Thursday, December 19, 2019

Time restricted eating.


Counting calories for weight management is not only tedious but ultimately ineffective. Clinical studies confirm that most dieters increasingly skip the counting, stray from their diets, and in the long run regain lost weight. 
Intermittent fasting (or time restricted eating) offers an effective alternative to calorie counting.
By limiting pancreas stimulation, it is also beneficial for patients with metabolic syndrome, pre-diabetes, and diabetes,  all of which are linked by altered insulin metabolism.
We all fast when we are asleep, and then eat from 7 AM to 6 PM with a snack later in the evening. Ergo most of us have an eating interval of 12 or 13 hours alternating with a fasting interval of 11 or 12 hours.
Intermittent fasting as currently used in the literature (time restricted eating is technically more correct) refers to extending the length of our normal night time fast in conjunction with restricting our daytime eating hours. One of the most popular versions of intermittent fasting is called the 16:8 plan. You eat during an eight-hour window, say, from noon to 8 p.m., and then fast for the other 16. 
There is a solid rationale for extending a daily fast rather than alternating 4 or 5 days of a normal eating with 2 or 3 complete fasting days per week.  The daily schedule synchronizes your calorie intake with the body’s normal 24 hour circadian cycle, the master clock controlling multiple metabolic digestive processes. Vary the timing of eating from day to day and these processes get out of sync. Likewise the eating window should start at about the same time every day.

The distribution of daily calories across the eating interval is important. During physical activity, muscle cells actively remove glucose from the blood (to fuel contraction) and blunt a rise in blood glucose. Eating early in the day means less insulin is released to divert dietary calories into liver fat or fat cells. Thus it makes sense to distribute total daily calories 25-50-25 percent rather than, let’s say, 25-25-50 which leaves the bulk of any blood sugar rise occurring while you are more sedentary at the end of the day.

In this recent study on intermittent fasting nineteen individuals shortened their normal daily eating interval of 15 hours to 10 hours without limiting their calories,  the kinds of food that they ate, or how much they exercised.
The results?
  • Individuals ate an average 200 fewer calories per day (without trying) and lost an average of 7 pounds over the following 3 months.
  • They lost three percent of their body fat and reduced their belly fat by three percent
  • They lowered their high blood pressure, bad LDL cholesterol, fasting blood sugar, triglycerides, and HBA1c (a measure of poor blood sugar control).
How does limiting pancreas stimulation and minimizing blood insulin levels lead to these benefits?
When blood sugar levels rise, the pancreas responds by releasing insulin and glucose (sugar) is moved from the bloodstream in to liver and fat cells for storage.The fat cells grow larger and we gain weight. The liver also converts excess sugar calories into fat. Liver fat in turn blunts the effectiveness of insulin, the cause of metabolic syndrome, pre-diabetes, and diabetes.
Time restricted eating has become a popular weight loss strategy as many people find it easier to follow than traditional calorie restriction diets. And best of all, after the study was completed, nearly 70 percent of the participants reported that they were sticking with the diet on their own. 
Best of all, time-restricted eating is the healthiest way to eat, whether or not you are working on weight management.


https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30611-4

 https://nutritionfacts.org/video/the-benefits-of-early-time-restricted-eating/


https://nutritionfacts.org/video/eat-more-calories-in-the-morning-to-lose-weight/
https://www.medscape.com/viewarticle/923557_1 (may need password)

https://www.drmirkin.com/nutrition/long-total-fasts-may-be-harmful.html

---
Added after publication. Why time restricted eating works.
https://www.drmirkin.com/nutrition/why-intermittent-fasting-works.html 
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Sunday, November 24, 2019

Hijacking our autonomy.


The debate on the extent to which our behavior is the result of our nature (our inheritance) versus nurture (our life experiences) is one of the oldest topics in psychology. Think of nature as the genetically based pre-wiring of our brain and nurture as the influence of post conception external factors such as our culture and what we learn.



Over the last half century there has been an increased appreciation of the importance of genetics in decision making. Fifty years ago it was taught that how we were raised was by far and away the most significant factor shaping beliefs and how we lead our lives.



