No free lunch: No calorie sweeteners shown to cause gut changes that induce glucose intolerance

No-calorie sweeteners have proven to be relatively useless in the fight against obesity, despite what the food industry may tell you.  In a new study published in Nature, researchers provide evidence that no-calorie sweeteners can induce metabolic changes that lead to glucose intolerance in both mice and humans.  This study found that the changes in glucose tolerance come about from shifts in gut bacteria.

The mouse arm of this study started by feeding mice a 10% solution of either saccharin, aspartame, or sucralose in place of drinking water and comparing their glucose tolerance to control mice given either water alone or a 10% glucose solution.  After 11 weeks, the glucose tolerance in the mice given the artificial sweetener was worse than the mice given water or even glucose.  Previous research has shown that certain no calorie sweeteners can alter the gut microbiome, so the researchers gave mice a 4 week course of antibiotics to wipe out the microbiome.  The result...Glucose tolerance returned to normal.

To make certain that the effects were due strictly to changes in the gut microbiome, researchers transplanted feces from the mice given saccharin in to germ-free mice who had not had the sweetener.  Within a week, the germ-free mice had the same changes in glucose tolerance as those who consumed the no-calorie sweetener.  Looking at the fecal samples, researchers found changes in the microbiome that mirrored changes in the microbiome of humans that eat no-calorie sweeteners.  Furthermore, a follow-up with 7 humans with no history of using no-calorie sweeteners who were fed saccharin at the maximum daily limit allowed by the FDA found that 4 of the subjects had poorer glucose tolerance after 7 days and an altered gut microbiome that, when transplanted in to mice, resembled the one seen in mice fed saccharin.

This study brings up a few important points.  While the dosage of no-calorie sweetener was high, it was within FDA limits.  So while you may not consume these sweeteners at the level seen in these studies, the point is that they aren't entirely benign.  Furthermore, relying on these sweeteners as a crutch to kick a sweet tooth may not be in your best interest, especially if you are diabetic.  Secondly, some people did not respond negatively to the no-calorie sweetener.  An important question to answer would be whether or not Type 2 diabetics, who have poor glycemic control in the first place, are more likely to be susceptible to poorer glycemic control from these sweeteners due to their microbiome.  I would be willing to bet that people with Type 2 diabetes are more likely to rely on no-calorie sweeteners because they "have no direct effect on blood glucose".  Unfortunately, they apparently have an indirect effect on blood glucose that is just as bad as a direct one.

Finally, even though the people who weren't affected by the artificial sweeteners were in the minority, the fact that their glucose tolerance wasn't affected, nor was their microbiome, points to no-calorie sweeteners being benign for them.  As is a frequent topic in this blog, an individualized approach to health and diet is always the best approach.

Do Type 1 and Type 2 Diabetes share a common cause?

A new study recently published in the journal FASEB provides evidence that both Type 1 and Type 2 diabetes share a similar cause that differs only in the rate at which either disease occurs.  In the study, researchers found that human amylin, a hormone long associated with Type 2 diabetes, accumulates in toxic clumps that destroy the beta cells of the pancreas responsible for producing insulin.  This causes progressively worse pancreas function, leading to failure, that ultimately culminates in either form of diabetes(1).  Let's take a closer look at the findings.

When you eat a meal, insulin is secreted to help control the level of glucose in the blood by making cells in the body take in glucose.  At the same time, the hormone amylin is also secreted to help insulin regulate blood glucose by slowing gastric emptying, reducing digestive enzymes, and causing you to feel full.  When a person secretes more amylin than they can break down, clumps of the protein form on the pancreas negatively impacting beta cell function and causing cell death, thus decreasing insulin production.

In this study, researchers took mice and inserted copies of the human amylin gene, making them either homozygous or hemizygous.  Mice who were homozygous for human amylin received two copies of the gene while mice who were hemizygous only received one copy.  Mice who had two copies of the gene experienced higher levels of amylin, rapid destruction of the pancreas, high levels of insulin, a shortened stage of prediabetes, and juvenile-onset, or Type 1, diabetes.  The mice that had one copy of the gene experienced lower levels of amylin and a more prolonged period of prediabetes, which led to adult-onset, or Type 2, diabetes.

If we look at this in concert with the research on leptin resistance that shows it to precede insulin resistance, we get an interesting picture.  Leptin is another hormone that signals you to stop eating and is secreted by fat cells.  People with leptin resistance produce a lot of leptin, but the cells in the hypothalamus that help regulate food intake don't respond to it.  As a result, people with leptin resistance don't get the "full" signal and continue to eat when they don't need to.  At some point, this may cause them to overproduce amylin causing the toxic clumps associated with Diabetes.  Of course, this is an extreme simplification of a complex topic that needs further study, but it does paint a picture that both could be prevented or reversed. In addition, this study was done in mice so further studies in humans are needed.

Bonus nerd info:  Interestingly enough, amylin shares a common effect on cells with amyloid beta, the protein associated with Alzheimer's disease.  Both cause dysfunction of the mitochondria and an increase in free radical production due to interference in the activity of complex IV in the mitochondria.  The end result of high free radical production...cell death.  These mechanisms only differ in where the cells they affect are found, amyloid beta in the brain and amylin in the pancreas(2).

Some nutritional recommendations are Bolshevik

A recent article making the rounds in Australia and New Zealand attempts to expose the dangers of the Paleo Diet by pointing to scientific advice that just doesn't exist while at the same time pointing to the paucity of clinical trials supporting the diet.  The two primary faults of the article are inconsistent logic as well as utilizing scientific data in a way that it cannot be utilized, both of which combine to make a dizzying array of non-points that make it difficult for a layperson to differentiate fact from fiction.

At the heart of the story is the notion that there is no hard scientific studies showing the Paleo diet to be more effective than the standard diet recommended by most health authorities.  This is not to say there aren't many studies that show a Paleo diet to be more healthy than a Mediterranean Diet for several populations, there are several.  What it says is that these studies do not have enough participants to make a clear determination as to whether the diet is better than what health authorities currently recommend.

In my opinion, this is a valid point.  However, when these same health authorities point to the healthfulness of processed food products such as whole grains, they are using data that cannot be used to make that determination.  One of the inherent problems with nutrition research is that you have studies that are well controlled that can be used to say A causes B. Since these studies are well controlled they tend to have a very small number of participants because they restrict external influences that may affect the results.  Theses are the types of studies that are coveted by scientists, but they are extremely expensive and hard to do and, therefore, quite rare.

