Should You Have a Strict Holiday Eating Strategy?

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Tis the season for gaining weight. It began on Thanksgiving, but we’re in it big time now. If you’ve lost weight and want to make sure you don’t see it again, what do you do? Let’s review some of the research on strategies that people who’ve lost weight and maintained it have used.

The first is a report from the National Weight Control Registry. In order to be a subject in that study, you have to lose 30 pounds and maintain it for at least a year. Researchers took a group of recent additions to the study and asked them specific question on their strategies during the upcoming holiday season at that time, and then tracked how they did. They also recruited a group of normal weight people and did the same thing.

Most of the experimental group said they were going to follow their typical routine as related to diet and exercise plan. In other words, they were going to try to strictly follow their weight loss routine. The normal weight individuals didn’t really have any special plans. Most successful losers did follow their plan although it was more difficult during the holiday season. About the same percentage of successful losers and normal weight subjects gained weight, maintained their weight, or lost weight during the holiday season. The difference was that the successful losers found it more challenging to do so based on their response to survey questions.

Is that the best strategy? Stay the course? Another study on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: J Consult Clin Psychol. 2008. 76(3): 442–448.

Will the Diet of Your Culture Improve Your Microbiome?

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Does the diet of your ancestors impact your microbiome? A review examined whether the common foods found in specific cultures can benefit people of that culture who are following a diet high in refined carbohydrate and low in fiber, as is common in the U.S. Let’s take a look.

The Gold Standard: the Mediterranean Diet

The Mediterranean diet has been studied more than any other; it emphasizes vegetables, whole grains, fish and seafood, nuts and seeds, olive oil, fruit, and limited sweets. The benefits for reducing heart disease, hypertension, and T2D are well documented, and we’ve always assumed that the Mediterranean diet is appropriate for everyone. But is it? The point to this review is that while there are similarities, there are cultural differences that may be important.

For example, there are more tubers (root vegetables) in African diets and virtually none in most Asian cultures. The Latin diet has more dairy products while some Asian diets contain almost none. If you want to become more familiar with cultural diets, check out www.oldwayspt.org. It’s a non-profit organization that has developed cultural appropriate diets and teaches people to prepare foods using traditional cultural spices.

It makes sense; one size does not fit all. One interview in the paper was with an Eastern Indian physician who had always recommended the Mediterranean diet to her clients of Indian descent, but the whole grains of the Mediterranean diet were not the same as traditional Indian grains. Once she changed the types of grains and other high-fiber foods to more culturally appropriate choices, her patients did better in following a higher fiber diet.

The Benefits of a Culturally Appropriate Diet

Simply stated, people are more inclined to follow a healthier, high-fiber diet if it’s based on their own culture. The differences in grains and vegetables may be subtle but seem to be important. The tastes and flavors may be more familiar to first or second generation immigrants.

There is also speculation that the microbiomes of people from varying cultures may have an evolutionary aspect. In other words, whether you’re a recent immigrant or a fourth generation of immigrants as I am, your microbiomes may respond better to foods that your ancestors have eaten for generations. Remember the short-chain fatty acids (SCFA) in the Thursday Memo this week? They may be dependent, not just on fiber, but fiber from the foods of your ancestors.

The Bottom Line

This paper gives us something to think about. What if we ate a more plant-based diet that’s more culturally based? I think it’s worth a try. It doesn’t mean that you won’t benefit from eating a high-fiber food that’s not culturally based; there’s no question that you will. But if you ate culturally based foods and they were prepared based on cultural tastes, you might decide to eat more of them and you might get more benefit.

The first thing I did was to look at traditional foods from my ancestors in Poland and other eastern European cultures. I’m not done yet, but it seems cabbages and root vegetables are definitely part of my future diet; I’ll keep you posted as I research my diet further. In the meantime, check out Oldways to get some perspective on what culturally appropriate foods may benefit your diet. If you’re an African-American man married to a Chinese-Canadian woman, you’re going to have some very interesting meals.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2019; doi: 10.1001/jama.2019.18431.
2. www.oldwayspt.org.

Does Fiber Improve Your Microbiome?

