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Sugartown

In 1993, I actually wrote that sugar and carbs were fine. Want to be healthy? Eat more pasta and healthy grains, I wrote. Fats were the big evil. I was so wrong – but this was what the studies showed. This is what many doctors believed. Fat was our enemy. Fat was the reason we were becoming – not nearly so much as we are now, I might add – a nation of lard butts.

For decades, this was reflected in packaged “healthy” foods. Eat as many cookies as you want: yes, they’re chock full of carbs and junk calories, but no worries! They’re LOW FAT. This was the new food gospel, and we saw it proclaimed on our grocery store shelves – low-fat chips, ice cream, cakes. Guilt-free! Breakfast cereal – great! It’s got NO FAT! We saw the birth of olestra, which not only had no fat – it was indigestible! Side effects included gas, cramps, bloating, diarrhea, and, most appalling of all, “anal leakage.” Lays potato chips, Ruffles, and Doritos at the time that were “FAT FREE” and contained olestra had the word “WOW” in huge letters right there on the bag. I guess they meant the taste, but maybe they were referring to what happened when you ate it, as in: “Wow! I just pooped my brains out!”

In 1967, Nancy Sinatra had a hit song called “Sugartown.” She sang, “I got some troubles, but they won’t last. I’m gonna lay right down here in the grass, and pretty soon all my troubles will pass” (most likely, she did not mean “pass” in the olestra way) “ ‘Cause I’m in shoo-shoo-shoo, shoo-shoo-shoo, Sugar Town.” There were about five more “shoos” in that line, but you get the drift.

Sugartown was the place to be. We believed it because of review articles like one that appeared in the New England Journal of Medicine (NEJM) the same year as “Sugartown” – 1967. It discounted evidence that linked sucrose consumption to coronary heart disease. Doctors believed it. They told their patients. Their patients believed them.

It turns out that this particular study was secretly funded by the Sugar Research Foundation (SRF). Now we know, thanks to a bombshell article recently published by University of California-San Francisco scientists in the journal, PLoS Biology, that the SRF (now defunct) was completely evil. It manipulated the science.

It not only “discounted evidence linking sucrose consumption to blood lipid levels and hence coronary heart disease,” report the study’s authors, Cristin Kearns, Dorie Apollonio, and Stanton Glantz. It also “withheld information from the public” linking sugar to changes in the microbiome that can lead to bladder cancer.

But it’s not just the SRF, which later became the International Sugar Research Foundation (ISRF); it’s a bunch of sugar industry trade associations. And it wasn’t just back in the 1960s. All of these groups have “consistently denied that sucrose has any metabolic effects related to chronic disease beyond its caloric effects,” Kearns, Apollonio and Glantz state. In other words, the main side effect these groups are willing to acknowledge is that sugar makes you gain weight.

Let’s take a moment here for me to say that I love sugar. I do. I love cookies, and chocolate cake, and coconut custard pie, and Mexican Coke with real cane sugar instead of corn syrup.  But I really limit it.  I don’t like food Nazis, who tend to be snarky and condescending and who alienate people who really could benefit from what they’re trying to say by making snide statements like, “What’s next, a deep fried stick of butter?” (I actually read that this week in a nutrition magazine that means well, but its tone is so snotty that it’s off-putting.)

That’s not what I’m trying to do at all. What I’m writing about here is the disturbing idea that sugar has been linked to serious illnesses and that the sugar industry has suppressed this information. If we had known six decades ago, maybe a lot more people would be alive now, and maybe our country wouldn’t be struggling so hard with obesity, heart disease, and diabetes.

In case you’re wondering, Kearns, D.D.S., M.B.A., is an assistant professor at the University of California San Francisco (UCSF) School of Dentistry. Stanton Glantz, Ph.D., is Distinguished Professor of Tobacco Control in the Department of Medicine at UCSF. He’s seen this same kind of twisting and distorting of medical evidence a lot; the tobacco industry did it for years. Dorie Apollonio, Ph.D., is an associate professor in the Department of Clinical Pharmacy at UCSF. Together, these UCSF researchers make a formidable team.