On the other side of the coin are studies that can have a huge number of participants but that aren't controlled at all.  No matter how many people you have in these studies, you can never say A causes B because you aren't testing whether A causes B, you are testing whether there is a relationship between the two.  This second type of study is where most, if not all, nutritional recommendations come from.  The problem is, using these studies to say eating X improves health is essentially lying because the studies do not say A causes B or B causes A, they say A and B share a relationship that deserves further testing in a well controlled experiment.

In the very few well controlled experiments that experts use to show whole grains to be healthy, whole grains are compared to refined grains as a control group.  In effect, these studies do not show whole grains to be a healthy part of a diet, it shows them to be healthier than refined grains, which we know to be fairly unhealthy.  Of course, it's difficult to identify which type of study the health authorities are using to refute the Paleo diet in these articles since they don't post any references. 

On the logical fallacy end of things is the point that our ancestors ate seeds of grasses, which is a fair point.  However, comparing a loaf of Pepperidge Farms bread to the types of grains eaten by our ancestors is hardly a scientific comparison.  For one, the traditional way to prepare grains is to soak them, which aids in digestion and cuts back on some of the toxic properties of grains.  Secondly, grinding grains with a mortar and pestle is hardly the same as the modern processing of grains in to bread by machine.

Another logical fallacy in these arguments is that grains are somehow necessary to a healthy diet.  While this is not directly stated in these articles, it is implied by the notion that cutting out grains or specific food groups is detrimental to health.  While the authors like to point out that the diet of our ancestors varied greatly, and many included seeds of grasses(grains), this notion does not in anyway imply that grains are necessary to health.  In fact, many modern hunter gatherer societies don't eat grains and do quite well.

While I agree with many points health authorities make against a Paleo Diet, particularly that a high meat/low carb/low diversity diet is a good idea, I feel these arguments are against the lunatic fringe of those implementing the diet.  A lot of this has to do with earlier iterations of the diet and the now increased availability of the books and sources that promoted it.  Over time, the message that Paleo diet proponents have crafted has become more refined and more scientifically sound.  A great reference for what I believe to be the future of the movement can be found here.  Rather than pointing the finger at macronutrients such as carbs or fat, the modern processing of food and it's effect on the microbiota of humans is implicated.

While I don't think this will quell the influx of experts who argue against the diet, it will certainly make it more scientifically valid.  None of this is to say that a rigid Paleo diet is absolutely necessary for health.  However, making better food choices a majority of the time based on principles identified by the science being generated from principles of evolutionary health can only be beneficial in the absence of hard scientific data that shows one way or another that processed grains, whether whole or refined, are something healthful to eat.  That data, despite the insistence by health authorities, does not exist.

MIssing Microbes: A book review

I recently purchased the book Missing Microbes: How the Overuse of Antibiotics is Fueling our Modern Plagues and finally got the time to read it. This book hits me on so many levels.  First, it's on a topic I find very interesting, the bacteria in our guts and the functions they perform for us that we're unable to perform on our own.  Second, the author takes a very balanced approach in looking at how antibiotics, as well as C-sections, have contributed to significant changes in our microbiome that may be a causative factor in many of the diseases we see today.  Finally, it provides insight in to how and why we may want to change the way we look at things when it comes to our healthcare system.

The book begins by taking a look at the rise of "Modern Plagues" that have only recently become prevalent in Western society but have yet to become epidemic in more traditional ones.  Obesity, Type 2 diabetes, allergies, and asthma are just a few things he tackles in this section.  Next he moves on to the microbes that were once our chief enemy and how they have always, and will continue to well past our extinction, rule the planet.  He then moves on to the microbes that have become our friends, our microbiome.  Our microbiome is the collection of bacterial cells that live within our body and outnumber our own.  In fact, he states that without us our microbes would do just fine; but without all of the microbes that cover our skin, colon and every crevice of our body, we would essentially be losing an organ critical to our survival.  In other words, we would likely be dead.

Probably one of the more telling things he mentions early in the book is how microbial diversity keeps our inner ecosystem in balance.  Just like a forest teeming with life, diversity promotes inner balance.  However, when a keystone species within that ecosystem is lost, the ecosystem, or a large part of it, collapses as other species that were dependent on that one also thin out or disappear. Furthermore, while we focus on microbial species that are abundant in humans, these may not necessarily be the lynchpins that hold everything in place.  A great example of this is how people assume calcium is the most important mineral for maintaining bone density because it is the most abundant while current research seems to point to magnesium as being more important.  Most abundant doesn't necessarily mean most important, it only means most plentiful  This is important because the differences between our microbial genes are far more important than our human genes.  Wiping out an entire species can have huge implications on our health.

He discusses the usual dance of functions associated with the microbes in your colon, immunity as well as nutrient generation and absorption, but adds a few functions that I was unaware of.  These include blood pressure regulation, estrogen regulation, and generation of chemicals required for optimal brain development.  This could perhaps be the link between gut bacteria and autism.  The scary part is that you don't need to wipe these microbes out forever to have bad consequences, removing them during a critical time in development can have pretty serious effects.

For most of the book Dr. Blaser focuses on the stomach microbe H. Pylori and how antibiotics wipe it out.  He states on many occasions throughout the book that we don't know that losing H. Pylori is the cause of the problem, but we do know that losing H. Pylori or another microbe associated with it is not good.  This is a refreshing take because most authors try to push their agenda as being the primary reason we are seeing XYZ, but Dr. Blaser doesn't take that approach, he is much more scientific and points to changes throughout the microbiome as being important, not just the loss of a single species.

Another balanced approach he takes is towards antibiotics.  Many times throughout the book he praises antibiotics and the many problematic pathogens they have eradicated.  What he sees as the two most problematic issues with antibiotics is over-prescription and the profit system around the pharmaceutical industry.  A decade ago antibiotics were prescribed for basically everything as there was no observable downside to using them, an attitude that has been overturned by current research in to the microbiome.  Antibiotics have their use and should be taken when appropriate, but only when appropriate.  The days of haphazardly taking an antibiotic for a virus, something they don't work against, need to be over.

