Tag Archive for: nutrition

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Rising CO2 and Nutrition: The Bottom Line

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All of nature is a delicate balance; when any component changes, there will be some sort of effect—maybe good, maybe not. The mineral nutrient and trace element content composition of a plant, technically called the ionome, reflects a balance between carbon, obtained through CO2 in the air, and the remaining nutrients, obtained from the soil. If the CO2 increases in a disproportionate way to the nutrients available from the soil, it could create an ionomic imbalance. In other words, the balance of nutrients is disrupted. This imbalance in CO2 and soil nutrients could affect the nutrient content of the plant including the protein and micronutrients.

That’s exactly what scientists found in their research. Remember, they used a CO2 level in the FACE-field testing to mimic CO2 levels at the end of the 21st century. Most species of rice declined in protein, iron, and zinc, but that was expected based on prior research. But there were also consistent reductions in vitamins B1, B2, B5, and B9. On the upside, they did find an increase in vitamin E in some varieties of the rice.

Here’s the concern: rice is a staple for two billion people. In fact, it’s their primary source of nutrients because food is not plentiful in many of those countries. A 10% decline in protein could have a major impact on the growth and development of the people dependent on rice for their primary food source. The same is true for any of the other nutrients; they’re critical for the immune system and many other biochemical functions.

The Bottom Line—For Now

While this research is real, it’s most definitely not complete yet. The CO2 projections for the turn of the century may not be accurate; they could be lower or they could be even higher. What if they were higher? Let’s take it one step farther and consider the food supply in the U.S. and Canada right now. What if the current CO2 levels are having an impact on our food supply now, not just on rice, but in all the food that’s grown? What if our food is becoming less nutritious?

This raises two points. If there were ever a reason to complement your diet with dietary supplements, this would be it.

Take it a step further. I get more queries on what people can and cannot eat because they have issues with specific foods such as wheat. What if it’s not the gluten in wheat that’s the problem? What if it’s the changes in nutrient content that upsets the balance of amino acids? Or the B vitamins? That imbalance may be the actual culprit. Only more research will tell.

This one is far from over. I’ll keep watching to keep you informed.

What are you prepared to do today?

Dr. Chet

 

Reference: Science Advances: DOI: 10.1126/sciadv.aaq1012.

 

How Researchers Determined the Effect of CO2 on Nutrition

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An international group of researchers wanted to know how higher CO2 levels would impact the nutrient content of a staple in the diet of over two billion people: rice. If the nutrient levels change substantially, that could have an impact on the nutritional status of many people who might already be undernourished.

Over several years the researchers grew 18 strains of rice that are raised throughout the world. They used an interesting technique called FACE, which stands for free-air CO2 enrichment. The technique uses tubing to emit CO2 near the plants. The amount emitted is dependent on the CO2 levels on the plot of land and controlled by sensors. That allows them to keep the CO2 levels constant just as they would be when grown in fields while the plants grow in a natural outdoors setting.

The researchers used the CO2 levels that are estimated to occur by the end of this century. True, none of us will likely be alive by then, but most of us know people who will be. The knowledge gives agricultural scientists time to develop plants that can grow with adequate nutrient content in those CO2 levels. CO2 may not increase as expected, but future generations can be prepared if they do.

What did they find? I’ll let you know on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: Science Advances: DOI: 10.1126/sciadv.aaq1012.

 

Does Carbon Dioxide Affect Nutrition?

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Carbon dioxide is a waste product of energy metabolism. When we burn the food we eat, the protein, carbohydrates, and fat will be eliminated as carbon dioxide and water. When we use the gasoline in our cars or lawnmowers, CO2 and water are also released during that form of metabolism (called combustion) as well. The benefit for us and our cars is that we get energy. The problem is that we’re producing too much CO2 from gasoline and other fossil fuels.

CO2 levels have risen and fallen over the millennia in response to global trends, but since the invention of the internal combustion engine, the atmospheric CO2 levels continue to rise. As the number of uses for engines has increased, so have CO2 levels; they’re now 100 ppm higher than the previous highest level.

