Monday, December 30, 2013

Health Research Recap hiatus and a new Paleo Challenge starting Jan. 1st

I hope no one minds that we are taking a little break from the weekly Health Research Recap for a little while to cover some things I've been working on and would like to cover.  I have read quite a few books recently and would like to do a review of each, starting with The Paleo Manifesto by John Durant on Thursday followed by Last Ape Standing by Chip Walter.  Both of these books are great and deserve to be recognized as they have altered my view of human health and performance.

I am also hard at work on a blog series titled, "The Human guide to being human".  One of the things that makes it difficult for people to understand how their lifestyle choices impact their health is that they really don't know how the human body works.  In this series, I am going to cover how our cells work as well as genetics, epigenetics, evolution, and that funky thing brewing in our large intestine called the microbiome that appears to have a huge impact on our health.  All of these topics are so fascinating and woven in to one another that I feel most people can dramatically improve their health simply by understanding how each works, how they all work together, and making decisions that take all of these things in to consideration.

Finally, I suppose I am a glutton for punishment, but I want to start a new Paleo challenge at the beginning of the year.  A central theme in both books mentioned above is how gene/environment interactions play a pivotal role in how we live today and the path we took to get here.  Most people who have flocked to the Paleo diet are covering the nutritional environment, but most aren't covering other, equally important, environments.  This challenge will be the most comprehensive challenge I have done and will include a nutrition component, sleep component, general physical activity component, exercise component, and stress component.  Each one will have concrete parameters and a way to score them.  Since I will be quite busy starting the 1st of the year with clients, I'm going to make it simple to score so that you can score it yourself and give me your scores each week.  We will do this via my Synergy Wellness Paleo Challenge facebook page found here.  Feel free to send me a friend request and ask to be in the group and I'll sign you in.  Once you are in you can invite any friends/clients who want to join.  Don't worry if you don't get in by Jan 1st, the first 5 days will be practice and we can do total scores and average weekly scores.  I will be putting up the scoring system on the facebook page on Dec. 30th.

That's all for now, My review of The Paleo Manifesto by John Durant will be up on Thursday.  Enjoy your New Years' celebration.

Friday, December 27, 2013

5 tips to help stop GERD

Most people who experience GERD immediately go to the pharmacy and grab an acid reducer to stop the symptoms associated with GERD.  In my last blog I went over the reasons why this is a bad idea.  In this blog I will give you some tips on how to reduce GERD.

1)Reduce stress

This may seem like an odd tip, but it's based on hard science.  Automatic processes such as digestion, heart rate, blood pressure, and breathing are controlled by the autonomic nervous system(ANS).  You have a finite number of resources and your autonomic nervous system helps determine what systems deserve the limited resources you have.  When you are stressed, your ANS partitions resources toward your muscles, putting you in fight or flight mode so you can get away from whatever is attacking you or turn it in to food.  This directs resources away from your organs of digestion until the stress is resolved.  At that time, resources are directed back to the organs of digestion to help your body recover.  This process, while useful in times of physiological stress such as coming upon a bear in the woods, can be detrimental when the stress is psychological or ongoing.  All stress is handled in the same way by the ANS so all stress will negatively impact digestion unless it is managed properly.  One of the best things you can do right before you eat is take in a deep breath and relax.

2)Sit down to eat

This goes right along with the reduce stress tip.  Too many people eat on the go or while standing up and this can negatively impact digestion for the same reason as above.  When you eat, you want to sit down, relax, and take your time. Too many people shove something in to their mouth quickly and jump right out the door.  Even if you are getting in to the car and sitting down, you are exposing yourself to stress in the car during your commute, especially if you have to deal with Jersey drivers like I do.  Sit down, take your time, and don't jump right up once you've finished eating.

3)Chew your food

Digestion begins in the mouth as amylase, the enzyme responsible for digesting carbohydrates, starch to break down starch before it enters the stomach.  Focus on putting manageable bites of food in to your mouth and chewing each mouthful 30 times.  This will help digestion and make sure food is properly digested so that it doesn't cause bacteria to overgrow from your large intestine in to your small intestine where they can cause problems.

4)Eat smaller meals

In general, I prefer people eat 3 meals a day.  However, if you are not producing enough digestive enzymes, you may want to focus on 5-6 smaller meals to allow your body to break everything you eat down.  The goal is to make sure all of the food that can be digested by you is absorbed before it gets to the end of your digestive tract where the beneficial bacteria in your gut can finish digesting what you can't.

5)Use digestive enzymes

As long as you don't have any ulcers, digestive enzymes can be used to help break down your food when you aren't making enough on your own.  The added bonus is that as you use these enzymes, you begin making more of your own so you can ween yourself off of them.  A project I have been working on leads me to believe that this works by reducing the amount of food available to the bacteria that is making it's way in to the small intestine where it doesn't belong.  This bacteria is also negatively influencing your digestive process by altering the digestive tract and once it is starved, you begin producing enzymes on your own.  The enzymes you need to take and how much is dependent on what and how much you eat.  Betaine HCl w/Pepsin or NOW foods Super Enzymes both seem to work pretty well in capsule form.  I more or less agree with this article from SCDLifestyle on how to determine your dosage.  However, make sure you get Betaine Hcl WITH Pepsin, not just Betaine Hcl.

