Chemicals in Our Environment

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We have always lived in a world of chemicals. Some were always part of the planet, such as water and the minerals in the earth; more and more, they’re made by humans when they convert raw materials into chemicals that we can use. As you can imagine, the problem is that whether raw or processed, chemicals can be hazardous to our health. Who hasn’t heard about parabens in skincare products? Phthalates in plastic containers? Tar and carbon monoxide from cigarettes? Formaldehyde and carbon monoxide in wood smoke? For the benefits all those products may bring, they come at a cost to our health and the health of the planet.

The major concern is that exposure to environmental chemicals can be hazardous to our health. Recently researchers published an article about the potential hazards of a chemical that could increase the risk of Parkinson’s disease by 500%. I decided to find out what I could about trichloroethylene (TCE). It’s pervasive in products we all come into contact with in everyday life. A partial list includes adhesives, cleaners, solvents, lubricants, paint strippers, pharmaceutical manufacturing, and many more. If you’re alive, you’re going to get exposed to it.

In the article, the researchers used seven case studies to make their argument that TCE contributes to Parkinson’s disease. It’s a compelling observational hypothesis. As is typical in these types of papers, there’s no way to determine cause and effect. Part of the problem is that the metabolism of TCE is complex and not completely understood.

How much exposure is too much? Chronic exposure is a problem, but what about painting one room in your house? Given that it’s impossible to have zero exposure, we need that type of research, not just on TCE but on all chemicals in our environment.

Next week we’ll take a look at chemicals in our water and wrap up with what we can do about it next Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. https://content.iospress.com/articles/journal-of-parkinsons-disease/jpd225047
2. https://www.jstor.org/stable/4619449

Chemicals in Foods

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The last Memo focused on nutrients from foods versus nutrients from supplements. Coincidently, a long-time reader sent me a link to an article about the Dirty Dozen, recently published by the Environmental Working Group (EWG). Paula also sent me articles to read on our exposure to chemicals in cleaning products and our environment. As a result, I’m going to write about chemicals in our food, our environment, and our water. Then I’ll cap it off with how we can deal with these chronic chemical exposures.

EWG annually publishes two lists of vegetables and fruits: The Dirty Dozen and the Clean Fifteen (1). Topping the Dirty Dozen list this year were strawberries followed by two superfoods: spinach and kale. The top of the Clean Fifteen was avocadoes.

There are two things to understand. First, this is the EWG’s assessment of data pubished by U.S. Department of Agriculture according to standards they’ve set. Second, EWG does no testing of the foods themselves. Our taxes pay for the testing. You can read the rationale used for inclusion in the list in the EWG report (2).

The USDA Summary Report is also available for your viewing (3). Here are a couple of stats I found interesting. In 2021, over 99% of the samples tested had residues below the tolerances established by the EPA: 24.0% having no detectable residue. Residues exceeding the tolerance were detected in 0.53% (54/10,127 samples tested). The complete list of all samples tested along with results is found in the addendum to the USDA Report.

What does this mean? It depends on your point of view. If you have zero tolerance for any pesticide residues, there will be few vegetables and fruit you can eat. The question is this: what do we consider an acceptable risk? We’ll get to that, but we’ll look at chemicals in our environment on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.ewg.org/foodnews/full-list.php
2. https://www.ewg.org/foodnews/summary.php
3. https://www.ams.usda.gov/sites/default/files/media/2021PDPAnnualSummary.pdf

Food or Supplements? Yes!

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The results of the polyphenol study examining the impact on cardiovascular (CVD) risk factors were mixed. Here’s what the researchers found:

  • Neither the polyphenol-rich foods (berries, spices, herbs, teas, nuts, seeds, etc.) nor extracts had a significant effect on LDL- or HDL-cholesterol, fasting blood glucose, IL-6, and C-reactive protein.
  • When looking at the studies using polyphenol-rich food, there was a significant decrease in systolic and diastolic BP.
  • The polyphenol extracts had a significant effect on total cholesterol and triglycerides and had a greater reduction of waist circumference.
  • However, when both whole-food polyphenols and polyphenol extracts were used together, there was a significant reduction in systolic BP, diastolic BP, endothelial function, triglycerides, and total cholesterol.

The Upside

Polyphenols in foods and supplements were effective in reducing risk factors for CVD, both independently and when combined. This wasn’t a seminal paper that changes approaches to nutrition forever, but there were benefits. I think that’s something that was needed. It supports what my approach has always been: eat as healthy a diet as you can, and fill in the nutritional gaps with supplements.