Today we find the pendulum has shifted and it is our genes (DNA) that are thought to have the greater impact - perhaps as much as 80%.



But genetics and past experiences are just modifiers and a final  decision is still our choice and not predestined…..maybe. Additional modifiers have been identified and suggest our free will may not be quite as free as we’d like to think.



How we react to our world is the result of the complex interaction of many small molecules (chemical neurotransmitters) at the connection of the brain nerve cells. And we now have many examples of how this interaction can be biased by various biologic agents.



An good example is a tropical ant infected with a species specific fungus. The fungal cells produce a chemical (a neurotransmitter) that leads to very un-ant like behavior. Just before dying, the ant leaves its nest and climbs a nearby plant.  It then bites down on a leaf and its jaws lock as it dies. The fungus then completes its own life cycle with the resulting spores now more easily spread by the wind.



Toxoplasma, a parasite that normally infects cats, presents a similar possibility in humans. Humans are not the usual intermediary host (which is a mouse or rat in the wild) but can be inadvertently infected. Blood work indicates as many as 1 in 4 adults have been infected during their life but a healthy immune system keeps the parasite in check.



In the mouse, the parasite hijacks the nervous system in a way that increases the odds of an infected mouse being eaten by its appropriate host, the cat. The rodent’s inborn avoidance of cat odor is dampened and its response time and coordination are slowed. So when a cat finally does pounces, the parasite has shifted the odds away from the mouse escaping.



Studies suggest parallel neurologic changes in infected humans. Data show an above average percentage of prior toxoplasmosis infections in several diseases associated with disordered thinking (schizophrenia, bipolar), as well as more frequent traffic and work site accidents which raises the possibility of slowing reflexes and coordination as well.



The toxoplasmosis parasite likewise uses neurotransmitters manipulation. They have a unique enzyme that makes dopamine (a neurotransmitter) to release into surrounding brain tissue. 



The microbiome is another example of a biologic agents that may influence our thinking. These bacteria (in our large intestine) produce a number of small molecules, among them the same chemicals (dopamine, serotonin and gamma-aminobutyric acid) used by the brain’s neurons to communicate with each other and to regulate mood.



Just as with toxoplasmosis, investigations have uncovered specific variations in the microbiome of patients with a wide range of neurologic and psychiatric conditions, including depression, autism, schizophrenia, and bipolar disorder. Whether these changes are the cause of these conditions and not a result is still being sorted out.



And the list goes on. Including chemical plasticizers (in our water bottles) with endocrine like effects as well as a similar potential in the over 2000 new chemical agents being added to the environment annually.



In the end we are still in charge of our decisions, but these examples suggests we should not take that freedom for granted.


References:
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Thursday, October 10, 2019

Using fiber to manage our weight


Statistics from early 2019 show the US obesity rate approaching 40 percent after holding steady around 35 percent a decade earlier. These numbers are even more startling when you consider it was only 20 years ago that no state had an adult obesity rate greater than 15 percent.



What’s behind this trend? Most authorities point to diet rather than lifestyle. We just eat too much, more calories than we use.  And the excess are stored for the future. Our weight sneaks up.



How does our diet differ from past generations? The most likely explanation is a shift in the ratio of plant to animal protein.



Man has been an omnivore (eating both animals and plants) for at least a million years. A unique bone disease associated with vitamin B12 deficiency (a vitamin found only in animal meat and dairy products) is proof that man has always needed some animal protein in his diet.



But analysis of fossilized feces (paleopoop) suggests that meat was a rare treat in a diet containing more than 100 grams of plant fiber a day.



With plants the primary source of nutrition, it has been speculated that it was the fiber in our ancestor’s diet that sent the signal we had eaten enough. Dietary fiber is metabolized in the colon into short chain fatty acids (SCFA). These SCFAs in turn can affect multiple metabolic pathways so it is not unreasonable to conclude they might provide the satiety signal. Eat less fiber, fewer SCFAs are produced, and we remain on the hunt for more food. So it may be the absence of adequate fiber in our diet that is the trigger to keep pouring in the calories.