Now, back to the 60 years of manipulating the science and hiding the harmful effects of too much sugar. As recently as 2016, the Sugar Association issued a press release blasting findings from a study published in Cancer Research. In that study, done in mice, scientists found that dietary sugar induces increased tumor growth and metastasis when compared to a non-sugar starch diet. But instead of saying, “Hey, you know, maybe you might want to consider not eating so much sugar – all things in moderation,” the Sugar Association doubled down, stating that “no credible link between ingested sugars and cancer has been established.” Nothing to see here, move along, move along. Look over there – doughnuts with sprinkles!

In this PLoS paper, the UCSF scientists lay out a trail of damning evidence. In that first project in the 1960s, one group of rats was given a diet of 75 percent fat but no sugar. A second group of rats ate a diet of less fat, just 15 percent, but 60 percent sucrose, and their little bodies metabolized all that sugar as a carbohydrate. The sugar-eating rats developed thiamine deficiency, which then led to heart failure. But in the rats that ate more complex carbohydrates and no sugar, the gut bacteria, or microbiome, changed and actually started synthesizing thiamine.

This study intrigued SRF scientists, who thought that maybe, if the microbiome could be adjusted, the gut could tolerate sugar better. This idea led to Project 259, in which scientists led by W.F.R. Pover at the University of Birmingham in the UK studied the effect of sugar in the gut between 1967 and 1971. Pover’s team showed, in rats and guinea pigs, that eating more sugar led to higher levels of triglycerides; in turn, this led to higher levels of beta-glucoronidase in urine a finding that’s linked to bladder cancer and in an internal document, scientists described this research as “one of the first demonstrations of a biological difference” between rats that eat a lot of sugar and rats that don’t.

Project 259 didn’t just link sugar consumption to cancer, but to hypertriglyceridemia, an elevated level of triclycerides (a type of fat) that raises the risk of heart disease, say the UCSF scientists, and these findings stayed hidden for decades until the UCSF scientists uncovered them. Also suppressed was evidence linking higher doses of sugar to other “renal disorders, urinary tract infections, and renal transplant rejection.” Eat sugar – reject your donor kidney!

Even worse, the sugar industry did what every good magician knows how to do: misdirect. In previous research, published in the Journal of the American Medical Association (JAMA), Glantz and Kearns, with colleague Laura Schmidt, examined SRF internal documents and historical reports and found that the SRF secretly funded studies, including one published in 1965 in the NEJM, “promoting fat as the dietary culprit in coronary heart disease.”

Imagine there’s a gunshot, and the killer quickly places the murder weapon in somebody else’s hands and starts shouting, “He did it! It’s that guy!” and then slinks away. That’s what the sugar industry did.

For six decades, we have blamed fat – and as a society, we now look more and more like the tubby earthlings on the big spaceship in the Pixar movie, “Wall-e.” We’re huge, and we’re unhealthy.

Sugartown is not so sweet.

©Janet Farrar Worthington

 

How to Age Well: Part 1

Quality of life is the key:  our goal shouldn’t be just to live to a ripe old age.  No one wants to be old and decrepit (or decrepit at any age, frankly).  But old and healthy – now that’s an exciting goal.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

The secrets of healthy aging, he has found, aren’t so secret after all.  The best “fountain of youth” we have right now are some common-sense building blocks that can help everyone, at every age, live better.

Nutrition:  Make Every Bite Count

If you do it right, just about everything you eat can help your body.  This doesn’t mean you have to have an ascetic diet of nuts and berries, or be a food martyr who never eats birthday cake, macaroni and cheese, or a BLT with chips and a pickle.  But comfort foods and flat-out junk should be the exception, not the rule, and you should make most of your dietary choices good ones. 

Now, what does this mean?

Eat Fresh Fruits and Veggies

healthy food“Fresh fruits and vegetables are very important,” says Walston, “particularly ones that are rich in potassium.”  High-potassium fruits and veggies – including bananas, oranges, strawberries; dried fruits, like raisins, apricots, and prunes; spinach, tomatoes, avocados, beans and peas, and potatoes – are the best way for you to get potassium.  Potassium is also found in dairy products, in whole grains, meat, and fish.