The biggest hurdle Dr. Blaser sees going forward is the way the pharmaceutical industry is set up.  It makes no sense for a profit driven company to develop a targeted antibiotic because that limits the number of people they can sell it to.  Broad spectrum antibiotics are where the research goes because they have a wider application and, thus, a wider customer base.  The problem here is that in addition to wiping out the bad bugs, they wipe out the good bugs and could potentially wipe out a keystone species if it is sufficiently small in numbers or multiple rounds of broad spectrum antibiotics slowly decimate the population.

Finally, another problem that is taking center stage these days is the use of antibiotics in livestock.  While most people look at the use of antibiotics in these animals as a preventative measure due to the poor conditions they are kept in, they are actually given antibiotics because it makes them grow larger.  In fact, 70-80% of the antibiotics sold today are used specifically for this purpose.  There are multiple problems with doing this including promoting antibiotic resistant microbes, antibiotic residues creeping in to our food, and runoff from farms contaminating the water supply with antibiotics.  He goes over the many repercussions of antibiotic exposure, not just from taking them in therapeutic doses, but from constant low dose exposure that we likely get from these avenues every day.

Throughout the book Dr. Blaser sheds a lot of light on how our microbiome helps us, how it has been changed, and the consequences of these changes.  While there is a focus on H. Pylori as this is the microbe he has spent most of his life studying, he is extremely thorough in covering everything.  I highly recommend this book to anyone who is concerned for their health or their child's.  A relationship between IBD, GERD, heartburn, and several other non-lethal but potentially annoying health issues can be traced to changes in our microbes.  Dr. Blaser does a great job of describing how and why these things happen and provides a prudent approach for preventing them through changes in healthcare policy and our attitude towards the necessity for drugs and procedures that may not be necessary.

Missing Microbes by Martin Blaser, MD

Gluten Freedom: Everything you wanted to know about gluten from the leading expert

I was recently looking for a new book to purchase when I came upon the book Gluten Freedom by Dr. Alessio Fasano.  Dr. Fasano is considered the expert when it comes to Celiac disease, gluten sensitivity, and gluten research.  I'm sure Cameron Diaz's new diet book will sell more copies which is kind of sad, but this book is not only solid on information, but it manages to do so while also being engaging.  I have followed Dr. Fasano's work and thought this book would provide me with the most up to date information on gluten and how it affects human health since it was just published late last month.  I wasn't wrong.

It's hard to come across a good reference book that is also easy to read on a topic as complex and scientific as this.  For the most part they are loaded with jargon and provide scientific facts with little practical information.  This book literally should be called Everything you Ever Wanted to Know About Gluten but Were Afraid to Ask.  The book is broken up in to 4 parts and each part has quite a bit to offer.

The first part, called Gluten Enters the Picture, goes over the history of gluten: what it is, and why it's problematic.  I don't want to give out a ton of the book since it's so good, but let's just say there are several reasons why most people should pay attention to gluten.  He begins by discussing the three gluten related disorders: wheat allergy, gluten sensitivity, Celiac disease, and the way each condition causes problems.  If you think this is primarily a genetic problem, think again.  The gene variants that cause Celiac disease can be found in 30% of Caucasians and Celiac disease is literally exploding everywhere from Asia to Europe to all around the globe.  Even so, you don't need these genetic variants to become sensitive to gluten and just because you have them doesn't mean that you will get Celiac disease.  Despite the gene being so common in Caucasians, Celiac disease currently affects only 1% of them which points to the environment being as important in its development as having the gene variants. One of the more troubling aspects of this disease is that studies show that as many as 3,000,000 Americans likely have Celiac disease, but only around 200,000 have been diagnosed.

Even if you don't get Celiac disease, you can become sensitive to gluten.  This is because no human has the enzymes necessary to break it down and it causes an immune response...in everybody.  Now, this doesn't mean everyone should avoid gluten and Dr. Fasano states this emphatically.  Many things we eat initiate an immune response, whether they become an issue is based on many things including age, health, and the microbiome.  Given the history of Celiac disease, looking at blood samples from every decade shows that it doubles in occurrence every decade, it's becoming a growing problem heavily influenced by our environment.  Dr. Fasano also discusses whether GMOs could be to blame(Unlikely), things that likely contribute to it, and even diagrams the specific components of gluten that are problematic for people and the responses they elicit.

Probably the most interesting part of this section was that while most people think of Celiac disease and other gluten related conditions as specific to the digestive tract, most people who get diagnosed with Celiac disease present with neurological symptoms, not digestive symptoms.  Many people never even experience digestive disturbances making the disease a chameleon.  There is a lot more to this section including leaky gut and zonulin, the brain, and autoimunity.

Part two is called Learning to Live Without Gluten and goes through most of the diet stuff: what to avoid, what you can eat, and provides a basic template for developing gluten free meals.  Part 3 is called Gluten-Free Life and goes over many of the trappings of trying to live in society gluten free, discusses pregnancy and gluten, and provides a chronological guide to living gluten free.  This is important because gluten related disorders, including Celiac disease, can strike people at any age with no history of issues with gluten containing foods in the past.  This is a drastic change from the early days of research where it was considered a solely pediatric condition that wasn't even present in the US.

There are quite a few stories of people coming down with the disease and the years of misdiagnosis that most people experienced during the early stages of Celiac research.  Despite many advances thanks to the research, many people still wait to get a proper diagnosis.  There are also quite a few tips given by people who have learned to live a gluten free lifestyle the hard way: by being diagnosed at a time when no one knew what gluten was and when availability of gluten-free food was scarce at best.

Part four is one of the primary reasons I bought the book.  It's called Going Beyond Gluten and covers what is currently going on in gluten research including the environmental factors at play(Aka the microbiome) and therapeutic interventions that could possibly lead to the previously unthinkable: worry free consumption of gluten by people with Celiac disease and gluten sensitivity.  As Dr. Fasano points out in the book, throughout the history of gluten and Celiac disease research, many things that were once held as gospel were eventually overturned as the science clarified the picture.  This includes existence of the disease in the US and Asian populations, it's prevalence, when it can afflict you, and how to successfully diagnosis the condition.

Overall this is an amazing book that clarifies quite a few things that I was uncertain about with regard to gluten.  It thoroughly goes over the research on gluten to date and also gives a glimpse at what we can expect to see come out in the future.  For someone with a gluten related disorder, it provides quite a bit of insight from people who have personal experience in dealing with a diagnosed gluten related disorder.  It contains recipes as well as helpful tips in navigating society while going gluten free, whether you are doing it for yourself or your family.  In addition, there are several resources in the back that provide help to people who may be having a difficult time going gluten free on their own.  This book should be required reading for anyone with a gluten related condition as well as people who work with them who wants to know the science behind gluten as well as how to successfully live a gluten free life.

