Artificial Sweeteners, Obesity, and Diabetes

/in /by

Last week, you may have seen headlines that said something like “Artificial Sweeteners May Cause Obesity and Type 2 Diabetes!” Just about every news organization picked up a press release from the Experimental Biology meeting. In the press release, researchers gave some of the results of a paper that was presented at a scientific session, including comments by the lead author, Dr. Brian R. Hoffman.

The purpose for doing the study, he said, was because of the epidemic of obesity and diabetes in the U.S. While there’s little question that excessive sugar intake, combined with excess calories over years, does contribute to obesity and type 2 diabetes, no one has really examined the role artificial sweeteners may play.

In these studies, he and his research team examined the effect of high levels of sugars, aspartame, and acesulfame potassium on epithelial cells taken from rodents in a test-tube study. Then using another group of rodents, they overfed them sugars and the same artificial sweeteners for three weeks. The objective was to see what changes occurred in proteins and metabolites that were produced in cardiovascular epithelial cells in the test-tube study and the blood of the rodents.

They found that there were modifications in proteins under both conditions, which may have led to changes in the products they produced. But is this meaningful research or not? I’ll tell you what I liked about the study in Thursday’s memo.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

“My Doctor Told Me”

/in /by

I get asked health questions all the time about weight loss, fitness, diet, and more. If a physician told the questioners something they should or should not do, they will let me know, and then I know my job just got harder. That’s why “my doctor told me” are four of the most powerful words I ever hear.

The problem when it comes to nutritional recommendations, which can include both diet and supplements, is that physicians are not trained in the basics of nutrition. They may have read a summary about a high-fat diet or a multivitamin and tell their patients not to try this or take that, but they have no basis of training to know whether the study was well done or not. Even when they get the training, the specter of evidenced-based medicine (EBM) raises its head.
 

The Problem with Evidence-Based Nutrition

I decided to check out the Gaples Institute website. There’s general information about a healthy diet for patients. There’s also a course that healthcare professionals can take online to learn about nutrition. I read the brochure that’s available for physicians to find out what they will learn in the four modules of the course.

It’s nowhere near enough. Four 45-minute modules? I’ve been studying nutrition for 30 years, and there’s still so much I don’t know; it’s impossible for them to learn enough in three hours to reliably counsel their patients. In addition to that, the Gaples Institute uses the same low-fat approach to reducing the risk of heart disease that has been used for the past 50 years. And how has that worked for us? We have the highest obesity rate we’ve ever had.

Yes, physicians should understand there are better fats than others. Yes, physicians should understand that refined carbohydrates and deep-fried foods should be limited. But because the materials use data from large epidemiological studies that fit the EBM criteria, this is not real nutrition training. It provides them a single way to teach their patients, and that’s not providing any real nutrition training.

To say I was disappointed would be an understatement. Physicians need in-depth nutrition training, not a course that teaches a specific dietary approach to disease prevention. That doesn’t mean the Gaples approach won’t help some patients, but it ignores alternative approaches that might also help patients. While I said that “my doctor told me” were the most powerful words I hear from people, I also know that if they hear something they don’t like, they won’t do it, evidence based or not. Knowing what to do next requires real training in nutrition. That won’t happen in a three-hour course.
 

The Bottom Line

We’ll just have to wait and see what happens with nutrition training for physicians. It’s not really their fault; there’s so much to learn about treating disease, it leaves little to no time to teach prevention. For now, that’s left up to us as patients. While nutrition is complicated, you can always count on these six words to help you prevent degenerative disease:

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Online. 4/11/2018.
2. Arch Intern Med. 2011;171(14):1244-50.

 

Physicians as Teachers

/in /by

As the interview in JAMA continued, Dr. Devries continued talking about the lack of training and why it was a problem in his mind. He cited a study published in 2013 by the U.S. Burden of Disease Collaborators which concluded that the leading risk factor for degenerative disease and mortality was a poor diet. A poor diet! He suggests that because physicians are so poorly trained in nutrition—meaning not at all—their patients are suffering the consequences.

Dr. Devries became frustrated and together with others formed the Gaples Institute for Integrative Cardiology, a non-profit that aims to teach the public and physicians about diet, exercise, and the mind-body approach to heart health.

For the rest, it’s not just giving a patient a couple of handouts with healthy diet guidelines. Physicians have to somehow become the teachers. For that, they need training. But even before training can be addressed, insurance companies must be willing to pay for this type of physician-patient time—or any time beyond the 15-minute consultation limit imposed by many healthcare businesses. While the insurance companies may provide websites and materials and even some training with dieticians, it doesn’t carry the power the physician would have.