These tips should help you manage the symptoms of GERD.  Although they are very helpful, don't expect immediate results overnight.  GERD is likely something that takes a while to develop, so it will take a while to correct.  Begin implementing these tips and you should be on your way in improving your digestion and correcting GERD.

Monday, December 23, 2013

Health Research Recap (Week of 12/16/2013)

A trio of studies on gut bugs provides some interesting insight in to the inner workings of the microbiome.  The first study found that extreme diets that focus on either animal or plant matter exclusively can change the microbiome very quickly.  The researchers found a shift in the microbiome  within a day of switching to the all animal diet.  In addition to changing the composition of bacteria within the gut, it also changed the gene expression patterns of the bacteria that were there.  One interesting finding of this study is that the all meat diet increased the amount of a type of bacteria associated with inflammation.  This confirms initial findings of the Human Gut Project that show that people who eat a Paleo diet typically have higher amounts of bacteria associated with inflammation.  This study is very interesting and provides a lot of usable information for a project I am currently working on.  However, you have to take this data with a grain of salt.  Each diet was at the polar end of a continuum and most people eat somewhere in the middle.  You also have to take in to consideration that the inflammatory bacteria are beneficial in this scenario.  You don't want to be myopic when looking at the microbiome, it is highly likely that each type of bacteria is in there for a reason and they increase in proportion to provide metabolic flexibility to the host.  The agreement with the findings of this study and the Human Gut Project on the Paleo diet pretty much confirms a theory that I have that most people eating a Paleo diet are eating far more meat than vegetables, which I don't believe to be a good thing if you want to maintain metabolic flexibility.

The next study showed how the microbiome helps prevent bad guys from causing problems.  The study found that mice that were bred to not have gut bacteria are more susceptible to infection than mice who had an intact microbiome.  The mice were exposed to Listeria infection and within 24 hours the germ-free mice had 10,000 times more of the bacteria in their small intestine and 1,000 times more in lymph nodes that surround the small intestine than the mice with a microbiome.  The most interesting part of this study is that molecules that help regulate gene expression, called micro RNA, were lower in the mice with a microbiome than the mice that were germ-free.  This indicates that these miRNA are the mechanism that Listeria use to infect the host and having a microbiome is necessary to prevent this step and fight the infection.

Another study looked at the effects of Bacteroides fragilis, a microbe found in the gut of humans thought to be related to autism, in mice.  In mice that were bred to model autism, researchers found that dosing the mice with B. fragilis caused a reversal of some of their autism-like behaviors.  The mice also had a reversal of GI symptoms associated with the disease.  I've heard quite a bit about this particular strain of bacteria lately, and most of it seems to be in autism research.  As with all microbiome research, it is likely not as simple as taking a probiotic strain and you are cured, most diseases are multi-factorial and require a multi-factorial approach.

In other autism news, researchers found that children with autism respond well to peer solicited interaction.  Under normal conditions, kids with autism are less likely to engage other children in play than children without autism.  When the interaction was engaged by other children, children with autism played in the same manner as children without it.  This can be beneficial in multiple ways.  First, it is important for children with autism to learn about social interactions and this does that.  In addition, the study found that children with autism had higher levels of the stress hormone cortisol than children without it.  Exposing them to this stressor over time should help them learn to modulate the stress response and dampen it's effects on their ability to be social, just like exposing people to the stress of exercise helps them grow stronger.  This study also shows, in my opinion, that children with autism aren't anti-social, they just don't understand social interaction as well as children without it.

A study found that it's cheaper to bribe kids to eat fruits and vegetables in school than to just let them throw them out in the trash.  Forcing schools to give children fruits and vegetables in the hopes that they will eat them led to a minor increase in consumption.  In other words, most are thrown out.  Giving kids cold hard cash(It was actually small amounts of change) led them to consume 80% more vegetables than they otherwise would, regardless of the amount of money they received(Where were you 30 years ago?).  It appears a week of doing this didn't lead to a permanent change in habits, so the researchers want to redo the experiment over a longer time-frame to see if they can get the habits to stick. You may be wondering how it would be cheaper.  This new policy of giving more fruits and vegetables increased spending for lunches by $5.4 million, the kids end up throwing away $3.8 million of that.  Also, this would save us a fortune on the back-end in healthcare costs associated with the Standard American Diet.

In another study on eating habits in children, a study found that food selection choices by children mirrored those of their elders.  The diet of parents as well as grandparents had an effect on the food choices of children, but it also worked the other way around.  This study illustrates how food can have an effect on other generations, both good and bad.  The takehome message for parents should be, "Monkey see, Monkey do", so eat your veggies if you want your kids to.

I'm not going to spend a lot of time covering this one because it belongs in the pile of "No-duh" studies.  Food advertised during children's programming is nutritionally inferior to the food advertised during adult programming.  This certainly doesn't bode well for developing good eating habits at an early age, but putting your child in front of a television for multiple hours a day is probably not good in any way for their overall health.

The Type 2 diabetes drug Metformin provides only minor benefits in obese children who are also following a diet and lifestyle modification program.  Somehow I don't think this is going to prevent them from recommending it anyway.  In my opinion it's not worth the potential side effects for a minor benefit that could probably be achieved with more lifestyle modification.  The best way to fight obesity is to prevent it in the first place, and I don't believe it's caused by a Metformin deficiency.

