Fearsome Twosome: C. Diff and Clade A

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Clostridioides difficile, C. diff for short, is a serious bacterial infection typically acquired after antibiotic treatment in a hospital. Antibiotics disturb the microbiome balance, and as a result, a bacterium that typically may not be a threat becomes one. But C. diff is not just a single bacterium.

In a recent paper, researchers from London sequenced and compared the DNA of 906 strains of C. diff—906! They reported that 761 strains came from humans living in 33 countries. They found that C. diff is still evolving. In fact, one species has adapted to living in hospitals; the type of C. diff that seems to dominate has been termed Clade A. It didn’t develop overnight; it took many years, but it developed specifically for the hospital environment.

Clade A has two characteristics that are a problem for us. It’s resistant to anti-bacterial cleaning products and therefore survives after cleaning. Even more critical is that this form of C. diff has developed the ability to use sugar as a fuel. The researchers actually tested modifying the diets of mice exposed to Clade A and found that it thrived with a sugary diet.

Where does that leave us? I think that further research should explore changing the typical hospital diet including elimination of sugars and simple carbohydrates. The cleaning part is more complicated. Heat will kill it, but that applies to only hospital instruments; for instance, you can’t heat a door handle or a bed’s handrail or to a high enough temperature to kill bacteria. A different solution must be discovered.

For now, in addition to the normal antibacterial precautions, I think it’s smart to greatly limit simple carbs post-surgery or when you’re spending a lot of time in a hospital.

What are you prepared to do today?

        Dr. Chet

Reference: www.nature.com/articles/s41588-019-0478-8.

Should Your DNA Guide Your Diet?

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In an opinion piece, a college professor in the U.K. who had written about personalized nutrition wanted to find out whether she should change her diet based on her genetic profile. She decided to send her DNA to Norway for analysis.

Her genetic profile indicated that she was at risk for having high cholesterol and an increased risk for cardiovascular disease. To deal with that, she became a vegetarian. She also takes high levels of B vitamins because she doesn’t process one of the B vitamins very well. Her point was that knowing her genetics gave her the motivation to take control of her diet and lifestyle. She now advocates that all of us should take control of our health through personalized nutrition based on our DNA analysis.

I’m not so sure. I think genetics are one piece of a complex puzzle. What causes the genes to express themselves? What turns them off? More than anything, what role does the microbiome play when combined with the genes? We still don’t know the answers to any of those questions.

Someday we may be at a point where we can be very specific about nutrition, but we’re not there yet because we not only don’t know the answers—we don’t know the correct questions to ask. For reliable results, it still comes down to what I always tell you: Eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

Reference: http://bit.ly/2ZclpII

Does Exercise Intensity Affect Obesity?

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As I wrote on Thursday, exercise intensity did not seem to impact mortality, or death rate, in a large group of older women. Of course, living longer is important to many people. Could exercise intensity provide benefits as it relates to reducing the staggering 40% rate of obesity in the U.S.? Maybe. Let’s look at a recent study from Taiwan.

The Taiwan Biobank Study is a longitudinal study that recruits Han Chinese subjects 30 to 70 years old. Much like the All of Us study, researchers take anthropometric data such as height and weight as well as blood samples for multiple DNA analyses. They also collected data on physical activity; their objective for this part of the study was to see if exercise and the intensity of exercise impacted genetic manifestations of obesity.

Genes and Obesity 

What manifestations? Body mass index, percent body fat, and waist circumference among others. Researchers asked the subjects what type of exercise they did, how long they exercised, and how many times per month they exercised. Then they calculated a BMI Genetic Risk Score (BMIGRS) based on the genetic markers for five obesity-related gene combinations. This was complicated; you know I like to see raw data, but with over 16,000 subjects and all of the compounding variables, that’s not realistic.

When they divided the subjects into quartiles based on BMIGRS, they found that the exercise with the greatest impact on the obesity-related genes was jogging. That was followed closely by mountain climbing, walking, exercise walking, international standard dancing (the kind of ballroom dance you learn at a studio or see on Dancing With the Stars), and a longer practice of yoga. Those activities had an impact on the expression of the genes related to obesity. It means that it down-regulated those genes, which means that if you jog, your BMI is lower, you have a lower percent body fat, and your waist circumference will be smaller.

