Artificial Sweeteners and Your Health

An article published in the online version of Primary Care brings up the issue of whether artificial sweeteners are a positive, helping people lose weight, or is there more to the story. Editor David Rakel MD, FAAFP discusses a recent article in the neurologic journal STROKE showing an association between the number of artificially sweetened beverages consumed per day and the onset of a stroke. This relationship was seen only with artificially sweetened beverages not with sugar sweetened beverages.

Dr Rakel goes on to discuss the ongoing public health concern of consuming nonnutritive sweeteners and its effects on weight gain and insulin resistance. Recent studies known as observational studies have linked high consumption of beverages with nonnutritive sweeteners with weight gain, increased visceral adiposity and a 22 % higher incidence of diabetes despite consuming less energy.

The reasons for consuming fewer calories but gaining weight are considered to be many. Sweet tasting compounds including NNS activate sweet “taste receptors” that were once thought to be only located in the mouth but are now known to be throughout the body. This activation results in release of insulin. The continued release of insulin by the pancreas, without energy producing calories present to be metabolized, may lead to insulin resistance. Insulin resistance involves insulin being released in response to food being consumed but is becoming ineffective in moving sugar into the cell where it can be metabolized into energy.

There is additional belief that supplying sweetness without calories may result in disturbances to appetite regulation and communication within the body about when we are full. Products such as aspartame, saccharin and sucralose have been found to have negative effect on the intestinal bacteria or microbiome potentially having an effect on glucose tolerance and metabolism.

We see artificial sweeteners on tables in every setting. Aspartame produces a sweetening effect 200x sugar. Saccharin produces a sweetening effect 500x sugar. Sucralose is 600x sugar sweetening and Advantame 20,000x sweeter.

A teaspoon of sugar only contains 16 calories. Portion control of products made with real sugar may be the safest and healthiest way to eat sweets as the holiday season approaches. A level teaspoon of sugar in your coffee or tea may be far healthier for you than that packet of artificial sweetener.

Advertisements

Inflammation as a Cause of Heart Attacks and Strokes

Years ago I attended a series of lectures sponsored by the Cleveland Clinic to promote its proprietary lab tests that were geared to detect previously undetectable causes of heart attacks and strokes. A cardiologist at Cleveland Clinic, along with a research nurse out of Emory University Hospital and Medical Center, noted that 50% of the men having heart attacks and strokes were within the recommended life and health guidelines. They didn’t smoke, their blood pressures were controlled, they had lipids within the recommended guidelines and their weight was appropriate – as was their activity level.

They unofficially dubbed it the Supermen study and showed that by reducing “inflammation” they could reduce the number of heart attacks and strokes. They concentrated on periodontal disease and rheumatologic diseases as sources of inflammation. They believed that angina and heart attacks and strokes did not occur because a blood vessel gradually narrowed much like a plumbing pipe clogged with hair and debris. They felt that soft lipid plaque under the surface in vehicles dubbed “foam cells” ruptured through the blood vessel wall into the lumen through the endothelial lining under the direction of inflammation in the body.

This breakthrough into the blood carrying portion of the blood vessel was perceived as a fresh cut or wound which was bleeding. The body’s natural response was to try and stop the bleeding by creating a clot. This clot occurred quickly in a small vessel and every living item downstream, not supplied by a collateral blood vessel, died from lack of oxygen and fuel to function. They treated the identifiable inflammation and felt that statin medications (Lipitor, Zocor, Pravachol, Crestor , Livalo and the generics) had an of- label quality that reduced inflammation as well as lowered the cholesterol.

I bought into that theory and incorporated these blood tests into the patient population most at risk and the appropriate age where prevention would make a major difference. Tests like hsCRP, Myeloperoxidase, Apo-B and others were used for screening. Finding the inflammation and treating it for men who met the definition for entry into the Supermen study was far more difficult. The whole theory of inflammation causing acute cardiac and cerebrovascular events was treated much like climate change, genetically modified foods and even vaccinations with a large degree of community doubt.