The Problems

There were several issues. The studies included in the meta-analysis had little cohesiveness as to subjects used, sources of the foods, or the type of supplements; some used capsules while others used juices or drinks.

The issue with foods, among many, is the digestion and absorption of the active polyphenols. There’s competition with other nutrients and then the issue of the microbiome—is it functioning properly in every subject?

The issue with supplements, besides the delivery system, is whether the dose is appropriate or therapeutic. Would the amount of quercetin found in apples be the correct dose, or would you need to eat 10 apples? Would it respond the same way in the body isolated from the other polyphenols, or would another factor come into play?

The Bottom Line

In spite of its flaws, I think this study was fantastic. It demonstrated that nutrients extracted from foods can be effective in reducing CVD risk. It demonstrated that foods alone aren’t the answer and neither are supplements; it’s their use in a complementary fashion where the benefits may be found. The researchers set the stage for putting more effort into nutrition research, because there’s so much we don’t know. Yet. Until then, your best bet to support your health is to eat your vegetables and fruit, add herbs and spices, munch on seeds and nuts—and then supplement your diet with quality supplements.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.sciencedirect.com/science/article/pii/S2161831323000029

Food or Supplements?

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One of the changes I’ve made in selecting topics to write about in these Memos is to read the table of contents of the scientific journals to which I subscribe, especially the nutrition journals. It’s easier to see what’s controversial by looking at news feeds, but they miss a lot of positive nutrition science. One question that’s ever-present is this: when it comes to nutrients, is getting nutrients from supplements as good as getting nutrients from food?

Researchers searched four databases of scientific journals to find randomized-controlled trials that examined the effect of either polyphenol-rich foods or polyphenol extracts on risk factors for cardiovascular disease (CVD). It’s estimated that there are more than 8,000 types of polyphenols, including flavonoids, polyphenolic amides, phenolic acids, resveratrol, and ellagic acid. You’ll find polyphenols in fruits, vegetables, spices, herbs, teas, nuts, and seeds.

They found over 1,100 studies that fit the profile. Using subject, statistical, and nutrient criteria, they whittled the number of studies down to 46. Then they conducted a meta-analysis of the impact of food and supplements on the following CVD risk-factors: systolic BP, diastolic BP, endothelial function, fasting blood glucose, total-, LDL-, and HDL-cholesterol, C-reactive protein, Il-6, and waist circumference.

Nutrition studies are usually messy, and this one was no exception. I spot-checked the 46 studies and found different foods for the polyphenol sources and different extracts for the supplements. Still, it was as well-done as such a study could be. I’ll give you the results on Saturday.

Tomorrow night is the Insider Conference call for March. The topic is the absorption of omega-3s, and I’ll also answer your questions. Become an Insider by 8 p.m., and you can participate in this live event.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.sciencedirect.com/science/article/pii/S2161831323000029

Erythritol: Reserve Judgment for Now

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The study published in Nature Medicine on erythritol is complex to say the least. I gave you three quarters of the results. There was one more part that I want to cover and then give you my primary issues with the study. As I said in Tuesday’s Memo, I’ve posted a Straight Talk on Health podcast for Members and Insiders that gives my complete thoughts on sugar alcohols, especially erythritol (remember to log in first).

Erythritol and Clotting

The final part of the study was actually a preliminary report on a much larger study. They had eight subjects drink 30 grams of erythritol mixed with 300 ml of water. That corresponds to estimates of what a high intake would be. Then they tracked serum erythritol levels in the subjects for seven days. They also tested for indicators of blood clotting factors and found that some were increased for a few days after consuming the erythritol drink. The implication is that high intake of erythritol might contribute to blood clots forming. The question is: who is at risk?

Primary Issues

My primary concern is the lack of adequate controls. This was an observational study, not a clinical trial, so no cause and effect can be determined. Researchers took measurements on several cohorts of subjects with diagnosed coronary artery disease (CAD). Those subjects had a host of risk factors including high blood pressure, type 2 diabetes, high LDL- cholesterol, and on and on. The ages in each cohort ranged from a median of 65 in the Discover cohort up to 75 in the European cohort.

