The Facts About Masks

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When I finished last week’s Friday Memo with “Wear the damn mask!” I knew it wouldn’t be the last of it. I spent the weekend reading the research about what masks could and could not do to limit our exposure to the COVID-19 virus. The primary goal of wearing a mask is to prevent you from spreading the virus to others. If everyone were to wear a mask, that could reduce our potential exposure in social settings.

Before I cover that, two things that seem to travel social media. First, people avoid masks because they don’t want to continually re-infect themselves. This took no research at all: if you’re infected with COVID-19 or any other respiratory virus, you’re infected. Period. You can avoid spreading it to others by wearing a mask, but you can’t reduce any hazard to yourself because you already have the infection. If you aren’t carrying the virus, you can’t infect yourself by breathing into your own mask. That should be pretty clear.

Second, people are concerned that the carbon dioxide levels building up in the mask, but it’s not as simple as oxygen in and carbon dioxide out. The air you breathe in is 21% oxygen and 0.4% CO2 and what you breathe out is 16% oxygen and about 4% CO2. The rest is nitrogen. Due to the proximity of your nose and mouth to the mask, there’s limited exposure to CO2; if there were a significant amount of room for the carbon dioxide to build up with no air flow within the mask, that could be an issue. In a human breathing normally, the air will constantly change to high oxygen and low carbon dioxide.

We’ll take a look at mask materials on Thursday; what is best?

What are you prepared to do today?

        Dr. Chet

COVID-19 Attacks the Whole Body

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Our look at diseases associated with COVID-19 continues in this pre-4th of July memo. Let’s turn to diabetes. We know, based on prior reports, that people with type 2 diabetes as well as other comorbidities are susceptible to getting the worst symptoms of COVID-19. But now, there are also some reports that COVID-19 infections may cause diabetes; people diagnosed with COVID-19 with minor symptoms have developed type 1 diabetes later.

How could that happen? The first way may be a direct attack on the pancreas because it also contains many ACE2 receptors. Or it may be that as the virus stays in the body, it triggers an autoimmune response. Or it may somehow stimulate other dormant viruses due to the inflammation and immune response.

One of those is the Epstein-Barr virus; almost 90% of us have been exposed to it. Epstein-Barr impacts the nervous system in a significant way. Perhaps the challenge to the immune system somehow triggers the activation of Epstein-Barr to cause neurological dysfunction from mild to severe.

In doing the background research for these Memos, I found that scientists are looking at every organ for potential consequences of the COVID-19 virus infection. We already knew of cardiovascular problems as well as kidney damage; lung damage was significant whether the patient was on a ventilator or not. The impact on blood vessels, which are full of ACE2 receptors, are the root cause of many of the problems. With the loss of taste and smell, it may be that the virus causes the death of enough of those organelles that we are permanently impacted. We’re learning some patients develop problems in their brains such as strokes, psychosis, and altered mental state, and we’ll discover more conditions that are impacted by the virus as time goes on. And we haven’t even begun to discuss the microbiome.

The Bottom Line

As I wrote several weeks ago, I don’t want you to fear this virus but you’d better respect it. That means you do your best to avoid getting it and avoid spreading it.

This is the beginning of the major holiday of the summer. Being restricted in what we can do and where we can go has worn on people, perhaps even you. So let me leave you with two thoughts.

First, if getting into a pool is part of your holiday plans, go ahead. The chlorine in a well-maintained pool or hot tub will kill the virus and sunshine helps, so have some fun; but if you’re just socializing while wet and not social distancing, wear a mask.

Second, I’ll finish where I began this series: with wearing a mask in public. You don’t have to like it. Who does? Science clearly shows it reduces the risk of catching or spreading the virus which, as we’ve seen, has far more implications then just a little fever and cough. So if you’re going into public places, do what I do and wear the damn mask. Please.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. 2020. doi: 10.1038/d41586-020-01891-8.

COVID-19 and the Small Intestine

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With the ACE2 receptor implicated in the long-term side effects of COVID-19, let’s begin with the digestive system. The gastrointestinal distress such as cramping, pain, and diarrhea are obvious, but there are reports that some people have had to have their entire small intestine removed due to damage from the COVID-19 virus. How could that happen?