Gluten Freedom by Dr. Alessio Fasano

Does gluten sensitivity exist?

Last week, articles took the internet ablaze questioning whether gluten sensitivity exists.  Multiple articles written by multiple people claimed gluten sensitivity doesn't exist, including this one titled, Researchers who provided key evidence for gluten sensitivity have now thoroughly shown that it doesn't exist.  These articles take a look at a study published last year that had some very interesting findings, they just didn't find that gluten sensitivity doesn't exist.  In fact, it found the opposite, that it does exist.  However, the study raises questions on those who see improvements in GI symptoms on a gluten free diet.  Those findings are:

• Gluten may not be the primary trigger in grains that induces GI symptoms in susceptible individuals
• Most of the people who improve on a gluten free diet may be responding to reduced FODMAPS and not less gluten
• Gluten sensitivity is poorly defined and the criteria for diagnosis is terribly inaccurate

Let's take a look at the study to see what we can pull from it.  The study happened in 2 parts.  In the first part, the authors followed 37 people with non-celiac gluten sensitivity(NCGS) and IBS but not Celiac disease through 3 different diets that followed 2 weeks of reduced FODMAP intake.  FODMAPs are fermentable carbohydrates that humans cannot digest but resident bacteria in the digestive tract can.  The 3 diets contained either gluten only, gluten and whey, and whey only and each person underwent each diet for 1 week.  They tested the subjects for intestinal inflammation and immune system activation as well as a subjective assessment of fatigue.  In this part of the study, gluten specific effects were found in 3(8%) of the participants, and symptoms improved during reduced FODMAP intake but worsened when gluten OR whey were introduced in subjects.

In the second part of the study, 22 subjects were given diets that increased FODMAP intake and included either gluten, whey, or no additional protein for 3 days and subjectively assessed for GI symptoms.  All subjects received all 3 diets.  This part of the study found that GI symptoms increased by similar levels in all groups with no specific response to gluten.  However, there was an order effect which means that the order that a person received each diet had an effect on the results.  In other words, people who received the diet with gluten first all had similar results to one another but different results than people who had whey or no gluten first.

So what does this study show?  First off, this study supports the notion that NCGS exists, but that only a small number of people who respond positively to a gluten free diet are responding to lower gluten exposure.  Instead, they may be responding to a reduction in FODMAP intake.  But what does that mean?

First off, NCGS is poorly defined.  To be diagnosed with NCGS you simply have to have symptoms of gluten sensitivity, not have celiac disease, and see an improvement in your symptoms with a gluten free diet.  So anyone who has IBS or other GI problems who responds positively to removing gluten qualifies.  There are 2 problems with this.  The first problem is that a gluten free diet can mean many things.  For some people it means removing grain-based foods, for others it means removing the gluten from grain-based foods.

If the culprit is specifically gluten, either one should work.  The problem is, if it's not gluten and as this study suggests FODMAPS that are the problem for most people with GI symptoms, removing grain-based foods would be a successful approach while consuming grain-based foods with the gluten removed would have little effect since they would still contain FODMAPs.  But why are FODMAPs a problem?  The answer potentially lies in something called small intestinal bacterial overgrowth, or SIBO.

SIBO is a condition where bacteria overgrow in to the small intestine.  While the large intestine houses a large number of bacteria, the small intestine houses far fewer in comparison.  When an excessive amount of this bacteria begins to take up residence in the small intestine, people experience the same IBS symptoms associated with NCGS.  In fact, some studies put the number of people with IBS who also have SIBO at approximately 80%(1, 2).  Furthermore, those who eradicate SIBO see dramatic improvements in their symptoms(2).  While there is a simple test for SIBO, the authors of the study did not test for it.  This is ironic since FODMAPS should exacerbate SIBO and IBS symptoms by providing substrate for bacteria that make their way in to the small intestine to ferment, causing bloating and gas.

The second problem that was not tackled directly in this study was gluten sensitivity that presents with symptoms outside of the GI tract.  Though gluten sensitivity and Celiac disease are both associated with GI symptoms, Celiac disease presents itself most typically with symptoms outside of the GI tract(3) and gluten sensitivity often presents itself with neurological symptoms and no GI symptoms(4).  The brain is one of the most common sites for symptoms related to gluten sensitivity including headaches, brain fog, vertigo, and more(3).  This study only looked at people with symptoms of IBS and suspected gluten sensitivity and left out people who may fit the criteria of gluten sensitivity with no GI symptoms.  So people who see relief from vertigo, headaches, rashes, or any other manifestation of NCGS without IBS were not included in this study so the results don't pertain to them.

So what can we pull from this study?  In the majority of people with symptoms of IBS and self-diagnosed gluten sensitivity, their GI symptoms may be caused by FODMAPS and not gluten.  This does not rule out that they are sensitive to gluten as gluten sensitivity can present itself with symptoms outside of the GI tract, and it certainly doesn't rule out the existence of gluten sensitivity in the population since the study showed 8% of the subjects had gluten specific effects.  The good news here is that a large chunk of people who think they are sensitive to gluten may have SIBO which is something that can be improved with a low FODMAP diet.

On the other side of the coin, people who eat a gluten free diet that contains grain-based foods with the gluten removed who still experience GI symptoms may want to look at reducing FODMAP intake as well.  Dropping grains altogether as well as legumes and a few other fruits and vegetables for a brief period, as is seen in the specific carbohydrate diet, may fix the problem if SIBO is the culprit.  Once the issue is fixed, a normal diet can resume.

Conclusion

Most of these articles professing that NCGS doesn't exist are sensationalizing the research that they use to try and support their preconceived notion.  This study showed that most people who have self-diagnosed themselves with NCGS based on symptoms of IBS are not experiencing GI symptoms due to gluten.  This is backed up by a study published earlier this year that found that only 1 in 4 people who self-diagnosed themselves with NCGS fit the criteria for diagnosis(5).  Oddly the author of the article mentioned at the beginning of this blog took that as evidence that gluten sensitivity doesn't exist, which isn't the case.  It doesn't surprise me that most people who self-diagnose themselves with gluten sensitivity don't have it.  I'd imagine most people who self-diagnose themselves with aggressive colon cancer on WebMD don't have that either.

