2018 Cholesterol Guidelines and Evidence-Based Medicine

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I was encouraged by the AHA’s new cholesterol guidelines for one reason: the promotion of a joint decision between patient and physician on a treatment plan if one was necessary. That’s the basic tenet of evidence-based medicine: any and all treatment plans should take into consideration the wishes and desires of the patient. Many factors can go into that—the age and current physical state of the patient, the financial cost of treatment, and the physical cost of treatment compared to the potential benefit.

The only concern I have is this: will that discussion actually take place as intended or will it be a one-sided conversation with the physician making the decision for the patient? Will the physician listen or ignore the patient’s views? Paula and I have a great primary care physician and specialists who always listen to us, but I know it’s not that way everywhere. It’s easy to say, “If he won’t listen, just find another doctor,” but that isn’t always an option in rural areas or if your health insurance limits your choice.

The physician side of evidence-based medicine is just half the story. I’ll give you my thoughts on the rest of the guidelines on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

AHA’s 2018 Guidelines on Cholesterol

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Here’s what the American Heart Association announced this past weekend: a 120-page research-based paper on new cholesterol guidelines and how the guidelines were developed. The paper was five years in the making, involved twelve medical and physician associations, and includes ten documents to explain and summarize what the guidelines say. For the foreseeable future, these will be the guidelines used by physicians trying to reduce the risk of cardiovascular disease.

The guidelines focus on control of LDL-cholesterol in combination with the state of the individual: those with and those without diagnosed disease. Primary prevention is for those who’ve not been diagnosed with atherosclerotic cardiovascular disease (ASCVD). Secondary prevention applies to those who have been diagnosed with ASCVD. The flow charts for treatment plans are complicated, even when isolated and presented on individual pages.

What I liked the most is that management of CV risk begins with a conversation between the physician and patient. The discussion revolves around risk factors, both lifestyle and the test results. The goal is to come to a consensus for treatment if a person’s CVD risk is high. What does that treatment involve? We’ll take a look on Thursday.

The Insiders Conference Call is tomorrow night. If you’re not an Insider yet, you still have time to join and take part in the call. I’ll be covering the latest research on omega-3s and vitamin D as well as answering your questions.

What are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

Research Update on Coffee and Alzheimer’s Disease

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I began drinking coffee when my mother put coffee with sugar and milk into my baby bottle—sounds shocking today, but that’s the way it was. Over 60 years later, I still love coffee, especially strong coffee. That’s why a health headline suggesting coffee may reduce Alzheimer’s and other neurological conditions caught my attention. I had to check it out.

Don’t rush off to the nearest coffee bar just yet, especially if you don’t drink coffee. This was a laboratory experiment to examine a by-product of coffee roasting called phenylindanes. The researchers examined whether these chemicals could prevent the aggregation of amyloid-beta and tau, the building blocks of the plaques and tangles of Alzheimer’s disease. Turns out, they can prevent those clusters and that’s great, but these are test-tube studies.

We’ve seen this many times before. Test-tube studies show beneficial effects of some nutrient and a product is rushed to market with no human trials. While that wasn’t the intent of the researchers, it probably will happen; you can still buy green coffee bean extract for weight loss even though the major clinical trial has been not just discounted but retracted.

I think it shows there’s power in plant nutrients. Eating or drinking a wide variety of all plants will help reduce inflammation, and thus the production of harmful chemicals in our bodies. The benefits are not just limited to raw vegetables or fruits. Cooking can have a beneficial impact on the phytonutrients just as the roasting of coffee beans may have. We don’t have to focus on a single nutrient for benefits.

The keys to health don’t change. Eat better. Eat Less. Move more. And have a cup of coffee or two along the way if you like it.

What are you prepared to do today?

Dr. Chet

 

Reference: Front. Neurosci., 10-2018 https://doi.org/10.3389/fnins.2018.00735

 

Genetics or Lifestyle?

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My dad died of a heart attack when he was 41. That fact has always been hanging over my head, especially when I had a heart blockage 16 years ago; the coronary artery was opened, I had a stent put in and have had no issues since. Was it my genes or was it lifestyle? Genotype or genes versus phenotype or lifestyle. I’ve always said genes, but not any more.

