. This absolutely phenomenal lavender-flowered plant is one of those plants that are classified as weeds in some areas, but in others are cultivated for their nutritious parts.

Chicory as a Fiber Source

I first became aware of chicory when I found out the root is the source of one of my favorite types of fiber called inulin. The reason that I like that particular type of fiber so much is that it can act as a prebiotic and feed many of the bacteria of the microbiome. But first, it acts like any other type of soluble fiber: it absorbs fluid to help food move through the small intestine. Then when it gets to the large intestine, it can supply the thousands of microbes with food.

Chicory is not the only source of inulin, but it’s the greatest source. Here are some of the other major sources of inulin if you wanted to get it by eating plants; all of these amounts are per 100 grams of a serving; that works out to about 3.3 ounces:

  • Chicory root contains about 40 grams
  • Jerusalem artichoke has 16–20 grams
  • Garlic has 9–16 grams
  • Raw asparagus has 2–3 grams

It might be relatively easy to eat 3.3 ounces of artichokes or asparagus. But I’m not sure many people are going to want to be around you if you eat 3.3 ounces of raw garlic every day, although it could be a big assist in social distancing. Just a thought.

Chicory as Food

I was surprised to find out that almost the entire chicory plant can be eaten; it has been cultivated as food in Europe since the 1600s. Depending on the age of the plant, as well as the time within the growing season, the leaves of the plant can be considered a salad delicacy. I don’t usually stop and eat or even nibble when I’m out for a walk/run, but chicory is in the endive family and the flavor is supposed to be somewhat bitter and crunchy like endive. That’s if eaten raw. When cooked, the flavor mellows out quite a bit, as it does for dandelion greens, another relative. When used in foods, it appears that chicory is often eaten like celery. The leaves, the roots, and the leaf buds are boiled and added to foods. Chicory seems to get more intriguing as a potential food all the time.

Chicory has also been used as an additive to or a substitute for coffee. Evidently when dried and roasted it has a very distinctive flavor that enhances coffee. In fact, after World War II, England and Germany roasted chicory root as a substitute for coffee beans. While I’ve never tasted it, I know that there are several brands of American coffee that contain roasted chicory root. What I don’t know is how that might impact the ability to act as a fiber and prebiotic. Because you’re trying to extract flavor from the root plus roasting the root, there may not be any of the desired digestive qualities available.

Chicory as a Nutrient

Because it’s a plant, you know that it must have phytonutrients. I’ve talked about the benefits as it relates to the microbiome, but there may be other benefits from consuming the plant or extracts from the plant. For example, in some of my background research on this, it seems that some people apply a paste of chicory leaves on the skin for swelling and inflammation. In another trial on rodents, chicory was used in combination with a variety of other herbs to see if it would lower blood pressure. It did, but it’s still a long way from a very small study on rats to developing natural ways of dealing with blood pressure.

One thing is for sure: using the parts of the plant that we know are the most effective for the digestive system is probably a good idea. We know that adults should be getting 25 to 30 grams of fiber per day, but most people seem to be able to hit only between 12 and 13 grams. So if taking this type of fiber known as inulin sourced from chicory root or eating more artichokes and asparagus is possible, you’ll get a lot of benefit from this plant. Maybe this will inspire you to taste the leaves of the plant with the little purple flowers on the side of the road in your next salad.

That’s exactly what I did on a trip to the store before writing this Memo. I noticed some chicory growing on the side of the road in an area that had a little bit of parking. So I stopped my car, got out, picked several different sized leaves, and then ate them. The plant had blossoms so that may have made a difference in the flavor. It was extraordinarily bitter but left no aftertaste. It would be interesting to be able to get some chicory that was specifically designed to be used in salads to see if it would taste similar. I would say this: if you can drink an IPA, I think you could eat salad with chicory in it. That’s my experience with eating chicory leaves to date. I’ll stick with inulin from the root for now.

New Info and Some Time Off

There’s a new Basic Health Info posted on the Health Info page at drchet.com about the myths and facts of face masks as described in actual scientific research. If you’re tired of people throwing fantastic tales of masks’ effects at you, here’s where you can go to get the facts: Cloth Masks: What the Research Says

We’re taking next week off to catch up on some big chores around the house, maybe even relax an hour or two, so expect to hear from me again on August 4.

What are you prepared to do today?

        Dr. Chet

Reference: BMC Complement Altern Med. 2017 (3) 7;17(1):142.