If you learn anything from this study, it's that you should see a doctor rather than self-diagnose yourself with anything.  Another thing you should pick up from the hoopla surrounding these articles based on a study is that the authors are trying to get clicks, they're not trying to be accurate.  The title Gluten sensitivity doesn't exist is likely to grab more attention than Gluten sensitivity exists but maybe less than we thought because it will grab the attention of both people who have already decided it doesn't exist and people who have benefited from a gluten free diet.  More clicks equals more $$$.  It doesn't help that so few people even check the sources these authors cite in their work.

The final thing you should take home is that we are in the embryonic stages of gluten research, a knee jerk reaction based on a few bloggers' incorrect opinion of a study that didn't show what they say it showed isn't going to change the science.  All it does is give you an incorrect opinion that goes against what the research and MDs working in this field are seeing on a day to day basis.  Spreading it on social media without checking that it's accurate only increases the confusion and doesn't do a service to anyone.

As the research progresses I'm sure there will be further refinement since the criteria for diagnosis is so crude.  This means that some people who are undertaking a gluten free diet may learn that gluten isn't a problem and their issue may be a much simpler fix that will allow them to eat foods they thought weren't right for them.  I don't see how that's a bad thing, even if you don't want to eat gluten regularly I don't see why having the option is something you should preoccupy yourself with.  On the flip side, if you don't believe gluten sensitivity exists, why not pick up some peer reviewed journals and read them?  The internet isn't peer reviewed so any yahoo with a computer can print something and send it out to cyberspace, I'm living proof of that.  :)

Confused about gluten?  The dude who is the go to guy on gluten research just wrote a book that I referenced in this article and it clears up a lot of the confusion about the research.  Take a look...

Gluten Freedom by Dr. Alessio Fasano

Understanding stress: The autonomic nervous system

Over the last 2 blogs I have gone over stress and how it affects the body.  Stress is one of those things that many people have heard about and few understand.  Over the course of the next couple of blogs I will break down how stress is handled and things that we do in our lives that can lead to mismanagement of stress.  First, to get a better understanding of how stress affects the body, it's important to understand a part of your peripheral nervous system that controls mostly involuntary functions such as heart rate, breathing rate, bood pressure and digestion called the autonomic nervous system.

Autonomic Nervous System 101

The autonomic nervous system is the control center of your vital organs.  It helps prepare the body for the environment it 's in by directing resources to the most pressing needs.  It does this through it's three branches: The sympathetic, parasympathetic, and enteric branches.  It used to be broken down in to the sympathetic and parasympathetic branches until it was learned that the enteric branch, which controls the digestive system, can function without assistance from the parasympathetic branch.  Since we know very little about the specifics of the enteric branch outside of how it's controlled by the sympathetic and parasympathetic branches, we'll simply consider those 2 branches.

The sympathetic branch of the autonomic nervous system is also referred to as fight or flight.  When sympathetic nervous system activity increases it diverts blood flow to muscles and away from the organs of digestion, increases heart rate and blood pressure to increases oxygen to muscles, and mobilizes energy for use to either fight or flee a stressor.  The parasympathetic nervous system directs blood flow away from muscles and towards the organs of digestion while decreasing heart rate and blood pressure.  The parasympathetic nervous system is referred to as rest and digest.  The picture below shows the primary functions of each branch.

Looking at this figure, it would be easy to think of the 2 branches as being antagonistic to one another, but that isn't the whole story.  While the effects of increased activity of each system is antagonistic of the other, they are actually complementary to one another in the grand scheme of things.  While fight or flight allows you to battle a stressor in the environment, rest and digest allows you to recover from that stressor and be prepared for the next.  In this way, proper function of one branch is dependent on proper function of the other.


The sympathetic and parasympathetic branches also have other effects throughout the body, but they are much more nuanced.  During the initial stages of increased sympathetic nervous system activity, the immune system is enhanced, but if sympathetic nervous system activity is increased chronically, it has a depressive effect on the immune system.  This is thought to be one of the processes underlying the increased inflammation found in the metabolic syndrome and heart disease.  In the reproductive system, increased parasympathetic activity promotes erection while increased parasympathetic activity induces orgasm.

At any time, most people are at varying degrees of both sympathetic and parasympathetic activity.  The autonomic nervous system doesn't function in an on/off manner; when sympathetic nervous system increases it doesn't completely shut off parasympathetic activity.  Instead, they are both typically activated to some degree with increased sympathetic activity typically causing a decrease in parasympathetic activity and vice versa.  Under extreme circumstances in either direction, one can  basically be forced in to the other due to dysregulation in the system.  In other words, if someone is under constant, unabating stress that is never recovered from due to poor parasympathetic "tone", they will be forced in to a long term parasympathetic state.  In converse, someone who completely removes stress and physical activity from their life is likely to see a lowered threshold for activating the sympathetic nervous system.  In other words, things that pose a minor threat are handled as major ones.

Conclusion

The autonomic nervous system is comprised of three branches with opposing, but complementary, functions that allow us to adapt to the environment we are in.  Increased sympathetic activity prepares the body to respond to a stressor while increased parasympathetic activity helps the body recover from it.  Under normal circumstances, the sympathetic and parasympathetic nervous systems work together to help you respond to the world you live in.  Under extreme conditions, the autonomic nervous system can become dysregulated making the individual's response to the environment exaggerated and maladaptive.

In my next blog I will go over how lifestyle factors can contribute to dysfunction in the autonomic nervous system.

L-Carnitine, red meat, and heart disease

In a recent article that hit most every newsroom last week, red meat kills people again.  Here is a link to one of the articles (1) and here is a link to the actual study (2).  The headlines that hit the newsstands were along the line of, "Red meat increases heart disease!" and things along that nature.  If the rate that nutritional information does a flip flop doesn't normally give you vertigo, it will today.  In an article published less than a week later, researchers note that an increase in L-Carnitine is protective in people who have just experienced a heart attack (3).  Before I show you why you should not rely on the news media to dictate your lifestyle choices, let's look at what each study showed.

In the first study, researchers compared the effect of L-Carnitine supplementation between meat eaters to non-meat eaters.  In meat eaters, bacteria in the gut fermented L-Carnitine in to TMAO, a chemical known to accelerate atherosclerosis while this effect was non-existent in non-meat eaters.  Since L-Carnitine is high in red meat, researchers believed that constant red meat consumption led to changes in gut flora that promotes an environment beneficial to creation of TMAO.  So, excessive red meat consumption leads to higher levels of bacteria that convert Carnitine to TMAO and this can increase atherosclerosis.  Check!