No real nutrition training of physicians, no hands-on nutrition training by physicians, yet what physicians say resonates with their patients in ways they don’t realize. On Saturday I’ll tell you the four most powerful words I hear about health.

What are you prepared to do today?

Dr. Chet

P.S. The fiber drink recipe I talked about last week is now available on the Health Info page at DrChet.com.

 

References:
1. Arch Intern Med. 2011;171(14):1251-57.
2. JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805.

 

A Doctor’s Nutrition Training

/in /by

“Essentially zero.” That’s the answer a physician gave in an interview when asked how much nutrition he received in medical school. The lack of substantive training continued all through his internal medicine residency and specialty training. His expertise? Cardiology. What’s worse is that he said that nothing has changed since.

The interview with Dr. Stephen Devries was recently published in JAMA. He goes on to talk about how he was well-trained to deal with cardiac events when they happened. His frustration came with his inability to do much to help his patients. They would return with the same serious cardiac problems. Why? Because nothing changed in their lifestyle to help prevent reoccurrence. They didn’t learn anything because he didn’t teach them anything about how to do that.

I’m going to talk more about this interview, but here’s a challenge for you. The next time you have a doctor’s appointment, whether general practitioner or specialists, ask them what type of nutrition training they had when they were in medical school or in their residency. It will be interesting to find out their answers.

Reminder to all Insiders: the monthly Conference Call is tomorrow night. If you’re not an Insider yet, there’s time to join before the call.

What are you prepared to do today?

Dr. Chet
Reference: JAMA Online. 4/11/2018.

Yum, It’s Fiber Soup!

/in /by

Every day, I put a combination of psyllium fiber, inulin fiber, and a probiotic into a glass, add water, stir it up, and drink it down. Then I follow it with another glass of water to make sure the fiber doesn’t have to draw fluids from my gut. That gives me around six grams of fiber in addition to what I get from vegetables and fruit.

My grandson Riley has watched me do that for probably as long as he can remember. Several weeks ago, he decided he wanted a taste. I gave him one. He liked it, maybe because I use a psyllium that’s pink lemonade flavor. Soon he began reaching into the silverware drawer when I mixed it and getting a spoon so he could taste some directly. He’s still working on his spoon skills; he learned he has to keep the spoon bowl-side-up or it lands on his shirt. He began calling it his soup; well, it’s his “zoopa” but we think he means soup.

I decided I would mix up some for him in his own bowl. He gets it after dinner, although he asks for it at every meal; it’s about half of what I take or three grams of fiber with his probiotic added. Because of the psyllium fiber, it begins to turn to a gel, which really helps his spoon skills. He makes sure that bowl is scraped clean, better than anything else he eats. We make sure he also drinks water afterward for the same reason I mentioned earlier. He needs about eight or nine grams of fiber per day, and this adds to the total he gets from food. Without question, he is never constipated.

Next week we’ll add a new Basic Health Info with the recipes for the fiber mix and some details about why and how you should take in fiber as well as the benefits. This week was about building better health habits, and this is one you most likely need. You can call it what you want, but join Riley and start getting your fiber soup every day—because I know you’re not going to let a three-year-old get more fiber than you do.

What are you prepared to do today?

Dr. Chet

 

Giving Up Those Pointless Battles

/in /by

Every morning you can hear a “boink” on one of the back windows of the house. Every 15 seconds or so, another one. Then it begins to travel to another window. Boink. Boink. Boink. It’s a female cardinal. Time after time after time. Day after day. Upstairs windows, downstairs windows; the back of our house is almost all windows, so she has many choices. Boink. Boink. Boink. It’s been weeks, and she hasn’t learned yet and most likely is not going to learn to stop doing that. The battle continues. It’s pointless.

I’ve read the reasons why cardinals do this: a reflection of themselves or of the trees or shrubbery they’re on. Why she does it isn’t important—she’s still not getting into the house. And while she concentrates on attacking our windows, she’s not finding a nice male cardinal or building her nest. We’ve decided she’s not the smartest cardinal on the block, so maybe it’s better if she doesn’t reproduce.

Her day-after-day pointless battle raised a question in my mind. What are you doing day in, day out, that’s interfering with attaining the health you want? Starting every day with two pieces of toast with your eggs? Why not just one? Or try it with none? Are you walking at your usual window shopping pace? Why not try to increase the number of steps in the same time frame or get where you’re doing quicker by stepping up the pace? Always doing three sets of 15 repetitions? Why not raise the weight and drop to sets of 10 reps?

Or maybe it goes deeper. Are you fighting pointless battles just because you always have? Are they keeping you from doing what you truly need to do? What struggles could you walk away from?