What does this have to do with nutrition? After all, don’t plants need CO2 for photosynthesis? They combine CO2 and H2O together to make sugar, right? Correct. But what researchers wanted to know is whether the excess CO2 would affect the nutrient content of specific crops. Are we growing supercrops? That could have immense implications for global nutrition. I’ll talk about what they discovered on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: https://go.nasa.gov/2zkpdjL.

 

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Health Headline: Diet and Hearing Loss

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Researchers examined nutrition data collected between 1991 and 2013 in the second Nurses Health Study to examine whether adherence to a healthier diet reduced the risk of hearing loss. They developed a scoring system for three dietary approaches: the Alternate Mediterranean Diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010). They also gave the subjects a hearing health questionnaire to ascertain hearing loss in 2009 and 2013. The researchers divided the diet scores into quintiles and examined the trend across increasing adherence to each of the three diets as determined by the scoring system.

Researchers reported that as the adherence to each diet increased, hearing loss decreased. Those subjects who adhered to their diet best reduced their hearing loss by as much as 30%.

Headline worthy? A split decision. I’m in favor of any reason for nurses or anyone else to eat a healthier diet with more vegetables and fruit.

Why not headline worthy? The first issue was use of the food frequency questionnaire, which relies on recall for the number of typical servings of over 150 items during the past year. Yes, you read that right; the questionnaire asks, for example, how many times you had chicken in the last year and how big was the serving. Maybe you could answer questions like that accurately, but I couldn’t. And as the old axiom about data goes: garbage in, garbage out.

Second, it used a poorly validated self-report of hearing loss from fewer than 700 subjects in just two studies. That’s good enough for a pilot study, but not good enough to make a recommendation.

Third was that when examining the median values for scores in the highest quintile across all three diet assessments, adherence was no better than 67% and as low as 50%. That means 33–50% of the time, the subjects ate foods that were not part of each diet. What made up the other half to a third? Maybe that was the secret to success.

So while these are promising results, they simply point the way to a bigger, better study to see if a better diet makes a significant difference in reducing hearing loss. However, if fear of hearing loss will motivate you to eat healthier, that’s a good outcome. But if I suspected hearing loss to be in my future, I’d take other steps in addition to eating better.

The Bottom Line

That’s my look at last week’s health headlines and the science behind them. In every case, the science did not merit the conclusions. The rush to publicize results gets headlines, but really? That’s all it does.

We can say that they provide interesting results that need further study. Even without complete info, you could take positive steps such as eating better to perhaps help avoid the conditions studied—you’ve got nothing to lose by eating more fruits and veggies.

What are you prepared to do today?

Dr. Chet

 

Reference: The Journal of Nutrition, nxy058, https://doi.org/10.1093/jn/nxy058.

 

Health Headline: Ketogenic Diet and Type 1 Diabetes

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Researchers wanted to examine the blood sugar control of type 1 diabetics who use a very low carbohydrate, high-protein, moderate fat ketogenic diet. The diet was developed by Dr. Richard Bernstein, himself a type 1 diabetic. They used a unique study design: they requested volunteers from a Facebook group of children and adults who adhere to the Bernstein Diet. Over 300 volunteers completed an online survey about their diagnosis and diet. The diagnosis of type 1 diabetes was confirmed from medical records from a follow-up survey of medical staff.

This was a rigid ketogenic diet with no more than 30 grams of carbohydrate allowed per day. The average intake was 36 grams carbohydrate per day. The better the control of carbohydrate intake, the better the HbA1c score, with a mean of 5.7%. Remember, these were type 1 diabetics; there are many type 2 diabetics who don’t control their HbA1c that well. I think this study illustrated the potential of nutrition in affecting a disease system. One interesting aside was the healthcare professionals treating the patients seemed indifferent to the dietary approach regardless of the results.

Headline worthy? Yes, in context. Close to half the subjects did not provide access to medical personnel so the researchers relied on the initial subject surveys for information. They also had no access to any dietary records to confirm the diet. Still this was a unique way to use social media to gather information. The study has to be confirmed using traditional research design to assess the variables. But this approach examined people who live this diet on their own or with their children. That can provide insights that might be missed if the study were conceived by a group of research professionals discussing the question around a table.

What are you prepared to do today?

Dr. Chet

 

Reference: Pediatrics. 2018. doi: 10.1542/peds.2017-3349.

 

“My Doctor Told Me”

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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

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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

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“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.