Face-Off: Mediterranean vs. Keto

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Last week ended with the publication of an interesting study on two popular diets, Mediterranean and ketogenic, and their potential benefits for people with elevated HbA1c levels; HbA1c is a blood test that measures your average blood sugar levels over the past three months. I use the word “diet” as a description of the type of foods eaten, not as a weight loss program.

The researchers constructed what they termed the Well-Formulated Ketogenic Diet plan to compare with a Mediterranean diet. Both approaches reduced sugar, refined carbohydrates, and starchy vegetables; the Mediterranean diet added unprocessed whole grains, beans, and fruit. The subjects had either prediabetes or type 2 diabetes. The primary goal of the 36-week program was to monitor changes in HbA1c along with a variety of secondary measures including blood lipids.

The 40 subjects were randomly assigned to using the keto diet for 12 weeks and then switching to the Mediterranean diet for 12 weeks or vice versa. Food was delivered to all subjects for the first four weeks of both phases, which I think is brilliant—one of the hardest parts of learning a new way of eating is discovering how the foods can be combined and prepared, along with getting used to the different tastes. After those four weeks, they provided their own food that fit within the particular diet they were on at the time. The final 12 weeks were left up to the subjects.

The results demonstrated both dietary approaches reduced HbA1c about the same amount, and the decrease was maintained regardless of which diet they began with. However, there were some differences as well. I’ll give you those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Citric Acid: Stone Killer?

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Increasing fluid intake can reduce the risk of developing stones of all types: kidney stones, gall stones, bladder stones, or uric acid crystals. But there’s one more thing you could do to reduce the risk—add some citric acid to the fluids you drink. While the research on using a form of pharmaceutical is not clear yet, this is one thing we can do with diet.

We expect electrolytes such as sodium, potassium, magnesium, and calcium in sport drinks, but adding citric acid can help your blood’s pH as well as reduce the formation of stones. The simplest approach would be to drink limeade or lemonade; fresh squeezed or a manufactured drink, citric acid makes the drink tart and sour. The food with the highest amount of citric acid is lime, with lemon a close second. I typically use sugar-free lemonade and add the juice from one lime in a 16-ounce container. It’s very tart but not inedible.

Avoid the mentality of “if some is good, more must be better.” Research hasn’t shown that to be true, so let’s stick to what we know. And while citric acid is a weak acid, it may still give you an upset stomach if you have too much. One lime or lemon per day seems to reduce stone formation.

What are you prepared to do today?

        Dr. Chet

Reference: Korean J Urol. 2014 Dec; 55(12): 775–779.

Don’t Forget Fluids

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With the unseasonably warm weather many of us are experiencing, I thought it was time to remind you that it’s not all about water: the emphasis should be on fluids. Coffee, tea, milk, soda, sports drinks, soup—all of those count toward your daily fluid intake.

It’s true that some drinks are better than others. Sugary drinks take extra fluid to keep your blood osmotically balanced or to store the sugar as glycogen, but all drinks count as fluid. The only drinks that don’t count are alcoholic drinks because alcohol is a diuretic; caffeine isn’t a true diuretic, so worry about the caffeine only as it affects your sleep. But the rest? All good. Don’t forget that most vegetables and fruit are mostly water, so they count as fluid as well.

How much fluid do you need? One-half your body weight in ounces (if you weigh 200 pounds, make sure you’re getting at least 100 ounces of water every day), and more if you’re in the humid heat.

There’s one more thing you could add; I’ll let you know what on Saturday.

What are you prepared to do today?

        Dr. Chet

Taking Biotin? Tell Your Doctor

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Biotin is a B vitamin often used for skin health among other benefits; it’s involved in many metabolic processes in the body. Due to its chemical nature, it’s used as a coenzyme in several tests. One of those tests is for troponin, a protein released from the heart into the bloodstream during a heart attack. There are no large trials that have tested the effects of biotin on troponin testing, but a physician or lab tech needs to know if you’re taking extra biotin.

The amounts in multi-vitamins appear to cause no issues, but adding the biotin in products to improve hair, skin, and nails could be enough to impact the test. Did it in our subject’s case? Maybe. We don’t know for sure.

As we approach this long holiday weekend, take a minute to add up all the biotin you’re taking in supplements. If it’s more than one gram, and if you end up in the ER because of a suspected heart attack or stroke, tell the lab tech. It doesn’t impact your having a heart attack; it impacts the test as to whether you may have damage to your heart as a result of a heart attack. You don’t want that test to be inaccurate because it’s important to arriving at the correct diagnosis.

Enjoy the July Fourth holiday, check out the audios on sale for men and women, and I’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Still in Doubt? Check It Out Again

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In the last Memo, I said we weren’t done with the person who had waited three days. We spoke again after a couple of days, and she still had the same pain profile: back and chest, not as intense. She’d had a heart catheterization that came back clear: no blockages in any of her coronary arteries. Still the discomfort bothered her.