Now let’s jump ahead a million years to one of the biggest changes in man’s diet over the last 50 years - the explosive increase in processed foods.



Strictly speaking, a processed food is any grocery item that has been modified from its original form.  But processing covers much more than just mechanical alteration and can include the removal of fiber as well as  fortification with additional fats as well as sugar and salt. 



Why pick on processed foods?



Twenty people, in a month long controlled study, ate an unlimited diet of highly processed foods for two weeks and then switched to unprocessed or minimally processed foods for a second two weeks. On a processed diet they ate an average of 500 more calories per day and gained an average of two pounds over the two weeks. Then on an unprocessed diet lost an average of two pounds.



There are several possible explanations.



On processed foods,  subjects ate nearly 50 calories per minute but only 32 calories per minute on unprocessed foods. Eating processed foods means you can eat more calories before your stomach signals your brain you are full. It takes far more time to chew up unprocessed foods before you swallow them, and eating more slowly usually means you eat less.



Another possibility is the form and size of the food particles. Carbohydrates, fats and proteins all must be reduced to simpler single sugars, amino acids, and fatty acids before they can be absorbed into the blood stream.



Processing reduces the size of food particles and makes further digestion that much easier.  This in turn increases the calories you absorb from that food. Grinding whole grains into flour or cooking starchy vegetables increases the number of calories you absorb from those foods.



Cooking itself modifies foods and increases absorption. Boiling, baking or frying modifies starches, markedly increasing the calories you will absorb from root vegetables such as potatoes, turnips, cassava, yams, and rutabagas.



One has to consider energy density. Even before digestion the added sugar and oils increase the calories per ounce in processed food. The same portion size contains more calories.



And finally there is the fiber argument. Less fiber for the microbiome and fewer SCFAs for the satiety feedback loop. Not to mention that processed foods contain emulsifiers as a way to prolong shelf life and keep ingredients from separating.  In mice emulsifiers disrupt intestinal bacteria (the microbiome) resulting in weight gain. If these same changes occur in the human colon, emulsifiers may be another piece of the weight gain explanation as they mean any fiber reaching the colon could be less effective in SCFA production.



What does this all mean for weight management? A few simple changes in your diet, a few less calories per day,  can pay big rewards over time.



Eat fewer processed foods. Change your route through the store. Ultra - processed foods lurk in the center aisles.  Walk the perimeter with its fresh fruits and vegetables first and go down the aisles only when you have a specific item in mind.



Add more fresh fruits and vegetables to your diet. Especially fruits and vegetables that are not cooked, ground or softened. They are great as a snack alternative.



And eat more whole grains, beans, seeds and nuts that have not been ground into flour. This includes fewer foods made from flour such as bakery products and pastas.



It will take some planning, but using what you know about fiber provides an opportunity to quit counting calories.

References:



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Friday, September 6, 2019

What's new in colon cancer?


Colorectal cancer is the second leading cause of cancer death in the United States and the third most common cause of cancer death in the world. Your lifetime risk of developing colorectal cancer is a bit less than 1 in 20.


But there is a light on the horizon. Since 2000, the diagnosis rate for those 50 and older has dropped by a third with recent work on screening and prevention showing how we can improve the numbers even further.


Colon cancer starts in the lining cells of the large intestine in a “two hit” process.


The first step, theorized to be an exposure to an environmental toxin or infectious agent in a genetically predisposed individual, initiates the rapid growth of a single cell which then, over time, grows into a benign polyp.


A second change then occurs in one of these rapidly growing polyp cells results in the first cell of a colon cancer. If this polyp is removed at this early stage, the small cancer is cured.


Left in place, however, the cancer slowly increases in size until at some point it grows through the wall of the colon. It has been estimated that the time from benign polyp to colon wall cancer is in the neighborhood of 10 years.


This physiology is the basis for screening colonoscopy. Identify and remove polyps and you will prevent, and in some cases, cure colon cancer.


The effectiveness of colonoscopy screening is the likely explanation of the drop in the rate of colon cancer diagnosis over the last 20 years. It has been estimated that over 60% of people over 50 years old have been screened.