Here’s some of what potassium-rich foods can do for you:  Blood pressure:  When you get your blood pressure tested, you’re told it’s one number over another one.  That number on the top is systolic blood pressure, and potassium can lower it by several points.  Heart: Potassium helps your heart beat, which happens about 100,000 times a day.  It can help regulate the heart rhythm, too.  Cholesterol:  Potassium, by itself, is not a designated cholesterol-lowering agent; however, if you are eating foods rich in potassium, this means you’re not loading up on saturated fat.  Just eating this good food instead of junk can lower your cholesterol.

Fresh fruits and vegetables are also are anti-inflammatory.  This is very important, because inflammation has been linked to many diseases, including several forms of cancer.  When you eat these healthy foods, don’t blow it, Walston adds:  “Don’t add salt and don’t overcook them.”

Get More Protein

Protein is increasingly important; we need it more now than we did when we were younger.  “Protein helps muscles function better, and it is also important to help maintain muscle mass.”  True, you can get protein from a cheesesteak sandwich, but it’s better to “choose high-quality protein that is low in fat,” says Walston.  Salmon, for example, is a great source of protein; so are chicken, lean beef and pork, eggs, beans, soy, and low-fat dairy products like yogurt.   “We need about 30 grams of protein at a sitting to stimulate muscle growth optimally,” and the best time to take in protein is after exercise; this helps the muscles recover and grow.  “You can also get it from a protein shake or energy bar.”

Get Plenty of Vitamin D

Vitamin D helps keep your bones strong.  It also helps keep your muscles, heart, brain and immune system healthy, and can help prevent cancer.  Having low levels of Vitamin D is bad: A study published in the Archives of Internal Medicine found that people with the lowest levels of Vitamin D had more then twice the risk of dying from heart disease and other causes, compared to those with the highest levels.  The researchers listed “decreased outdoor activity” as one reason that people can become deficient in Vitamin D.  You can get it in milk, oily fish, mushrooms, eggs, and meat.  You can also take a supplement.  The National Institutes of Health recommends 600 IU (international units) of Vitamin D a day if you’re under 70, and 800 IU a day if you’re over 70.

sunshineAnd get some sun:  “Your body needs direct sunlight exposure to activate the vitamin D.”  A pretty amazing reaction happens when the sun hits your skin: the UV-B rays activates vitamin D into a form that your body can use best.  You don’t need to bask in the sun for hours; just a few minutes – 20 or so – a couple of times a week  is plenty of time to gain this benefit.

Get your shots

Lower your risk of getting the flu, or pneumonia, or shingles by getting a shot.  Many pharmacies, grocery stores, and big-box stores like Walmart and Target offer these shots at a low cost.  Take them up on it.  The risks of getting one of these illnesses far outweigh the inconvenience and minor expense of a vaccine.   

Coming up next:  Part 2:  Keep Moving, Don’t Fall, and Keep Your Mind Active.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.

Charred Food Bad, Veggies Good for the Prostate

grilled meatGood news for people who love barbecue, hot dogs, burgers, and steak cooked on the grill: It pays to eat your veggies.

The key to this story is something called “PhIP.” A few years ago, noted Johns Hopkins scientist Bill Nelson, M.D., Ph.D., director of the Sidney Kimmel
Comprehensive Cancer Center, began investigating its role in cancer. PhIP is a funny little word. (Pronounced “fipp,” it’s a short name for a long chemical
compound.) It sounds so harmless: “Hey, let’s get PhIP and go over to the club for some tennis,” or “I don’t give a PhIP what you do,” or “Let’s do some
PhIP shots!” But it’s not.

PhIP is found in meats cooked at high temperatures. It is a “pro-carcinogen,” a chemical that turns into something that can attack and mutate DNA, and is
known to cause prostate, breast, and colorectal cancer in rats. Unfortunately, we create carcinogens, or cancer-causing agents, with every steak we grill
or piece of chicken we fry, and PhIP is one of them. In 2007, Nelson and pathologist Angelo De Marzo, M.D., Ph.D., reported in Cancer Research
that when rats are exposed to PhIP, DNA mutations occur in the prostate. Since then, they have learned much more about this little sucker’s role as a
dietary contributor to cancer. I recently wrote about Nelson’s work for Discovery, the research magazine for the Brady Urological Institute at Johns
Hopkins.