I’ve talked to many people over the years who were going through the same thing. I always recommend they go to the ER immediately. She had done that, albeit a couple of days later, and the diagnosis was indeterminate. She did have extremely high blood pressure which had come down with treatment in the hospital, but like most people, she disliked some of the side effects and didn’t want to take the meds. As we talked, she mentioned that she also had dizziness going up a flight of stairs and her vision was blurry. That was it—that’s a symptom of a stroke, so I recommended she go back to the ER if someone was there to drive her.

They ran more tests including and MRI of her head. No blockages or evidence of a stroke; her blood pressure was still way too high, but that could be managed at home. Still there was a diagnosis of a heart attack based on enzyme levels even though the ECG didn’t show it. She is working on lifestyle changes to get off blood pressure medications if possible.

But the enzyme level triggered something in my memory, and I’ll tell you about that on Thursday. Make sure you read it before the holiday weekend begins. Remember, the audios Dr. Chet’s Health Tips for Women with Dr. Pam and Health Tips for Men are still on sale through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

Three Freaking Days!

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When it comes to health, my experience has shown that women tend to take a little better care of their health than men do. I checked back to when I began to use the phrases, “Never, never, ever, ignore chest pain” and “When in doubt, check it out!” It was about 20 years ago. And yet I’m still surprised when people don’t do it.

In fact, it happened within the past two weeks. A reader called me about some health issues. She wasn’t a stranger; we had talked before about her issues. This time it was an inquiry about discomfort in the chest and back—not really pain, but not nothing either. Doing some yoga and deep breathing seemed to help. I always tell people that the safest, most conservative approach is to go check it out at the emergency room. That’s the only way you know for sure. We left it at that.

Finally, a couple of days later, the discomfort got worse and moved toward her left arm. She finally went to the ER—three freaking days after the symptoms began. At least she didn’t wait ten days like my friend Jim.

I understand the hesitation; I’ve faced it myself. No one wants to seem alarmist or silly, and not everyone has health insurance to cover the costs. Still it’s better to be alive with a hospital bill than with a damaged heart or worse for delaying.

The Bottom Line

Let me be very clear about this: when it comes to your heart or your head, when in doubt, check it out. Delaying may make things worse.

Or the problem may turn out to be nothing. You thought we were done with this person? Nope, but I’ll save it for next week.

Women’s hearts are different and the symptoms related to heart disease may be different. This may be a great time to pick up Dr. Chet’s Health Tips for Women with Dr. Pam. As an incentive, I’m lowering the price on the MP3s to $4.95 for Health Tips for Men and Health Tips for Women through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

When In Doubt, Check It Out

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Father’s Day reminded me of some of the wonderful men I’ve known who’ve passed on. The one I miss the most is my best friend Jim even though he’s been gone over 20 years. I can’t help but believe he might still be with us if had done just one thing: check it out.

Jim started having chest pain at Thanksgiving Dinner; he told his wife that he was just tired and stressed from the holidays. He actually went to work on the following Monday, but as the week went on, he felt worse and worse. He was having a heart attack for nine days! By the time his family insisted on calling an ambulance on the following Saturday, it was too late. He died in the ER.

When in doubt, check it out. That’s where the phrase came from, although the symptoms in Jim’s case were clear. It doesn’t apply only to chest pain or other symptoms of a heart attack. If you have blurry vision, a sudden headache, or your face is drooping, that could be a sign of a stroke. Even if the symptoms subside, you have to get them checked out. Better a trip in an ambulance than a hearse.

Jim left behind a family. His wife, three kids, and grandkids needed him desperately at times over the following years; I needed him, too. I want you to be safe and healthy, not the gaping hole left in the family photo. So when in doubt, check it out.

If you haven’t heard my Health Tips for Men, now might be a good time to purchase a copy. There’s more to Jim’s story and nine other health issues that impact men. But what about women? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Science Says Coffee Is Good

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Research is based on curiosity; in order to do good research, you have to ask good questions. Researchers in the coffee study asked: Will a little sugar negate the benefits from drinking coffee? We don’t know whether this was the initial question or if researchers wanted to find out whether artificial sweeteners might have negative effects that altered the benefits of plain coffee.

Turns out artificial sweeteners did not have an impact on the mortality of those who used it over the seven years of the observational study. If you drink from one to 4.5 cups of unsweetened or sweetened coffee, there’s a reduction in mortality from CVD and cancer.

If artificial sweeteners did have an impact on mortality, the headlines would have been bigger than they were. Last week’s look at the safety of melatonin for kids led me to ask the author “Why melatonin?” Multiminerals in gummy form generally contain iron, and that can be toxic to toddlers in high quantities. So why not start looking there and then examine other nutrients? To date, I haven’t gotten an answer.

What Do We Mean by “Coffee?”

I explained how I drink my coffee earlier in the week. However for today’s coffee drinkers, there could be high-sugar flavors added as well as whipped cream and other assorted milks. It seems like a science unto itself to know how to order some of the “coffees” available today, let alone fill those orders. Based on what I read in the Methods section, the questionnaire they used didn’t go into that kind of detail. Extra sugar and fat from elaborate coffees may have a negative impact that won’t be determined in this study.

