Tag Archive for: supplement

The Bottom Line on Preschoolers, Probiotics, and Gastroenteritis

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“These studies are likely to have significant impact towards eliminating use of medications that don't seem to work.”

That’s a quote from a physician interviewed by NPR who wrote a commentary accompanying the two research papers on probiotic use for gastroenteritis or GE (1). I think it perfectly illustrates the fallacy of the pharmaceutical model of research on nutrition and its impact on health:

Nutrients are not medications.

They may come in pill form, they can be administered like medications, but they’re nutrients nonetheless.
Questions About the Studies
The . . .

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Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Do Calcium Supplements Harm Your Heart?

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Over the past few years, concern has grown about the relationship between heart disease and calcium intake. A couple of studies have shown a possible association between calcium intake and cardiovascular disease. In an article also published this month in the Journal of Women’s Health (1), two clinicians reported on a number of studies including one that examined calcium intake and heart disease. Their purpose was to update clinical guidelines for physicians and internists who regularly treat women and heart disease.

They selected a study that included a meta-analysis of studies on calcium intake from food and supplements (2). You know my position on meta-analysis and its overuse and limitations, but in this case, the researchers wanted to establish positions for both the National Osteoporosis Foundation and the American Society for Preventive Cardiology on calcium intake and heart disease. I think the use of this statistical method was warranted.

After an exhaustive review of the studies and re-analysis of the data, researchers found that calcium intake, from either food or supplements, at levels up to 2,000–2,500 mg per day are not associated with CVD risks in generally healthy adults. Although they found a few trials that reported increased risks with higher calcium intake, the risks were small and not considered to be clinically important even though they were statistically significant. The results applied to women and men.

At this point, with data from tens of thousands of subject, taking calcium from food or supplements will not harm your heart if you’re healthy. Does that mean you should limit calcium if you’re not healthy? No. There just isn’t sufficient data to know. In my opinion, if you take 800–1,000 mg of calcium per day, I think you’ll be fine but you should always check with your physician. You need calcium for many reasons, including bone and blood health and conducting signals between nerves. Especially if you don’t consume a lot of dairy, take your calcium supplement.

What are you prepared to do today?

Dr. Chet

 

References:
1. J Women’s Health DOI: 10.1089/jwh.2018.6932
2. Ann Intern Med 2016;165:856–866.

Bioavailability Ends with Bioactivity

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Here’s where we stand: we’ve digested a nutrient and it’s been absorbed into the bloodstream. How is it going to be used? How do we get the benefit of vitamin C, magnesium, alpha-carotene, or caffeine? Let’s take a look.

Many target cells have receptors that are specific to a nutrient, like a wrench that fits only one size of bolt. For example, when blood sugar rises after pasta is digested and absorbed, insulin is released from the pancreas. Insulin will attach to a specific insulin receptor on the cell membrane, and that will allow a glucose molecule to enter the cell to be used. Cells also have receptors for vitamin C to be absorbed into cells.

That’s fairly straightforward. The next step would be actually performing a function once the nutrient enters the target tissue. Let’s look at caffeine for example. There’s a genetic factor; one version of a gene can process caffeine quickly while a mutation of that gene processes it slowly. I can drink coffee and immediately go to sleep. Others may process it slowly and may not be able to sleep in the evening after a cup of coffee for lunch. Same nutrient, different effects on different people.

In addition, there are numerous enzymes that help make chemicals such as hormones or structures such as cartilage. If enough of an enzyme isn’t being manufactured or it’s blocked from being utilized, that can have an impact on how well a nutrient works. An example would be insulin; if cells are not producing enough receptors, or the receptors are resistant to insulin, blood sugar would rise. That leads to overall insulin resistance, one aspect of being prediabetic.

Another example would be the manufacture of glucosamine. The process requires fructose-6-phosphate and the amino acid glutamine; the first is a result of the breakdown of sugar while the later is the most prevalent protein-building amino acid in the body. The manufacture of glucosamine also requires an enzyme. If a person doesn’t make enough of that enzyme, that affects the production of glucosamine which then impacts the production of other forms of connective tissue such as cartilage, ligaments, and bone.

The Bottom Line

Every day there are new nutrition products introduced that are supposed to be better for you because more nutrients are available, but nutrition just doesn’t work that way. As I’ve tried to show you this week, the problem is that it isn’t quite as simple as what you see in Internet ads. Nutrients have to be digested, absorbed, and used by the body, and things can go wrong at any step along the way. Each individual’s body is unique and comes with its own idiosyncrasies and difficulties, and that’s what makes nutrition so complicated.