A new study in nutrition fails to find any benefit in taking multivitamins for health.  This comes as no surprise to me, nature seems to have packaged food with nutrients and cofactors that enhance effectiveness and absorption.  A perfect example of this is vitamin C and bioflavonoids packed together in citrus fruit that work synergistically with one another in this way.  Another trap you fall in to when looking at nutrition as a bunch of isolated nutrients is the assumption that we've identified all nutrients that are essential to human health.  We know about vitamins because deficiencies in them lead to diseases of deficiency that occur relatively quickly, but that doesn't mean we've identified everything we need to be healthy.  Cancer could potentially be caused by a deficiency of nutrients that activate cellular antioxidant pathways, hence broccoli's potent anticancer benefits.  These are just a couple of the many reasons why you should rely on food and not supplements as your primary source of nutrients.  One thing of note, I do not agree with their recommendation of whole grain breads.  Processed food is processed food no matter which way you cut it, whether it comes from whole grains or not.  If you want to eat whole grains, eat them in their natural form and soak or ferment them.

It appears that the health risks associated with smoking tobacco are epigentic in nature.  A new study found changes in genetic expression associated with health problems that are common in people who smoked, but none of those changes occurred in people who used smokeless tobacco. This points to the act of smoking as being detrimental to health, and not specifically to the use of tobacco.  Of course, this does not exonerate tobacco as being healthy, just that many of the negative things related to it are due to smoke entering the lungs.

Finally, a bonus gut bugs study.  Children who grow up with household dogs are less likely to suffer from allergies than children who grow up without them.  This study compared mice previously exposed to dust from houses without dogs and those exposed to dust from houses with dogs.  Exposing mice to the dust from houses where dogs live caused a change in their microbiome and lowered their immune response to common allergens when compared to mice who were exposed to dust from houses without dogs.  The researchers found higher levels of a strain of bacteria called Lactobacillus johnsonii in the mice exposed to dust from houses with dogs.  When they exposed mice to only this specific strain, they found a dampened inflammatory response in the lungs as well suggesting this particular strain is important for proper lung function.  However, just exposing them to L. Johnsonii did not have as strong of an effect as exposing them to dust from houses with dogs, further strengthening the argument that the entire microbiome and not just singular strains found within it is responsible for optimal effect.

Thursday, December 19, 2013

Why you shouldn't take stomach acid reducing medicines for GERD

Stomach acid reducing medications are commonly used by people to reduce the symptoms of gastrointestinal problems.  Proton pump inhibitors such as Prilosec and Nexium as well as H2 blockers such as Zantac are available over the counter and also by prescription and are frequently used by people with heartburn, GERD, and other associated gastrointestinal disorders.  They work by reducing the amount of acid the stomach produces.  The way the theory went was that the stomach overproduced acid and this acid would climb in to the esophagus and cause the constant throat clearing and gas associated with these conditions.  The problem is, this theory doesn't appear to be correct and it turns out that many people who are experiencing these issues actually have low stomach acid.  Let's take a look at how the current theory goes and why taking acid reducers is a bad idea.

I often talk about gut bacteria and gut dysbiosis on this blog because it is a hot area of research.  While most of these bacteria are in the colon, far away from from where the symptoms of GERD are found, they have a large impact on the way you digest food.  Research is just uncovering their role in digestion now, we know they impact how quickly food goes through your digestive tract, and there are certainly other roles that we will uncover in the future.  However, their role in GERD and gas and bloating is pretty simple and easy to understand.

Below is a diagram of the digestive tract.  As you can see, contents from the stomach enter the small intestine where digestion and absorption occur.  The small intestine enters the large intestine, or colon, where you cease digesting nutrients and the bacteria within your gut start.

When bacteria remain in your colon where they belong, everything goes along hunky dory.  They ferment undigested food that enters the large intestine and, since they are confined to the large intestine, most of the gas escapes out the back door.  There is a one way valve between the large and small intestine that separates the two called the ileocecal valve.  It's function is to allow food to pass from the small intestine to the large intestine, but prevent the contents from flowing back from the large intestine in to the small intestine.

When the beneficial bacteria make their way in to the small intestine, this is where things go wrong.  Most of these bacteria make various gases as a product of fermentation, and when they are in the wrong place or overgrown, they can cause a lot of pressure.  If this is in your colon you simply pass gas.  When it happens in your small intestine, the gas has a long, convoluted path to travel which leads to discomfort and burping. This is where they play a role in GERD.  When the gas reaches the stomach, all of it that has built up blows up in to the stomach and accumulates further.  This pressure eventually opens up the lower esophageal sphincter that prevents food and acid from flowing from the stomach in to the esophagus and you get GERD.  It doesn't make much sense that GERD is caused by too much stomach acid, it's not like your stomach makes so much acid that it fills up to the top.  Also, stomach acid still is subject to the law of gravity, and people often complain of GERD while sitting and/or standing.  It makes much more sense that pressure from built up gas in the small intestine provides a force to propel the acid that is in there upward, forcing it's contents in to the esophagus by opening the lower esophageal sphincter.