The first of the new developments is an easier but equally effective screening test. Advances in immunologic testing allows low risk individuals to collect a small stool sample for testing. Individuals with low risk have no personal or family history of colon cancer or polyps. The stool is then tested for remnants of abnormal proteins shed by polyps. The colonoscopy is reserved to evaluate for and remove polyps only in those who are stool test positive.


This annual fecal immunochemical test (FIT) gives physicians an additional tool to take advantage of that 10 year screening window. More screening equals earlier removal (and cure) of more small colon cancers. The FIT is inexpensive, seemingly as effective as colonoscopy screenings, and more readily available to patients.


The next advance suggests we may be getting closer to the idea of preventing colon cancer rather than just finding it in its early, curable stages. It looks like colon cancer might be an infectious disease.


Thirty years ago, we found that stomach ulcers are often the result of a bacterial infection (H. Pylori) of the digestive tract, rather than the result of acid irritation alone. We now have suggestive evidence that a certain bacteria may be associated with those cell changes that lead to colon polyps and colon cancer.


High concentrations of a family of bacteria (Fusobacterium) were found in colon cancer tissue removed from more than 1000 people at surgery. Even more interesting was finding the same bacteria in an occasional colon metastases (cancer that had spread), implying an even stronger linkage. The benefits of targeting and eliminating this specific colon bacteria (with antibiotics or diet) is being investigated.


And finally, while studying the role of colon bacteria as a cause of colon cancer, there were clues as to how our diet may play a role in the initiation or inhibition of cancerous cell growth. That means making changes in our diet might decrease our personal risk of developing colon cancer.


It’s old news that vegetarians have less colon cancer, 20 - 30 percent less than non-vegetarians. But why?


One possibility could be the elimination of a cancer cell stimulant. Studies of groups on high versus low meat diets revealed a three fold variation in the concentration of nitrosamines, a potentially cancer causing compound, in their stool.


Another might be the addition of an actual inhibitor of cancer growth. The microbiome produces short-chain fatty acids as it metabolizes dietary fiber. Laboratory experiments exposing colon cancer cells to one of them, butyrate, slows and can even stop cancer cell growth. Take away the butyrate and the cells resume growing.


More fruits and vegetables, less red meat, and it appears you can impact your colon cancer risk.


Even after colon cancer’s development, diet changes impact a patient’s future course. In a study of 1,000 people already diagnosed with colon cancer spread beyond the colon, those who modified their lifestyle to a healthier diet with added exercise decreased their risk of dying over the next seven years. The risk was decreased by 42 percent compared to those who did not change their diet.



Better screening, prevention with simple diet changes, and the chance that we might eliminate one reason for that first cancer cell are three reasons I’m optimistic that the trend line for colon cancer diagnosis (and deaths) will continue on a downward trend.

References:











Aspirin may decrease CRC by its effect on the microbiome. https://www.medscape.com/viewarticle/937141

Egg and colon cancer risk via TMAO

Less meat/alcohol and more dairy = less colon cancer

https://www.medscape.com/viewarticle/958688 
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Thursday, August 1, 2019

Coffee - a health risk?


Coffee is one of the most commonly consumed beverages worldwide. Two thirds of Americans drink at least one cup of coffee a day, with the average consumption at 3.1 cups of coffee per day. In the US that’s 400 million cups of coffee a day or 146 billion cups of coffee per year.



Although that is a lot of beans, we are not even close to being a leader in per capita consumption. Finland comes in first at 12 kg of coffee per person per year with the other scandinavian countries - Sweden, Norway, and Denmark - close behind. The US places a distant 25th at 4.2 kg per person per year.



Which brings up the question as to whether all this coffee is affecting our health.  Is Starbucks vying with fast food as a leading contributor to our country’s declining longevity?



Roasted coffee is a complex mixture of more than 1000 bioactive compounds including caffeine and a number of antioxidants.  For those who drink coffee, it provides more of their daily dietary antioxidants than tea, fruit, and vegetables.



A 2017 analysis of over 200 individual studies documented a health benefit for coffee drinkers and the more cups a day, the greater the reduction in all cause mortality. There was  a decrease in heart disease and cancer as well as a number of neurologic conditions. Decaffeinated coffee was as beneficial as caffeinated coffee in its health impact. 