The scientists have discovered that veggies help counteract the effects of PhIP. “When we fed rats tomato and broccoli along
with PhIP, the animals lived longer and showed reduced incidence and severity of prostate neoplasms (new, abnormal cell growth; particularly of PIN,
prostatic intraepithelial neoplasia – funny-looking cells that are linked to prostate cancer), intestinal cancers and skin cancers as compared to rats fed
PhIP alone,” says Nelson. “This provides even more evidence that eating vegetables may protect against cancer-causing agents like those in overcooked
meats.”

grilled veggiesThere is a twist to the story: Food safety pays off, too.
Nelson, along with De Marzo and scientist Karen Sfanos, Ph.D., has also explored the idea that prostate cancer may involve a combination of “environmental insults” – bad things in the diet, plus something else that weakens the body, like an infection. They wondered whether chronic inflammation, caused by bacterial infection, would make a difference in rats that had consumed PhIP. Using a specific strain of E.coli isolated from a patient with chronic prostatitis/chronic pelvic pain syndrome, they found to their surprise that the charred food plus the nasty bug seemed to have a systemic effect.

Together, E.coli and PhIP caused an increase in the development and progression of cancer in the skin and digestive tract. (Note: many people have E.coli in their gut and it is harmless, but some strains can get into meat when it’s processed and can survive if the meat is undercooked.) The rats that received the double punch of E.coli plus PhIP fared worse than rats that ate the PhIP alone. In one study, the bacteria- and PhIP-consuming rats developed more precancerous lesions within the prostate and might have developed even more problems – except they also died sooner.

In further experiments, they found that “when we inoculated PhIP-fed rats with E.coli in the prostate, the animals developed acute and chronic
prostate inflammation out of proportion to that seen with PhIP ingestion or E.coli inoculation alone, and had more prostate neoplasms, intestinal
cancers, and skin cancers,” says Nelson. “This hints that prostate infections and dietary carcinogens might interact to promote chronic prostate
inflammation and prostate cancers, and that prostate infections might augment carcinogen effects on other tissues, as well.”

What does this mean for you? One, that if these things cause changes in the prostate, it’s a pretty good bet that they are hurting you elsewhere, as well,
so take precautions: eat a veggie in addition to a potato. Potatoes are delicious, but they don’t help fight cancer the way green, leafy vegetables and
tomatoes do. Two, tomatoes and broccoli probably aren’t the only vegetables that can help diffuse the bad effects of charred meat; these are just the ones
that were studied in this particular investigation. Three, don’t eat undercooked meat. You’re not just risking food poisoning, which comes in like a
freight train and goes away quickly; you may be adding to your risk of developing cancer.

Nelson, along with De Marzo, Sfanos, and Hopkins colleagues recently published two papers on these striking new findings in the journals PLoS ONE
and Cancer Prevention Research.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant
publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical
professional.

Heart Attack Triggers: The Four Deadly Horsemen

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

Regular disclaimer:  This is a blog.  It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.

Coffee’s Number Two Side Effect

coffee beansImagine:  John Wayne in True Grit, charging bad guys on horseback, with the reins in his teeth, a Colt revolver in one hand and a Winchester rifle in the other, and suddenly, he veers off and heads for the woods.   He’s acutely regretting that cup of coffee he had back at the campfire.

Well, that didn’t happen, because he’s John Wayne.  But it certainly might happen to us lesser mortals.  In fact, this laxative effect is a known consequence — or, hey! It’s a benefit, depending on how you look at it – of drinking coffee.  The effect can happen in as little as four minutes, according to an English study published in the journal, Gut.

Why does coffee make some people need to poop?  Several reasons.  It’s not the caffeine (decaf can produce the same effect), and it’s not the heat of the beverage; the English scientists tested drinking hot water in the same group of study participants, and nothing happened.  Out of 14 people studied (12 men, two women), eight of those who drank black, unsweetened coffee needed to move their bowels.  The coffee sped up the gut’s motility – movement of food through the digestive tract, using a series of muscle contractions called peristalsis – in the eight responders, but not in the others.  “The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes,” the scientists reported.  “These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.”