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Now let’s look at the results of increasing dietary fiber for people with diabetes. Researchers recruited over 50 type 2 diabetics (T2D) for a 12-week study. The control group was given standard recommendations for a healthy diabetic diet. All current medications were maintained and both groups received acarbose, a starch blocker. The experimental group was put on a diet of prepared high-fiber foods and a diet higher in vegetables and fruits. Stool samples were collected periodically to assess the impact of the diet on the microbiome.

While the variables were straightforward, the analytic techniques were extraordinarily complex. It’s easy to say you want to examine the microbiome, but that’s not simple to do with thousands of types of microbes to analyze. Several types of bacteria from different species responded to the increase in fiber: bacteria that produced short-chain fatty acids (SCFA). The SCFAs are important because they feed the cells in the gut that do all the work during digestion and absorption.

HbA1c levels decreased faster and in a higher percentage of subjects in the experimental group than the control group. The fiber group also lost more weight and their blood lipids improved more than controls.

This was a small study, limited by the complexity of analyzing the microbiome, but the improvement in T2D simply due to an increase in fiber from foods is important. One more thing: this was a Chinese study, so typical high fiber foods from China were used. Is that important? We’ll find out Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Science. 2018. 359:1151–1156.

How Your Microbiome Affects Exercise Benefits

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It seems every day, there are several studies on the microbiome and its impact on our health. At this point, they’re preliminary but the picture is emerging that as goes your gut, so goes your health. I’ve picked three new studies to review this week.

As an exercise physiologist who’s done research on this topic, I’ve always recommended exercise as a way to improve control of blood sugar for prediabetics; that’s why this study surprised me. Researchers assigned 39 prediabetic men who had never used medication to either a control group or a high-intensity exercise group for three months. All men in the exercise group had similar improvement in fitness and weight loss. But only 70% of the men demonstrated an improvement in insulin resistance.

The way the responders processed protein and carbohydrates was different from non-responders. The researchers collected stool samples and then transplanted the microbiome of responders and non-responders into a group of mice; the mice responded to exercise in the same way as the man whose microbiome they received. The microbiome somehow responded differently to exercise and modified the expected results.

We don’t know about dietary differences between subjects that might have impacted the outcome because the subjects were told to maintain their current diet, but the results were surprising nevertheless. But I would still give the same recommendation for exercise to all prediabetics. The only difference would be to make sure they tracked blood sugars to see how their blood sugar responded.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Metabolism, DOI: 10.1016/j.cmet.2019.11.001.

Prescription Fish Oil: Questions Remain

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The REDUCE-IT clinical trial formed the basis for the expanded recommendations for use of Vascepa, the prescription fish-oil medication. This was an expensive trial, involving 11 countries and hundreds of medical centers with 999 physicians who recruited subjects, collected data, and kept track of the subjects for close to five years. With over 8,000 subjects, this was no easy task. As I said in Thursday’s Memo, they examined the primary and secondary prevention when the medication is taken with statins versus a placebo with statins.

While this was a tremendous effort, there are still some concerns, in my opinion.

Study Concerns

A board made up of physicians and the pharmaceutical company’s staff designed the study and helped execute it; the pharmaceutical company paid for the clinical trial, collected and managed the data, analyzed the data, and interpreted the results. Then the statistics were reviewed by an independent statistician. This creates a huge conflict of interest regardless of safeguards that may have been put in place.

When any type of study is supported by companies with vested interests in the outcome, there will always be questions. That has been true for every dietary supplement manufacturer that’s ever funded a study as well as the milk and sugar industry. It’s especially true for this study. I began by talking about a report from the financial sector. Billions of dollars are on the line. That has to be considered by the FDA before final approval is given.

I have a tendency to have faith in science, as skeptical as I may be at times. And that’s where my concerns lie; not in the financial aspect but in the study design and results.

My Concerns

As complicated as this study was, it was incomplete in my opinion. They did not collect any data on the subjects’ diet; a small change in diet could have reduced triglycerides (TG) enough to have a positive impact on secondary outcomes. The median change in TG over five years with the medication was 45 mg/dl, from about 215 down to 170 in the medication group, while it was reduced 13 mg/dl in the placebo group. We don’t know whether a group that focused on dietary changes to reduce TG would have the same reduction in CVD events; that would have been an excellent addition to the study design.

