At a recent meeting of doctors we discussed community issues that impact people’s health, such as nuclear and solar power, water conservation, denser housing and a tax on sugar sweetened beverages. A handful of physicians agreed that these issues are part of their calling. But, the majority in attendance did not. One of them went as far as to say that a tax on sweetened drinks showed that proponents hated the poor. Another doctor felt that education was not something doctors ought to concern themselves with.
No doubt readers will take sides just as my colleagues did, most likely along rigid party-lines that leave out flexibility and the welfare of patients. It is not my intent to aggravate the dramatic political chasm that exists in our country; but, I cannot be silent while obesity continues to climb, Western states inexorably dry up, people move in with relatives to cope with a deteriorating economy and power generation worsens pollution. My frustration mounted when 4 days after that doctor meeting, my local newspaper (The Salt Lake Tribune[1]) carried on its front page articles on the imperative need for water preservation and another one on struggling families crowding in relatives’ houses and apartments as they become unemployed and homeless.
I hope the upcoming generation of new physicians will remember what the founders of modern medicine understood and has been adopted as a principle of ethics by the AMA:
“The responsibilities of the physician extend not only to the individual but also to society and demand his cooperation and participation in activities which have as their objective the improvement of the health and welfare of the individual and the community… As good citizens it is the duty of physicians to be ever vigilant for the welfare of the community.”
Hugo Rodier, MD
Buffing up
Dietary supplements to increase muscle mass are used extensively by body builders and athletes. When one’s livelihood depends on gaining an edge over the competition it makes sense to reach for nutritional aids, as long as the substances are legal and harmless. But, in my opinion, supplementation for casual exercise buffs who just want to be healthy and look good may not be worth the bother or expense. For full disclosure I must say I work out for 100 minutes 6 times a week and that I do take supplements. But, they are aimed at general health, not body building. As it is, I end up taking a dozen different items at considerable cost of money and time. So, it is not worth it to me to look a bit more beefed up by adding to a list of supplements that I already consider a tad too long, yet, I am not sure what to cut back on, given the benefits I believe I accrue from those chosen items.
So, to add more supplements for the sake of vanity (which is what it would be since I am not in competition) seems to me an ego-driven pursuit that doesn’t add much to my health. Having said all that, the amino acid Arginine,[2] which I already take to take my blood vessels in optimal shape, has also been shown to reduce insulin resistance and build muscle. So has DHEA,[3] an adrenal testosterone precursor. Since I also supplement whey protein, I am getting enough glutamine,[4]another amino acid that builds muscle, and also helps maintain gut and brain health. I feel that these 3 products are safe and enough for me to be healthy and look… well, OK, good enough.
The 3 supplements above may be safely used in diabetics, too; those items reduce insulin resistance. Stress, poor diets, toxic environments and inactivity are the main factors that lead to poor health in diabetics. On inactivity, we just learned that even one single day of vegetating does significant metabolic damage to diabetics,[5] meaning that they do not process food as well. Imagine the cellular damage when diabetics plop in front of the TV for an evening surrounded by refined sugars.
Sweet News
“Low-salt diet increases insulin resistance in healthy subjects,”
- Metabolism Clinical and Experimental 2011;60:965
“Insulin resistance and hepatitis C: an evolving story.” Greater changes of infection in pre diabetes.
- Gut 2011;60:1139
Diet soda pop causes weight gain in the elderly; higher glucose levels with diet soda.
Am Diabetic Association, San Diego June 2011
“Impaired Fasting Glucose Is Associated With Renal Hyperfiltration in the General Population.” Pre
diabetics show kidney dysfunction. J. Diabetes Care 2011;34:1546
“Increased Risk of Hypertension After Gestational Diabetes Mellitus.” Make sure you are tested for
diabetes each year if you have had this problem. J. Diabetes Care 2011;34:1582
“Increases in central fat mass and decreases in peripheral fat mass are associated with accelerated arterial stiffening in healthy adults: the Amsterdam Growth and Health Longitudinal Study.” Your beer belly is a sign that your arteries have begun to stiffen up. Am J. Clin Nutr 2011;94:40
More on sugar addiction
Here is another article pointing in this direction. Since people have a hard time acknowledging this ubiquitous problem, I am providing the entire abstract for your review:
“Background: Food is a powerful reinforcer that motivates people to eat. The relative reinforcing value of food (RRVfood) is associated with obesity and energy intake and interacts with impulsivity to predict energy intake. Objective: How RRVfood is related to macronutrient choice in ad libitum eating tasks in humans has not been studied; however, animal research suggests that sugar or simple carbohydrates may be a determinant of reward value in food. This study assessed which macronutrients are associated with food reinforcement. Conclusion: These results are consistent with basic animal research showing that sugar is related to food reward and with the hypothesis that food reward processes are more strongly related to eating than are food hedonics.”[6]
The evidence continues to mount that the problem begins when mom eats junk food while pregnant: “Maternal “junk-food” feeding of rat dams alters food choices and development of the mesolimbic reward pathway in the offspring.”[7]
Questioning the innocence of the purple pill
These acid blockers came out when I was in Medical School. Back then we were delighted to have zantac and tagamet for serious ulcers; so, the stronger proton pump inhibitors like omeprazole were viewed as potentially problematic since acid was shut off completely. Prescribing the latter drugs required a consultation with a gastroenterologist. But, marketing of these drugs has been so intense that now they are over the counter. Gone are the days of caution.