COVID-19: What We Don’t Know

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I’m sure you’ve heard the expression “What we don’t know could kill us” and that’s truer today than at any other time. While we may argue about masks and social distancing, there’s just still too much we don’t know about the novel coronavirus. The critical factor is that because of what we don’t know, we aren’t able to work on treatments that can be administered to more people sooner once they’ve been diagnosed.

The Microbiome

You’ve heard me repeatedly say that the immune system starts in the gut; I don’t think many healthcare professionals would debate that anymore. That’s why knowing how the microbiome deals with COVID-19 is critical to establishing prevention and treatment programs. I don’t mean preventing people from catching the virus—I mean preventing them from getting a very serious form of the infection that results in hospitalization and severe treatments such as intubation and respirators.

We know that the digestive system is full of ACE2 receptors as I’ve written about before. What we don’t know is how to specifically make the microbiome more robust. What specific foods should we eat? What specific strains of microbes should we ingest to help immune function?

If we should eat more vegetables, should they be raw or can they be cooked? There are 6,500 different microbes that we know of at this point with multiple strains; if we’re supposed to take specific microbes, which strains are the most effective? We just don’t know enough to make our personal immune system stronger. We should still do the things that we’re doing by eating more vegetables, taking fiber and probiotics, but we could do better if we had more specific information.

Genotype and Phenotype

We know that age is a risk factor for a serious case of COVID-19; we also know that conditions such as heart disease, hypertension, and type 2 diabetes are also associated with a serious COVID-19 infection. And that’s about it for right now. Let me give you three questions that may or may not be important but certainly have to be checked out.

Does race have an effect? In addition to the observations about co-morbidities and healthcare opportunities, there may be some impact related to race that hasn’t been examined yet. Or instead of race, maybe it’s ethnicity. Think about it; from an ethnic perspective, what was different between the people of Italy and Spain, where there were significant deaths, from those who lived in Norway and Denmark? What about male pattern baldness? What about familial hypercholesterolemia? Could either of those be a genetic risk factor?

What about phenotype? Are people who are ex-smokers at greater risk than those who never smoked? We would think so, but nobody’s studied it. What about people who’ve lost a significant amount of weight and maintained it? What about people who exercise regularly compared to those who never exercise? All those traits would be associated with a healthier lifestyle, but we haven’t tested their impact of the risk of COVID-19. Lifestyle can impact the expression of your genes. And in some ways, once genes are expressed or turned on, they may not be downregulated or turned off. That could be important.

Do supplements help? It’s easy to say massive amounts of vitamin C and vitamin D and turmeric will help, but do they help everyone? What if you already have adequate vitamin D levels? Could adding even more be counterproductive? The same is true for vitamin C. We know that vitamin C is an antioxidant, but in high quantities, it may act as a pro-oxidant and increase free radical damage. How much is the right amount? Think of all of the supplements that we all take. It would be nice to know which are the key supplements to help our immune function against this virus and which ones just help our bodies in our day-to-day activities. At this point, we don’t have enough information.

Better Treatments

The whole point of treatments for COVID-19 is to force the virus to back off long enough to allow the immune system to do its job. There are no medications that I’m aware of that can target the virus and kill it; that means it’s up to the body to do the killing, and even after a vaccine is available, that will still be the case. We need better treatments that can neutralize the impact the virus has on the body so that the immune system can, in effect, clean up the mess.

There have been a lot of debates about some medications such as hydroxychloroquine. There are hopeful additions that include steroids, although they have issues as well. We may even find out that specific types of diets including fasting may be beneficial. Or they may be disastrous. We need more research to find better treatments, and we need that research now.

As it relates to a vaccine, we really don’t know if there ever will be one or how effective it will be. Even if one is developed, the logistics are just incredible. How are we going to get 330 million doses of a vaccine ready for administration when we still don’t have enough tests available or enough gloves and masks for healthcare workers? Early testing means early treatment. But if you can’t test people to begin with, and you can’t get the results to them quickly, using better treatments could end up being too little too late for any given individual.

The Bottom Line

The novel coronavirus will be with us for a while longer. Maybe indefinitely. As I wrote a couple months ago, we don’t have to fear it; we have to respect it. Your job is simple: take care of your body the best that you can with diet, exercise, supplements, and reducing stress. If you’re going to venture out of your home, wear a mask, social distance, and wash your hands frequently. That’s our job. And know that there are people who will keep trying to find the answers we need and still more people who will help us if we get sick. We can give them time to work and lighten their load if we do our part.

What are you prepared to do today?

        Dr. Chet

You’re Invited to a Live Dr. Chet Seminar in Atlanta!