The second study was a meta analysis (Large study evaluating many studies) and found that using L-Carnitine was beneficial in the recovery from a heart attack.  People who used L-Carnitine were less likely to die from any cause, were less likely to experience arrythmia, less likely to experience angina, and had smaller infarct size than those who did not use L-Carnitine.  So, Carnitine conveyed a benefit to the person using it, specifically for heart health.

These 2 contradictory studies highlight a couple of problems.  First, the headlines that state, "Red meat increases heart disease" are wrong.  Having a specific type of gut flora that may be found in meat eaters would indicate you shouldn't take L-Carnitine supplements.  If you don't eat tons of red meat you are unlikely to have gut flora indicative of the people in this study that had a problem with TMAO.  Next, by looking at the study we can find the limitations of what the study can say.  One thing of note was that this study did not control for veggie intake.  What if the benefit of being vegan wasn't that you are not eating red meat, but that vegetable intake is high?  A meat eater that eats a lot of vegetables would have very different gut flora than a meat eater who eats none.  Maybe the vegan diet is beneficial because of the high vegetable intake, not because of a lack of meat.  This is one of the reasons the Synergy Wellness Program recommends a large diversity of foods.  A larger diversity of foods allows the bacteria in your gut to be diverse, preventing pathogenic bacteria from being able to grow to a capacity that could impact your health.

One of the problems with getting your science information from the popular press is that they seem to ignore what a study shows as well as the limitations study design put on what you can extract from a study.  When you see an article that one week shows coffee to be bad for you, then the following week find one that says it's bad for you, more often than not the problem isn't that the data is conflicting it's that people are ignoring the fact that certain types of data are not appropriate for drawing conclusions.  Even when the data is appropriate, the title of the article is meant to grab your attention, not be scientifically accurate.  Keep this in mind whenever you are looking at "science" in the popular press.

Health Research Recap (Gut bugs edition)

Well, I was going to stop doing a Health Research Recap and then a ton of gut bug studies popped up this week.  Moving forward I will only do these recaps periodically so I can focus on other stuff, but here's what we have this week.

The microbiome, the collection of bacteria that colonizes your entire digestive tract is incredibly complex.  There are so many things to consider when trying to build a healthy, diverse microbiome, but why build a diverse microbiome?  A diverse microbiome is clearly associated with health, and a disturbed microbiome is found in many health conditions such as inflammatory bowel diseases, autism, Type 2 diabetes, and depression.  At this point it is clear as to how to build a healthy microbiome.  In a presentation at the Gut Microbiota for Health World Summit, experts presented what we currently know.  A diet high in fruit and vegetables provides ample substrate to build a diverse microbiome while antibiotic use, being delivered by C-sections, frequent use of NSAIDS, and not being breastfed are all factors that can lead to a less diverse microbiome.

The effects of antibiotics on the microbiome were also discussed in relation to weight gain as there is a clear association between antibiotic use in childhood and weight gain later on in life.  A study looking at Crohn's disease identified the specific strains of bacteria that are affected in the disease, and as the abundance of specific strains of beneficial bacteria becomes reduced, the abundance of pathogenic strains begins to increase.  While antibiotics are frequently used to help combat Crohn's, they may be contraindicated because they are not selective in which bacteria they effect, and reducing the number of beneficial bacteria may have the same effect as increasing pathogenic bacteria by removing competition.  Since this study indicates a clear pattern in the microbes that are affected, it seems obvious that these strains compete with one another for resources and a dual approach of reducing the bad guys while increasing the good guys is the best course of treatment.


Good or bad, there will always be competition between bacteria that require the same resources.  Co-infections of parasitic organism is very common because some share common food sources, and treating one without treating the other can lead to problems as they may have been keeping each other at bay until you removed the competition for resources.  Both are simply trying to survive so competition may prevent one from taking a stronger hold in the body.  Beneficial strains of bacteria are known to crowd out pathogenic strains via this competition.  Candida albicans is typically a benign strain of yeast found throughout the digestive tract and may even exert some beneficial effects.  People with HIV tend to have higher levels of C. albicans and lower levels of a different strain called Pichia while the reverse is seen in healthy people.  Candida overgrowth is common in those with HIV, and it turns out that Pichia and C. albicans compete for resources in a petri dish.  This indicates that Pichia may help keep C. albicans levels in check by limiting the amount of resources it has to grow.

In addition to competing, parasitic organisms can also team up against you.  The fungal form of Candida albicans cannot colonize teeth effectively, but is often found in the oral cavity.  On it's own C. albicans won't adhere to teeth, but in the presence of Streptococcus mutans it develops the ability to adhere to teeth as the enzyme that S. mutans uses to metabolize sugar also causes C. albicans to produce a glue-like substance that causes it to bind to S. mutans and adhere to teeth to form plaque.  In the presence of both organism, the risk for cavities doubles and the severity of cavities increases seven-fold.

The microbiome is a critical factor in the development of the immune system.  Mice raised to be microbiome free have a reduced ability to fight infection as they have a poorly developed immune system with fewer immune cells.  This effect is not only seen in the gut where the microbiome exists, but throughout the body as well.  Since these are areas where bacteria don't typically exist, it appears that the organisms that make up the microbiome are exerting their effects from the gut on the entire body.  The vagus nerve is believed to be the "string" these bacteria are pulling to exert these body-wide effects because when you cut the vagus nerve the beneficial effects of probiotics disappears.  When you look at the vagus nerve and where it connects, it makes perfect sense as the vagus nerve connects the brain and gut together.  This could also explain why brain and gut health are so closely linked.

It is clear that our understanding of the microbiome is in it's infancy.  We are just starting to unravel the effects of specific strains of bacteria on gut and overall health.  Lactobacillus rhamnosus is a probiotic strain that has been studied at length and shown to help support those with poorly developed microbiota.  It exerts some of it's effects via the production of a protein called p40 that, when attached to receptors of intestinal cells, exerts an anti-inflammatory effect and prevents cell death.  While it would be nice to be able to simply take a few probiotic strains to heal many of the conditions that a disturbed microbiota is associated with, it's not that easy.