One of the characteristics of these specific cells that contain the ACE2 receptor is that they function to absorb nutrients. If the virus interferes with absorption of nutrients by cells, the first cells that will be impacted are in the small intestine; it could literally starve to death. Second, a significant blood supply goes to the digestive system. We know that the COVID-19 infection can cause unusual clotting; if the blood flow is restricted to the small intestine, that could also cause cell death.

While we’re not done with this topic yet, I think it should be clear that we don’t know as much as we need to about the long-term effects of COVID-19. That’s why it’s so important for research to continue and for all of us to be vigilant in protecting our own health and the health of everyone we encounter.

Because of the holiday weekend, we’ll complete this tomorrow, but the discussion is far from being over as more research reveals more issues from exposure to this virus.

What are you prepared to do today?

        Dr. Chet

References: www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified

ACE2 Receptors: Gateway for COVID-19

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The number of cases of COVID-19 continues to rise and rise and rise. As restrictions on shopping, dining, and entertainment have been reduced, and then sometimes reinstated, the debate over which businesses should be open, social distancing, and even whether to wear a mask continues. Let me make it simple for you: wear your mask to protect others from you and you from them. Period.

There has also been a tremendous rise in the research on COVID-19, specifically, the short-term and long-term effects of the virus on the body. This virus is different from others; it isn’t as simple is getting the flu or a severe cough, and then life returns to normal after a week or so. Research is finding some significant long-lasting effects on the body. The locations impacted seem to contain high numbers of the ACE2 receptor, the receptor used by the virus to enter our cells. We already knew the sinuses, lungs, and adjoining blood vessels contain significant numbers of ACE2 receptors as well as the kidneys.

Researchers for a data analytics company examined every published paper, over 100 million of them, to find out where ACE2 receptors have been found and then performed an analysis examining every potential interaction, over 45 quadrillion of them. They found that there are significant numbers of receptors on the tongue, the nasal passages, and the ciliated passages to the lungs. The most significant find was the enterocytes that line the small intestine. That means that should the virus get to those locations, it can potentially wreak havoc there. We’ll talk about some of the organs and systems that have been impacted by COVID-19 the next two days.

What are you prepared to do today?

        Dr. Chet

Reference: eLife 2020;9:e58040 DOI: 10.7554/eLife.58040

Spice Up Your Life and Be Healthier

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Before I get into this memo any further, keep in mind there were only 12 subjects in this study, and we don’t change our recommendations for an entire society based on a limited numbers of subjects. We just have to recognize that this is a preliminary study. Second, because they examined a large number of variables, the probability of getting a false positive increases.

As long as we keep those in mind, the results were really surprising. Adding spices to a high-fat, high-carbohydrate meal reduced the inflammation caused by that meal. While coconut curry chicken might not be your preference, I’d wager you’ve eaten a bacon cheeseburger with fries and a soft drink at some point. That can easily add up to a similar profile of a high-fat, high-carbohydrate meal. So let’s take a look at the spices.

The Spices

The spice blend included the following spices, but not all dishes contained all the spices. For example, the turmeric was used in the chicken dish while the cinnamon was used in the biscuit:

Turmeric
Ginger
Cinnamon
Oregano
Parsley
Basil
Coriander
Cumin
Red pepper
Rosemary
Black pepper
Bay leaf
Thyme

This is not a magic blend by any means, but each of these spices and herbs have different phytonutrient blends. The magic comes from those phytonutrients. Recall the image of the various sizes of measuring spoons. A teaspoon is 5 grams, a half teaspoon is 2.5 grams, and an eighth of a teaspoon is 0.625 grams. That illustrates how little of a spice you need per serving. Keep that in mind if you decide to spice up your meals.

What we don’t know is whether there’s any interaction between those spices and herbs that would impact the inflammatory hormones. We know that turmeric and ginger have been studied extensively. The researchers recommended testing each spice individually.

Two Observations

There are probably dozens of factors that need to be examined, but two stand out in my mind. First, we’ll need to find out the impact of cooking on each of the different herbs and spices. Does heat destroy the phytonutrients or does it enhance them? We have a partial answer from this study because the spices were put into the dishes as they were being prepared and not added as a topping.