Do you have to jog? No. All the listed exercises had an impact on the obesity genes so if you can’t jog, that’s fine. Extended yoga and dance were also on that list, and they don’t have the impact on joints that jogging or even mountain walking would have.

There were also some other interesting findings. Joggers exercised less time, about 30 minutes, and fewer days per month, about every other day. Walkers walked nearly an hour at a time and walked two out of three days.

The Bottom Line      

One thing was clear: every type of exercise was better than no exercise. I’ve said many times before that exercise by itself is not a great way to lose weight because you have to invest so much time in it to have an impact, and no matter what exercise you choose, you still have to eat less. But if you want an advantage that will impact any obesity genes you have, higher intensity exercise is better. You have to adjust for orthopedic and any other issues, but the more intense the exercise, the better the results. If you’re going to walk 10,000 steps per day, walk them like you mean it.

What are you prepared to do today?

        Dr. Chet

 PLOS Genetics | https://doi.org/10.1371/journal.pgen.1008277.

Is the 10,000-Steps Goal a Myth?

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One of the things many people do for fitness is try to get 10,000 steps per day. Researchers recently wanted to know whether that many steps really gives a person any health advantage, because the concept of 10,000 steps per day wasn’t based on any real science—it came from a Japanese company who invented a wearable step counter in 1965 and just made up a number that sounds good.

Researchers analyzed data from 16,741 older women who agreed to wear a step counter at least 10 hours per day for at least four days a week during waking hours. They divided the subjects into quartiles based on the number of steps per day. After four years of follow-up, they discovered that hazard ratios declined as the number of steps per day increased. No real surprise there. What was surprising was that there were no additional benefits after 7,500 steps per day; in fact, the mortality began to decline with as little as 4,400 steps per day.

Is the goal of 10,000 steps per day a myth? Not in my opinion; most of us are too sedentary most of the time. The mean age of the subjects in this study was 72. It may be that younger women need more steps to impact mortality because they have potentially more years to live; then maybe after reaching 72, they can scale back. Hard to say. But they looked at mortality only; 10,000 steps per day may have benefits they didn’t examine.

I would have thought walking intensity might have had an impact, but it didn’t in this study. However, another recently published study may provide more insight, especially as it relates to obesity. We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.

Readers Report on MSG

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Of the dozens of responses to the Memos on MSG, most readers reported the types of symptoms commonly attributed to MSG along with some interesting physical responses. Several people responded that they had always heard to avoid MSG, so they have. I thought one particular comment was interesting: upon looking at the foods that contain MSG, especially snack food, he wouldn’t eat them anyway so it was never an issue for him.

Many people get a true allergic response within minutes of ingesting MSG. This is the list of reactions: swelling, hives, itching, redness, headache, migraines, coughing, palpitations, shortness of breath, numbness around the mouth and cheeks, joint stiffness, pain in the arms, sleepiness, stupor, trouble sleeping, vomiting, and diarrhea. If they avoid MSG, they don’t have the symptoms.

There were a couple of unusual reactions I have to mention. One individual found that if he has MSG in food for dinner, he has vivid dreams, usually involving someone chasing him around or being in a struggle situation. He never gets them otherwise, so he avoids MSG.

Another person said when he eats food with MSG, he craves chocolate.

The common theme was that everyone used trial and error to find the culprit. Here’s your challenge, even if you’ve never attributed a problem to MSG: if you get some of the symptoms on the list, examine the content of the foods you eat. Can you narrow down a suspect for your symptoms? The goal is know yourself and the way to do that is to pay attention.

What are you prepared to do today?

        Dr. Chet

Sports for Kids: A Better Way

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I hope you took the time to read the Norwegian Children’s Rights in Sport document; if not, please do, especially the Plan for Development. The focus is on making sure the child is safe and secure no matter their abilities. The goal is for all kids to develop the joy of learning sports by having fun and gaining lifetime skills.

The kids also have the right to master a variety of skills in many sports. The ages 6 through 12 are not for specialization, they’re for generalization. Kids have the right to decide how much or how little they want to participate in sports and much they want to train. That doesn’t mean that this is all willy-nilly; it’s very organized with progressions from skill to skill and sport to sport.