They also didn’t have a group using fish oil from dietary supplements. True, it’s not their responsibility, but we can’t know whether the same benefit might not occur if the dosing of EPA were equal:

  • Almost every study that has used fish oil to examine whether CVD outcomes could be reduced has used fish oil with 1 gram of EPA.
  • If the amount of EPA were the same, a head-to-head comparison between a supplement and medication that each had 4 grams EPA might have found a similar benefit.

The real issue is that we don’t know what makes the fish-oil medication work, just like we don’t know completely how dietary omega-3 fatty acids work. Is it just the reduction in the TG or how the oils work in the body? Are genetics involved? Diet? The microbiome? We have no idea at this time.

The Bottom Line

I’ll keep on eye on the approval process for this fish-oil pharmaceutical and let you know how it will be prescribed in the future. The decrease in TG found in the study can be done with lifestyle changes alone, so is it going to be worth the cost of a pharmaceutical for a slight reduction in CVD events? Remember the difference between medication and placebo was just 4.8%. If you fall in that category, you’ll have to decide for yourself: pharmaceutical fish oil or lifestyle change. In this case, a little work may go a long way.

What are you prepared to do today?

        Dr. Chet

P.S. This will be the last Memo until after Thanksgiving. Paula and I are doing something we haven’t done in 20 years: go on a real vacation, just us, just for fun. No work of any type. Talk to you again December 3.

Reference: N Engl J Med 2019;380:11-22. DOI: 10.1056/NEJMoa1812792.

Primary vs. Secondary Meds

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One of the key questions for the FDA advisory panel to consider was whether the prescription fish oil was a primary preventer of cardiovascular disease or a secondary preventer. What’s the difference? Primary prevention of CVD would impact the disease and stop events before they occurred in the subjects taking the fish-oil medication. Secondary prevention would prevent additional CVD events from happening in those with established CVD.

If you were a type 2 diabetic with an additional risk for CVD such as obesity or being a smoker, taking the prescription fish oil with a statin would prevent a heart attack or stroke from happening; that’s primary prevention. Based on the Reduction of Cardiovascular Events with Icosa-pent Ethyl–Intervention Trial (REDUCE-IT) that didn’t happen, but it did prove to be a secondary preventer of additional cardiac events in those subjects in the study with established disease.

The question is whether the FDA will approve the prescription fish oil as a primary prevention or a secondary prevention pharmaceutical. The advisory panel seemed split on that count. The assumption by some was that there was disease present even though the event had yet to occur. Others said “prove it” by doing an actual clinical trial to examine that question. We’ll find out how the FDA decides later this year. As I mentioned yesterday, the financial implications are huge.

There are still some things to consider with the clinical trial, and I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: N Engl J Med 2019;380:11-22. DOI: 10.1056/NEJMoa1812792.

Prescription Fish Oil Update

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“This Fish-Oil Heart Drug Could Be Big, Could Be Huge.” That was the headline in a well-known financial report after a Food and Drug Administration panel unanimously voted in favor of an expanded use for the prescription fish-oil drug. I mentioned this was a possibility when I first talked about Vascepa in October. The FDA is expected to make a final decision by the end of the year.

What is the expanded use? The medication could be prescribed to those who have established heart disease or type 2 diabetes with another CVD risk factor and are already taking statin medications to lower cholesterol. The advisory panel approved the use because research showed that when combined with statins, it could reduce CVD endpoints such as death, heart attacks, and strokes by an additional 4.8% when compared to a placebo over a 4.9 year follow-up period, 17.2% versus 22%.

One more thing. The medication could be prescribed to those with triglycerides as low as 150 mg/dl. That would include millions more potential users in the U.S. and Canada alone. You can see why the headline was in the financial news; the potential profit for investors could be huge. A lot is riding on what the FDA decides. I’ll explain that on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Bloomberg Online. Max Nisen. Posted 11-15-2019.

Can Cilantro Help with Seizures?

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Paula and I dislike cilantro; it tastes like soap to us. According to research, that’s a genetic trait. However, cilantro appears to have some very interesting qualities relating to seizures and neurological disorders. Here’s the study.

A research group examined the components of the herb Coriandrum sativum. This herb, commonly known as cilantro, has been used as an anticonvulsant in natural medicine. Their objective was to isolate components that could act as an anticonvulsant. This was not easy research. How do you know what to look for? There are minerals that transmit signals, and there are gates and channels that have to open and close for signals to move throughout the brain and nervous system.

