Writing this edition of my health newsletter aboard an all-you–can-eat-and-drink cruise ship seems a bit dissonant, but I was asked to speak about cutting edge medical concepts to a group onboard; should I tell them that chocolate makes depression worse, not better?1 And that limiting alcoholic drinks to 1-2 a day is best while they try to enjoy their time on the boat?2 Soda pop will also be flowing freely, increasing the passengers’ risk of diabetes and heart disease.3 And the more “fat-free” sweets they eat the higher their cholesterol will be.4 While on their vacation, could they be receptive to the science of the glycemic index, which shows that the higher the sugar content of foods the higher the risk of heart disease?
Some of the passengers will eat well, meditate and maybe do a little yoga and chi gong on the trip to improve their mood5 and lower their inflammation levels to prevent diseases like dementia.6 But, the vast majority will feel justified in enjoying their vacation by indulging in precisely the same habits they have grown accustomed to when they seek to escape the harsh life they are likely to be toilingwith on Terra Firma. And this is why I will not to be a party-pooper; I will focus my talk on a more veiled concept, like the journal Science finally highlighting the simple concept that most of the immune system is in the gut; it is there where diseases and obesity begin.
Hugo Rodier, MD
“The Microbes Made Me Eat It”
We share our bodies with a huge array of microorganisms. Many of these live in the intestine and number in the trillions. The interaction between our immune system and these gut microbes plays an important role in the metabolic diseases that plague developed countries, with profound implications for the rise in obesity and what can be done about it.7
The concept that gut microbes may be messing with our metabolism and “forcing” us to eat the sugar they thrive on is not new; but when the journal Science speaks, doctors listen. So, prepare for doctors who read journals, rather than listen to drug reps, to start talking about improving your gut environment with better diets, which they have not done in the past.8
Then, there is the possibility that the obese may lack a gene in the intestinal mucosa or lining that not only protects people from infections but also governs their metabolism; both of these functions are found in the gut:
Metabolic syndrome is a group of obesity-related metabolic abnormalities that increase an individual’s risk of developing type 2 diabetes and cardiovascular disease. Mice genetically deficient in Toll-like receptor 5 (TLR5), a component of the innate immune system that is expressed in the gut mucosa and that helps defend against infection, exhibit hyperphagia and develop hallmark features of metabolic syndrome, including hyperlipidemia, hypertension, insulin resistance, and increased adiposity. These metabolic changes correlated with changes in the composition of the gut microbiota, and transfer of the gut microbiota from TLR5-deficient mice to wild-type germ-free mice conferred many features of metabolic syndrome to the recipients. These results support the emerging view that the gut microbiota contributes to metabolic disease and suggest that malfunction of the innate immune system may promote the development of metabolic syndrome. 9
It sounds complicated, but it is very simple: our immune system in the gut is driving a lot of diseases in our body. Perhaps the most common and in the long run the most devastating, is how the gut determines how we metabolize our food. If this is not done properly because we got our gut flora used to processed foods, we will grow obese and have many inflammatory diseases.
Gut flora imbalances begin innocently enough; symptoms like gas production are often dismissed with veiled accusations that the patient is too anxious and swallowing air. But, in reality, the bad bacteria in our gut are producing the gas, which may also lead to constipation.10 The latter problem is also dismissed with a recommendation to take a laxative, thereby missing an opportunity to work on nascent gut serotonin problems; if left untreated, excessive gas, constipation and other chronic digestive problems will disrupt our brain-gut connection by messing with our serotonin system, 90% of which is found in the gut.11
And on a related note, metabolic problems may also lead to gall bladder stones.12 Other than eschewing processed foods we may also try curcumin/turmeric to treat the stones13 before your surgeon takes out your gall bladder without telling you what started the problem.
Vitamin D update
Ironically, we are sailing into a storm. Hopefully most people on the boat know about supplementing this pre-hormone. Here are yet more studies about doing so safely:
“Vitamin D Insufficiency May Be Linked to Allergies, Asthma,”
J. Family Practice News May 1st 2010, page 32
“Vitamin D deficiency in urban youth with asthma,”
J. Pediatrics 2010;156:A3
“Low Serum 25-Hydroxyvitamin D Levels Are Associated with Increased All-Cause Mortality Risk in a General Population: the Troms study,”
European J. Endocrinology 2010;162:935
“Association of A1C Levels With Vitamin D Status in U.S. Adults: Data from the National Health and Nutrition Examination Survey;” check vitamin D levels in diabetics.