They did not have a comparable cohort of apparently healthy controls in the same age group. They could have chosen a group of subjects who had blood drawn at their annual physical but no apparent diagnosis of CAD. While still not getting to cause and effect, it would have strengthened the basic observations if major adverse cardiovascular events (MACE) was seen or not seen in the controls.

The same is true for the study on the erythritol drink. Why not get a group with diagnosed CAD and see if the same clotting effect happened? If not that, why not just do a simple test that measures clotting time? That’s done for anyone who takes a blood thinner such as warfarin.

The Bottom Line

The researchers called for more research on erythritol to examine the increased adverse events in the present study, and I agree. Because erythritol is part of many low-carbohydrate foods and drinks designed for diabetics and those on a ketogenic diet, we need to know more about the risks. This was a good research paper but incomplete. The best we can say as to whether we should use sugar alcohols is that we must reserve judgment until a lot more research is done.

If you’re concerned about artificial sweeteners, try to cut back and use a variety of them to reduce the risks associated with any particular one. But for your health’s sake, don’t switch to sugar; the risks of high sugar consumption are even greater than those associated with artificial sweeteners. For ideas of asking the right questions in those future trials and more on sugar alcohols, check out the Straight Talk on Health just posted by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Is Erythritol Safe?

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Health writers have been talking pro and con about a new study that was published about erythritol, a commonly used sugar alcohol. The paper demonstrated an increased risk of major adverse cardiovascular events (MACE) if a person had too much of the sweetener in their bloodstream. In that sugar alcohols are found in more and more products, especially those geared toward the ketogenic diet, are people really at risk for a major cardiac event, or worse, death? Let’s take a look at the results of the study.

The researchers used data collected during consecutive heart catheterizations at the Cleveland Clinic, termed the Discovery cohort, a U.S. population extracted from a large genetic study conducted by the Cleveland Clinic, called U.S. validation cohort, and a European validation cohort similar to the one selected from the population in the Discovery cohort. The two key elements were that all subjects had blood samples drawn that could be studied and all were tracked for at least three years. Researchers developed tests to specifically identify the quantity of erythritol found in subjects’ blood.

The researchers separated the subjects into quartiles and compared those with the lowest levels of erythritol with those with the most. In all three cohorts, with blood samples taken in different parts of the U.S. and Europe and over different years, the highest quartile had a significant increased risk of MACE in over three years compared to the lowest quartile—two to three times as high.

In Saturday’s Memo, I’m going to review the major issue with the study. I’ll also post a Straight Talk on Health for Members and Insiders that takes a deeper dive into all the issues surrounding the study and whether this is something to be concerned about or not.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Protein Intake: Perspective Required

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The research paper that concluded that higher protein intake was associated with muscle loss and sarcopenia seems to offer more questions than answers. That’s actually a good thing, because future research can examine those questions. But there are questions that the researchers didn’t mention.

Researcher Observations

This is an observational study. Simply put, the subjects who completed all the tests were followed for several years, depending on when they joined the study. Therefore, no cause and effect can be inferred because the researchers were watching, not intervening.

The original number of subjects with sarcopenia was low at just 4.3%. With so many subjects over 72, the number should have been closer to 10%. The researchers acknowledged as much. If the study’s subjects had less sarcopenia than the general population, it’s hard to draw conclusions that are helpful to everyone.

My Observations

The single characteristic most closely associated with loss of muscle mass and sarcopenia was age. Protein intake was a covariate for sarcopenia but it was actually in the middle of the pack as a risk; a covariate is a separate attribute that can be measured alongside the primary variable being investigated.

The study included limited data on diet and exercise. I would expect that not very many subjects were exercising at levels high enough to sustain or increase muscle mass. That conflicts with the research data from clinical trials that show that increasing protein intake in older subjects on a weight training program increases strength and muscle mass.

What stood out more than anything was the limited amount of testing for sarcopenia and the mixed bag of testing procedures. If it’s such a problem, which every researcher in aging admits is the case, why aren’t there better diagnostic tools available to diagnose the condition? How can physicians treat a disease they aren’t diagnosing?

The Bottom Line

There is no reason to worry about protein intake as we get older based on this observational study. What we need to do is begin to retain muscle mass or reclaim our muscle through resistance training, better protein intake, and the strategic use of supplements. If you’re interested in a program to do just that, the Taking Back Your Muscle is still available on my website.

What are you prepared to do today?

        Dr. Chet

Reference: https://academic.oup.com/ageing/article/52/2/afad018/7036280

Is High Protein Intake Associated with Sarcopenia?