Last week at a major European Cardiology meeting the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) showed that by administering an anti- inflammatory medicine for three plus years at an appropriate dosage, we could reduce the number of heart attacks and strokes significantly. Using a monoclonal antibody, “Canakinumab” at 150 mg every third month they treated inflammation and reduced the number of events. The downside was the annual cost of this medicine currently stands at about $200,000 per year making it unavailable for most of us.

The surprising and startling finding was that it reduced lung cancers by 70% and other malignancies as well. The true finding in this study may be its use as a cancer weapon in the future. The study truly opened the door for research into new and less expensive approaches to treating inflammation. It validated inflammation as a pathway to vascular disease. Now we need to find a way to make that treatment affordable to all.

Biphosphonates Raise the Risk of Atrial Fibrillation

Atrial FibBiphosphonate drugs such as Fosamax, Boniva and Actonel are used commonly to treat osteoporosis and to prevent the progression of bone disease from low mineralization or osteopenia to osteoporosis. The most common side effect we normally see is gastrointestinal upset with inflammation of the esophagus and stomach especially when the pill is not swallowed with sufficient liquids.  Patients receiving biphosphonates are cautioned to take the pill with sufficient liquid, while remaining upright for 45 minutes to an hour.  Biphosphonates have revolutionized the prevention of and treatment of osteoporotic bone disease.

In October’s issue of Chest Medical Journal Dr. Abhishek Sarma, MD, of Maimonides Medical Center in Brooklyn, N.Y. shows that biphosphonate use is associated with an increased risk of developing the arrhythmia atrial fibrillation.  Atrial fibrillation is a disorderly rhythm of the upper chambers of the heart leading to ineffective blood flow and increased risks of clots forming in the heart chambers and disseminating causing strokes. Older adults, the same patient population that is at risk for osteoporosis, is the patient group who when they develop atrial fibrillation require the use of blood thinners such as warfarin or xarelto or elliquis to prevent clot formation and strokes. Dr. Sharma performed a review of existing randomized controlled and observational studies.  He concluded there was a 27% increased risk of developing atrial fibrillation if you were taking biphosphonates. They looked at six observational studies with almost 150,000 participants and six randomized controlled trials with 41,000 patients. The increased risk occurred in patients taking the biphosphonates by mouth or by intravenous infusion. They postulated that biphosphonate use triggers an inflammatory protein that effects intracellular calcium and leads to arrhythmias.

The study clearly requires follow-up. If you stop the biphosphonates will the patient return to a normal rhythm on their own or if chemically or electrically shocked back into a normal rhythm?  It is clear that we need to prevent and treat osteoporosis but it is now important for us to determine what this new finding means to a person’s long term health. If you are taking biphosphonates speak to your physician about this new finding and how or if it relates to you.

Increasing Dietary Fiber Decreases Your Stroke Risk

Fruits and vegetables v2Diane Threapleton, MSC, of the University of Leeds, England, and colleagues reported in the online version of Stroke that eating more dietary fiber may modestly reduce your chances of having a stroke. Additional grams of dietary fiber intake was associated with a 7% lower risk of hemorrhagic or ischemic stroke.  She said a 7 gram per day increase in fiber is easy to achieve being the equivalent of two servings of fruit like apples or oranges or an extra serving of beans.

United States guidelines call for the average man to consume 30 – 38 grams of fiber per day while the average women should consume 21-25 grams.  We fall far short of that with the average male consuming only 17 grams of fiber per day and the average woman only 13 grams.

Researchers note that soluble types of fiber form gels in the stomach and bowels, slowing the rate of absorption of foods and slowing gastric emptying. This slowed emptying increases our feelings of being full so we consume less food. They additionally noted “bacterial fermentation of resistant starch and soluble fibers in the large intestine producing short chain fatty acids which inhibit cholesterol synthesis by the liver and lowering serum levels.”

Once again, nutritional common sense prevails. Eating healthy, including more fresh fruits, vegetables and whole grain products results in more fiber ingested and fewer health issues occurring.