Let me use the illustration from the last Memo about dodgeball. If kids are put into groups with similar abilities, they can still play dodgeball. They can develop their eye-hand coordination much better than if they avoid that game altogether. They can be given drills that allow them to focus on the ball release, to anticipate which direction to move, and how to catch the ball. The progression may be different and slower than more talented kids of the same age, but they will progress. They may never play dodgeball again, but they can develop skills that help them become a goalie in soccer. If they grow into their teenage and young adult bodies with better skills, who knows where that may lead? The most important point is for kids to learn to associate sports with having fun.

There are two elements that are the antithesis of American youth sports. Travel teams are prohibited, and no scores are kept for any game up to the age of 12. Local communities can have competitions within a reasonable distance and that’s encouraged, but nothing like the travel teams we see in the U.S.

No keeping score? It’s prohibited and if caught, coaches and parents are subject to penalties. They’re also not allowed to keep statistics: no leading scorers, no saves in hockey. The emphasis is on learning a variety of skills in many sports to encourage life-long activities.

I haven’t seen documentation of long-term effects, but it would be reasonable to anticipate a reduction in obesity and a less sedentary lifestyle than we have in the U.S. today, and that could reduce healthcare costs. We might even find a smaller carbon footprint if people are more inclined to walk or bike or ski to their destinations.

Where’s the Competitive Spirit?

Don’t be deceived—competition is encouraged at the right time. Once children over 13 decide they want to become competitive athletes, the training escalates with more info on nutrition, practice of sport-specific skills, and higher levels of competition. Once they’re in, they go all in. Remember this: the first kids who went through this change in the approach to sports for kids are the young adults who won all those medals in the last Winter Olympics. Now they’re turning their attention to the sports in the Summer Olympics.

Competitive? Of course they are. They just want to end up with a population of adults who have a life-long appreciation for movement and a commitment to keep going. So far, it seems to be working.

The Bottom Line

I think anything that helps kids develop an appreciation for movement is a good thing. Could the Norwegian way work in the U.S.? Most likely not because the current system of an exclusionary approach to sports is so entrenched, but it could work within a community or a school district. If the focus is on playing, having fun, and getting good coaching in sports skills all year round for young kids, that could translate to benefits for all ages. Maybe it would prevent the burnout student athletes experience who start competing at six years old. By the time they finish high school, too many are done. For life. That costs the child and it also costs society.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.aspeninstitute.org/blog-posts/norway-won-winter-olympics/

An Alternative Path for Athletic Kids

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At the last Winter Olympic Games, which country won more medals than any other? The U.S.? China? Russia? No, it was Norway—a record 39 medals. How does a country with about five million people outperform countries such as Germany with 80 million, Canada with 35 million, or the U.S. with 325 million? As you might expect, there isn’t one simple answer, but it may be related to their approach to sports for kids.

In 2007, the government of Norway adopted a set of rules called Children’s Rights in Sport; you can read the document by clicking on the link in the references. Their approach begins with the premise that kids should play sports because they enjoy it and that what they learn with their friends will last a lifetime. So the very first idea is that sports will be a life-long activity. Contrast that with the approach to sports in the U.S. As we proceed through elementary, high school, and college, fewer and fewer people participate in sports on a regular basis. The emphasis is on competition, not life-long skills, so the kids with an average amount of skill learn that if they’re not a star, sports isn’t for them. They become sedentary adults.

Ever play dodgeball in phys ed class? You probably remember kids with rocket arms mixed with kids a foot shorter and poor reaction times. How well does that work out most of the time? The entire Norwegian approach focuses on developing sports skills consistent with the abilities of the child, not on the kids who perform best. The approach involves community sports clubs. The approach takes whatever skills a child has and helps them improve with children of similar abilities, including children with physical disabilities.

How does this approach lead to better performance in the Winter Olympic Games? We’ll continue on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Children’s Rights in Sport

Kids and Sports in America

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In my travels, I stay in a lot of hotels and speak in many venues from convention centers to hotel ballrooms. No matter the season, I can count on there being a team of kids staying in the hotel. I don’t mean professional teams; I mean kids’ teams from baseball and softball, gymnastics, volleyball, and of course the number one sport, soccer. Pick an age group and there’s a team tournament being held somewhere. I don’t mean local community events; I mean that the kids participate in travel teams, which means the entire family travels.