The fact that this happened so darned fast, the researchers speculated, doesn’t mean that coffee actually rockets through the system.  Instead, “we suspect that coffee may induce a ‘gastrocolonic response’ by acting on epithelial receptors in the stomach or small bowel.”  This might be activated by nerves or hormones in the GI tract; also, they added, “coffee has been shown to promote release of gastrin, which can increase colonic … motor activity.”  So for some people, coffee shifts the gut into temporary fast-forward mode. 

Why Does Coffee Make You Poop?Coffee is a great way to wake you up, and it’s also a great way to keep you regular. What’s so special about coffee that it makes you poop?—–For a collection of all our videos, check out TestTube Video!

Posted by Discovery News on Wednesday, July 29, 2015

What else does it do?  I am fortunate to be married to an excellent gastroenterologist, Mark Worthington, M.D., formerly on the medical faculty at the University of Virginia and Johns Hopkins and now in private practice in Arizona.  “Basically, coffee causes a net secretion of fluid into the small intestine,” he says.  “For most people, the colon takes up the slack – it sucks up the extra water – but it gets activated in the process.  For some people, coffee actually leads to diarrhea because the colon can’t handle it all.”  People who particularly have trouble with coffee, he adds, are those with colitis (inflammation of the colon).  Also: “coffee sweeteners, such as Stevia, can cause diarrhea in some people.”  If you add a lot of dairy to your coffee, and dairy products are difficult for you, this might make coffee a bit of a digestive challenge, as well.

Is that it?  Well, no, there’s the acid.  Coffee is loaded with a phenol called “chlorogenic acid,” and – again, not in everyone – for those of us who lack cast-iron stomachs and are already prone to acid reflux, or for people who drink coffee on an empty stomach, the acid can irritate the stomach lining.  This is called gastritis, and it can result in heartburn, hiccups, pain in the belly, nausea, and can even make you throw up if you don’t get some food in there to help combat the acid.  Caffeine itself – let’s face it, the major reason we drink coffee – also can cause the stomach to pump out more acid.   

Note:  Don’t think I’m anti-coffee.  I’m not at all.  Coffee also does a lot of good things, including help lower your risk for Alzheimer’s disease, which I will talk about in some future post.  This is not that post.

Good news for your tummy:  If coffee starts your day off with an upset stomach or gives you the rumblies, don’t despair:  You are not alone.  In fact, there are so many people with this problem that gut-friendly coffees – with more available all the time – have been developed just for you.

Which is good news.  However, if you’re one of those susceptible to coffee’s Number Two side effect – no matter how gentle or organic or gourmet your coffee may be — you’ll still probably have to poop after you drink it.

©Janet Farrar Worthington

Regular disclaimer:  This is a blog.  It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional. 

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Can Your Gut Bacteria Make You Depressed?

Mr. Rogers' Neighborhood

Gene J. Puskar/Associated Press

If you’re old enough to remember Mr. Rogers, you might remember him singing the happy little song, “So, who are the people in your neighborhood, in your neighborhood, in your neighborhood… they’re the people that you meet when you’re walking down the street.  They’re the people that you meet each day.”

This isn’t Mr. Rogers’ neighborhood.  It’s a lot smaller, but there are some interesting characters here.  They are bacteria, also called gut flora, or microflora.

The microflora in the gut are way more important than anyone realized even a few years ago.  This microbiome is made up of communities of bacteria and other organisms.  Tiny changes here can have big effects — not only on our digestive tract, but on our emotions.

Cynthia Sears, M.D., professor of medicine at Johns Hopkins Medical Institutions, is the director of the Scientific Advisory Board of the new Johns Hopkins Food, Body & Mind Center.  (I wrote about some of the research going on at this center in a recent post.)  In addition to finding links between diet and disease, scientists at the Center, particularly Sears, are studying the role of good and bad bacteria in making us sick and keeping us healthy.

