Iron from Meat and Type 2 Diabetes

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The abstract begins simply enough: “Dietary Haem iron intake is linked to an increased risk of Type 2 Diabetes.” Haem iron is another word for heme iron, iron sourced from animal meat. But let’s get back to the statement. The first question that pops into my mind is this: how did they measure iron intake from all sources, especially when you consider the scope of the study?

The research team examined data from over 200,000 potential subjects from three large studies of healthcare professionals; some of the subjects were followed for as long as 36 years. Researchers wanted to examine associations between iron intake from all sources and the risk of type 2 diabetes. They also examined blood markers in a subset of close to 38,000 subjects: insulin, lipids, inflammation, and uric acid levels.

They found that heme iron intake resulted in a Hazard Ratio of 26% increased risk for the development of type 2 diabetes when comparing the highest quintile with the lowest quintile of heme iron intake. The heme iron intake was also correlated with poor blood profiles such as high insulin, hs-C-reactive protein, and lipid levels. Nothing from non-heme sources.

Is it time to reduce meat intake? That’s not my initial question. My question is how’d they do that? How did they measure the heme and non-heme iron levels in over 200,000 people? We’ll hold on that for now and look at a study with almost 2 million subjects on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.nature.com/articles/s42255-024-01109-5

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

One Decision, Lasting Impact

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I love behind-the-scenes shows: how do things work? That probably explains why I like to dig into health studies the way I do. My latest fascination is with a show on the National Geographic channel called Disaster Autopsy. Several scientists examine man-made disasters to find out what went wrong. Most of the time, it comes from a single decision or single event that was unforeseen but made a lasting impact. The disaster didn’t happen right away; in some cases, it was decades later.

Does this apply to our body as well? You may think I’m talking about a single decision you made related to health—one decision made years earlier, that could seal your fate. Health is not quite that simple with multiple variables that interact. Still, after reading the Memo of the lifestyle factors that influence a healthy brain, have you made any changes?

The science of health can do the same thing: have an impact that lasts. The next three Memos are related to the choices that researchers can make by looking at the data in depth instead of superficially; they can impact health recommendations for decades. At the same time, we’ll find out the benefits of a phytonutrient called quercetin.

What are you prepared to do today?

        Dr. Chet

Research Update: Cancer and Diet

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A recent paper used an interesting approach to treat pancreatic cancer using a high-fat diet. That flies in the face of the typical approach: “If it was ever alive, don’t eat it.” In other words, a vegan diet. I’ve reviewed fasting prior to cancer treatment, which demonstrated improved outcomes for those who fasted, but this diet is radically different.

The Study

This study was all about finding the weakness in a defensive mechanism and attacking it.

Researchers were studying the mechanism that cancers use to get energy. The thought is that cancers use sugars and carbs, but cancer’s need for fuel to grow isn’t that limited. Researchers were studying how cancers switch to using fat as a fuel when there are no carbs available. Just like with the keto diets, the liver, and subsequently cancer cells if present, switch to using fat as a fuel in the form of ketone bodies. The protein that stimulates this switch is called eIF4E.

Researchers were able to find a current chemotherapy drug called eFT508 that blocked the ability of eIF4E to turn on the fat metabolism pathway. However, that didn’t stop the cancers from growing—they used other fuels such as carbs. But when they first treated the cancers with the chemotherapy drug that prevented the cancer from using fat as a fuel, then put them on a high-fat diet, the tumors all shrank.

In this study, the type of cancer was pancreatic cancer, one of the deadliest. This was a rodent study, but the chemotherapy drug is already approved for use in humans. Clinical trials are surely to follow in humans.

The Bottom Line

The authors speculate that cancers have more than one weakness that can be exploited with a combination of dietary and pharmaceutical interventions. Their breakthrough came almost 15 years after discovering what blocked the fat metabolism pathway. To me, this is one of the most exciting studies I’ve read in a long time. Just remember that this was one potential treatment for one type of cancer, but it represents hope.

I’ll be back in a week with a new Memo. If you’re here in the U.S., enjoy the final holiday of the summer—but don’t forget to eat your fruits and vegetables.

What are you prepared to do today?

        Dr. Chet

References:
1. https://medicalxpress.com/news/2024-08-fasting-ketogenic-diet-reveals-vulnerability.html
2. https://www.nature.com/articles/s41586-024-07781-7

Research Update: Preventing Dementia

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How many of you have had this experience: “Why did I walk into this room—what was I supposed to do?” I’ll bet you begin to wonder, “Am I losing it?” I don’t think so, but just to be sure, I decided to present the Lancet Commission’s latest update for dementia prevention, intervention, and care. They’ve published a list of lifestyle habits that, based on research, are associated with preventing dementia. The 2024 report added two more lifestyle objectives.

I’ll present the 13 recommendations without saying how to achieve those habits with the latest additions at the end. For now. But over time, I’ll address those in future Memos, webinars, and audios as I review the complete research. I think it’s important to know the what to begin with. Remember, these are life-long habits.

Specific Actions to Reduce Dementia Risk

  • Ensure good quality education is available for all, and never stop learning throughout life.
  • Encourage exercise because people who participate in sport and exercise are less likely to develop dementia.
  • Maintain a healthy weight and treat obesity.
  • Make hearing aids accessible for people with hearing loss, and decrease harmful noise exposure to reduce hearing loss.
  • Treat depression effectively; I would add early as well.
  • Encourage use of helmets and head protection in contact sports and on bicycles.
  • Reduce cigarette smoking by any practical means.
  • Prevent or reduce hypertension and maintain systolic blood pressure of 130 mm Hg or less from age 40.
  • Reduce high alcohol consumption.
  • Prioritize age-friendly, supportive community environments, and housing to reduce social isolation by facilitating participation in activities and living with others.
  • Reduce exposure to air pollution.
  • Make screening and treatment for vision loss accessible for all.
  • Detect and treat high LDL cholesterol from midlife.