Second, if you take supplements with phytonutrient blends in them, it may be wise to take them either before or while you’re eating so the phytonutrients will be available to help during the digestive process. I’ve always recommended taking your supplements whenever you can remember to take them, and I still stand by that because consistency is more important than timing. But if you can increase the potential benefits by taking them with meals, that’s a good idea.

The Bottom Line

The reason that I loved this approach to research is because it was practical. By that I mean, instead of assessing only one food or a specific group of foods, this study looked at what we would consider “bad foods” together with herbs and spices that are full of phytonutrients to see how they work together.

If you think about it, if saturated fat and refined carbohydrate were as bad as they’re thought to be for the risk of CVD or type 2 diabetes, those diseases would take effect much faster. But perhaps, cake with dark chocolate frosting or French fries with ketchup work with their phytonutrients to somewhat neutralize the bad effect of the food by itself. It doesn’t mean that we don’t bear responsibility; we should still eat as healthy as we can. But perhaps if we choose wisely, we may be able to enjoy some of the food that are perceived as not as healthy if we can spice them just right.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:1600–1609.

The Health Benefits of Spices

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Continuing our look at the research study on the effect of spices on markers of inflammation, there were some interesting results. The high-fat, high-carbohydrate meal was coconut curry chicken, a cornbread muffin, and a biscuit; that strikes me as an odd meal, but you do what you must for research. The only difference was the spices added to allow for comparative results.

Examining the effect of the 1,000-calorie, high-fat, high-carbohydrate meal, the researchers found an increase in the release of inflammatory hormones above baseline in all subjects. So that’s the first result: inflammation was increased after eating the test meal with no spices added.

Compare that to consumption of the same meal with six grams of spice blend: it significantly reduced IL-1β secretion at four hours after the meal compared with the meal with none of the spice blend. Also, IL-6, IL-8, MCP-1, and TNF-α secretion after the meal containing six grams of the spice blend was below baseline values for each cytokine (inflammatory hormone). These results suggest that spice consumption may reduce inflammation after a high-fat, high-carbohydrate meal for hours after eating. The paper is Open Access, so you can read it yourself at the link in the references.

Those are interesting results, and I’m guessing you really would like to know which spices were used in the study. I’m going to give you that spice blend and put this research in context in Saturday’s memo. But if you haven’t done our little experiment with the teaspoon, half teaspoon, and eighth teaspoon, please do it before then.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:1600–1609.

Can Spices Make You Healthier?

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I’d like you to do something before you read the rest of this memo. Go to your drawer that contains measuring spoons, and pull out the teaspoon, half teaspoon, and eighth teaspoon. Then measure out salt or sugar for each different volume and put it on a plate. Notice how little there is by the time you get to the eighth teaspoon. Keep that image in your mind for the remainder of the week.

Too often, nutrition research lacks a practical approach; researchers try to drill down into the details before they look at the larger response to any intervention. In other words, examining what people actually eat and cook, then changing something and seeing what happens. I don’t mean exaggerated results such as weight loss, but more subtle effects such as changes in triglycerides, cholesterol, blood sugar, and in this case, markers of inflammation.

This week we’re going to take a look at a recently published paper that took exactly that approach. Researchers selected a group of 12 overweight male subjects with at least one additional risk factor for cardiovascular disease and fed them a high-fat, high-carbohydrate, 1,000-calorie meal. They fed them the same meal on three different days: once without any specific spice blend, second with two grams of a spice blend, and the third time with six grams of the same spice blend. They tested the subjects to see what markers of inflammation were changed after each feeding. I’ll give you the results in Thursday’s memo.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:1600–1609.

SFCA, Sodium Intake, and High Blood Pressure

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Researchers in the United Kingdom recruited people with elevated systolic and diastolic blood pressure for a randomized, placebo-controlled, crossover study on diet and blood pressure. The scientists put all 145 subjects on a low-sodium diet for six weeks. Half the subjects was given a placebo while the other half was given a slow-release sodium supplement. After six weeks, the subjects were crossed over to the other group for another six weeks. The objective was to see if sodium intake impacted the microbiome and short-chain fatty acids (SCFA) production to reduce blood pressure.