Sears has focused on the many interactions between the gut’s microflora – the little ecosystems of bacteria that live and die down there in without our ever knowing about it – and our health.  I recently interviewed her for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.  Rapidly expanding evidence, she told me, suggests “that the complex communities that we carry with us, which are on every surface of the body, are essential to health.  But they’re also associated with disease” — both right there in the gut, and distantly.  “They influence liver function, the function of the deep tissues, the enteric nervous system.”  They may also contribute to heart disease, pancreatic conditions, and be linked to our mood and to psychiatric disorders, as well as our weight.  “This concept is amazing,” she says, “particularly the idea that they can influence our mood and how we function in life.”

So, imagine that you have depression, and a doctor has put you on an antidepressant.  And it’s not really helping that much.  Then imagine that a doctor tells you, “the problem could be in your gut.”  This discussion is still pretty new, Sears says, but “our hope is that we will be able to identify the bacteria that produce the right metabolites, the ones that make you feel better,” to change how the microbiome functions.  “So if the microbiome has bad molecules, that we could modify it or treat it in such a way that you get good molecules and change the balance.”

Good bacteria

Photo Credit: sahilsajjad via Compfight cc

I asked her if this might one day eliminate the need for antidepressants.  Probably not, Sears says.  “But there are a lot of people who probably don’t fit into classic psychiatric criteria, who don’t feel well.  So this idea that we can use food and possibly ‘good’ bacteria to modify function and make someone feel better, and help turn someone’s life around, is very intriguing.”

Fermented Foods and Probiotics

Is there anything you can do to help clean up the neighborhood of bacteria in your gut?  Well, yes:  You can eat fermented foods, which contain probiotics, or you can take supplemental probiotics.  The problem with probiotics is that they are not regulated as drugs by the FDA, and there is a lot of variability in quality and effectiveness.  Similarly, there is a surprising lack of definitive, scientific journal-published research absolutely proving that fermented foods are helpful to your health.  However, that said, there is a lot of anecdotal evidence that they are.  The fermented items listed below, eaten in moderation, are not harmful to your health.  You may want to give them a shot for a couple of weeks, and see if you feel better with them in your diet.

Sauerkraut.  It’s fermented, hip, it’s happenin’ — check out the gourmet varieties (like Wildbrine’s Arame Ginger) of sauerkraut in the refrigerated section at upscale grocery stores — and it’s been around since the 4th century B.C.  First of all, it’s cabbage, and cabbage is already good for you, just raw out of the garden.  It’s in the family of cruciferous vegetables, along with broccoli and cauliflower, which have long been shown to help prevent cancer.  But the fermentation process brings some new chemicals to the table, including: isothiocyanates, which counteract carcinogens and help the body remove them; glucosinolates, which activate the body’s anti-oxidants; and flavenoids, which help protect artery walls.  Sauerkraut has few calories.  However, if you eat too much of it, it can cause diarrhea.  Again, moderation in all things.

Kombucha.  Fermented black tea.  Again, we’re starting with something that is already good for you; tea is rich in antioxidants.  Fermented black tea delivers a load of probiotics to your gut.  In addition to aiding digestion, these beneficial bacteria boost the immune system and can relieve irritable bowel symptoms, yeast infections, and other problems.  In one study, rats given kombucha had higher levels of “good” HDL cholesterol, a finding linked to a lower risk of cardiovascular trouble.   FloraStor, a commercial probiotic that’s used to treat C. difficile colitis, was isolated from kombucha.  A study from India found that a form of kombucha was just as effective as the drug, omeprazole (Prilosec), in healing stomach ulcers.  (Note: If you have an ulcer, I wouldn’t chuck Prilosec and start drinking kombucha.  For one thing, the kind you get might not have the kind of bacteria these scientists studied; also, how much would you need to be drinking every day, and for how long?  Ideally, as fermented foods become more popular, they will be better studied and their benefits will become a lot more clear.)

file5321333011701Yogurt.  Look for the words, “Live and active cultures.”  These are probiotics, and besides increasing the number of good bacteria in your gut, they can help reduce symptoms of irritable bowel syndrome, and also can help improve symptoms of inflammatory bowel diseases, such as Crohn’s and ulcerative colitis.  Greek yogurt has more protein than traditional yogurt; it takes longer to digest and can help you feel full longer — which, in turn, can reduce the need for snacks between meals, so as a bonus, it may help you lose weight.

 

 

©Janet Farrar Worthington

Regular disclaimer:  This is a blog.  It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional. 