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The next stop on the Dr. Chet tour is going to be in Atlanta, GA, to talk about Nutrition for the 21st Century.

I’ll start with the most important question: what’s the best diet? The keto craze is in full swing, with Paleo right behind. The opposite side is going vegan, an all plant-based diet. What’s best for weight loss? For more energy? For weight maintenance? I’ll let you know the pros and cons of each approach so you can make the right choice for you.

Second, no matter which diet you choose to follow, will you get adequate nutrients? No matter how healthy the diet, there will always be gaps because of the way our food is grown and processed. This time around, it’s not just getting the right nutrients for your body but also your microbiome, the microbes in your digestive system that are critical to your immune system. They require healthier choices as well. I’ll cover the basic nutritional supplements for adults and children to lay a good foundation.

How do you decide on a quality manufacturer? There are new companies being started every day, and I’ll give you specific criteria you can use to evaluate supplement manufacturers. If you’re going to put supplements in your body, you want to be certain they’re safe and effective. I’ll let you know how to do that.

Next, there are some conditions that may be the result of a lack of adequate nutrients. Supplements don’t cure diseases, but the right nutrition may help your body help itself. I’ll cover some common conditions.

I’ll also have time to answer your questions. The goal is to provide you with enough information for you to make healthy choices every day. Please join me to get the latest information to do exactly that.

Who should attend? People who find themselves confused by the nutrition information available; one day something’s good, the next day it’s bad. I’ll clarify that for you. If you’re concerned about your personal health or that of your family, or you’re a business owner who wants to understand supplementation and diet better, you should be there. Everyone will walk away with something that will help them make healthier choices.

Nutrition for the 21st Century
March 22, 2020, 2 – 5 p.m.
Dunwoody Country Club
1600 Dunwoody Drive
Atlanta GA 30350

$29.95

Important note: Country club rules say you can’t buy tickets at the door, but you can buy them on your smartphone in the hallway or on your way there by going to drchet.com; please complete your purchase by 1:45. Your name will be added electronically to the list.

What are you prepared to do today?

        Dr. Chet

Will the Diet of Your Culture Improve Your Microbiome?

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Does the diet of your ancestors impact your microbiome? A review examined whether the common foods found in specific cultures can benefit people of that culture who are following a diet high in refined carbohydrate and low in fiber, as is common in the U.S. Let’s take a look.

The Gold Standard: the Mediterranean Diet

The Mediterranean diet has been studied more than any other; it emphasizes vegetables, whole grains, fish and seafood, nuts and seeds, olive oil, fruit, and limited sweets. The benefits for reducing heart disease, hypertension, and T2D are well documented, and we’ve always assumed that the Mediterranean diet is appropriate for everyone. But is it? The point to this review is that while there are similarities, there are cultural differences that may be important.

For example, there are more tubers (root vegetables) in African diets and virtually none in most Asian cultures. The Latin diet has more dairy products while some Asian diets contain almost none. If you want to become more familiar with cultural diets, check out www.oldwayspt.org. It’s a non-profit organization that has developed cultural appropriate diets and teaches people to prepare foods using traditional cultural spices.

It makes sense; one size does not fit all. One interview in the paper was with an Eastern Indian physician who had always recommended the Mediterranean diet to her clients of Indian descent, but the whole grains of the Mediterranean diet were not the same as traditional Indian grains. Once she changed the types of grains and other high-fiber foods to more culturally appropriate choices, her patients did better in following a higher fiber diet.

The Benefits of a Culturally Appropriate Diet

Simply stated, people are more inclined to follow a healthier, high-fiber diet if it’s based on their own culture. The differences in grains and vegetables may be subtle but seem to be important. The tastes and flavors may be more familiar to first or second generation immigrants.

There is also speculation that the microbiomes of people from varying cultures may have an evolutionary aspect. In other words, whether you’re a recent immigrant or a fourth generation of immigrants as I am, your microbiomes may respond better to foods that your ancestors have eaten for generations. Remember the short-chain fatty acids (SCFA) in the Thursday Memo this week? They may be dependent, not just on fiber, but fiber from the foods of your ancestors.

The Bottom Line

This paper gives us something to think about. What if we ate a more plant-based diet that’s more culturally based? I think it’s worth a try. It doesn’t mean that you won’t benefit from eating a high-fiber food that’s not culturally based; there’s no question that you will. But if you ate culturally based foods and they were prepared based on cultural tastes, you might decide to eat more of them and you might get more benefit.