In a perfect world, researchers would take stool samples under all conditions to test for changes in microbe content, but that approach is expensive and time-consuming. Instead they chose to monitor changes in SCFA because they’ve been associated with blood pressure.

Researchers found that while taking the placebo, subjects on the low-sodium diet saw all SCFA increase; 2-methylbutyrate, butyrate, hexanoate, isobutyrate, and valerate were significantly increased. The increases in SCFA were associated with reductions in blood pressure and arterial-wall stretchability.

What does it mean? We’ve known for decades that sodium plays a role in blood pressure. This study demonstrated that sodium reduction directly increased the production of SCFA, which then lowered blood pressure. What we don’t know is the specific beneficial microbes affected or exactly how sodium negatively impacts them. Research continues and I’m sure we’ll find that out eventually.

The Bottom Line

On the other hand, it may not be necessary to find out. Scientists like me always want to know the specific bacteria and the mechanism by how it works. We know that fluid retention is involved somewhere. But we already know that if we reduce sodium, we’ll positively impact our blood pressure. We also know that fiber is the essential food for these SCFA-producing bacteria in our microbiome. If we focus on a more fiber-rich diet as well as take a fiber supplement, we may be able to increase our odds of reducing blood pressure without medication. If we need the meds, we take them, but if we can do it by feeding our microbiome, that’s even better.

What are you prepared to do today?

        Dr. Chet

References:
1. Hypertension. 2020;76:73–79.
2. Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.

Health Benefits of SCFA

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Let’s continue our look at short-chain fatty acids (SCFA) and what they do besides produce energy. Most of these are observational in nature; by that I mean when SCFA go up or down, effects are observed. What we don’t know at this point is why.

For example, when diabetic animals are given the SCFAs acetate and propionate, they maintain better glucose control. That means that adding SCFA to their diet can improve their ability to maintain blood sugar levels. Wait a second; is this the same acetate that’s found in vinegar? Yes. The problem is that the studies don’t provide consistent results.

The same is true for fat storage. When SCFA levels go up, fat storage appears to go down, but drinking vinegar doesn’t necessarily provide that benefit. Observational studies show that as SCFA levels made by the body go up, fat storage goes down. That can prevent weight gain, but we don’t know whether it causes weight loss. The same is true for cholesterol levels; SCFA are associated with lower cholesterol levels.

The problem is that we don’t know the precise mechanisms yet. In other words, what does making SCFA do to the metabolic systems in the body? To the genes? Or receptors for various functions? That’s what scientists are working on. Further, exactly what type of bacteria produce the right SCFA? There’s general agreement that Bifidobacteria produce acetate and propionate when fermenting fiber, but which Bifidobacterium? There are over 50 varieties. Maybe more than one—they may interact in sequence. We don’t know at this point.

What role do SCFA have in controlling blood pressure? Does sodium also have an impact on SCFA production? We’ll take a look at a recent study on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.
2. Front Microbiol. 2016; 7: 925. doi: 10.3389/fmicb.2016.00925

Short-Chain Fatty Acids: DIY Nutrition

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Short-chain fatty acids (SCFA) are critical to your health and well-being, yet you may not really know where they come from or what they do. In my opinion, the most interesting thing about SCFA is that they’re not generally found in our diet; we make them ourselves! We do that when bacteria in the microbiome work to ferment digestible fiber.

By definition, SCFA contain less than six carbon molecules. The three you may have heard about are acetate, propionate, and butyrate. SCFA can provide us with up to 10% of our energy needs. They’re especially important to colonocytes, a type of endothelial cells of the large intestine that need energy to digest and absorb food that we use to produce the rest of the energy we need.

I’ll cover what else SCFA do on Thursday. In the meantime, one way to increase the production of SCFA is to get more fiber, whether from foods or supplements. It’s especially important after a course of antibiotics; research has shown that after the microbiome is upset by antibiotics, the production of SCFA can be impaired, which impacts many biological processes.

The monthly Insider Conference Call is tomorrow night at 9 p.m. Eastern Time. You can still participate by becoming an Insider by 8 p.m. tomorrow night. If you have questions about COVID-19 or any other health topic, this is your chance to get answers. I hope to talk with you then.

What are you prepared to do today?

        Dr. Chet

Reference: Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.