Sucralose: A Treatment for Auto-Immune Disease?

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In test-tube and rodent research, researchers have found that sucralose given in high amounts may help reduce the immune response, thereby preventing the body from attacking itself, which is the essence of an auto-immune disease. How about that? For all the negative comments about sucralose, wouldn’t it be a kicker if it turns out that this artificial sweetener may actually help people?

But let’s take a closer look at what they found and what they didn’t find. The researchers made sure to point out that when the amount of sucralose necessary in rodents is translated to human amounts, they would be at the top end of the Acceptable Daily Intake (ADI).

In reality, humans don’t normally get that much sucralose. It would be logical to think that perhaps lower amounts of sucralose may be compromising the immune system for normal users, but researchers tested it and didn’t find any issue. They found the blunting of the immune response only in high amounts.

There is a lot of research to go before any clinical trials are done to eliminate or test other factors such as the microbiome. Still what has been cursed by many might be their treatment plan in the future.

The Bottom Line

I think these two studies on sucralose and eyedrops illustrate the unintended consequences of pharmaceuticals and artificial foods and that the consequences may be positive or negative. They just might have a function that can be beneficial to our health beyond what we know today. Of course, we may find out other substances may be more detrimental than we thought. We have to understand both are possible. In the meantime, we still must sustain a good diet and exercise program.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41586-023-05801-6 Received: 15 September 2021

Eyedrops for Alzheimer’s?

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A recent study is looking at eyedrops for glaucoma and the potential prevention or possible treatment for Alzheimer’s disease. I have a vested interest in that because I have glaucoma and use a form of the medication in question for it. The function of the medication is like a localized diuretic; the medication is absorbed into the blood stream and is carried throughout the body.

Researchers discovered that an enzyme inhibitor called a carbonic anhydrase inhibitor affect the formation of amyloid bodies in blood vessels. The medication may work inside the mitochondrion in some way to prevent formation of these proteins associated with Alzheimer’s disease. When they administered the medication to mice at about eight months of life forward, the mice didn’t demonstrate the cognitive decline found in untreated mice.

While the actual mechanism of action is not specifically understood yet, if it proves effective in clinical trials in humans, a pharmaceutical developed to help with one condition may benefit people in other ways. Not all intended consequences turn out to be negative. I’ll cover another interesting study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1002/alz.13063

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146

How Popular Diets Impact Your Heart

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When the American Heart Association (AHA) speaks, news organizations tend to report what they say and people tend to listen. It’s doubly true when they rank all the popular diets according to how they relate to heart health. Because we seem to live in a society based on the “see food, eat food” diet, that can be meaningful. Here’s what a group of experts did to evaluate popular dietary approaches to diet and rank them according to AHA guidelines for a heart-healthy diet.

The AHA has ten dietary guidelines for eating a heart-healthy diet, such as “Eat plenty of vegetables and fruits” and “Choose healthy sources of proteins.” For the complete list, click on this link to the article; the scientific statement is open access on the AHA website.

Then the panel selected the most popular diets in the U.S. such as the Mediterranean diet, the DASH diet, several versions of a vegetarian diet, low-fat, paleo, and ketogenic diet. They gave each diet a full point for following each of the AHA guidelines or partial points depending how closely they followed the guidelines.

This was not an arbitrary assignment by a panel of experts; they used the best information available to determine the best heart-healthy diet. Who got the highest score? Mediterranean? Vegan? Ketogenic? I’ll let you know on Saturday along with my thoughts on the diets. One thing’s for certain: eat your fruits and vegetables. You may as well start with that right now.

What are you prepared to do today?

        Dr. Chet

How Fasting Impacts Your Mitochondria

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The research scientist in the webinar focused on mitochondria and aging in his part of the presentation. He has helped research and develop a nutrient that appears to help with mitophagy, the process of removing and replenishing old mitochondria. The naturally produced chemical is called urolithin A. It’s produced naturally by the microbiome in response to eating foods such as fruit, especially pomegranate, and nuts. The problem is that we may or may not produce enough urolithin A, depending on the state of our microbiome. There has been decent research on the supplement, and I talked about the supplement in Aging with the Vengeance: Reclaiming Your Power.