Rebound Headaches:  A Cautionary Tale

This isn’t what I intended to write about; in fact, I’m in the middle of a series on the gut.  However, the series has been derailed briefly, because I have been derailed, I hope briefly, by one mother of a headache. 

viseThree times in my life, I’ve been in so much pain that I have not even felt like a human.  One was during the birth of my second child; he was turned around in such a way that there was tremendous pressure on my spine, and I couldn’t even talk.  Seriously, I was reduced to moaning sounds like an animal.  But this is a men’s health website, so I’ll spare you that story and move right to the other two times, which have been migraines.  Actually, the migraine I’m going to talk about is the one I’m getting over as we speak.

There are people who suffer from migraines and spend more days in pain than not.  I am not one of those people, and usually, if I get a migraine, it goes away after a while and has an attributable cause.  There are a bunch of known dietary triggers for migraines, including chocolate, aged cheeses, soy, and vinegar; caffeine; alcohol (red wine, beer, sherry and vermouth); food additives like MSG (monosodium glutamate) and hydrolyzed vegetable protein (HPV); nitrates (preservatives) found in hot dogs, pepperoni, jerky, lunch meats, and other smoked or preserved foods; tannins, found in tea, red wine (again with the red wine!), cider, and red-skinned fruits like apples and pears; sulfites (this is another preservative), found in dried fruits and red and white wine; the artificial sweetener, aspartame (NutraSweet and Equal). 

This is not a complete list, but it goes along with what we’ve been talking about recently, that sometimes food can make you sick.  Here’s something to think about: If you think something in your diet is making you sick, try giving it up for three weeks.   Just one category at a time (like, dairy foods) – otherwise, you won’t know which thing you gave up was making you feel bad.  We will talk more about this in the future, I just wanted to get this in there. 

But it’s not always diet.  There are numerous other triggers for migraines, and I have three of them:  stress, fatigue, and dehydration.  All three of them kicked in and that’s what started my recent 12-day trip to hell.  So what I want to talk to you today is in the headache category, and it’s certainly a migraine, but to a certain degree, it was also self-inflicted and needlessly prolonged.  It started for me on Mother’s Day weekend; our choir at church did three back-to-back concerts that might not have fazed a hardier person, but they knocked me on my rear end.  So that was the precipitating factor.  But what I did next escalated it to the extent that on the worst day, yesterday, I was seriously considering going to the emergency room.   

The first thing I did, some of you men reading this may well identify with:  I denied it.  I thought, “This is not a migraine.”  I had too much to do to deal with a migraine.  I had to keep going.  So I started taking Advil.  This is by no means any indictment of Advil; it is a fine product.  I just overused it.  I started taking two, and then four a day.  The headache would go away, and I would be able to get some work done, plug away at my various writing projects, chauffeur my youngest child, walk the dogs, do the housework, etc.  Then it would come back. 

headacheI failed to make the connection that this was one prolonged event. 

In fact, I even joked about my daily headache, and I thought if I could just make it to the weekend, or to bedtime, or a break in the on-the-run schedule, surely it would get better.  By Day 10, I was up to six Advils a day, and the headaches kept coming back and were getting worse.   I now know that this was a series of rebound headaches.  Other symptoms of rebound headaches can include irritability, difficulty concentrating, restlessness, nausea, memory problems, and lack of energy.  In my defense, you don’t do your best thinking when you’re having a migraine, so maybe that’s why it took me so long to figure it out. 

In my case, the headache was a vascular one; severe pain on my right temple and a big-ass pulse that throbbed visibly (in fact, my right temple freakily stuck out more than my left). 

What I should have done.

I should have realized that this was a migraine and taken actual migraine medicine to knock it out immediately.  I actually have a prescription for Frova, a very effective drug that probably would have worked better, had I taken it sooner.  But the thing had gotten so out of hand, it was hard to rein it back in.  I took one on the evening of Day 10, and it got better.  Day 11, it came back.  I took another one.  It helped, but didn’t stop it.   By this point, I had wised up to the ibuprofen (Advil), so I tried acetaminophen (Tylenol) plus caffeine.  This helped a little, but not enough.