The longevity benefit (approximately 3% per cup) was greatest for the first four cups but even a fifth and sixth cup added an additional boost. The final numbers are impressive. A 17% reduction in all cause mortality, an almost 20% reduction in cardiovascular disease, and a similar reduction in cancer.



The liver fared even better with a 29% lower risk of non-alcoholic fatty liver disease and a 39% lower risk for liver cirrhosis (scarring). 



As did the brain. Coffee drinkers have a lower rate of developing Parkinson’s disease, a decreased risk of depression, and an amazing 25% decrease in the incidence of Alzheimer’s disease. Interestingly, a single randomized study focused on Parkinsonism, there was an improvement in movement symptoms after just three weeks of two cups of coffee a day.



Even the current diabetic epidemic was impacted positively with a 25% risk reduction.



Athletes have long taken advantage of the improvement in athletic performance with just a single cup of coffee - runners randomized to drink coffee shaved about six seconds per mile off their times while weightlifters could squat more weight. 



What about risks? 



There is a marginal increase in complaints of esophageal reflux (heartburn and indigestion).



Fracture risk is increased in women (only) -  one percent with one cup a day rising to 14% at higher daily intakes.



Interestingly there was one cancer that is statistically more common in regular coffee drinkers - ovarian cancer. The reason is not clear and this may be a statistical blip.



Coffee has a cholesterol raising effect which parallels increasing intake of unfiltered coffee. It is speculated that an oily substance in the bean, removed with a paper filter, is the culprit.  The implications of this observation are uncertain as increasing coffee consumption is not associated with more adverse cardiovascular outcomes, including myocardial infarction.



Coffee should be avoided in pregnancy based on a well documented association with low birth weight, preterm birth, and miscarriage.  Most obstetricians suggest pregnant women limit their caffeine intake to 200 milligrams (one small cup of coffee) a day.



Although most of us have heard about the risk of extra heart beats (palpitations and atrial fibrillation) from too much coffee, data shows the opposite to be true.  Caffeine does not increase the risk of atrial fibrillation. And low doses of caffeine, defined in the study as less than five cups of coffee a day, may even have a protective effect.
Finally, let’s not forget those with insomnia who are especially sensitive to the effects of caffeine.



Where does this leave us? My take aways:



1) If you are pregnant, cut back your coffee.



2) If you have a history of osteoporosis with its increased risk of fractures, cut back on your coffee.



3) Otherwise drink as many cups a day as you’d like, the more the better. We’re not yet at the point of prescribing coffee for specific diseases, but like aspirin it is a readily available, over the counter product, with surprising health benefits.
References:






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Sunday, June 30, 2019

Eating for exercise


Regular exercise along with a sound diet is key to staying healthy.  You will live longer, and they will be healthier years. Regular exercisers miss fewer days of work, have a lower overall cancer rate, experience fewer heart attacks, and are less likely to have to deal with chronic diseases such as diabetes and dementia.


You can tap into the benefits of exercise with just fifteen or twenty minutes of your time a day. Aerobic exercise (get that heart rate up) four days a week combined with resistance work the other three.  As you experience the benefits, you may find yourself adding extra weight time in the gym or walking/cycling longer distances. And you may even go on to train for a 10k run or a multi-day walking/bicycling vacation.


A common concern is how to go about planning your diet to guarantee the proper nutrition and hydration for training as well as when participating in longer events.


Muscles use both sugar and fat as an energy source. The harder you exercise, the more important sugar becomes as the preferred energy source. And in a sprint, only sugar will do.


On a balanced diet you will have enough stored sugar (as glycogen) to support 70 - 90 minutes of high level aerobic activity.


Training doesn’t require special sports drinks or power bars - even competitive  athletes get the nutrients they need from ordinary foods. You won’t need to eat for a gym workout or walk/run/ride of less than an hour at a casual pace.  Only when you are doing longer rides or runs will you need to add snacks with additional carbohydrate calories to avoid “running out of gas” as your body is forced to use less efficient fat metabolism. If that happens, you will have “bonked” (cycling) or “hit the wall” (running).