The good news is they found one. They’re called neuronal voltage-gated potassium channel subfamily Q or KCNQ for short. If those channels are not working properly, it causes a dysfunction that can cause severe epileptic encephalopathies. Those types of seizures are resistant to modern anticonvulsants. Researchers found a component called long-chain fatty aldehyde (E)-2-dodecenal that’s able to activate a variety of KCNQ channels, thus preventing seizures.

There is a lot of research that still needs to happen, but this study shows that it’s theoretically possible for the chemical in cilantro to help. The results must be confirmed in animals and humans, but that shouldn’t stop anybody from eating cilantro now. Even though the specific component can’t be quantified in every cilantro leaf we might eat, it may still be beneficial. If someone suffers from seizures, especially if they’re resistant to medication, regular use of cilantro in meals may help.

Mushrooms, berries, and cilantro—although we don’t have all the details, food can assist medicine and may play a more important role in the future. We just have to make sure we eat better, each and every day.

What are you prepared to do today?

        Dr. Chet

Reference: The FASEB Journal, https://doi.org/10.1096/fj.201900485R.

Remember the Berries!

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Did you ever forget where you put something? Do you ever have trouble remembering the right word when you’re trying to explain something? Did those events ever make you worry about your memory? Based on the questions I get, many of you are concerned. The second study examined what foods may help your memory.

Researchers tested a group of over 200 subjects using a variety of short-term memory and cognitive tests. They then gave the subjects in the experimental group a blend of polyphenols from grapes and blueberries in capsule form with a total of 258 mg of concentrates daily; the control subjects got a placebo.

After six months, they retested all the subjects. They did not find an overall effect. But when they examined those who began with the poorest memory and learning ability, those subjects gained the most benefit. The researchers estimated that some subjects gained the equivalent of 14 years in memory ability.

Where do you buy this blend? It’s not available in this exact blend that I could find. However, a half cup of red grapes has 100 mg of polyphenols while blueberries have about 400 mg of polyphenols. The amounts will vary by the variety of grape, but that’s something you can start doing today to improve your memory. While we don’t know if other berries will have the same impact, any berry has polyphenols. Even if they don’t help with memory, they’ll certainly have other health benefits.

We’ll wrap this up on Saturday. There’s still time to take the survey to help me decide where I’m going in 2020.

What are you prepared to do today?

        Dr. Chet

Reference: The Journals of Gerontology: https://doi.org/10.1093/gerona/gly166.

News on Food as Medicine

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As a conventional medical journal and one of the leading medical journals in the world, The Journal of the American Medical Association doesn’t often publish reviews of the impact of food on health. However, a recent edition of the Journal included a summary of three such studies, and that’s the topic for this week.

The first study examined whether mushrooms, which are full of vitamins, minerals, and phytonutrients, decrease the risk of cardiovascular disease (CVD) or type 2 diabetes (T2D). The researchers re-analyzed the data from the Nurses’ Health Study and the Health Professionals Follow-up Study. When they compared more than five servings of mushrooms per day with less than one serving per day, they found no differences in the rate of symptoms or markers associated with CVD or T2D. One interesting note was that if mushrooms were substituted for meat, there was a decreased risk of T2D.

This is one of the first studies to acknowledge the problems with nutrition data in these types of studies. The data on mushrooms were only collected at the beginning of the studies; that doesn’t allow for comparisons over time. Further, the questionnaire didn’t allow for data on a variety of types of mushrooms. The best observation at this point is that we don’t know whether mushrooms or specific types of mushrooms are beneficial for reducing the risk of disease until more research is done.

We do know they’re good for you, so enjoy your mushrooms; sautéed mushrooms are a great addition to many dishes. Here’s another way to enjoy mushrooms: Creamy Mushroom Soup from the Health Info page at drchet.com. Check out the other recipes while you’re there.

We’ll look at another study on Thursday.

What are you prepared to do today?

        Dr. Chet

P.S. Don’t forget to complete the survey on Dr. Chet’s Traveling Health Show. I could be coming to a city near you in 2020! Click the link below to go to the survey.

Survey

Reference: AJCN https://doi.org/10.1093/ajcn/nqz057.