What caught my attention was that intermittent fasting may also help with renewing and replenishing mitochondria. The problem becomes what kind of fasting are we talking about? Complete fasting? Eating during only a few hours per day? I’ll cover the two most popular forms.

Intermittent Fasting

Intermittent fasting is “in” right now. It is especially popular when combined with the Paleolithic or the ketogenic diet. What it essentially means is that you take in no calories by mouth for up to 20 hours per day, often called the 20:4 approach, and then you eat during that four-hour block of time. Research has shown that people lose weight, get better control of their prediabetes, and may even reduce some of the metrics related to cardiovascular disease such as blood pressure and cholesterol levels. But specific to mitochondria, the data are nowhere near as clear.

Fasting Mimicking Diet

I first encountered the fasting mimicking diet, or FMD for short, when I looked at the research of Valter Longo. He’s a scientist who has used periodic fasting with patients undergoing cancer treatment. For one to five days before treatment, they go on an FMD which drops down to 500 calories per day in some cases, and then they go back to their regular diet and go through their normal chemotherapy protocol. The critical factor is that he’s shown an improved quality of life as well as improved outcomes for people who used the FMD during treatment as opposed to those who ate their normal diet.

In research in mice, using FMD has demonstrated a reduction in symptoms of Alzheimer’s disease and dementia. Parkinson’s disease, obesity, type 2 diabetes, and others have also benefited from the FMD approach. Dr. Longo has created a commercial program that is available.

Why FMD? As near as I can gather, the concept utilizes the body’s protective mechanisms that allow energy to continue to be produced at a high enough rate to continue carrying on with life (such as searching for food in other eras) in the absence of food until food can be found. Research in athletes who’ve used FMD versus a normal diet has demonstrated maintenance of strength and endurance after going through a five-day FMD protocol while continuing to work out.

The Bottom Line

In my opinion, FMD makes sense. Fasting for two days and then going back to your normal diet for a couple of weeks just makes more sense than obsessing about when you can eat every day. But you may feel intermittent fasting’s a better way to go for your life, and that’s fine as well. One thing for sure is that I’m going to continue to follow this research.

The whole point to this is that restricting calories for long blocks of time stimulates the body to take good care of our mitochondria; that’s one battle that we have to win if we expect to age with a vengeance. And the great thing is that you can begin at any age.

What are you prepared to do today?

        Dr. Chet

Dietary Supplements: Certified

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Recently I watched a webinar on mitochondrial health and athletic performance co-sponsored by the American College of Sports Medicine and a nutritional company. The speakers were a clinical researcher and a PhD dietitian for a professional basketball team. I’m going to review what the clinical researcher talked about on Saturday.

Today I’m going to focus on a comment by the dietary specialist. She believes as I do that supplements complement a good diet, but when she started talking about dietary supplements, she said they aren’t regulated by the Food and Drug Administration. At that point, I would typically stop listening because she’s incorrect; both the FDA and the FTC regulate dietary supplements; it’s just done in a different way than over-the-counter medications and pharmaceuticals.

Then she said that whatever supplements she recommends to her players, she looks for products that are certified by NSF or the United States Pharmacopeia (USP). I agree. These are not easy certifications to obtain. It isn’t just that the supplement is tested once and it’s over—it’s an ongoing process that costs a lot of money for the company, but they’re industry standards. Certification is something you should consider when you purchase dietary supplements of any type but especially related to sport performance.

What are you prepared to do today?

        Dr. Chet

How Coffee Relates to CVD

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Researchers in Germany used a unique approach in the Hamburg City Health Study: they selected the first 10,000 volunteers. Volunteers who didn’t drink coffee were eliminated from the study, so they ended up with 9,009 subjects.

The researchers collected dietary data along with a variety of other demographic and physiological variables, integrating lifestyle-related behavior, comorbidities, biomarkers, electrocardiographic and echocardiographic data, and finally major cardiovascular diseases (CVDs). They divided up the subjects by coffee intake: low = less than three cups a day, medium = three or four cups per day, and high = more than four cups of coffee per day.

Results

This epidemiological cross-sectional study resulted in the following:

  • High coffee consumption correlated with slightly higher LDL cholesterol
  • Moderate and high coffee consumption correlated with lower systolic blood pressure and lower diastolic blood pressure
  • Different levels of coffee intake didn’t impact heart rhythms or function
  • Most important, coffee intake did not impact the presence of CVD nor prior cardiac events such as heart attacks and heart failure

Were the results of coffee and LDL cholesterol concerning? No—the difference was just five mg/dl, well within measurement error.