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If there’s one thing I’ve learned studying health, fitness, and nutrition for 35 years, it’s this: what we thought we knew yesterday may change based on what we learn today. Given that, I was still surprised to see an article in my news feed with a title “High Protein Intake Associated With Sarcopenia.” The Taking Back Your Muscle webinar uses strategies that research has shown help increase muscle strength, including eating more protein. What gives with this latest research?

Researchers selected as their subjects from the TwinsUK cohort. Subjects must be over 60 years old and have completed specific tests since 2010. Just over 3,300 men and women were selected to be included in the data analysis. Researchers examined a variety of variables including education, income, other diseases and conditions, strength, and muscle mass. Protein intake was measured. Researchers did find the opposite of what they expected: higher protein intake was associated with sarcopenia.

Did I get it wrong? I’ll talk about the rest of the study on Saturday. I wouldn’t change your protein intake just yet because there seems to be a larger problem that looms over us as we age. The article is open access, and you can read it at this link.

What are you prepared to do today?

        Dr. Chet

Reference:https://academic.oup.com/ageing/article/52/2/afad018/7036280

Exploding Gallbladders: Just the Facts

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Let’s take a look at the actual case study on the exploding gallbladder and figure out what’s relevant and what’s conjecture—by all parties.

The Case Study

The paper was the result of a close examination of the medical information gathered when a 69-year-old man went to the emergency room at SUNY Brooklyn Medical Center with a perforated gallbladder. There were three parts to the paper:

  • The introduction focused on curcumin and its potential for causing issues in people with gallbladder disease.
  • The second described the treatment plan for the patient, mostly antibiotics and pain relievers.
  • Finally, a review laid the groundwork for why curcumin caused the perforation in the gallbladder.

The reason? Curcumin may increase the strength of the contractions in the gallbladder duct as it moves bile. A large stone was blocking the duct, so curcumin caused the pressure to buildup in the gallbladder and boom: explosion! Well, perforation, but you get the idea.

The Problem

There was no evidence to show that curcumin directly contributed to the gallbladder issues. What was also in the case study but not considered was that the patient had a history of gallstones. He was also taking five medications for hypertension, high cholesterol, and an enlarged prostate.

The writers of the case study were a medical student and a nephrologist (a kidney specialist). Based on published information, neither was an expert in the digestive system. It appears to have been conjecture on their part as to the cause of the gallbladder perforation. The comments on food and supplement oversight, while referenced, did not demonstrate any understanding of the FDA’s oversight of food and supplements; they’re not controlled as pharmaceuticals are, but both the FDA and FTC have control over the claims they can make. The amount of curcumin used by the patient was within the standard range for use of the supplement.

The Bottom Line

I can’t fault the writer for the Daily Mail; writers sometimes tend toward the sensational, and an exploding gallbladder is a perfect fit. The physicians and the article reviewers should have realized the faults in the analysis. Could a gallbladder explosion have been possible? Yes, but without accounting for the current status of the patient’s disease and considering pharmaceutical interactions of the meds the patient was taking, they used the “Ready, Fire, Aim” approach to assess what might have happened. We might expect that from reporters with no health background but not from medical professionals.

They were right about one thing. More research on interactions between food, herbs, and pharmaceuticals is necessary—but that isn’t news.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Exploding Gallbladders!

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Health Memo readers frequently forward health-related articles to me to ask my opinion; I read them all and respond to the sender if asked. Combined with my health news feeds, I read a lot about health—opinions about health, that is. I’m going to share a couple with you in the next few Memos and—wait for it—give you my opinion about whether what is being said is accurate, and more important, meaningful.

Let’s begin with curcumin, a very popular dietary supplement and a component of the herb turmeric used in cooking. It’s generally used as an anti-inflammatory for a variety of conditions, including joint health. The health headline in the Daily Mail implied that a 69-year-old man’s gallbladder exploded due to the interaction of the gallstones in his gallbladder with the high doses of curcumin he was taking. The Daily Mail seems to focus on celebrity news more than other types of news, but that doesn’t mean we can ignore the story.

The Daily Mail article was based on a case report published in a journal focused on just such case studies. The reporter took language from the paper that suggested that supplements avoid the regulatory process, creating a set of circumstances that could be potentially dangerous, as in this case. It also suggested that adverse reports with supplements are not reported. Is that all true? More importantly, what are the implications of such an article? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313