The first thing I did was to look at traditional foods from my ancestors in Poland and other eastern European cultures. I’m not done yet, but it seems cabbages and root vegetables are definitely part of my future diet; I’ll keep you posted as I research my diet further. In the meantime, check out Oldways to get some perspective on what culturally appropriate foods may benefit your diet. If you’re an African-American man married to a Chinese-Canadian woman, you’re going to have some very interesting meals.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2019; doi: 10.1001/jama.2019.18431.
2. www.oldwayspt.org.

Does Fiber Improve Your Microbiome?

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Now let’s look at the results of increasing dietary fiber for people with diabetes. Researchers recruited over 50 type 2 diabetics (T2D) for a 12-week study. The control group was given standard recommendations for a healthy diabetic diet. All current medications were maintained and both groups received acarbose, a starch blocker. The experimental group was put on a diet of prepared high-fiber foods and a diet higher in vegetables and fruits. Stool samples were collected periodically to assess the impact of the diet on the microbiome.

While the variables were straightforward, the analytic techniques were extraordinarily complex. It’s easy to say you want to examine the microbiome, but that’s not simple to do with thousands of types of microbes to analyze. Several types of bacteria from different species responded to the increase in fiber: bacteria that produced short-chain fatty acids (SCFA). The SCFAs are important because they feed the cells in the gut that do all the work during digestion and absorption.

HbA1c levels decreased faster and in a higher percentage of subjects in the experimental group than the control group. The fiber group also lost more weight and their blood lipids improved more than controls.

This was a small study, limited by the complexity of analyzing the microbiome, but the improvement in T2D simply due to an increase in fiber from foods is important. One more thing: this was a Chinese study, so typical high fiber foods from China were used. Is that important? We’ll find out Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Science. 2018. 359:1151–1156.

How Your Microbiome Affects Exercise Benefits

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It seems every day, there are several studies on the microbiome and its impact on our health. At this point, they’re preliminary but the picture is emerging that as goes your gut, so goes your health. I’ve picked three new studies to review this week.

As an exercise physiologist who’s done research on this topic, I’ve always recommended exercise as a way to improve control of blood sugar for prediabetics; that’s why this study surprised me. Researchers assigned 39 prediabetic men who had never used medication to either a control group or a high-intensity exercise group for three months. All men in the exercise group had similar improvement in fitness and weight loss. But only 70% of the men demonstrated an improvement in insulin resistance.

The way the responders processed protein and carbohydrates was different from non-responders. The researchers collected stool samples and then transplanted the microbiome of responders and non-responders into a group of mice; the mice responded to exercise in the same way as the man whose microbiome they received. The microbiome somehow responded differently to exercise and modified the expected results.

We don’t know about dietary differences between subjects that might have impacted the outcome because the subjects were told to maintain their current diet, but the results were surprising nevertheless. But I would still give the same recommendation for exercise to all prediabetics. The only difference would be to make sure they tracked blood sugars to see how their blood sugar responded.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Metabolism, DOI: 10.1016/j.cmet.2019.11.001.

New Research Yields One More Factor

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The last recommendation for you in living every day you’re alive involves keeping the body working its best through regular maintenance. That means seeing your healthcare professionals on schedule. Here are some examples of what that can mean.

Researchers recently published a paper on the impact of a narrow band of ultraviolet light on the microbiome. If people were deficient in vitamin D, their microbiome was not as healthy as those who had normal vitamin D levels. The UV light did not improve the microbiome of those who had normal vitamin D levels, only those who did not. That’s why you need to get your bloodwork done regularly, including getting your vitamin D levels checked. Whether by sun or supplement, vitamin D is critical to your microbiome and many other aspects of your health.

A couple of years ago my glasses were broken and I needed a new prescription, so I finally had my eyes examined. It had been at least five years since my last exam. Turns out I have glaucoma; by using a couple of drops a day, I haven’t lost any vision. But if I hadn’t had my eyes checked, who knows what could have happened?

One more. It seemed like I kept getting shorter and shorter every time I had a checkup, so I had a bone density test done. Turns out I have osteopenia. Long-time runners like me aren’t supposed to get that, but there it is. I changed my supplements and I’ll get checked again this year.

I’ve often talked about the importance of protecting your dental health. Yes, teeth can be replaced, but it’s really expensive as Paula and I know from experience. While a dental checkup may seem like lot of money, it’s worth it to protect not only your teeth, but many other aspects of your health such as heart and digestive health.

Today’s lesson is get your body checked on a regular basis. We don’t ignore our hearts (for the most part) but the ability to see, to hear, to have strong bones, even to chew food is dependent on taking care of those specialty organs on a regular basis.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Microbiol., 24 October 2019 | https://doi.org/10.3389/fmicb.2019.02410.