Researchers recently published an analysis of over 800 million individuals after examining births, deaths, and relationships between the individuals: in other words, who married whom, how many children they had, how long they lived. They found that a role for a genetic component of longevity was supported in family trees of people who were related. But here’s the interesting thing: they also found that there was a longevity relationship between non-blood relatives as well. In other words, the subjects’ in-laws shared similar traits for longevity.

What does that mean? Perhaps people unconsciously select mates with comparable traits. Because we don’t do that intentionally by genetics, it means that similar environments have a similar impact.

The actual role of genetics was estimated to be well below 10%. In other words, phenotype or lifestyle is more meaningful than your genes for how long you live. This was a very complicated mathematical analysis, so we should proceed with caution, but there’s little question that lifestyle has more to do with longevity than your genes.

Good genes give you a good start, but what you do after that matters most. What should you do? Eat better. Eat less. Move more.

Your body. Your choice. What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1534/genetics.118.301613

 

Vote!

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I wouldn’t normally recommend skipping your exercise, but I’m making an exception: if your exercise time is the only time you can go vote today, choose voting.

The health of our country is an important element of living a healthy life; we all need to be committed to keeping the U.S. system of government healthy.

What are you prepared to do today? If you’re in the U.S., I hope you’re voting. Readers in Canada, India, U.K., and elsewhere: stick to your exercise plan.

Dr. Chet

 

Research Update: Gut on a Chip

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In the final research paper I’ll review, the headline that caught my attention was “Probiotics are not always ‘good bacteria’.” That’s something I really hadn’t seen before so I had to check it out.

In this case, I had to learn about a new technology called organ-on-a-chip. Over the past five years or so, researchers have tried to develop a three-dimensional approach to doing research on various organs including the gut. Essentially what they have done is develop what are called chips with living tissue on different sides of a membrane. As it relates to the gut, they have the epithelial layer, the actual absorbable tissue from the gut, on one side and the endothelial layer on the other side. They can then control fluids and nutrients to study what happens in healthy versus diseased conditions.

In the study that resulted in the headlines, the researchers examined what happened when probiotics were introduced into a damaged gut such as we would see in irritable bowel disease or Crohn’s. Using a mouse-model chemical that destroys the gut tissues, what they found was that once the chemical was removed, the inflammation was reduced and the gut was repaired.

If the probiotics were introduced before the gut damage, the destruction was ameliorated, thus preventing some damage. When the probiotic was introduced after the damage, the inflammation was reduced but the repair process was impeded.

Prior research has demonstrated that probiotics are beneficial in human trials for people with damaged epithelial cells or simply stated, the inner portions of the gut. It seems curious that it would slow repair in this gut-on-a-chip model; even so you might feel better because inflammation is reduced.

What should we do? The digestive system, just like any other organ system, is part of a total organism. On a chip, even with more than one component represented, it’s still not the entire organ and certainly is missing the effects of some other organs that may have an impact. The only way to know for sure is to duplicate the study in living beings, whether in rodents or humans.

Based on human trials, there’s no reason to change the use of probiotics if you have inflammatory bowel disease. Talk with your physician, but at this point there’s no reason to stop using probiotics.

The Bottom Line

Probiotic research continues at a rapid pace, and I believe that the ultimate “cure” for any disease or condition will be found there. It doesn’t mean we’ll live forever; it could mean we get to live healthier all the days we’re alive. I continue to take my probiotic as does everyone in the family, including my three-year-old grandson Riley. And don’t forget you can get even more good bacteria from vegetables and fermented foods.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://doi.org/10.1016/j.jcmgh.2017.12.010.
2. www.pnas.org/lookup/suppl/doi:10.1073/pnas.1810819115/-/DCSupplemental.

 

Research Update on Probiotics and Staph Infections

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One of the primary threats to our health is infection—specifically, antibiotic-resistant infections. We’ve all probably heard of people who became critically ill due to a life-threatening staph infection. A new research paper may give us insights on how we might be able to reduce the risk of getting infected with staphylococcus bacteria.