J. Diabetes Care 2010;33:1236
“Randomized Trial of Vitamin D Supplementation to Prevent Seasonal iInfluenza A in Schoolchildren,”
American J. Clinical Nutrition 2010;91:1255
“Vitamin D and the Magic Mountain: The Anti-Infectious Role of the Vitamin,”
J. Pediatrics 2010;156:698
The risk of respiratory infections, including TB, influenza, pneumonia, and other upper and lower respiratory tract infections, is much greater in children with vitamin D deficiency (serum 25(OH)D <10 ng/mL). This inverse relationship between vitamin D status (low in winter and high in summer) and infection is what was found when rickets was epidemic. Recent experiments have shed light on the immune-enhancing properties of vitamin D that combat M tuberculosis and other infectious agents. The concept prevalent in the late 19th century that infections caused rickets can now be reversed, because mechanisms exist by which vitamin D deficiency leads to increased infections.
So you want to live longer
Cultivate loving relationships, exercise, take relaxing vacations while reading a good book like “Fever Dream” by Preston and Child14 and eat good food. More specifically, avoid the 4 behaviors that, when combined, increase 4 times the risk of death: tobacco, alcohol, less than 3 fruits and veggies/day and physical activity less than 3hrs/wk.15 Other than that:
“Glucose Restriction Can Extend Normal Cell Lifespan and Impair Precancerous Cell Growth Through Epigenetic Control of TERT and p16 Expression;” epigenetics means that food and chemicals influence how our genes are copied and tailored.
FASEB J. 2010;24:1442
“High Glucose Inhibits Glucose-6-Phosphate Dehydrogenase, Leading to Increased Oxidative Stress and β-Cell Apoptosis;” apoptosis is cell death.
FASEB J. 2010;24:1497
“Insulin Resistance Predicts Mortality in Nondiabetic Individuals in the U.S.,”
J. Diabetes Care 2010;33:1179
“Metabolism and Cancer in La Jolla;” poor use of energy from food = cancer = premature death.
J. Cancer Research 2010;70:3864
“Coffee Consumption and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Japanese Women;” coffee in moderation reduced mortality.
J. Nutrition 2010;140:1007
“Whole-Grain, Cereal Fiber, Bran, and Germ Intake and the Risks of All-Cause and Cardiovascular Disease–Specific Mortality Among Women With Type 2 Diabetes Mellitus,”
J. Circulation 2010;121:2162
“Xanthones from Mangosteen Inhibit Inflammation in Human Macrophages and in Human Adipocytes Exposed to Macrophage-Conditioned Media,”
J. Nutrition 2010;140:842
“Chamomile May Reduce Anxiety, Depression,”
J. Family Practice News April 15th 2010, page 21
“PSA Levels Altered by Use of Thiazide Diuretics, Statins, NSAIDs,”
J. Family Practice News April 15th 2010, page 1
“Vitamin K: is micronutrient inadequacy linked to diseases of aging?”
American J. Clinical Nutrition 2009;90:889
“Type 2 Diabetes Prevention: an opportunity for a new discipline,”
J. Clinical Diabetes 2010;28:49
“Eusinophilic esophagitis; clue to food allergies”
J. of the American Medical Association 2010;303:1245
“Questionable Antipsychotic Prescribing Remains Common, Despite Serious Risks,”
J. of the American Medical Association 2010;303:1582
“Studies Probe Possible Link Between Bisphosphonates (Fosamax) and Femoral Fractures,”
J. of the American Medical Association 2010;303:1795
“Characterization of the Metabolic and pPhysiologic Response to Chromium Supplementation in Subjects with tType 2 Diabetes Mellitus,”
J. Metabolism; Clinical and Experimental 2010;59:755
“A Diet Based on High-Heat-Treated Foods Promotes Risk Factors for Diabetes Mellitus and Cardiovascular Diseases,”
American J. Clinical Nutrition 2010;91:1220