Here is an article that should give us pause. Because people are popping these drugs like they are totally benign, I also include the abstract: “Opportunities to Decrease Inappropriate Uses of Proton Pump Inhibitors” is one of 3 articles in the journal Archives of Internal Medicine raising concerns:
“PPIs were associated with an increase in the rate of spine, lower arm, and total fractures; Howell et al showed that PPIs increased the risk of Clostridium difficile infection; and Linsky et al showed that PPIs also increased the recurrence of C difficile infection. We deliberately grouped these articles together because we wanted to draw attention to the adverse effects of these drugs given data showing that 53% to 69% of PPI prescriptions are for inappropriate indications.“[8]
Update on gut bacteria; even MS involved
Friendly organisms in the gut continue to receive a lot of attention. This is why they are advertised so much these days. (To think I was told there was no evidence to recommend them a few years ago.) Now we even know that an imbalance of gut organisms may so profoundly alter our immune system that the risk of Multiple Sclerosis goes up.[9] Of course, they depend on us eating healthy, whole food high in fiber:[10]
“The nutrient load is a key variable that can influence the gut (fecal) bacterial community structure over short time scales. Furthermore, the observed associations between gut microbes and nutrient absorption indicate a possible role of the human gut microbiota in the regulation of the nutrient harvest.”[11]
Children may benefit from supplementing probiotics, too. In fact adding more fiber to infant formula and to older children’s diets helps nurture better gut flora;[12] this can help kids with abdominal pain.[13] Fiber with zinc may also treat diarrhea through the same mechanism.[14]
Most abdominal complaints, even Irritable Bowel Syndrome appear to involve the serotonin pathways of the gut. Remember that 95% of our body’s serotonin is found in the gut. An imbalance of serotonin release in the gut is associated with the immune system therein, which is intricately associated with our friendly gut flora:
“In patients with IBS, 5-HT spontaneous release was significantly increased irrespective of bowel habit and correlated with mast cell counts and the severity of abdominal pain. Our results suggest that increased 5-HT release contributes to development of abdominal pain in IBS, probably through mucosal immune activation.”[15]
More facts about our friendly gut organisms:
Gut bacteria imbalances are associated Fatty liver; common denominator: insulin resistance. Remember that gut bacteria helps your metabolism and food processing. J. Gastroenterology 2011;140:976
Colitis is seen when people have too much bacteria like Klebsiella and Proteous mirabilis and too little bifidobacteria. J. Cell Host Microbe 2010;8:292
Parts of probiotics (after lysis or breakdown) are called Muramyl peptides: they prime immune system, like vaccines do. J. Neuro Immunomodulation 1999;6:261
Antibiotics, by compromising healthy gut flora, allow pathogenic bacteria to colonize. J. Autoimm 2010;34:J220
C section leads to gut colonization of newborn by mom’s skin flora, not gut as it should be. J. Proceedings of the National Academy of Science 2010;107:1197
[1] Tuesday September 20th 2011
[2] Dietary L-Arginine Supplementation Reduces Fat Mass in Diabetic Rats,”
- Nutrition 2005;135:714
[3] NEJM 2006;355:1647 & European J. Endocrinology 2006;155:593
[4] “Glutamine Reduces Postprandial Glycemia and Augments the Glucagon-Like Peptide-1 Response in Type 2 Diabetes Patients,” J. Nutrition 2011;141:1233
[5] “Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake,” Journal Metabolism Clinical and Experimental 2011;60:941
[6] “Food reinforcement, energy intake, and macronutrient choice,” Am J. Clin Nutr 2011;94:12
[7] J. FASEB 2011;25:2167
[8] J. Arch Intern Med 2011;17:1004.
[9] J. Proceedings of the National Academy of Science 2011;108:4615
[10] “Predicting a Human Gut Microbiota’s Response to Diet in Gnotobiotic Mice,” J. Science 1 July 2011: 101
[11] “Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans,” Am J. Clin Nutr 2011;94:58
[12] “A Specific Prebiotic Mixture Added to Starting Infant Formula Has Long-Lasting Bifidogenic Effects,” J. Nutrition 2011;141:1335
[13] “Lactobacillus GG may improve frequency and severity of pain in children with functional abdominal pain, ” J. Pediatrics 2011;159:165
[14] “Oral rehydration solution with zinc and prebiotics decreases duration of acute diarrhea in children,” J. Pediatrics 2011;159:166
[15] “Intestinal Serotonin Release, Sensory Neuron Activation, and Abdominal Pain in Irritable Bowel Syndrome,” Am J Gastroenterol 2011;106: 1290