Researchers selected a remote village in Thailand to examine the relationship between bacillus and staphylococcus bacteria in humans; the researchers from the U.S. felt that residents of the remote location would be less likely to be exposed to food sterilization or antibiotics than people who live in urban areas. They collected and examined fecal and nasal samples from 200 volunteers from the village for the types and quantities of bacteria present.

They found that half the subjects had bacillus bacteria growing in their digestive system, and about two dozen subjects had fecal and nasal staphylococcus bacteria. They also noted that no subjects who had the bacillus bacteria had any signs of the staph bacteria.

The researchers then went on to do a rodent study to explain how the bacillus bacteria destroy the staph bacteria. While the how is important, it would take a lot of words to explain. Suffice it to say that regular consumption of bacillus probiotics can be protective against a staph infection. You can find it in sauerkraut, kim chi, and yogurt, or in supplement form.

One more research paper to review on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: Nature 562:532–537 (2018).

 

Research Update on Probiotics and Healthy Skin

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There has been so much research on probiotics published that it’s hard to keep myself informed, and you as well. This week I’ll summarize three recent studies on probiotics. Let’s begin with research on probiotics and skin conditions.

Researchers examined the effects of three strains of probiotics on skin inflammation in mice: two strains of lactobacillus and one strain of bifidobacterium. Three groups of mice were given one of the probiotics for two weeks while two control groups were given a placebo. After two weeks, the skin of four groups of mice was chemically exposed to an irritant to cause inflammation while the fifth group was exposed to a control chemical.

The researchers examined both blood and skin of the mice for indicators of inflammation after seven days of exposure. The markers for inflammation were lower in the groups who took the preventive probiotics than either of the positive or negative controls. While this was a small study on mice, it did demonstrate that probiotics helped reduce the skin response to chemical irritation. This may be the first step in identifying a probiotic that could help conditions such as atopic dermatitis in the future.

Keep taking a wide-spectrum probiotic, especially if your skin has been less healthy than you want it to be. If you have a teen with skin problems, probiotics may make a big difference. Another research update on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Beneficial Microbes, 2018; 9(2): 299-309.

 

Quality Manufacturing: Own It

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The most important trait of a quality manufacturer of dietary supplements is to own as much of the process as possible: farms to grow plants, laboratories to test all components of the supplements, scientists to base formulations on the latest research, manufacturing facilities for the products, and elements of the distribution process. As I said, no company can process every nutrient that may go into a supplement but the more they control, the better the oversight.

The problem will always be the lack of control. As control decreases, the probability of tainted supplements increases. Anyone, and I really mean anyone with the money, can put together a formula for supplements and find a manufacturer that will make it. The ingredients can be organic and natural or they can be the cheapest available. That person can also find a warehouse to store it and another company to distribute it, especially in these days of Internet shopping. Anyone can start selling his own formulations for supplements within a week to a month.

Lack of ownership isn’t necessarily a bad thing; we can’t begin with the premise that everyone is out to cheat everyone by cutting corners. But while someone might be an excellent nutritionist with a great idea for a supplement of some sort, they’re not necessarily an expert in the entire process of manufacturing. That could result in problems with the finished product that were unseen due to a lack of expertise.

In this week’s Memos, I’ve covered a simple way to assess the manufacturers of supplements. The only thing you have to do is ask the right questions before you buy. That protects you and your family.

What are you prepared to do today?

Dr. Chet

 

Quality Manufacturing: Independent Testing

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Let’s continue our look at how quality manufacturers could prevent tainted products. In-house testing is important, but all work should be verified by an independent testing company. There are several labs that perform such services such as NSF and USP. There are three important services they can perform:

  1. Inspect the facility to make sure the manufacturing process complies with FDA Guidelines for dietary supplements known as Good Manufacturing Practices.
  2. Verify the quantities of nutrients in the products listed on the product labels.
  3. Check for the presence of contaminants of all types.

It seems simple enough. Why don’t all manufacturers use independent testing companies? One of the reasons is cost: it’s not inexpensive, and it also must be continuous. But the trademark of a quality manufacturer is independent testing of the manufacturing facilities and dietary supplements they make.

We’ll finish this up on Saturday with one of the most important traits of a quality manufacturer.

What are you prepared to do today?

Dr. Chet