You should eat a good breakfast at least an hour before exercising - whatever you normally eat for breakfast. Avoid high sugar-added foods such as pancakes with syrup as they can may cause a steep rise in blood sugar, stimulate a surge in insulin, and result in a sudden drop in blood sugar with its associated weakness.


Many athletes undertaking a long event (where sugar supplements will be needed) will drink their supplement (liquid to facilitate stomach emptying and minimize nausea) five minutes before the starting gun, and then continue them every 15 minutes for the remainder of their ride/run.


And if they are training daily, or are on a multi-day cycling vacation, adding an extra carbohydrate snack or drink immediately after finishing will start the replacement of the body’s internal glycogen stores to be ready for the next day.


While exercising is the one time sugary drinks or snacks are OK. The exercising muscle doesn’t need insulin to use the sugar in a sports drink, soda, or energy bar. This ongoing blood glucose uptake prevents blood sugar spikes and explains why a walk after dinner, using the meal’s carbohydrates for energy (keeping them from being shunted into fat cells), is such a healthy habit.


Hydration is actually less important than you might think. Most trainers encourage using thirst as a guide to fluid replacement rather than focusing on a set fluid replacement schedule, as over correcting by drinking too much plain water can dilute the blood sodium with its own set of problems.


Hot and humid conditions, with water loss from sweating, are one time fluid replacement is needed during exercise. But how much depends on the length of the planned exercise.


Studies on the effects of dehydration on physical performance don’t show a negative  performance impact until body weight drops by 1 - 2 % (about 3 pounds for the average rider). Since you can lose up to 2 quarts of sweat an hour (3.5 pounds)  you have some cushion to protect you from over replacement.


How about energy drinks like Red Bull or Monster with their additives to pep you up when you are lagging? Several studies have highlighted frequent problems with elevated blood pressure, and several cases of sudden death have been reported. It might be safer to stick with a cold coke for fluids containing a caffeine boost, or gatorade if just for the fluid alone.


Where does this leave you? For a workout of an hour or less, drink when you are thirsty and eat if you are hungry. It is not clear why some exercisers feel the need for a snack 30 minutes into a
 workout or on a ride, but if your body is sending this message, best listen to it. But know there is no evidence that you are risking your health by not eating or drinking.


The physiology of digestion, nutrition, and athletic performance has been a personal interest for many years, so if you are considering training for a longer ride or run, my website “Cycling Performance Tips” (http://www.cptips.com/) will help you with additional suggestions on nutrition and hydration.


Additional references:

 https://vitals.lifehacker.com/what-to-eat-before-and-after-a-strength-training-workou-1798556343

 http://www.drmirkin.com/fitness/eat-to-compete.html


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Friday, May 31, 2019

A First Aid Travel Kit


Whether it's just a weekend trip or a week long vacation, packing a first aid travel kit will minimize the chances a minor medical problem will slow you down. It's likely it will remain unused, but if you have a problem (and they often seem pop up at night when all the drug stores are closed) a few simple items will save a lot of aggravation.


First a couple common sense reminders that might save the need to even think about first aid.


If it will be an active outdoor vacation, take a minute to be sure your tetanus vaccination is up to date. For over seas trips, you can find a list of recommended vaccinations on the Centers for Disease Control website (https://wwwnc.cdc.gov/travel)


If you have never checked, be sure your health insurance covers you away from home especially in a foreign country. Write down the policy number and contact information, and put them in the first aid kit.


Separate medical insurance/evacuation nsurance is usually part of any travel insurance you might have purchased for a longer trip. If you travel frequently, an annual policy such as the one available through Diver's Alert Network ( https://www.diversalertnetwork.org/annual-travel-insurance/) might make sense for you.


Prevention is key to keeping the first aid kit stowed, so keep these basic rules of general hygiene in mind: treat any any non city water that will be used for drinking and wash your hands before eating or preparing food.


On to the first aid kit.