So where does this leave us?  Obviously, in this scenario, reducing stomach acid isn't a solid strategy to solve the problem it's merely a band aid over the symptoms.  It would be like fixing an oil leak in your car by adding oil whenever it gets low, it may work but you are still causing damage elsewhere and it's not like you can trade your body in for a new one once the old one is dead.  Don't get me wrong, you don't want the enzymes that are produced by the stomach in the esophagus.  Science currently points to this as being a causative factor in esophageal cancer.  The problem is, there are other problems associated with reducing your stomach acid.  Chief among these is that many nutrients rely on stomach acid for absorption, namely vitamin B12 and magnesium.  The other problem is that it also makes the actual cause of GERD worse while masking the symptom that is telling you something's wrong.

Hydrochloric acid, pepsin and gastric lipase are secreted by the stomach to help break down food in to smaller, absorbable parts that can be used by the body.  Other enzymes are also secreted along the way to help break down the food you eat.  Until food is broken down in to these smaller units, it cannot enter circulation within the body and remains in the digestive tract.  When you reduce the amount of hydrochloric acid that is secreted in the stomach which also reduces pepsin, you increase the likelihood that undigested food particles will make it to the end of the small intestine as well as in to the large intestine.  This gives bacteria that reside in your large intestine the opportunity to have access to food that they shouldn't have and they can overgrow in to the small intestine, which also contains food they wouldn't normally have access to.  As a byproduct of their fermentation of this food, they create the gas that eventually leads to the pressure that forces the gastric enzymes up in to the esophagus.

So by taking these acid reducers you reduce the interaction of gastric enzymes with the esophagus which is good.  You don't fix what is causing the enzymes to enter your esophagus in the first place which is bad.  While the acid reducers initially work, by reducing your stomach acid you increase the amount of food that is available to the bacteria overgrowing in your small intestine which increases the pressure that forces what little acid you make up in to your esophagus.  You then take more acid reducers until what little stomach acid you make can't be forced up in to your esophagus, but your ability to digest and absorb food is shot.

As you can see, chronically using acid reducing medications as a means to improve GERD is a strategy that is sure to fail.  Next Thursday I will list 5 things you can do to improve your digestion and get rid of GERD.

Monday, December 16, 2013

Health Research Recap (Week of 12/9/2013)

Many studies have shown a relationship between what your mother eats before and during pregnancy and your health.  A new study on the effects of diet in mice shows that what papa eats may also play a role.  Vitamin B9, or folate, is known to prevent miscarriages and birth defects.  This has led physicians to recommend folate supplementation to expecting mothers.  In this study on mice, the researchers found that male mice with folate deficiency were more likely to have offspring that were born with birth defects.  These effects are mediated by the epigenome, the portion of DNA that carries information about the environment and transfers it between generations.  To send the proper signals to your offspring, consume lots of green leafy vegetables, nuts, fruit, meats, and eggs.  It's not all about what you eat, obese people may not metabolize folate properly so maintaining a healthy diet and body is also important.

Long term use of acid reducing medicines known as Proton Pump Inhibitors(PPIs) is associated with vitamin B12 deficiency.  Researchers found that patients who took PPIs were 65% more likely to experience B12 deficiency than people who didn't use the drugs.  Stomach acid helps the body absorb vitamin B12, so reducing stomach acid levels can negatively impact B12 status.  Not only are these drugs prescribed often for stomach issues, they can also be found as OTC medicines such as Pepcid and Prilosec.  The frustrating part of this scenario is that most people who are prescribed these meds are never tested for stomach acid levels, and in many instances they can actually be experiencing low stomach acid, which may be why people who take acid reducers such as PPIs experience B12 deficiency.  Another deficiency that is likely to come about from PPI use is magnesium deficiency as stomach acid also helps with magnesium absorption.

I have written about lipopolysaccharide(LPS) often in this blog in regards to it's effects on blood glucose control and heart disease.  A news study has uncovered a surprising new twist in how the body handles LPS.    Blood clotting helps wound healing and prevents bacteria from entering the body, turns out it also helps soak up LPS and prevent it from entering circulation.  I wonder if the high circulating levels of LPS found in diabetes, heart disease, and leaky gut may contribute to the increased risk of blood clots.  I know switching to the Paleo diet, which theoretically reduces leaky gut and LPS, caused my blood to thin out when compared to eating the Standard American Diet, this could be one of the ways by which this happens.

HDL is known as "good" cholesterol.  While I disagree with the notion that there is a bad cholesterol since you would die without the so called "bad" cholesterol, people with higher HDL levels seem to have protection against heart disease.  Researchers identified the gene by which HDL does it's work.  Toll-like receptors act as record for the immune system to identify foreign invaders.  The gene ATF3 works to regulate this response by reducing the inflammatory response.  HDL cholesterol works by activating ATF3 and reducing inflammation throughout the body.  It is important to note that eating a diet and living a lifestyle that keeps inflammation at bay is more important than having high HDL cholesterol, but people with high HDL cholesterol are offered more protection from bad lifestyle choices than people with low HDL cholesterol.  High, and thus protective, HDL cholesterol is defined as >60mg/dL.

Speaking of epigenetics, a study looking at changes in gene expression in meditation showed that a day of practicing mindfulness by people experienced in meditation led to changes in the expression of genes related to inflammation.  Several genes that are the target of analgesic and anti-inflammatory medications were down regulated, leading to a decrease in inflammation throughout the body.  In addition, the people practicing mindfulness also showed an improved cortisol response to stress.  What is even more impressive about the results of this study is that all of the tested genes were expressed to the same degree at the beginning, not only suggesting that the results were due specifically to the practice of mindfulness, but also suggesting our minds can have a powerful influence over the way our genes are expressed.  Talk about the benefits of having the proper mindset.