It's not just which bugs you have, it's how they interact with one another as well.  In a study looking at gut bugs and autoantibodies in Type 1 diabetes, researchers found that the microbiome of children who would eventually develop diabetes autoantibodies was similar to that of children who would not, but the bacterial populations within their microbiome interacted differently with one another.  This adds yet another layer of complexity in the way the microbiome influences health and shows us that further study is certainly needed.

Overall it looks like the next major step in health and medicine will look at gut health as central to optimal health.  The gut is a major interface between the environment and our internal environment, so it makes sense to make sure this barrier does what it's supposed to.  One of the keys to optimal gut health is a healthy and diverse microbiome.  At this point we have yet to determine exactly what a healthy microbiome is.  At this point the best advice is to eat a diverse diet rich in plant material, use antibiotics only when necessary and with probiotics to support your microbiome, and reduce the use of non-steroidal anti-inflammatory drugs.  For the health of your children, it is probably best to make every effort to give birth naturally and breast-feed them if at all possible.  Eating probiotic foods such as kimchi, sauerkraut, and raw yogurt or kefir if you tolerate dairy may also be beneficial.

Health Research Recap (Week of March 3, 2014)

Researchers believe Alzheimer's disease may be a more common cause of death than reported.  The CDC estimates that 83,494 deaths are caused by Alzheimer's per year.  Researchers looked at a group of 2,566 people aged 65 or over who routinely underwent testing for dementia.  The cause of death in 1/3 of the 1,090 who died could be attributed to Alzheimer's disease.  This translates to roughly 503,400 deaths per year from Alzheimer's, almost as much as heart disease and cancer.  The risk of death increased by 400% in those between the ages of 75-84 and 300% in those over 85 who were diagnosed with Alzheimer's disease.  The average time from diagnosis to death was approximately 4 years.  This problem is likely to get worse as baby boomers get older.

A study looking at children with parents that were smokers found that children who had 2 parents that smoked developed thicker artery walls than children whose parents didn't smoker or who only had 1 parent who smoked.  The increased thickness is likely not an issue for an otherwise healthy person, but it does increase their risk of heart disease and likely exacerbates other risk factors that they may experience such as a bad diet, excessive stress, or becoming smokers themselves.

Hops, one of the most beautiful and glorious plants on the planet, contain polyphenols that help fight cavities and gum disease by preventing bacteria from being able to adhere to surfaces in the mouth as well as the release of bacterial toxins.  Unfortunately for beer drinkers, these polyphenols remain with the spent hop plant, they do not make their way in to delicious, life-giving beer.

It's nice to see scientists band against idiocy.  A group of researchers recently penned a paper warning about taking the results of single studies that often look at single factors and drawing large scale nutritional recommendations from them.  This paper was primarily directed at the many anti-meat articles coming out in the press lately.  Many of these studies are done in mice who are fed meat without any other food types that protect against cancer such as fruits and vegetables and therefore can't really be applied to humans eating a mixed diet.  The most recent one that has taken the interwebz by storm which showed increased animal protein consumption increased the risk of death was epidemiological, so it's basically garbage with regard to drawing any conclusions.  It would be like saying practicing yoga causes meat consumption to go down.  While people who do yoga may eat less meat, the act of practicing yoga doesn't cause meat consumption to go down, there is merely a relationship between the 2.

Children with higher levels of the omega-3 fatty acid DHA tend to sleep better than children with lower levels.  Children who were supplemented with  DHA levels tended to get 1 more hour of sleep and awoke 7 fewer times per night than children given corn or soybean oil.  Unfortunately corn and soybean oil are inflammatory so I wouldn't consider them suitable placebo oils, therefore we can't tell with 100% certainty that the effect was from a positive effect from the DHA or a negative effect of the other oils.  Since most people likely consume many times more soybean or corn oil per day from processed foods and little to no DHA, it's safe to say that the effect is likely from a beneficial effect from the DHA.

The slow turn away from the bad advice to avoid saturated fat and replace them with polyunsatuated fats and carbohydrates gained some momentum this week as a British MD wrote an editorial in the journal Open Heart condemning the crappy science that those recommendations are based on. 

Consuming a diet high in fruits and vegetables is associated with a decreased risk for preterm delivery in pregnant women.  The authors point out that since the study was epidemiological, all you can really say is that a pregnant mother's diet will have an effect on whether or not she delivers early, not that avoiding fruits and vegetables causes preterm delivery.

Looks like Type 2 diabetes may be as epigenetic as it is genetic.  Researchers looking at the disease found epigenetic changes to over 800 genes in people who have the disease.  To assess whether the changes cause diabetes or diabetes causes the changes, they looked at healthy people and found that those with risk factors for the disease such as BMI or higher blood glucose were already developing these changes before the disease developed.  While people are awaiting a drug that will allow them to be able to sit on a beach, sip coronas, and eat ice cream cones ad libitum without getting Type 2 diabetes, they can improve their epigenetic risk factors by avoiding processed foods, reducing the amount of time per day they sit, and getting regular physical activity.

Taking antiobiotics appears to be a pretty significant risk factor for C. Difficile infection in kids.  No news here, other than doctors are still prescribing antibiotics that children don't need and this has unwanted consequences.  71% of C. Difficile infections in US children aged 1 to 17 occurred shortly after taking antibiotics, which wipes out your gut microbiome and doesn't differentiate between good guys or bad guys.  Unfortunately, many of the cases were in children whose initial problem would not be fixed with antibiotics.  Shame.

There's a new program for children with autism in North Carolina and 5 other states.  The program hopes to improve the lives of children who are graduating high school through development of social skills.  Info on the program can be found here.

Health Research Recap (Week of February 24, 2014)

A study on the effect of BPA on pregnant primates found that very low levels of BPA, levels similar to those found in human fetuses, can negatively impact the fetus of the pregnant mother.  BPA had an adverse effect on the develop on the lungs, heart, ovaries, and brain of developing fetus and indicate that chronic, low dose exposure to BPA may have a more detrimental impact than previously thought.

If you think you are only exposed to BPA through plastic drinking containers, think again.  A source of BPA that most people don't know about is found in receipts you get from the store.  Researchers wanted to find out if exposure from receipts had a significant impact on those handling receipts for 2 hours a day(Such as cashiers)  They found that handling receipts without gloves for 2 hours caused the level of BPA found in the urine to increase while handling them with gloves led to no significant increase in BPA in the urine.  Of particular note is that traceable BPA levels were found in 83% of the people before the no-gloves condition and in 100% after.