General items:

  • Alcohol wipes.
  • Bandaids. This is the most commonly used first aid item. Take various sizes including a couple large ones which work well on the heel if you happen to get a blister.
  • Tweezers. These should have a sharp point for those tiny pieces of wood or dirt that you can't seem to be able to get to with fingernails alone. Sterilize the area and tweezers first with one of those alcohol wipes (no need to introduce more skin bacteria), and consider applying a dab of Neosporin (no bandaid necessary) to the area afterwards to lower the odds of an infection.
  • Insect repellent and sunscreen. These are not generally thought of as first aid items but will prevent the skin irritation which can lead to bigger problems.

Over the counter medications:

  • Antacid tablets. If you have a sensitive stomach there is nothing better than a change in diet to bring on that indigestion.
  • Antihistamines. If you have allergies, generic Zyrtec and Claritin are longer lasting with less drowsy side effects. If you have trouble sleeping, throw in a couple benadryl, which can cause drowsiness, and which can do double duty as a sleep aid.
  • Antibiotic ointment. Neosporin is the most common. It will speed the rate of wound healing by minimizing the low grade infections that slow the healing process. Clean the injury and apply it early. Just a day or two is enough to jump start the healing process.
  • Steroid cream. The effectiveness of steroid creams or ointments is questionable, but if you have an itchy rash, it may be that one thing you'd really want to have on hand. Benadryl can lessen the annoyance as well.
  • Pepto-Bismol tablets. They are useful for an upset stomach as well as mild diarrhea. And if taken for prevention (2 tablets 3 times a day) will cut down the chances of contracting traveler's diarrhea by 90%.
  • Imodium. For diarrhea that doesn't clear on it's own (or with pepto-bismol).
  • Cough medicine. Lozenges are easiest.
  • Aspirin or tylenol. For general aches, pains, and fever.


And finally, if you are flying, take the medical kit in your carry on. Replacing a kit which goes missing along with your luggage might be difficult in a strange city or country.


Taking just a few minutes to visit the local drug store pre trip can pay big dividends on a vacation.

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Tuesday, April 30, 2019

Picking your protein.


Excessive carbohydrate calories, especially from the simple sugars glucose and fructose, increase the risk for obesity, high blood pressure, heart disease, and even cancer. Cutting back on your daily carbs will mean increasing the fat and protein calories in your diet. But what kind of fat? And what kind of protein?

Cholesterol and saturated fats have been tagged as major risk factors for blood vessel disease (atherosclerosis) for decades. But recent work suggests they are not the most important factor in all those heart attacks.  Merely a late stage contributor to damage already well under way.

The results of numerous studies and investigations points to Trimethylamine N-Oxide (TMAO) as the real culprit.


There is proof of cause and effect. In an experimental mouse model, raising blood TMAO levels by dietary manipulation increased blood vessel disease in the absence of any changes in the cholesterol or fat content.


Numerous clinical studies of heart disease (chest pain in the ER, progression of known atherosclerotic heart disease) show a direct correlation between increasing blood levels of TMAO and cardiovascular disease.


Carnitine, a protein found in red meat and to a much lesser degree in chicken and fish, is the source of TMAO. Any dietary carnitine not digested and absorbed in the small bowel  passes into the colon where bacteria (our microbiome) metabolize it to an intermediate molecule, TMA.  TMA is in then absorbed and modified further in the liver to TMAO.


There is a similar pathway for the production of TMAO from lecithin, a protein found in egg yolks.
Solid evidence supports diet as the major determinant of blood TMAO levels. A recent study documented that a diet low in red meat and eggs lowered TMAO levels independent of the amount of cholesterol or saturated fats in those diets.


TMAO production can be reduced with oral antibiotics (which alter the makeup of the microbiome) or by decreasing the dietary intake of carnitine. Vegans as a group have the lowest blood TMAO levels (and the lowest rate of cardiovascular diseases) while those on a regular red meat diet the highest.  Just replacing red meat with chicken will lower the amount of TMAO excreted in the urine by two thirds.
What does this suggest for your diet?


Carbohydrates should be limited, and this means daily caloric requirements will be replaced by increasing total protein and fat.