A trio of studies on exercise gives us a glimpse of it's positive effect on health.  The first looked at the use of exercise to combat the sexual side effects of anti-depressant use.  Women who participated in the study either performed moderate physical activity 3 times a week within 30 minutes of sexual activity or the same amount of activity not timed to their sexual encounters.  All of the women who exercise noted improved orgasm as an effect of regular exercise, but the women who timed their exercise 30 minutes prior to intercourse also had stronger libidos and improvements in overall sexual function.  The effect is believed to be due to activating the sympathetic nervous system which increases blood flow to sexual organs.  Antidepressants reduce sympathetic nervous system activation, which is a primary effect of the drugs, not a side effect.

A study that looked at the effects of following a healthy lifestyle for 35 years found that following 4 out of 5 healthy behaviors is associated with a drastically reduced dementia risk.  These 5 lifestyle factors are regular exercise, non-smoking, low body weight, a healthy diet, and low alcohol intake.  While it is not news that these lifestyle factors are important to health, people who followed 4 out of 5 had a 60% decreased risk of dementia and a 70% decreased risk of diabetes, heart disease, and stroke.  Of the factors, exercise was identified as the most powerful factor in affecting disease risk.

In the third study, researchers found that beginning exercise as early as possible is highly beneficial in improving depressive symptoms in people with Parkinson's disease.  In the study, participants who exercised for 48 weeks noted improvements in depressive symptoms when compared to a group who had only been exercising for 24 weeks.  Since 50% of Parkinson's patients suffer from depression and the depression symptoms are often worse than the motor symptoms, reducing the depressive symptoms is important.  In addition, as the person falls in to their depression, they are more likely to withdraw from social interaction, decreasing physical activity and leading to a worsening of motor symptoms.  This study failed to show this effect, but a great component of this study that bears mentioning is that the participants were performing group exercise, which could have a synergistic effect in increasing social interaction as well as physical activity, a 2 for 1.

A new study on the effects of the Type 2 diabetes drug Metformin found that the drug had different impacts on heart metabolism in women than in men.  Metformin had a positive impact on heart metabolism in women, bet a negative impact in men.  The study looked at 3 treatment protocols for T2D, all including Metformin.  When the researchers looked at the data without separating the sexes, there was no difference in heart metabolism between the 3 groups.  However, when they looked at the data while separating the sexes, they noticed that the hearts of men burned more fat than glucose, an undesirable trait, while women were the opposite.  This was a very small study so more research is necessary, but it highlights how pharmaceutical drugs tend to enter widespread use in teh population before we know all of their effects.

Think that no-calorie sweetener is safe?  Think again.  We've all been told that sucralose, the no-calories sweetener also known as splenda, is one of the safer sweeteners to drink.  It turns out, not so much.  In a review of the science by researchers, studies looking at the effects of sucralose on health show that it has some significant damaging effects on the health of your gut.  In addition to affecting the way you process sugar, sucralose can negatively impact drug effectiveness, form toxic substances, and negatively impact the balance of beneficial bacteria in your gut.  While most of the studies they looked at were in mice, mice are also what drug companies use to determine whether a drug is safe for humans or not before beginning human trials.  Not safe for mice, not safe for humans.

Finally, a little science porn for a certain someone who reads and likes this review on facebook often and I haven't seen in a few years{You know who you are, tell Sharon I said hi  :)}.  Scientists have identified a genetic pathway that, when activated, may restart hair growth in dormant hair follicles.  This is lovely news for many men and women who suffer from hair loss, but is also good news for me as my father and both grandfathers are/were follically challenged.

Thursday, December 12, 2013

How science is manipulated to make you make the wrong choices

While I am certainly no fan of observational research, observational research isn't the only bad science out there.  An article I found on Science Daily a couple of weeks ago read, "Sugar intake not directly related to liver disease".  Since I am familiar with non-alcoholic fatty liver disease, and the title of this article completely flies in the face of what I know, I decided to take a look at the original article and see how the science was conducted.  As suspected, it was terrible science at it's best...or worst.

One of the more troubling aspects of the way science is conducted is the fact that you can design an experiment that will show pretty much whatever you want it to show, even if it looks like it's a solid study on the outside.  By simply designing a study in the proper way, you can show something that likely isn't true. In the study referenced on Science Daily, this was the case.  As you can see, the title makes the assertion that sugar has no direct effect on fatty liver disease, but the study didn't show this for a couple of reasons.

To take care of the low hanging fruit, this study was 2 weeks in length.  There is no way that fatty liver disease occurs over that short of a period.  Certainly you could see some effects of fatty liver disease in 2 weeks, and this study showed that one of the conditions did see some signs of fatty liver disease in a 2 week period.  The problem is, you can't use the way they designed the study to rule out the possibility that sugar intake has something to do with fatty liver disease.  Let's take a look at how the study was designed.

This study looked at healthy, overweight men and put them in to either a high fructose (Fructose as 25% of calories) or high glucose (Glucose as 25% of calories) group.  The men then ate a diet that was isocaloric(Provided exactly the number of calories they needed) for 2 weeks followed by a diet that was hypercaloric(Provided more calories than they needed) for 2 weeks and measured for signs of fat accumulation in the liver.  In the isocaloric condition, neither group showed signs of fat accumulation in the liver, but the high fructose group showed increasing insulin resistance, a risk factor for fatty liver disease.  In the hypercaloric period, both groups showed signs of fat accumulation in the liver(1).