I recently saw a segment on youth sports on a national sports show. One of the scenes that stood out to me was a parent using profanities toward the umpire or referee. I used to be a football official and took my share of abuse. No one used profanities at games, but that was 20 years ago and things are much different today. Kids with some talent who show an interest in a sport can get moved along rapidly to higher levels of competition. It seems that failure is not an option once they get there.

What does this focus on competition at early ages do to kids? Is it healthy? Does it create champions? Hard to say for sure, but there may be another way, one that leads to lifetime participation in sports and activity. We’ll take a look on Thursday.

What are you prepared to do today?

        Dr. Chet

Nutrition Education: The Best Solution

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The scientific paper about nutrition education programs from South America was an opinion piece derived from a student’s dissertation defense. It addressed nutrition labels in Brazil: the labels were too focused on the caloric content instead of the ingredient information.

The paper gives an example of two foods that have 97 calories but are vastly different in nutritional value. Chewy fruit-flavored candy had 21 grams of carbs, no protein, 1.5 grams of saturated fat, and no fiber; 14 almonds had 3.6 grams of carbohydrate, 3.5 grams of protein, 8.4 grams of healthy fat, and 2.1 grams of fiber. The almonds also had several vitamins and minerals while the chewy fruit candy had none.

The question is whether labels alone can change the nutritional health of a nation. Hard to say. Brazil came up with a simple public health approach using three recommendations:

  1. Choose whole, minimally processed foods
  2. Cook those foods yourself
  3. Eat those foods with other people

I think that’s an excellent approach. It means that people may have to shop a little more often and spend more time preparing food. But when you consider travel to get take-out or fast food, or the expense of food delivery, we can get better and fresher quality foods with fewer preservatives and more nutrition for around the same price.

Eating those foods with other people, at a minimum, means that families eat at least one meal together daily, possibly two if we include breakfast. The other possibility is to invite neighbors, friends, or other family members. We don’t have to fix feasts; just fresh, healthier foods that are simple to cook and share.

The Bottom Line

I think the Brazilian approach could work in the U.S. If we were to use the public health nutrition education program from WWII with an emphasis on the benefits of the foods for our health along with videos people could use to prepare the foods simply, and even scale that down to individual communities where small groups could learn how to shop and cook, we can change the health of the nation.

I also think it begins with parents: they’ll have to lead the way if they expect children to eat better. When we visited Paula’s cousin, who has three children under two (a toddler girl and identical twin baby boys), we remarked at the variety of food their daughter was willing to eat. Her dad said that she may be the only kid in preschool asking, “Excuse me, where is the hummus?” It may mean that parents will have to learn more about healthier foods and how to prepare them. I think it’s a small price to pay to improve their kids’ potential for better health.

What are you prepared to do today?

        Dr. Chet

Reference: Adv. Nutr. 2019;10:549–556.

Improving Nutrition in South America

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One of the problems today with public nutrition education programs is that there’s an important element that would prefer it not be done. In fact, food manufacturers are doing all they can to avoid any approach that may impact sales of high-fat, high-sodium, high-sugar, and highly processed food. I get it—they want to sell as much as they can. But to suggest that ketchup is a vegetable in the school lunch program doesn’t make any sense. I’m not going to comment further because that could take a month of Memos.

Instead let’s look at what some countries in South America have done to address nutrition as their obesity and related disease rates rise. One of the most controversial steps was taken by Mexico: the government put a 10% tax on high-sugar drinks, snacks, and sugary cereals that have limited nutritional benefit compared to total calories. It was not easy because the people of Mexico, much like the U.S., are against paying any more in taxes. But as of 2019, consumption of sugary sodas has dropped 12% in the poorest segment of the population and 5% in more affluent segments.

One of the most innovative approaches is used in Chile: foods high in added sugar, saturated fats, sodium, and high in calories have to place black stop signs on the front of package labels, and those foods can’t be sold or promoted in schools or promoted on television. Children have been educated about the meaning of the label changes and are steering their parents away from foods with black stop signs on the labels.

These radical approaches had to fight the food industry all the way, but the good of the people outweighed the profits of the industry. There may be a better way yet, and that’s what I’ll talk about Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.washingtonpost.com/business/2019/07/16/latin-americas-war-obesity-could-be-model-us/