Is Coffee Safe to Drink?

Coffee was always safe to drink; the question was how our bodies responded to consuming it. Neither of these studies was perfect, but they show that even high coffee consumers, including myself, may not be at any significant risk for promoting or advancing CVD or cardiovascular events.

I think for most people coffee and caffeine are closely linked. What most of us don’t realize is that coffee is a complex liquid consisting of more than 1,000 bioactive substances, including phytochemicals that have proven beneficial for many organ systems; it’s not only a nervous system stimulant because of the caffeine content.

The Bottom Line

When it comes to coffee, I think it’s person-specific. Taste aside, some people may process caffeine differently, which may impact how much coffee someone could enjoy. These studies add to a body of work which shows that coffee is safe for the heart and other organs; other benefits or issues require further study. For me, time for another mug of Sumatra Roast.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.nature.com/articles/s41598-023-31857-5

Research Update: Coffee and Heart Rhythms

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In one of the first jobs I ever had, the foreman would pour a half-cup of coffee and fill it up with water; he’d had a heart attack and his doctor told him to limit his coffee intake. Fifty years ago, physicians recommended that people avoid coffee if they had high blood pressure or had a cardiac event such as a heart attack. The thought was to lower the stimulating effect of caffeine to keep heart rate and blood pressure lower. In the interim, some studies showed that coffee contributes to cardiovascular disease and more recently, that it may not. So if you love coffee the way I love coffee, you may be encouraged by a couple of recent studies.

The first study examined the effect of coffee on heart rhythms in 100 subjects with a mean age of 39 who served as their own controls. All subjects had a variety of blood tests as well as genetic tests to determine if they were fast or slow processors of caffeine. They also wore a new-age heart rhythm monitor for the 14 days of the study. I’ve worn that monitor, and it gives accurate EKGs to monitor heart rate and heart rhythm abnormalities such as premature atrial contractions and atrial fibrillation.

The subjects were notified the evening before whether they were going to be on a two-day coffee drinking cycle or two-day caffeine avoidance; the idea was to track immediate impacts. The good news: there were no differences in abnormal rhythms on coffee days versus non-caffeine days and no impact of caffeine processing. One interesting observation: on the days subjects drank coffee, they walked more steps. We’ll look at the impact of coffee on cardiovascular disease events on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: N Engl J Med 2023;388:1092-100.

Dealing with the Chemicals in Our Lives

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We began this journey with the EWG Dirty Dozen, examined common chemicals we come in contact with such as TCE, and looked at the latest threat—PFAS. These chemicals are ubiquitous, so we’re left with the challenge of how to protect ourselves.

In reality, this is nothing new. Every home and business dumped waste into the nearest body of water until relatively recently. Before companies dumped chemicals into oceans and rivers, oil deposits naturally seeped into rivers. During the 1800s coal was used for heating, and the smoke often obscured the sky over London; it looked a lot like the image above, minus the electric lights. During the 1970s, emissions from cars caused a similar haze over Los Angeles. The difference today is that we have the means to test for chemicals in our air, our water, and our food, and we know more about how environmental chemicals affect our health.

Most people survived then and most people will survive today. The question is this: at what cost to our health? Complete avoidance of chemicals isn’t going to be possible for most of us, so what should we do?

Avoid Exposure

There are several ways that we can limit our exposure to chemicals. The most common forms of exposure are as a gas we breathe, in the water we drink and bathe in, and in our food and drink. If you have to work in an environment that requires exposure to chemicals, take whatever precautions are recommended. For those of us who do not, we should still follow any directions on such products.

If you use solvent cleaners, glues, or paints, wear the correct mask and gloves as recommended. Make sure the area is well-ventilated and stays that way for as long as recommended. Even if you’re using a paint brush and roller with latex paint, wear a mask. Is that overkill? Try this: after using a roller for any color paint, blow your nose. Aerosolized droplets get airborne and travel into your sinuses and lungs. Black spray paint will give you an even more dramatic illustration of what happens without a mask.