(Before I go further, I think most people read high fructose and immediately think of high fructose corn syrup.  This is a mistake.  While high fructose corn syrup does contain more fructose than sucrose(aka table sugar) does, HFCS is 55% fructose/45% glucose while sucrose is 50% fructose/50% glucose.  They are essentially identical for our purposes.  If you are really worried about high fructose consumption, and you should be, avoid agave syrup like the plague.)

The authors of this study then came to the conclusion that fatty liver disease is a disease of high caloric consumption, not high sugar consumption.  The problem is, the study didn't show this, and here's why.  There was no true control group in either scenario.  Why wasn't there a group of people who ate a sugar free diet in both an isocaloric and a hypercaloric state?  If fatty liver disease is only caused by an increase in calories, you would need to show that people who eat no sugar but that eat too many calories also show signs of fatty liver disease.  They didn't even bother testing these conditions.  In addition, what if I ate isocalorically and ate 40% of my calories from either fructose or glucose?  Certainly if there is no direct link between sugar and fatty liver disease the total dosage of sugar shouldn't matter.  Again, they didn't test this condition.

This brings up another point that is probably the most important.  In the isocaloric and hypocaloric state, there were different total dosages of each type of sugar.  It is just as likely that the total dosage of sugar is the culprit and not whether you are in an isocaloric or a hypercaloric state.  They did nothing to control for this so they can't rule it out, yet they do anyway.  Things like this are supposed to be caught in the peer review process and studies like this shouldn't be published, but they are, this one in the journal Gastroenterology.

The worst thing of all?  From a mechanistic standpoint we believe that non-alcoholic fatty liver disease is caused by too much fructose and/or glucose consumption, which overwhelms the liver's ability to use either sugar, leading to the formation of fat droplets.  So, the prevailing theory is that fatty liver disease is caused by a dosage of sugar that exceeds the liver's processing capabilities, but the authors didn't feel the need to design the study in a way that controlled for this?  I guess it's somewhat enlightening that one of the authors is on the scientific advisory boards of Mars, inc and Coca Cola.

Bad science aside, there are other problems with using this science to approve sugar consumption.  Do people who eat higher amounts of sugar tend to eat at calorie maintenance or do they tend to over-consume calories?  What happens if you alternate between over-consuming and consuming the appropriate amount of calories daily or weekly while eating sugar?  Since non-alcoholic fatty liver disease progresses over the course of years, a study that is 2 weeks in length is not likely to provide you with any sort of applicable knowledge.

As you can see, you need to dig very deep to see if what is being reported is accurate.  The problem is not only with the use of observational research in the nutritional sciences, clinical trials can be manipulated to show whatever you want them to show if you design them in the right way. 

Monday, December 9, 2013

Health Research Recap (Week of 12/2/2013)

A study looking at a high risk gene associated with late onset Alzheimer's disease found that people with the gene begin seeing changes in their brain beginning in childhood.  If this has you terrified, don't be.  The researchers stated that the gene actually contributes very little to the risk for developing Alzheimer's disease when compared to lifestyle factors such as diet and physical activity.  How about that?

Researchers believe that supplementation with the Omega 3 fatty acid DHA can be protective against certain forms of Alzheimer's disease.  A recent study showed that DHA can cross the blood brain barrier where it can improve markers for inflammation and slow the development of Alzheimer's disease.  There were questions surrounding whether the Omega 3 fatty acids were able to cross the blood brain barrier and improve levels of DHA, which are correlated progression of Alzheimer's.  This study showed that DHA levels in the brain are related to progression of Alzheimer's disease and Omega 3 supplementation improves these levels.

Another study on obesity found that children whose parents experience high levels of stress have a BMI 2% higher than children whose parents experience low levels of stress.  Furthermore, children whose parents experience higher levels of stress also gained weight at a faster rate.  While the numbers seen in the study were quite low, people develop their lifetime eating habits while they are young and obese children tend to become obese adults.  The way the study was conducted, it appears that showing this stress is the important factor.  If you are experiencing high levels of stress, it's best to manage it in a way that your children aren't exposed to uncontrolled outbursts.

Not getting your sleep will not only make you cranky, it can also increase your risk for obesity and mood disorders.  A study looking at sleep disturbances and obesity found that 75% of obese participants in the study had poor sleep.  In addition, 52% were anxious and 43% were depressed.  There was also a relationship between mood disorders and sleep disturbance as those who reported poor sleep were more likely to experience either mood disorder. 

Another study on depression found that women who are depressed during pregnancy can cause changes in the development of the wiring of their children's brain.  The amygdala is the emotional center of the brain. While children of mothers who were depressed during pregnancy developed a normal amygdala, they had a decrease in connectivity to the right amygdala.  You may remember the amygdala as it is the target of improvements related to the stress reducing effects of meditation.  Perhaps meditating during times of depression may be a good idea in pregnant women. 