The Bottom Line

These 13 steps to reduce the risk of developing dementia are independent of genetic factors. That makes sense; we can have the worst set of genes, but if they’re never expressed due to a good lifestyle, the development of dementia can be reduced or at least delayed. We’ll explore how we can do these things in the future, but you probably see the place to begin in several habits: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01296-0/abstract

Back Pain: A Potential Solution

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Back pain is a leading cause of work-loss days according to the Georgetown University Heath Policy Institute; that’s true in just about every high-income country. Finding a solution to reduce back pain occurrence not only reduces lost wages but also improves the quality of life of the individual.

Researchers in Australia wanted to find out whether a walking and educational program would reduce the recurrence of lower back pain resulting in medical treatment. They selected only patients who had lower back pain of undetermined origin; 701 patients were randomly assigned to the control group and experimental group. Both groups received the educational program. The experimental groups also received coaching on a walking program that they were to perform on their own. The goal was to walk 30 minutes per day, five days per week, but the program was adjusted to accommodate individual needs depending on initial fitness levels.

The results were interesting but not unexpected, in my opinion: those subjects in the walking group were 28% less likely to have a reoccurrence. Even better, the time to the next lower back pain event was about twice as long in the walking group, a median of 208 days versus 112 days in the control group. The researchers also found that the quality-of-life index they used was better in the walkers and that the walking program was cost effective compared to conventional treatment.

Lower back pain is something most of us experience at some point in time; wouldn’t it be great to go more than 200 days until your next episode? While some can be issues with nerves and vertebrae, at least some have no real cause other than weakness and tightness in muscles. With some basic core exercises and walking most days of the week, the solution just might be found on the sidewalk or pavement right outside your front door. Just make sure you get professional guidance before you start.

What are you prepared to do today?

        Dr. Chet

References:
1. https://hpi.georgetown.edu/backpain/
2. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(24)00755-4.pdf

Your Breath and Your Dental Health

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When I speak at events, I often answer questions afterward. To maintain some confidentiality, I often ask people to get close so it remains private. When you’re that close to people, you get a really good sense of the odor of their breath. People worry about garlic and onions but to me, those are normal. What shocks me is the odor of gum disease—I can’t believe people can’t smell it. Based on an article Paula sent to me, I understand it now.

The current name for it is smell blindness. Based on interviews with nose and throat specialists, it all has to do with saturating the nerve cells that detect odor, called olfactory cells, with the molecules from that odor. The nerve cells become so used to that stimulus, a person can’t smell that odor anymore. It’s kind of sad when you can’t smell your expensive perfume anymore, but it’s not a big problem. You probably don’t notice how your house smells until you walk back inside after being gone for a while. But when you carry the source of the smell around with you in your mouth all the time, it’s a huge problem and hard to solve.

I don’t get worried about adapting to many smells. If you like cats, there’s going to be a litter box odor you may not notice any more. Same may be true of the perfumed shampoo or conditioner you use every day. But the odor associated with gum disease means that there’s infection, and that’s problematic. Not only can it destroy your gums and loosen your teeth, the bacteria can get into your blood stream and impact your heart.

Not only is it bad for your health, it’s not good for your social life or professional prospects. And to look at it from another perspective, if you have a business where your employees get up close to people—checking their vision or cutting their hair, for instance—it’s a smart move to offer dental care. And it’s the right thing to do.

The author suggested that in a quiet moment, you ask someone you really trust to smell your breath. Even if you breathe into your cupped hands held in front of your nose, you may not be able to smell it. Better to ask a friend or loved one to do it to get an impartial opinion. If it smells like infection, see a dentist for a professional analysis. This one is too easy, and potentially too deadly, to ignore. Whether you have bad breath or not, everyone should be flossing every day and brushing after meals.

For more info on treatment for periodontal disease, go to the Store at drchet.com and check out The Bottom Line on Periodontal Disease; Insiders get a free copy of any Bottom Line.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.washingtonpost.com/wellness/2024/08/02/smell-bad-breath/

Long COVID and Possible Solutions

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I had a talk with someone who had a question about a skin condition, something that’s been a minor issue but suddenly got much worse. I happened to mention that sometimes when you deal with the flu or COVID, your immune system is weakened and it can impact other conditions; people report their symptoms began to get worse after a bout of COVID, almost to the day after recovering. Cause and effect? No way to know for sure. But long COVID is a reality; long COVID is a smorgasbord of illnesses that have been somehow triggered by COVID.

Coincidentally, an article was published on the development of treatments for long COVID. While there isn’t complete agreement exactly why it happens to some but not all those who’ve had COVID, physicians and scientists are looking at combinations of medications and supplements for possible solutions. While the article focused on using the antiviral Paxlovid, I was interested in the nutrient approach—specifically, the nutrients that focus on helping the mitochondria. Whatever else may be going on in long COVID, fatigue seems to be the worst side effect of the long COVID symptoms. That has to include an impact on the mitochondria regardless of whether it’s neurological or hormonal or even genetic in nature.

While other supplements were discussed, my experience is with N-acetyl cysteine and the amino acid glycine. Research has shown that when taken together, they help with repair and recycling of mitochondria. The typical amounts are about 600 mg of each per day; I’ve taken it regularly for a few years and I’ve noticed a difference in energy levels. Talk with your physician if you have long COVID or just have fatigue. There are also meds being tested for long COVID. The rest you know: eat less, eat better, move more.

What are you prepared to do today?

        Dr. Chet

Reference: Paxlovid, Vitamin Supplements Show Promise With Long COVID – Medscape – July 29, 2024.