Then, my wonderful daughter stepped in.  She has done a lot of research on natural remedies, and I want to share some of these with you.  Now, before you make some judgment and say, “Here we go, one of these crunchy granola types, she’s going to tell me to peel some willow bark and boil it.”  Not at all, and shame on you!

What I am saying is, “Here are some more weapons for your arsenal.  Try any and all of them, because the headache is your enemy, and you need to confuse it, so you can disarm it.”

All of these treatments did something very important:  They diverted blood flow away from the headache. 

This strategy is your new best friend.  This is what you must do, whether it’s through prescription remedies, over-the-counter items, or complementary medicine (natural remedies).  I think it’s a good idea never to rely on one treatment to take care of you and make it all better.  There’s something to be said for the kitchen-sink approach:

Go after it with all you’ve got. 

The first thing that helped:  Peppermint oil.  Rubbed on the temples, but I dabbed it all over my face.  (Note:  Peppermint oil can be irritating to the skin, so I probably shouldn’t have put it all over my face.  Now it looks like my face is chapped in various places, but the pain is better, so I don’t even care.)  Peppermint oil contains menthol.  Menthol cools.  It counteracted the heat and temporarily dulled the pain in my temple.  I blessed it; I was so grateful to that peppermint oil. 

Thinking the menthol was a good thing, I got out some Icy Hot and put it all over my back.  Icy Hot has menthol and menthol salicylate, so it cools the skin and also causes a warming sensation that relaxes the body.  Basically, it distracts your brain from the pain.  If I’d had any capsaicin (an ingredient in chili peppers, this warms the body and relieves pain, too), I would have put that on, as well.  Not on my head, but on my back or shoulder. Again, just an effort to divert the blood flow and confuse the pain sensors.

The most helpful thing:  15 minutes soaking my feet in very hot water with Epsom salts.  This had several benefits.  One, Epsom salts contain two helpful elements: magnesium and sulfate (not to be confused with sulfites, the food preservative mentioned above).  Deficiencies in both of these can cause headaches.  Magnesium is hard to absorb through the stomach, mainly because it’s also a laxative.  But you can absorb it just fine through the skin in an Epsom salt footbath.  The salts help draw out toxins from the body, too.  But the biggest thing is, if it’s just as hot as you can stand it, this diverts blood flow from the headache in a big way.  A hot shower helps do this, too; it would also have helped if I had put my hands in the hot Epsom salt water instead of my feet.  (Have you ever had a migraine and noticed that your hands are cold?  That’s because all the blood flow is in your head!)  The effect there is like taking the oxygen away from a fire; without fuel, it can’t keep burning. 

Through this combination of remedies, I have turned the corner on the headache.  I did not go to the ER, I did not call my doctor and get another high-powered medicine. Maybe I should have, but again, when there’s something wrong with your head, you can’t think too well. 

What have I learned? 

tablet wrapperDo I think you shouldn’t use over-the-counter headache remedies?  Of course not.  Acetaminophen is good, particularly with caffeine and/or aspirin added.  It is odd that caffeine can trigger a migraine and is also used to treat one, but there you go.  Ibuprofen is good.  Prescription drugs are good.  Natural remedies are good.  But I truly believe you have to mix it up. 

Have you ever watched a football game when the quarterback keeps doing the same play over and over – even though it’s not working?  And you’re yelling at the TV, “Mix it up, moron!” Any pain reliever can cause a rebound headache if you use too much of it. This includes migraine medications, and especially opiates (Tylenol with Codeine, for example).

If you have more than two headaches a week, if you need to take pain medication for your headache more than twice a week, if the recommended dose doesn’t get it, or if your headaches are getting worse or lasting longer, go see a doctor.  But also remember:  You may be having rebound headaches.  Mix up your treatment approach, and try to limit the fuel for the fire by diverting the blood flow.  Confuse the enemy.

P.S.  My mother-in-law, who has suffered from terrible migraines for years, meditates to get her body to slow down, which helps whatever medicine she’s using work better.  Tension definitely plays a role in many headaches, so medication and yoga may be something for you to explore, as well.

©Janet Farrar Worthington

Regular disclaimer:  This is a blog.  It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.