Researchers have found a "clock" within the stomach that may help regulate the times when we consume more food.  Nerves in the stomach respond to stretch in order to tell us when we have eaten enough.  These nerves are most sensitive during waking hours, probably to allow us to consume more food while we are more active.  This may help shed some light on why people who work night shift or have a disturbed circadian rhythm tend to eat more.  An interesting aspect of this research is that fasting may cause alterations in the sleep/wake cycle that decreases our ability to sleep, and this may be the mechanism by which it works.  It has been proposed that an interesting way to beat jet lag would be to fast for 24 hours prior to your trip and eat breakfast at home or on the plane at the time breakfast would normally be consumed at your destination.

In autism news, researchers found that changing the gut bacteria of mice who had autism with the probiotic B. fragilis had a positive effect on autism like behaviors.  In humans, children of mothers who had a severe viral infections during pregnancy are more likely to be autistic.  The researchers recreated this condition in mice and exposed them to the probiotic.  The result...The mice had less anxiety and were more likely to communicate with other mice.  The mechanism behind this improvement?  The mice had a leaky gut that was corrected with the probiotic.  Whether this is reproducible in humans is eyt to be seen, but taking steps to correct leaky gut in children with autism may show an improvement in antisocial behavior.

In research on gut bugs in the buckets of disease that we know as children, the toxic bacteria C. Difficile is found in the guts of 1/3 of children between the ages of 1 1/2 to 3 years.  While it resides harmlessly in their gut and will eventually make way for healthier bacteria, it is not so harmless in adults.  While this is not cause for alarm and shouldn't cause you to begin shunning your children, it should make you more cognizant of who should limit their exposure to young children.  People with compromised immune systems and people who are on antibiotics may want to steer clear of young children who are not their own until their immune systems are stronger or their course of antibiotics is done.

In more gut bug news, people with colorectal cancer have a lower diversity of bacteria in their gut.  People with colorectal cancer had fewer bacteria of the class Clostridia, which contains members that ferment fiber in to butyric acid, which is used to heal gut damage.  In addition, they also had higher levels of Fusobacterium and Porphyromonas, which are associated with higher levels of inflammation in the GI tract.

A cool study found that the skin appears to communicate with the liver and affects liver metabolism.  Some mice who were bred to have altered fat metabolism also had greasy fur and accumulated fat in the liver.  The researchers hypothesized that the increased fat accumulation in the liver was due to an increased loss of water through the skin.  They put vaseline on the mice to prevent the skin from losing water and heat due to evaporization of water from the skin and the fat in the liver went away.  To make sure this wasn't from fat absorption by the skin, they used liquid latex and got the same result.  The more research we do, the more complex human biology gets.

One of the most important match ups of the last million years appears to have a clear cut winner. Researcher looked at the effects of coffee and alcohol on the length of telomeres.  Telomeres are little caps, like shoelaces, found on the end of DNA.  Every time a cell divides the telomeres on the cell's DNA shorten.  The length of the telomeres get shorter as we age and are associated with poorer health.  The researchers found that caffeine shortens, while alcohol lengthens telomeres.  Before you go out and celebrate the news, there is likely a limit to the amount of alcohol that is beneficial.  Once you exceed that point I imagine you get the opposite effect.  In other words, this study does not show that binge drinking is healthy, just that moderate to low alcohol consumption may be protective.

Thursday, December 5, 2013

Five tips to fight the holiday weight gain

It's that time of year again, it's time for the holidays.  One of the greatest times of the year from a cheerfulness perspective also happens to be the time of year where a large chunk of Americans get...Well...Chunky.  The following six tips can help you beat the holiday bulge and get you started out right for the new year.

1)Ignore calories, eat real food

One of the biggest problems people have in general about diet is a focus on calories.    Over the past decade we have learned a lot about human biology and the inhabitants of our gut called the microbiota.  Obese and lean people have different a different gut microbiota composition, and when you take mice and put the microbiota of lean mice in to obese mice, the obese mice become lean.  As you enter the holiday season, ignore the calories and just focus on making quality food the bulk of what you eat.  That way, when you make poorer food selections, your body can deal with them(And so can the good guys in your gut).

2)Make an effort to manage stress

While the holidays are mostly a cheerful time, they can also be quite stressful and stress can help you pack on the pounds.  Make an effort to manage your stress by getting things done early so you don't have loose ends and have to stress about time crunches.  In addition, maybe take a weekly yoga class, meditate, or find ways to laugh throughout the day.

3)Make sleep a priority

Poor sleep is another lifestyle factor that can cause extra holiday weight gain.  Let's face it, everyone gets really excited to see loved ones, have a party, or go on a trip during the holidays.  As a result, we are prone to missing a night of sleep here or there as we eagerly anticipate the forthcoming week or weekend rather than getting to bed early and shutting down.  Work through the racing thoughts in your head by getting to bed 30 minutes early and focusing deeply on your breath rather than your trip back home.

4)Eat resistant starch to counteract some of the effects of consumption

A while back I was going to do a blog on resistant starch because I was having such good results with it for myself and clients in improving digestion and blood glucose.  I decided not to because Richard Nikoley over at Free the Animal has done such a fabulous job doing it over there.  The basic jist is that resistant starch feeds the good bacteria in your gut and they heal up any damage you cause with substandard food choices.  Three to four tbpsp of Bob's Red Mill Unmodified Potato Starch will do the trick and you can get 19 days worth for $3.65 at most supermarkets.  Just make sure you don't heat it or the starch will no longer be resistant.  For more on this check out the resistant starch archive at Free the Animal. 