There's good reason not to throw away that sprouted garlic in your refrigerator.  Researchers found that when garlic was sprouted for 5 days, it contained many new chemicals that protected the young plant that may also be of benefit to humans.  Of particular interest is that the antioxidant activity of sprouted garlic was higher than unsprouted garlic and there were more potentially beneficial metabolites that require further study. one of which protected cells from different types of damage.

It seems the number of psychological side effects related to the use of anti-depressants may be worse than thought.  In a study of people aged 18-25, researchers found that in some cases, a majority of people using these drugs experienced psychological side effects.  The side effects most reported in included sexual difficulties(62%), feeling emotionally numb (60%), and withdrawal effects.  Despite experiencing these issues, 82% stated that they felt the drugs were helping their depression.

It appears as though you can die of a broken heart.  Researchers looking at the likelihood of death within the 30 days after a loved one passed found that the risk of stroke or heart attack doubles for those who have lost a loved one.  Apparently the increased stress associated with bereavement may be too much for some people to take.  In addition, some of the bereaved also neglected to keep up with taking their medications post-bereavement.

Those born by C-section are 26% more likely to become overweight adults according to a new study.  While birthing method probably has some effect on genetic expression due to many factors, this study must be taken with a grain of salt as there are many factors that could contribute to this process.  If these results hold up, it is likely that the effect would be mediated by a change in gut bacteria as those born by C-section are not inoculated with their mother's vaginal flora as they do not pass through the birth canal.

In good obesity news, the rate of obesity in those aged 2-5 has declined significantly by 43%.  While this is certainly terrific news, the obesity rate as a whole has remained the same and women aged 60 and older saw an uptick by almost 20%.  While the news about youngsters is certainly encouraging, the news about older women will likely have a large impact on healthcare costs that are already too high.

In monkey see monkey do news, it has been long known that people in lower socioeconomic areas are more likely to become obese or have type 2 diabetes.  In a study looking at people within these areas, the researchers found that the individual socioeconomic status of people in these areas didn't matter, even people who are better off that live in this area are more likely to be obese or have type 2 diabetes.



Research has shown a link between low vitamin D3 levels and autism, and now new research indicates why this may be.  Researchers found that vasopressin, oxytocin, and serotonin, 3 brain hormones associated with social behavior, appear to be activated by vitamin D3.  The researchers believe that supplementation with D3, serotonin, and omega 3 oils could help relieve some of the symptoms associated with autism.  Daily sun exposure, eating foods with tryptophan, and eating fish or grass fed beef are likely better alternatives to get these nutrients.
 

Health Research Recap (Week of February, 17, 2014)

Researchers found that children who were exposed to even mild to moderate family problems between birth and the age of 11 experienced impaired brain development when compared to children who didn't experience these problems.  The children who experienced this stress had a smaller cerebellum, a part of the brain responsible for motor development, skill learning and stress regulation.  The children were also more likely to experience psychiatric illnesses later in life.  An interesting aspect of this study was that children who experienced the problems later, around the age of 14, actually experienced an increase in cerebellum size, indicating that when the child is exposed to stress is an important factor as well.

Researchers and Norway have identified a link between hip fractures and magnesium intake.  They started by looking at the distribution of hip fractures in Norway as hip fractures are common there.  Once they established the areas where hip fractures were happening, they began looking at the magnesium and calcium content of the local water supply.  They found that people in areas where there was more magnesium in the water were less likely to experience a hip fracture than people who lived in an area that had less magnesium in the water.  They found no link between the calcium content of the water and hip fracture risk

Levels of the hormone Irisin, a hormone released after exercise, can be used to predict biological age in humans.  Irisin helps the body set metabolic rate by signaling fat cells to burn energy rather than store it.  Irisin isn't only important for metabolism, it's important for brain function as well.  Aside from it's job in helping regulate metabolism, Irisin also increases secretion of brain-derived neurotrophic factor, an important protein that is neuroprotective to the brain and thought to help prevent neurological diseases.  BDNF works by helping current neurons in the brain survive and by building new neurons, a process called neurogenesis.  While chronological age(Age in years) is what most of us use to define age, biological age can be defined by the biological state of the body.  Someone who is 50 years old but has better brain function, muscular function, and appears younger looking than someone who is 40 has a lower biological age.  People with higher levels of Irisin after exercise were younger in biological age than people with lower levels.

Taking high doses of the antioxidants Vitamin E and selenium may not be a good idea for men who don;t need them.  A recent study found that taking Vitamin E or selenium a standalone supplements increase a man's risk for high grade prostate cancer by 111% and 91%, respectively.  In an otherwise healthy person who is not deficient in these nutrient, there is no proven benefit to taking them.  The study did not look at using them as part of a multivitamin.  Unless you are using vitamin E or selenium to correct a deficiency with the help of a medical practitioner, I'd stay away.

We all know that teaching your children about the importance of a good diet can help them remain slim throughout life.  A new study found that being an involved parent, in general, can also help your children become slim adults.  The involvement doesn't need to necessarily be centered around food.  Just playing with your child, asking them how their day went, or just spending time with them are all potential ways to improve their chances of not becoming obese as they grow old. 

Involving children in developing programs to reduce obesity can have a powerful effect.  "Sodabriety", a program developed by teens in Appalachia to reduce sweetened beverage consumption has been very successful at reducing soda consumption and increasing water consumption.  Involving the people you are trying to change in designing the change can promote a sense of identity and togetherness as well as reducing the potential for negative peer pressure.

It appears that there may be something behind the notion that our tinkering with wheat has caused it to become more of a problem than it used to be.  People with IBS reported an improvement in digestive symptoms when they ate wheat products made from an ancient species of wheat.  When they ate modern wheat, there was no improvement in symptoms reported.  Furthermore, blood tests revealed a decrease in inflammatory markers when people were eating wheat products made from the ancient strain but not when they were consuming the modern strain.  Get ready for a flood of "Ancient" bread products in 3...2...1...

Finally, low and middle income families who live in areas with high fruit and vegetable prices are more likely to have children who are obese than people who live in areas where these foods are lower in price.  Families living in areas with high soda prices were less likely to have obese children, but this effect was not seen in areas with higher priced fast food.  They pointed out this may simply be a product of supply and demand, and areas with people who eat more fast food are more able to raise their prices than areas where people eat less fast food.