The Bottom Line

This was an observational study, so there’s no cause and effect implied. Still it’s good to know that the cup o’ Joe isn’t doing any harm and may actually be good for you. Now, about those tea drinkers…

What are you prepared to do today?

        Dr. Chet

Reference: Ann Internal Med. 2022. https://doi.org/10.7326/M21-2977

Coffee: One Sugar Please

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I have a strong relationship with coffee. I began drinking coffee when my mother put coffee in a bottle with a little sugar for me when I was a toddler. These days, a mother would get reprimanded by somebody if she did such a thing, but in the 1950s there weren’t the variety of drinks for children that are available today; milk, orange juice, and Kool-Aid, that was about it.

When I talk about coffee now, I don’t mean the fancy kind with steamed milk and espresso and other ingredients. I drink strong coffee, eight to ten ounces per mug, with exactly one teaspoon of sugar. I drink only Sumatra roast and use a Turkish grind, which is more like powder than grounds; I get the most flavor out of the beans when I brew it that way. I sit back and drink it, savoring every sip. (And yet somehow I married a woman who thinks the only thing coffee is good for is dipping a biscotti.)

The benefits of coffee have been established in prior studies of coffee drinkers compared to non-coffee drinkers. Coffee seems to reduce mortality from cardiovascular disease and cancer. No one seemed to separate the drinkers who used sweeteners from those who didn’t, and that’s why a recently published study caught my attention.

Researchers examined data from over 170,000 subjects in the U.K. Biobank Study; their purpose was to see if adding sweeteners to coffee, either sugar or artificial sweeteners, impacted the mortality of the subjects. I won’t make you wait until Saturday: the coffee sweetened with sugar had the same reduction in mortality as the unsweetened coffee. What about artificial sweeteners? I’ll talk about those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Internal Med. 2022. https://doi.org/10.7326/M21-2977

Supplements and Safety for Kids

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The real issue with melatonin and children is not with the actual overdose. Of the 260,000 calls to the U.S. Poison Control Centers, 218,000 were about kids under five years old. Kids will put just about anything in their mouths, especially those younger than five. The issues as I see them are the delivery system and access. This doesn’t apply to just melatonin but to all dietary supplements.

The Delivery System Dilemma

Gummy vitamins are chewable vitamins with taste, flavor, color, shape, and size similar to gummy candies. Therein lies the problem. That’s the way kids see them: as gummies. And neither the candies nor the supplements are going away any time soon.

Even after years of dispensing gummy supplements to Riley, if you gave me two red bears, I’d find it hard to tell the vitamin from the candy. In the image above, it’s vitamins on the left and candy on the right, but other than the green and clear bear candies, they look alike. Some are shaped more like gumdrops, but multivitamins are often bears and look just like their candy counterparts. At seven, Riley knows which gummies he gets when, how many of each, and what the jars look like; if your kids and grandkids are younger, you’ve got a lot of teaching ahead of you. It seems helping kids learn the difference between packages is another element of keeping them safe.

The global gummy vitamins market size was estimated to be valued around $5.9 billion in 2020 and is projected to reach $10.6 billion by 2025. According to Market and Market, Millennials prefer consuming these gummies due to factors such as busier lifestyles, rising disposable incomes, growing awareness regarding preventive healthcare measures, and maintaining better health. But don’t blame the Millennials; every age group has seen increases in the use of gummies as dietary supplements. They’re easier to use for people who find it hard to swallow whole pills, and let’s face it, they’re just more fun.

Chewables and powders are on the increase as well. Those shakes you make? Check the labels to see if they contain vitamins or minerals. Phytonutrients from whole plants are fine, but some powders add nutrients and herbs that may not be safe for children in high quantities.

Out of Sight Is Safe

I think the key issue is that kids need to be taught that gummy dietary supplements are not candy. Even more so, they have to be kept out of reach of children, not on the counters where they’re more convenient for adults (and for kids). Multivitamin-minerals, omegas, melatonin, and others have push-tops that can challenge even adults. Still it would be best to keep them as high as possible and out of reach, especially if you also use the adult versions.

For most kids, eating too many supplement gummies may result in an upset tummy at most, but some vitamins and minerals can be toxic to children, especially under five. Everyone with small kids underfoot should know the number for the U.S. Poison Control Center for many reasons: (800) 222-1222; registered nurses and pharmacists are there to help 24/7. Most other countries have similar help available.

The Bottom Line

I think the promotion of the CDC’s Morbidity and Mortality Weekly Report melatonin article was done poorly. Pediatric melatonin ingestions are not all poisonings as the article implied. However, delivery systems and child access can be problematic, and that should have been the focus. Every news outlet likes sensational headlines, but if the writers had actually read the paper, which is free to the public, instead of reading comments by the paper’s authors, they’d not have been so sensational in their presentation. Or maybe they would have. Who knows?

Now you know the real deal about the safety issues surrounding dietary supplements for kids. If you want to know more about the safety of melatonin for children as well as comments by the authors, listen to the latest Straight Talk on Health by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Gummy vitamins Market. Market and Market, 2020.