5)Approach the holidays like a round of golf

Whether you are playing golf or mini golf, you can get in to the same trap.  Maybe your first few holes are pretty good, but then you have a disastrous hole that takes away your confidence.  A good golfer shakes it off and gets back down to business, a bad golfer lets it get in their head and affect the rest of their game.  Don't let that happen to you, when you get off your game nutritionally, hop right back in to it with the proper mindset.  Rather than lamenting about the half of a cheesecake you wolfed down last night, don't skip your nutritious breakfast only to find yourself starving and making poor food choices 3 hours later.  Make your bad choices, do the damage, and get right back on track as soon as you can.

6)Take a hike

There is nothing worse for you than eating terribly and spending the next 3 hours sitting around the house whining about it.  If you go crazy with the cookies, do something slightly less crazy and take a 20 minute walk.  While eating 15 cookies is certainly not a good idea, eating 15 cookies and sitting on your keister is worse.  It's all about managing your choices, and if you want to choose to eat things you wouldn't normally eat, have at it.  Just remember you also have the choice to go for a walk afterwards.

Monday, December 2, 2013

Health Research Recap (Week of Nov. 25, 2013)

Researchers have known that increased social activity lowers mortality risk in older adults, and a recent study shows that part of this effect is due to increased mobility.  Being social with friends almost always requires people to get up and move, and by doing so older adults maintain better mobility throughout older age than do less social adults.  Part of this may also be due to increased muscle mass as maintaining muscle mass throughout later adulthood also decreases mortality risk.  The researchers also found that adults who maintained cognitive function and had fewer depressive symptoms were more likely to engage in social activity.  People with poorer cognitive function and/or who experience depressive symptoms should be encouraged more to be more social and partake in social activities with friends.

A recent study looking at how meals of different composition affect the blood glucose and insulin response in Type 2 diabetics showed that a high fat diet produced better blood glucose responses than a low fat or Mediterranean diet.  This study is interesting because one aspect of the Mediterranean diet that people tend to ignore is that it only includes coffee for breakfast.  In this study, people eating the Mediterranean diet ate their breakfast calories with lunch and enjoyed a glass of wine also.  Despite a much larger meal, the blood glucose response between the low fat diet and the Mediterranean diet were identical for lunch.  This flies in the face of the recommendation that Type 2 diabetics should eat frequent, small meals.  One thing I would have liked to have seen in this study was the absence of bread.  Despite the low carbohydrate group consuming <20% of their calories from carbohydrate, they still ate bread for breakfast and lunch.  I would have liked to see them get their carbohydrates from an unprocessed source.  I also would have liked to see what happened in both the low carbohydrate and low fat group if they had skipped breakfast as well.  Here's a link to the actual study.

If you never had a reason to question the decisions of the FDA, now you do.  Researchers have been taking a peep at thalidomide, a drug infamously banned for causing birth defects in children in the 1950s,
as a potential cure for Crohn's disease.  While the drug did show impressive efficacy in treating Crohn's disease and keeping children in remission for much longer than placebo, one has to question the judgement to use such a drug in young children.  While the researchers state that children of reproductive age should use methods to prevent pregnancy, I'm guessing a study of sufficient duration to determine if there is any sort of permanent damage on future reproductive health has been carried out. 

Need another reason to question the decisions of the FDA?  Do you remember the diabetes drug Avandia?  Two years ago the FDA restricted it's use because of research that suggested it was linked to heart problems.  Dr. Steven Nissen, head of cardiology at the Cleveland Clinic sounded the alarm in 2007 when a review of 42 studies showed a 43% increased risk of heart attack in people taking the drug.  A review of 50 studies by the FDA also showed an increased risk of heart attack, so they asked the drug maker, Glaxsmith Kline, to go back and look at their data.  In what should come back as no shock to anyone, GSK's review of their own clinical trials showed no increased risk of heart problems.  As a result, the FDA has lifted their restrictions on the drug.  Normally, I put way more stock in clinical trials than in epidemiological research.  However, I don't do that with pharmaceutical research performed and funded by Big Pharma.  Research funded by non-profit organizations tend to show results in favor of a newer treatment 40% of the time while pharmaceutical industry funded research tends to show results in favor of the newer treatment 66% of the time.

In a study on magnesium and bone loss, researchers from the VA showed that supplementation with magnesium led to lower blood levels of chemicals that indicate bone breakdown. The study was carried out in healthy, young men and included a 350mg daily dose of magnesium for 30 days.

Finally, in gut bug news, researchers took a deeper look at how fecal microbiota transplant(FMT) works to help people with recurrent C. difficile infection(RCDI) become healthy.  Transplanting the healthy microbiota from healthy individuals caused a major shift in the microbiota composition of people suffering from recurrent C. difficile infection.  C. difficile infection occurs after standard antibiotic therapy at a rate of about 20% after one round of antibiotics and is more frequent as the number of courses of antibiotics increases.  The primary symptom is diarrhea.  The proportion of pathogenic(bad) bacteria increased and the number of butyrate producing bacteria(good) decreased in people with RCDI. FMT partially reversed this change, causing greater diversity of bacteria in the gut, but not totally restoring the microbiota to that of healthy people.  Over time, the microbiota of people who undergo FMT for RCDI continues to change, suggesting that recovery from RCDI is pretty long.  A healthy diet high in vegetable matter should, in theory, speed up this process.