Maybe you’re thinking, “What’s the point if so much can go wrong?” What you have to remember is that most of the time everything works just as it should; not everything related to bioavailability goes wrong in every person. It’s also a matter of degree—maybe absorption will be cut by 50% or activity reduced 10%. I want you to understand why some nutrients won’t work as expected for a particular person, and why claims of better bioavailability aren’t a guarantee.

Yet we’re still here, aren’t we? We’re here because our ancestors survived. To steal a line from “Jurassic Park”: Nature finds a way.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2raDviy

 

Bioavailability Continues with Absorption

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On Tuesday I talked about some of the processing required to get nutrients ready for absorption. The next phase of bioavailability is the absorption of the nutrient from the gut into the bloodstream. Let’s look at what’s involved.

The absorption process occurs via the intestinal epithelial cells and they vary in size and function in the small and large intestine. Some nutrients such as lipids may use a passive process to be absorbed. Sugars, amino acids, and others will use an active process involving transporter enzymes as well as using energy to be absorbed. Vitamin B12 absorption is much more complicated; it requires something called intrinsic factor and then is passed to another protein carrier for absorption.

Here’s where absorption can go wrong. Maybe you don’t produce enough of a transporter enzyme for one or more amino acids. Perhaps you have a condition such as irritable bowel syndrome, and some of the areas where absorption occurs are missing. There are more scenarios related to absorption, but they can all lead to a lack of bioavailability. Then there’s the fact that all our bodies are the tiniest bit different. Because most absorption studies are done with simulations of the digestive system cells, product claims of greater bioavailability can easily differ from what actually goes on in your digestive system.

Let’s say that you have digested and absorbed a nutrient. Does that mean your body will actually be able to utilize the nutrient? That’s the topic of Saturday’s Memo.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2raDviy

 

Bioavailability Begins with Digestion

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Last Saturday’s Memo introduced a new concept: a systems approach to nutrition. One term that gets bounced around a lot related to dietary supplements or different types of food is bioavailability. Claims are made that “this form of our supplement is 10 times more bioavailable than that form.” It sounds so simple, right? It’s not—we’ll spend this week looking at all that’s involved in bioavailability. It begins with the entire digestive system.

Digestion is the process of breaking down a food or nutrient for absorption. There may be plenty of a nutrient consumed, but it has to be broken down into a form that can be absorbed. That begins in the mouth by chewing, and then the action really heats up in the stomach; acids are released to break the food into smaller molecules, if required. After leaving the stomach, the digestive enzymes begin to work on the food to continue the process. If it’s a nutrient from a supplement, it may be absorbed as it is or it may need to be modified biochemically. As the nutrient continues through the small and the large intestine, it may require a modification by bacteria before it can be absorbed.

There are many points in the process that can affect absorption. Does a person’s stomach release enough acid? Does the pancreas make enough digestive enzymes? Is there enough food that provides chelating agents for minerals? Is the microbiome healthy enough to continue the breakdown of the nutrient? You can see how the system can be affected in numerous places. But we’re not done yet. On Thursday, we’ll talk about absorption.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2raDviy

 

Power Up with Vitamin B12

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The final supplement I’ll cover this week is vitamin B12, sometimes called the energy vitamin. Many vitamins are involved with energy production, but a lack of B12 can certainly cause problems with energy and other issues.

Vitamin B12 is also known as cobalamin and if you’re wondering, yes, this vitamin does include the mineral cobalt. There are two primary functions of B12 in the body. The first is to help reduce the chemical homocysteine to methionine while helping folate be converted into a usable form in the same reaction. Without enough B12, homocysteine increases inflammation in the body . . .

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Do You Make Enough Coenzyme Q10?

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There’s one major difference between coQ10 and other vitamins, minerals, and nutrients such as omega-3s: we can produce coQ10 ourselves. The problem is that we may not produce all the coQ10 we need, especially as we get older.

CoQ10 is used in the production of energy from both carbohydrates and fat in the mitochondria of the cells. You remember mitochondria from science class; they’re often called the powerhouse of the cells. And coQ10 is the substance that’s used to produce that power. It’s critical in the steps where oxygen is used to produce ATP, the . . .

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What You Need to Know About Omega-3s

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This week I’m covering basic information about three supplements.  One of my favorites and one I don’t ever leave home without is omega-3 fatty acids.

There are three basic forms of omega-3 fatty acids: eicosapentanoic acid or EPA, docosahexaenoic acid or DHA, and alpha-linolenic acid or ALA. The body cannot make omega-3 fatty acids, so they have to come from food and supplements. ALA is an essential fatty acid—the body can make EPA and DHA from it but not very well—so getting EPA and DHA from diet and supplements is critical.

EPA . . .

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