Saturated fats, found in butter, cheese, red meat and other animal-based foods, do play a role in the development of cardiovascular disease, but there risk has been overstated.

Your decision on the source of the third component of the daily diet, protein, has considerable impact on your health. We know that vegetarians have the lowest levels of blood vessel disease, and your goal should be a move toward a meat free diet.


But that does not mean you have to become a vegan. You can add one or two meat free dinners a week. Or decrease red meat portion sizes. And now we know that your choice of protein, substituting chicken or fish for red meat, adds a third option.


http://www.drmirkin.com/nutrition/latest-research-on-tmao.html

https://www.drmirkin.com/nutrition/new-research-on-tmao.html

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Friday, April 26, 2019

Carbohydrates and the glycemic index


Diets high in carbohydrate calories increase the risks for obesity, high blood pressure, heart disease, and even cancer.

 Many of the health risks are related to the ease with which a carbohydrate is digested and absorbed. This is reflected in a food’s glycemic index - the higher the glycemic index, the more rapid the rise in the blood sugar after eating.

 All carbohydrates are built up from single sugar molecules. Simple carbohydrates (table sugar for example) is composed of just two single sugar molecules (one glucose and one fructose). Complex carbohydrates are made from longer chains of multiple sugar molecules.

To be absorbed from the small intestine, all carbohydrates must first be broken down (digested) into single sugar molecules. Some complex carbohydrates are easily digested (wheat flour for instance) while others are not (fruit and vegetable fiber).

 A food’s glycemic index is higher if it contains processed carbohydrates. In processed grains the outer bran and inner germ layer (which tend to bind its sugar molecules and retard their absorption) are removed from the original kernel of grain. The result?  A more rapid spike in blood sugar levels than after eating a less-processed grain.

 Table sugar is easily digested, readily absorbed into the bloodstream has a high glycemic index. As a result, these carbohydrate molecules are often absorbed faster than they can be used in normal metabolism.  The excess are converted into fat (triglycerides) and stored for future needs. This fat is the most likely culprit behind the health risks of high carbohydrate diets.

 Another negative aspect to high glycemic foods is their potential to cause “reactive hypoglycemia” (low blood sugar). The rapid spike in blood sugar levels immediately after eating stimulates the release of insulin from the pancreas. Insulin is needed to move blood sugar into many tissues. But the sugar from these foods is so quickly and efficiently absorbed that the insulin is often still working when there is no more sugar being absorbed. This leads to an equally sudden drop in blood glucose levels and symptoms of fatigue and hunger.

 Complex carbohydrates or starches are more slowly broken down by digestive enzymes and in turn more slowly absorbed. The rate of rise of the blood sugar after eating starches is less (their glycemic index is lower) and is spread over a longer period of time. The blood sugar spike is less severe, less insulin is released, sugar calories are absorbed over a longer period of time, and the body now has more time to use them as part of normal metabolism.  As a result hypoglycemia is less of a problem.

 Fiber is also a complex carbohydrate, but the sugar molecules are linked in a way that resists digestion. As a result they pass relatively unchanged into the colon.  Fiber has a glycemic index of zero.

 This poor absorption explains fiber’s health benefits. Once it reaches the colon, resident bacteria (the microbiome) which have the enzymes necessary to digest it, produce numerous small molecules in the process which can be absorbed and have proven health benefits.

 The following are a few ideas and conclusions to improve your (and your family’s) daily diet.

 First, limit your daily carbohydrate calories to no more than 50% of the daily total daily. The only exception is for those on a regular exercise program. As active muscles use glucose directly as fuel, any carbohydrate drinks and snacks that replace these exercise calories can be added to your daily total.

 Second, minimize simple sugars. Get rid of the sugar bowl on the table, take pre sweetened cereals and sugar-ed drinks out of the cupboard, and limit processed food which are often high in added sugars.

 Finally, take advantage of the health benefits of more slowly absorbed complex carbohydrates. Have an extra serving of vegetables instead of a piece of bread or a double serving of potatoes.

 And for an added health bonus, add a tablespoon of minimally digested flax fiber to your morning routine to keep the microbiome healthy.

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