When it comes to your home water supply, use a home filtration system that’s reverse osmosis or carbon-filter based. To be sure it traps PFAS, look for certification that rate NSF/ANSI 53 for carbon filters or NSF/ANSI 58 for reverse osmosis.

Avoiding hazardous chemicals in foods can be tricky. That’s why the EWG puts out the Dirty Dozen every year. You can always use the organic route and purchase only fruits and vegetables that were grown organically. You can also find free-range meat and poultry along with dairy that’s derived from cows raised vaccine free.

But if you like processed foods, the more highly processed foods will contain more chemicals that may be a cause for concern by some people with food sensitivities, even if they have GRAS approval from the FDA. You’ll have to find out by trial and error.

Let Food Be Your Medicine

There is one way to be proactive in dealing with chemicals in our environment, no matter what the form: eat a diet high in plant-based foods. The reason is simple: vegetables, fruits, herbs, whole grains, and nuts contain phytonutrients. Many different types of phytonutrients are involved in the detoxification processes of the body, so the more variety in your diet, the better. They will not make you immune to any damage, but they can help remove the toxic chemicals from your body. It’s beyond the scope of this Memo to cover every phytonutrient and what they might do; I say “might” because there are thousands of them. The simplest thing to do is to eat as wide a variety as you can and let your body figure it out.

If you remember the Memo on supplements from two weeks ago, the research I talked about strongly suggested that whether in fresh food or supplemental form such as powders or drinks, plant extracts are beneficial. Finding a good blend of foods and supplements should help your body deal with the chemicals in our world.

The Bottom Line

I hope this series has made you aware of the chemicals we face every day and what we can do about it. Let me leave you with two thoughts:

  • Not everyone will be impacted by chemicals in the same way. There are genetic factors in play together with your immune system that provide an immediate response from the microbiome forward.
  • The thought might have crossed your mind after reading about the Dirty Dozen and the Clean Fifteen that you should eat only organic sources. I don’t think it matters. This is the quote from the FAQs on the EWG website when asked that question: Everyone should eat plenty of fresh fruits and vegetables, whether organic or conventionally grown. The health benefits of such a diet outweigh the risks of pesticide exposure.

Do what you should have always done: Eat your vegetables! Eat organic if you can, but quantity and variety are more important.

Spring Break is next week, and we have a lot scheduled with Riley, our grandson. We’re taking the week off and will be back April 11. We hope you all have an exciting week with wonderful weather.

What are you prepared to do today?

        Dr. Chet

Chemicals in Our Water

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Here’s one for you to mull over. We’ve been exposed to this chemical group since the 1940s. It’s not just one chemical such as TCE from Saturday’s Memo; there are thousands of forms of these chemicals. Based on samples from large groups of people, over 98% of us have them in our bodies; they’re found in rainwater all over the world. At this point, we don’t really know what diseases or conditions can result from this group of chemicals. On top of all that, it’s slow to eliminate from the body and gets worse as we get older.

The chemical group is perfluoroalkyl and polyfluoroalkyl substances, more recognizable by its acronym PFAS. This non-flammable group of chemicals is found in many products including fire retardants, stain repellents—and until recently removed—cookware covered with Teflon. You may have seen the story of how Teflon production affected West Virginians in the movie “Dark Waters.” Here in west Michigan, we’re battling PFAS released into the water supply years ago by a shoe manufacturer.

The major concern is that PFAS are in our water supply everywhere and will be there for a long time, even it were banned today. What surprised me is how little is known about the effects on our health.

There is some association with several forms of cancer such as testicular and kidney cancer. These epidemiologic studies of PFAS and cancers have been informative, but not entirely conclusive. Along with other chemicals known as hormone-disrupting chemicals, PFAS may affect fertility, contribute to miscarriages, and be a factor in early-onset puberty. It may increase non-alcoholic fatty liver disease in women. There are some associations but no overwhelming smoking gun at this point. Even with no definitive link to diseases, we don’t want them in our body. The problem is that there’s no known way of speeding up their elimination from our body. It can take years.

You may be thinking that this was less than satisfying. Yes, it was, but it doesn’t mean there’s nothing we can do; that’s how I’m going to finish up this look at chemicals on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Environ Res. 2021 Mar; 194: 110690.