Why I’ll Keep Taking My Probiotics

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One thing I try never to do is to take cheap shots at research studies. I’ve acknowledged that my expertise in the methodologies of microbiome analysis is limited. I think that these research groups did something unique in their approach to assessing the microbiome. That doesn’t prevent me from pointing out some obvious issues with the studies that could have impacted the outcomes.
 

The Problems

The first issue was the lack of diet control in either study; diets vary between people, and that could have significantly impacted the results. The foods you eat can directly impact your microbiome for hours, and what the subjects ate the days before the sampling may have skewed the results. Before the study, they used a Food Frequency Questionnaire and determined there were no unique dietary issues that could have impacted the results, but not using a diet record during the entire 28-day study is curious. For the thousands of data points they did collect, they ignored the most basic.

What shocks me is that they knew better: these are the same laboratories that have shown both foods and synthetic additives can substantially impact the microbiome. Without studying the diet of the subjects, and only eight subjects at that, you don’t know who had a diet conducive to the restoration of the microbiome after antibiotics or not.

Second, they used a novel approach. They collected samples from the digestive system using endoscopic techniques in addition to the fecal samples typically collected. Very interesting, but they also used the typical colonoscopy prep which means no food and the complete cleansing of the colon. To their credit, they did test two subjects with and without the typical pre-colonoscopy prep and found few differences. Two subjects. I don’t need to say anything more. While the prep is not going to erase all the bacteria and other microbes, it will eliminate the food supply and could impact what bacteria are growing at the time of the sampling.

Third, they gave healthy people antibiotics; that may bear no resemblance to the microbiome of someone who has a serous infection. The best we can say is that taking antibiotics when you’re not sick may not be a good idea.

Finally, I’ve read research by this group in Israel before. They’re developing a weight loss program based on their microbiome research. It may have no relationship to these studies but it does demonstrate a willingness to monetize their research results, and that always raises my suspicions.

Sure enough, the purpose of these studies was to support a patent application. It may be for the collection technique or more likely, a test to ascertain what probiotics might benefit specific groups of people while healthy or with specific conditions. While they claim no conflicts of interest in the paper, I can’t think of a bigger one than this. While there’s nothing wrong with establishing tests and treatments based on your research, the procedures need to be tested in other laboratories before rushing to market. This strikes me as premature.
 

The Bottom Line

I think these two studies illustrate where we are with microbiome research: at the very beginning. They contribute to the body of knowledge but little else. Probiotics will impact everyone differently, and they may not be desirable for everyone under every condition. But unless we get a radical change in our diet that encourages the microbiome to grow healthy and strong, taking a probiotic every day is still a good idea. My family and I, including my grandson Riley, will continue taking our probiotics because nothing in this research raises any questions about the safety or potential everyday benefit of regularly taking a probiotic supplement, preferably with a prebiotic.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI:https://doi.org/10.1016/j.cell.2018.08.041.
2. DOI:https://doi.org/10.1016/j.cell.2018.08.047.

 

New Probiotics Research Results

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The methodology used in the two studies I’m reviewing is complicated. I mentioned the endoscopic biopsies on Tuesday (and a big thanks to the people who volunteered for an endoscopy); subsequent analysis of the actual microbiome utilizes very complex techniques. I’m not an expert in those techniques so I can’t assess the results the way I normally would, but here are the results published by the authors.

The first study examined the changes in the microbiome when subjects were given either a placebo or commercially available probiotic for 28 days. The most significant finding was that the results were highly specific to the individual. That’s no surprise for one reason: no two microbiomes are the same, even in people who live in the same household. That a probiotic with 11 different bacteria would have different effects on the 14 subjects in the intervention group is no surprise. Some showed no growth of any of the strains of the probiotic, while other subjects’ tests showed strains that took up residence.

The second study examined the effects of antibiotics when taken by healthy subjects under three conditions: no intervention (seven subjects), the commercially available probiotics used in the first study (eight subjects), and a self-donated fecal transplant (six subjects). They found that the microbiome of the subjects who took the probiotics was not restored to their pre-antibiotic state; the supplemental probiotics seemed to colonize, leading the authors to suggest that they impaired the re-colonization of the original microbiome. The microbiome of the other two groups seemed to recover.

Should we avoid probiotics as a result of these studies? I’m taking mine and explain why I’ll keep taking them on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI:https://doi.org/10.1016/j.cell.2018.08.041.
2. DOI:https://doi.org/10.1016/j.cell.2018.08.047.