You’re not a cardinal. You can change what you do to get better results. It may not require a whole lot more effort but unless you change things, you’ll keep getting the same results. Look at every one of your eating, exercise, and supplements habits. Look at where the conflicts are in your life. Where can you make changes that will get you better results?

What are you prepared to do today?

Dr. Chet

 

Your Payment Is Due

/in /by

Today is Tax Day here in the U.S.—if you owe the government any money, today is the day you have to file your taxes and pay up. There are penalties if you’re late, so you want to be sure you pay up on time.

Good health is the same way. The things you do that are beneficial such as eating less, eating better, flossing and brushing your teeth, exercising and many more things impact your health in positive ways. Overeating, refined carbohydrates, smoking, being sedentary, and other poor habits affect your health in negative ways. Done long enough, they’re going to impact your body.

Just like Tax Day, payment will become due. The price you pay depends on whether you have more good habits than poor ones. The only thing you don’t know is when you’ll have to pay that price: diagnosed as prediabetic at your next physical, headaches from high blood pressure, chronic bronchitis. Doesn’t matter whether you’re ready or not, someday you’ll have to pay for how you take care of your body. My advice is to choose wisely today and every day.

In this case, it doesn’t have to be the whole sum at once. Start small right now by skipping refined carbs just for today or taking a few extra steps. Definitely floss tonight before bed. You can sleep well at the end of the day knowing you’re headed in the right direction.

What are you prepared to do today?

Dr. Chet

 

It’s All in the Dash

/in /by

In this Memo, we’re going to pretend the survey’s treatment options for high blood pressure are real. The choices were a pill, a cup of tea, exercise, and an injection once a month. If they were real, which one might be the best option for you? To me, it all comes down to The Dash.

You’ve probably heard about The Dash before. It’s a story about a person’s life such as yours. On your gravestone, there’s a dash between the day you were born and the day you died; your life is in the dash. How does this relate to the treatments offered in the survey, even though hypothetical?

What treatment option will give you the best potential quality of life? Not just adding a month, year, or even five years; what will those years be like? Will you just be alive or will you be really living?

It’s a no-brainer. Whether real or imaginary, the treatment that offers you the best chance to really live during those five years is exercise. A cup of tea may provide some good phytonutrients. A pill or an injection may affect an organ or a system to keep your blood pressure under control. But regular exercise will actually treat the systems involved in hypertension: the heart, blood vessels, muscles, nerves, and even hormone levels. Exercise is not a salve to make you feel better. It’s going to have profound effects and give you the best chance at a good quality of life during those extra five years.

I know the study was just a pilot survey and no treatment can guarantee you that you’ll live longer. But what I said about exercise is real. It gives you the best chance at having a better quality of life, not just during a potential extra five years, but all the years before then as well. What do you want your dash to be like? It just depends on the answer to one real question:

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

The Survey’s Most Surprising Results

/in /by

Before I get into what I found surprising, I want to point out that this was a survey about hypothetical treatment options. It was just a preliminary or pilot project just to see how people would answer; the head researcher said as much. The other factor was that subjects were 45 and younger. If an older population were asked the same questions, the results could be different. Or maybe not.

What surprised me was that even when asked about something as simple as drinking a cup of tea every day, less than 100% of the people said they would do it for an extra five years of life. The 7% who said they wouldn’t do anything stuns me. It’s a survey! You could misrepresent your answers—go ahead and lie!—who would know? Maybe it’s a function of the under-45 population surveyed; maybe they hadn’t yet started to be concerned about their limited lifespans.

What’s amazing is that most subjects already had high blood pressure according to the report. They knew the treatments were hypothetical, and yet some still couldn’t be bothered to try to add five more years of life. If they care that little about a hypothetical treatment, how are they approaching actual treatment?

On Saturday, I’ll focus on those who said they would do something to live five years longer and which option might be the best—assuming they were real. It all comes down to The Dash.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

What Would You Pay for More Time?

/in /by

What price would you pay if you could gain an extra month of life? How about a year? How about five years? I think the longer you get, the more incentive to pay a higher price. It seems a large group of subjects agree with me according to a study reported this past weekend at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018.

Researchers surveyed over 1,300 people to determine what price they would be willing to pay for a longer life if they were diagnosed with high blood pressure. Subjects could choose from a daily pill, a daily cup of tea, regular exercise, or a monthly injection. The kind of treatment didn’t matter; the more additional time they got, the more willing the respondents were to consider the treatment.

Which was most appealing? The pill and the cup of tea. The least appealing? The injection. All treatments exceeded 93% if they would give a person an extra five years.

How about you? If you’re diagnosed with hypertension, what would you be willing to do for an extra month, year, or five years? While you think on it, Thursday’s Memo will be about something I found surprising in the study.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH