HEALTH TRENDS AND PREDICTIONS FOR 2018

As 2017 draws to a close, Aetna International’s Global President of Population Health, Dr Sneh Khemka, takes a look at the shape of the global healthcare market in 2018. His vision for 2018 embraces changes in disease patterns, antibiotic resistance, the ticking time bomb of undiagnosed disease, and the increased impact of healthcare technology.

Trends in global healthcare

1) Rapidly increasing global middle class. 
The world’s middle class is growing (in particular across the Middle East and Asia), creating more strenuous healthcare demands. This has resulted in new expectations from healthcare systems, demanding of digital, more convenient and sophisticated access. Due to this, challenges of how to deliver will continue to arise.

2) A change in global disease patterns. 
Partly due to the rapidly expanding middle class, there has been an increase in lifestyle related, as opposed to infection-related diseases. This is putting significant strain on local healthcare systems, as people are living longer and needing more expensive, long-term treatment.

3) Antibiotic and opioid crises.
Though world news is now attuned to the global antibiotic crisis, the opioid crisis is also sweeping developed countries as addiction to prescription medication is seeing an increase. Both are critical global crises, and urgently need to be addressed.

4) Undiagnosed diabetes.
High obesity rates have led to undiagnosed cases of diabetes around the world. In order to overcome this crisis, healthcare systems will need to acknowledge this worrying epidemic, currently manifesting as pre-diabetes and as metabolic syndrome, both of which most people are unaware they have.

5) Mental healthcare in developing economies.
In developed economies, there is distinct awareness of mental health issues and systems in place to cope with them. Yet, in developing economies, there is still a need for healthcare providers to work with governments to overcome social taboos and understand how mental health effects conditions, as well as economical productivity.

6) Global disparity of healthcare leading to unwarranted variation.
There is large divergence in the quality of healthcare provision and access around the world. 70% of people in the world have too little access to healthcare, whilst 5% of people have too much access. For example, America spends 19% of its GDP on healthcare, indicating the possibility that there are far too many and unnecessary services provided to people; while developing nations are often less than 3% of GDP – so how to address the inequalities?

Technology

1) Technology is on the frontline of patient care. 
It is essential to most healthcare systems around the world. However, although technology has advanced in healthcare, affordability has not. There are now increasingly expensive demands for enhanced solutions. This leads to ethical questions of how, and at what cost, we should extend life using technology - it is not easy to determine where technological intervention should end and where the human life cycle should kick in.

2) The data revolution is changing healthcare into a data-driven industry.
Healthcare has access to a wealth of data from wearable devices, to online analytics. Doctors can use this data to see what factors keep people healthy, rather than what makes them unhealthy. For example, aggregated data from online search engines are currently the best predictor of a viral epidemic. Data and technology also makes it easier for healthcare professionals to diagnose, treat and cure illnesses. This is evident in program such as IBM Watson, as it can search through 15 million journals to inform doctors about rare diseases and treatments.

Are Honey Nut Cheerios Healthy? We Look Inside the Box By DANNY HAKIMNOV. 10, 2017

I had a bowl of Honey Nut Cheerios recently. It’d been awhile. Regular Cheerios are more my thing. But sometimes I finish my box faster than my kids do and find myself straying to their side of the cupboard.

Honey Nut is America’s best-selling breakfast cereal, and by a comfortable margin. Roughly 151 million boxes and other containers of various sizes were sold over the past year, well ahead of the second best-selling breakfast cereal, Frosted Flakes, according to IRI, a Chicago based market research firm.

I had no idea. The only thing I could think about when I ate it again for the first time in years was how incredibly sweet it is. I looked at the back of the box and could see why. Three of the top six ingredients are sweeteners: sugar, brown sugar and honey.

Previously, I assumed Honey Nut Cheerios was a slightly sweeter Cheerios, but you learn things when you finally get around to reading the back of the box. It actually has about nine times as much sugar as plain Cheerios, per serving. An  of a number of popular cereals — a report that linked sugary cereals to the “nation’s childhood obesity epidemic” — put Honey Nut Cheerios’s sugar content second only to Fruity Pebbles. The same group found that one cup of the cereal had more sugar than three Chips Ahoy! cookies.

I asked General Mills about this, over a period of several days. They did not come to the phone, but responded with a series of communiqués.

“You mentioned that three of the top six ingredients in Honey Nut Cheerios are sugar, brown sugar and honey,” Mike Siemienas, a spokesman for the company, wrote in a statement. “What you didn’t mention is that the number one ingredient is oats. To be so singularly focused on one ingredient — sugar — is irresponsible and doesn’t help consumers look at the total nutrition offered.”

Honey Nut Cheerios debuted in 1979. The cereal’s forebear, Cheerios, originally called Cheerioats, was born in 1941 and has a more favorable nutrition profile. The plain version is low in sugar, “and you’re getting some oat fiber that can help lower your cholesterol modestly,” said Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest.

Unfortunately, that makes the contrast with its spinoffs difficult. Those include far more sugary options like Pumpkin Spice Cheerios and Apple Cinnamon Cheerios. The newest offering, Chocolate Peanut Butter Cheerios, has what looks like sugar flakes on it, but it actually has a lower sugar content than Honey Nut Cheerios.

“The company has capitalized on the good name of the original,” Ms. Liebman said. “We’ve been saying for years that Honey Nut Cheerios has more sugar than honey and more salt than nuts, in fact it’s got no nuts at all, it’s just got almond flavor.”

The center has quarreled with General Mills before. It sued the company over health claims made about another Cheerios offshoot, Cheerios Protein.

General Mills refers to cereals like Honey Nut Cheerios as “presweetened” — putting the sugar, brown sugar and honey into your cereal so you don’t have to. Back in 2009, the company made news by announcing an initiative had already been underway to drop the sugar figure into single digits in such cereals marketed to children. In the last decade or so, Honey Nut Cheerios has fallen to nine grams of sugars per serving, from 11. Or so it seems.

I undertook a review of highly sensitive corporate documents. And by that, I mean I looked at pictures of old cereal boxes on eBay, because apparently there’s a market for vintage, flattened cereal boxes. I found a box from 2003 that showed the serving size of Honey Nut Cheerios to be one cup, weighing 30 grams and having 11 grams of sugars. Today, a serving is three-quarters of a cup, and just 28 grams, with nine grams of sugars.

The serving size of regular Cheerios remains one cup. If Honey Nut Cheerios still had a one cup serving size, the sugar content would be in the double digits.

General Mills said little about what had happened, or when.

“There are several reasons that changes in serving size may occur including recipe improvements that may change the density of the cereal or regulation changes,” Mr. Siemienas wrote.

Serving sizes are regulated by the Food and Drug Administration, and can change if a cereal’s density changes. It appears that at some point in the last 10 or 15 years, General Mills tweaked the ingredients of Honey Nut Cheerios in a way that lowered the overall weight per serving, which had the effect of helping lower the stated sugar content. It has not been all smoke and mirrors; the percentage of sugar has decreased slightly as well, though rounding makes it difficult to say by how much.

“They’ve tested and tested and tested to try to find out how much sugar they can take out without it affecting sales,” said Marion Nestle, an emerita professor of nutrition and food studies at New York University. “They must surely be at the cut point.”

She said “you really want” kids “eating a whole grain, higher fiber cereal.”

Speaking for myself, I eat a lot more cereal than three-quarters of a cup. I poured that amount into a bowl. It looked sad. And small. It was an appetizer’s worth of Cheerios.

Don’t worry, General Mills. I’ll continue to eat Cheerios. But I had to have a difficult conversation with a 12-year-old recently. I broke the news that Honey Nut would not be returning to the cupboard. We’d be sticking with regular Cheerios.

“Can I just pour honey on it?” he asked.

He was joking. I think.

 

How Big Sugar Killed a 1968 Study That Pointed to a Heart Disease Link

Industries have been trying to influence the scientific debate around products for decades, a tactic that can sometimes have unintended consequences.

By Deena Shanker
November 21, 2017, 2:00 PM EST Updated on November 21, 2017, 8:31 PM EST

It’s no secret that big industries have long devoted tremendous resources to shaping scientific debates that may threaten profits, from Big Oil countering how fossil fuels cause climate change to Big Tobacco pushing back on how smoking will kill you.

This corporate stratagem, manifesting itself as subsidized scientists or lobbyists masquerading as researchers, can also lead to unexpected results. So when it comes to sugar and whether the sweet stuff does a lot more than rot your teeth, a discarded 50-year-old research project may have come back to haunt Big Sugar.

An investigation published Tuesday in the journal PLOS Biology reveals internal emails obtained from public libraries that illustrate how, almost 50 years ago, the International Sugar Research Foundation (ISRF) terminated funding for its own study—one that, according to the PLOS Biology report, was on the verge of linking sugar with bladder cancer and coronary heart disease.

“The sugar industry has maintained a very sophisticated program of manipulating scientific discussion around their product to steer discussion away from adverse health effects and to make it as easy as possible for them to continue their position that all calories are equal and there’s nothing particularly bad about sugar,” said Stanton A. Glantz of the University of California at San Francisco, one of the PLOS Biology study’s authors.

In a copy of a statement obtained by Bloomberg News, the Sugar Association—the current lobbying arm for the industry—called the new report “a collection of speculations and assumptions about events that happened nearly five decades ago.” According to its own review, the industry group said in the statement, the study in question ended because it was delayed, over-budget and overlapped with organizational restructuring. 

Four years later, though, an ISRF report interpreted the near-finished project’s findings, according to the new study: Rats with conventional microbiomes fed a high-sugar diet had elevated serum triglyceride levels, “suggesting the triglycerides were formed from fatty acids produced in the small intestine by the fermentation of sucrose.”

In other words, the ISRF was saying, a high-sugar diet may have impacted the rats microbiomes and raised their triglycerides. 

“[The study] would have added to the evidence that sugar was influencing heart disease risk by increasing triglycerides,” said Glantz. “My sense is that this would have represented a substantial contribution at the time. Sugar was saying, ‘Don’t worry about the sugar-heart disease connections’; this paper would have said, ‘Yes, worry.’”

The sugar industry has resisted efforts to declare a link between sugar consumption and heart disease. On Tuesday, the Sugar Association also said that to “allude to a potential connection between sugar and cancer is irresponsible and misleading.” But Cristin Kearns, a lead author of the new study, said the findings were “just one more piece of information that would have added to the picture that was forming.”

The implications of what happened to Project 259 go beyond its particular findings, she said. “The sugar industry probably knows more about the health effects of their products than they’re letting on.”

SHE TOOK ON COLUMBIA'S SODA INDUSTRY...THEN SHE WAS SILENCED.

The debate over taxing sugary drinks has turned into a ferocious global
policy brawl. In Colombia, proponents faced intimidation and censorship.

By ANDREW JACOBS and MATT RICHTELNOV. 13, 2017

BOGOTÁ, Colombia — It began with menacing phone calls, strange malfunctions of the office computers, and men in parked cars photographing the entrance to the small consumer advocacy group’s offices.

Then at dusk one day last December, Dr. Esperanza Cerón, the head of the organization, said she noticed two strange men on motorcycles trailing her Chevy sedan as she headed home from work. She tried to lose them in Bogotá’s rush-hour traffic, but they edged up to her car and pounded on the windows.

“If you don’t keep your mouth shut,” one man shouted, she recalled in a recent interview, “you know what the consequences will be.”

The episode, which Dr. Cerón reported to federal investigators, was reminiscent of the intimidation often used against those who challenged the drug cartels that once dominated Colombia. But the narcotics trade was not the target of Dr. Cerón and her colleagues. Their work had upset a different multibillion-dollar industry: the makers of soda and other sugar-sweetened beverages.

Their organization, Educar Consumidores, was the most visible proponent of a proposed 20 percent tax on sugary drinks that was heading for a vote that month in Colombia’s Legislature. The group had raised money, rallied allies to the cause and produced a provocative television ad that warned consumers how sugar-laden beverages can lead to obesity and diet-related illnesses like diabetes.

The backlash was fierce. A Colombian government agency, responding to a complaint by the nation’s leading soda company that called the ad misleading, ordered it off the air. Then the agency went further: It prohibited Dr. Cerón and her colleagues from publicly discussing the health risks of sugar, under penalty of a $250,000 fine.

The battle over taxing sugar-sweetened beverages is becoming one of the world’s most ferocious policy brawls — a clash of science, politics and money in dozens of countries and cities.

“The industry sees sugary-drink taxes as an existential threat,” said Dr. James Krieger, executive director of Healthy Food America, which tracks beverage tax initiatives. In the United States, the industry has spent at least $107 million at the state and local levels since 2009 to beat back soda taxes and beverage warning labels, a new study found. Compared to the domestic tactics, Dr. Krieger said, overseas, “it’s much dirtier, much more bare-knuckled.”

The harassment of Dr. Cerón and her colleagues was never proven to be carried out by the industry, and federal prosecutors declined to investigate. In response to questions from The New York Times, Coke and Pepsi said they were not involved, and Postobón, the soda company that filed the complaint about the organization’s ad, deferred comment to The National Business Association of Colombia. The association, which represented national and international beverage makers on the soda tax issue, said it had nothing to do with the episodes.

The International Council of Beverages Associations, the parent organization of trade groups around the world fighting the taxes, would not directly answer the question about whether its allies in Colombia were connected to the alleged harassment, but it condemned such actions.

“We reject under any circumstance the improper influence or harassment of any individual or organization for any purpose, at any time, in any way,” Katherine W. Loatman, executive director of the organization, said in a statement.

The experience in Colombia may be the most extreme, but a juggernaut of industry opposition has killed or stalled soda tax proposals around the globe, including in Russia, Germany, Israel and New Zealand.

Nevertheless, the idea is gaining momentum; such levies have been enacted in 30 countries, including India, Saudi Arabia, South Africa, Thailand, Britain and Brunei. More than a billion people now live in places where such taxes have driven up the price of sugar-sweetened beverages.

The battles have been particularly intense in emerging markets as the industry seeks to make up for falling soda consumption in wealthier nations. Latin America has surpassed the United States as the world’s biggest soft-drink market, according to the World Health Organization, with sales of carbonated soft drinks doubling there since 2000 while they declined in the United States.

The beverage industry asserts that soda taxes unfairly burden the poor, cause higher unemployment by squeezing industry sales, and fail to achieve their policy goal: reducing obesity. Studies of soda taxes have shown they lead to a drop in sales of sugar-sweetened beverages — a 10 percent sales decline, for example, over the first two years of Mexico’s tax — however, such measures are so new that there is not yet evidence of their impact on health.

“Slapping a tax on our products and walking away won’t do anything about obesity in this country or globally,” said William Dermody, spokesman for the American Beverage Association, an industry trade group.

But public health organizations, including the W.H.O., cite soda taxes as one of the most effective policy tools for cutting consumption of what nutritionists call a “liquid candy” that has contributed to an epidemic of obesity and related health conditions around the world. Dr. Kathryn Backholer, an expert on the issue at Deakin University in Australia, said taxes on soda were “low-hanging fruit” in the fight against obesity, diabetes and other weight-related diseases because such drinks are easily categorized to tax and sensible to target because they “have little or no nutritional value.”

Dr. Backholer and other experts said the turning point for soda tax proponents came in 2014, when Mexico — Coca-Cola’s biggest consumer market by per capita consumption — approved a 10 percent tax.

Mexico also showcased how dirty the fight could get.

Last year, numerous advocates of a proposal to double Mexico’s tax to 20 percent received strings of upsetting and fraudulent texts from unknown numbers. One man got a message saying his daughter had been seriously injured; another found a text saying his wife was having an affair; a third received a link to a funeral home. Spyware was found on the phones. The proposal failed.  READ MORE

 

Americans Are Retiring Later, Dying Sooner and Sicker In-Between U.S. life expectancy is declining, new calculations show.

By Ben Steverman - Bloomberg - October 23, 2017

The U.S. retirement age is rising, as the government pushes it higher and workers stay in careers longer.

But lifespans aren’t necessarily extending to offer equal time on the beach. Data released last week suggest Americans’ health is declining and millions of middle-age workers face the prospect of shorter, and less active, retirements than their parents enjoyed.

Here are the stats: The U.S. age-adjusted mortality rate—a measure of the number of deaths per year—rose 1.2 percent from 2014 to 2015,  according to the Society of Actuaries. That’s the first year-over-year increase since 2005, and only the second rise greater than 1 percent since 1980.

At the same time that Americans’ life expectancy is stalling, public policy and career tracks mean millions of U.S. workers are waiting longer to call it quits. The age at which people can claim their full Social Security benefits is gradually moving up, from 65 for those retiring in 2002 to 67 in 2027.

Almost one in three Americans age 65 to 69 is still working, along with almost one in five in their early 70s.

Postponing retirement can make financial sense, because extended careers can make it possible to afford retirements that last past age 90 or even 100. But a study out this month adds some caution to that calculation.

Americans in their late 50s already have more serious health problems than people at the same ages did 10 to 15 years ago, according to the journal Health Affairs.

University of Michigan economists HwaJung Choi and Robert Schoeni usedsurvey data to compare middle-age Americans’ health. A key measure is whether people have trouble with an “activity of daily living,” or ADL, such as walking across a room, dressing and bathing themselves, eating, or getting in or out of bed. The study showed the number of middle-age Americans with ADL limitations has jumped: 12.5 percent of Americans at the current retirement age of 66 had an ADL limitation in their late 50s, up from 8.8 percent for people with a retirement age of 65.

At the current retirement age of 66, a quarter of Americans age 58 to 60 rated themselves in “poor” or “fair” health. That’s up 2.6 points from the group who could retire with full benefits at 65, the Michigan researchers found.

Cognitive skills have also declined over time. For those with a retirement age of 66, 11 percent already had some kind of dementia or other cognitive decline at age 58 to 60, according to the study. That’s up from 9.5 percent of Americans just a few years older, with a retirement age between 65 and 66.

While death rates can be volatile from year to year, Choi and Schoeni’s study is part of a raft of other research showing the health of Americans deteriorating.

Researchers have offered many theories for why Americans’ health is getting worse. Princeton University economists Anne Case and Angus Deaton, a Nobel Prize winner, have argued that an epidemic of suicide, drug overdoses and alcohol abuse have caused a spike in death rates among middle-age whites.

Higher rates of obesity may also be taking their toll. And Americans may have already seen most of the benefits from previous positive developments that cut the death rate, such as a decline in smoking and medical advances like statins that fight cardiovascular disease.

Declining health and life expectancy are good news for one constituency: Pension plans, which must send a monthly check to retirees for as long as they live.

According to the latest figures from the Society of Actuaries, life expectancy for pension participants has dropped since its last calculation by 0.2 years. A 65-year-old man can expect to live to 85.6 years, and a woman can expect to make it to 87.6. As a result, the group calculates a typical pension plan’s obligations could fall by 0.7 percent to 1 percent.

 

Soda Tax Fizzles In Chicago As Cook County Officials Cast Decisive 15-1 Repeal Vote

In a shocking move that completely upends Chicago's endless pursuit of higher taxes and an overly-regulated nanny state, the Cook County Finance Committee took the unprecedented step of voting to actually repeal their unpopular 'soda tax' last night.  The 15-1 vote followed an outcry from local residents and small business retailers who say their soda sales crashed 90% after the original ban was passed.  Per ABC:

The vote to repeal the sweetened beverage tax was one spawned by revolt from people and business owners across the county, many who packed the board meeting Tuesday afternoon.

"I'm about 10 percent of where my soda sales used to be. It's really hurt me deeply in the pocket and my workers also. I'm very happy you are understanding this and going to repeal this tax," said Ken Blum, a blind vendor.

"I believe what we heard over the last ten and eleven months is that our residents are fed up, and they finally said enough. Tax fatigue has sunk in," said Cook County Board Commissioner Sean Morrison.

"I have heard from the people in my district overwhelmingly, the business owners, the retailers, as well union members in this building who are opposed to this tax," said Commissioner John Daley.

"Let me tell you I'm overjoyed and elated that this tax is going to go away. I mean the people in my district by an overwhelming majority don't want this tax," said Commissioner Richard Boykin.

by Tyler Durden

Oct 11, 2017 6:40 PM

California hits Gatorade in Court

SACRAMENTO, Calif. (AP) — Gatorade has agreed not to make disparaging comments about water as part of a $300,000 settlement reached Thursday with California over allegations it misleadingly portrayed water's benefits in a cellphone game where users refuel Olympic runner Usain Bolt.

The game, downloaded 30,000 times in California and 2.3 million times worldwide, is no longer available.

The dispute between the sports-drink company and California Attorney General Xavier Becerra was settled in less than a day after Becerra filed a complaint in Los Angeles County.

Becerra's complaint alleges the game, called Bolt!, misleadingly portrayed the health benefits of water in a way that could harm children's nutritional choices. The game encouraged users to "keep your performance level high and avoid water," with Bolt's fuel level going down after drinking water but up after drinking Gatorade, the complaint alleged.

The settlement should serve as a warning to companies that falsely advertise, Becerra said.

"Making misleading statements is a violation of California law. But making misleading statements aimed at our children is beyond unlawful, it's morally wrong and a betrayal of trust," he said in a statement.

Gatorade agreed to the settlement but has not admitted wrongdoing.

"The mobile game, Bolt!, was designed to highlight the unique role and benefits of sports drinks in supporting athletic performance. We recognize the role water plays in overall health and wellness, and offer our consumers great options," spokeswoman Katie Vidaillet said in an email.

In addition to agreeing not to disparage water, Gatorade agreed not to make Bolt! or any other games that give the impression that water will hinder athletic performance or that athletes only consume Gatorade and do not drink water. Gatorade also agreed to use "reasonable efforts" to abide by parent company PepsiCo's policy on responsible advertising to children and to disclose its contracts with endorsers.

Of the settlement money, $120,000 will go toward the study or promotion of childhood and teenager nutrition and the consumption of water.

The game was available in 2012 and 2013 and for a limited time in 2017.

 

Sugar not so sweet for mental health

Aug. 9, 2017

A new study suggests sugar intake may increase the likelihood of developing "common mental disorders", but some researchers are taking the findings with a pinch of salt Photo: AFP

Sugar may be bad not only for your teeth and your waistline, but also your mental health, claims a study that was met with skepticism by other experts.

Researchers at University College London (UCL) compared the reported sugar intake of more than 8,000 people in a long-term British study, to their mood.

The study participants, civil servants, were monitored from 1985-1988, and filled out a questionnaire every few years thereafter.

Researchers examined data from that study for an association between sugar intake and "common mental disorders" (CMD) such as anxiety and depression.

The UCL team found "an increased likelihood" for men with a higher intake of sweet foods and drinks to develop CMD after five years, and a general "adverse effect" on mental health for both sexes.

And they concluded, in a study published in the journal Scientific Reports, that "lower intake of sugar may be associated with better psychological health."

But dietician Catherine Collins, a spokeswoman for the British Dietetic Association, said this recommendation was "unproven".

Problems with the study, she said, included that sugar consumption was self-reported, and that sugar intake from alcohol was not counted.

The researchers, she said, appeared to confuse naturally-occurring sugar from foodstuffs such as milk, and "free sugars" added to hot drinks or in sweets.

"The dietary analysis makes it impossible to justify the bold claims made by the researchers about sugar and depression in men," Collins said via the Science Media Centre in London.

"Reducing intake of free sugars is good for your teeth, and may be good for your weight, too. But as protection against depression? It’s not proven."

Nutrition expert Tom Sanders agreed the results should be interpreted "with caution".

"From a scientific standpoint it is difficult to see how sugar in food would differ from other sources of carbohydrate on mental health as both are broken down to simple sugars in the gut before absorption," he said.

© 2017 AFP

Why One Cardiologist Has Drunk His Last Diet Soda

Sep 14, 2017

By Harlan Krumholz

Dr. Harlan Krumholz (@HMKYale) is a cardiologist and the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine.

Drinks and foods marketed to help us maintain weight may have been helping us to gain it, says WSJ Health Expert Harlan Krumholz. Photo: iStock Photo

I used to pound down diet drinks. Low-calorie had to be good, right? It was an invitation to enjoy as much as I wanted, guilt-free. Diet soda was a source of caffeine, and a companion.

And this was all consistent with my identity as a cardiologist. I am very interested in the prevention of heart disease—for my patients for the public, and for myself. So while I never saw diet soda as a health drink, I felt it helped keep my weight under control.

New research, however, has raised the very real possibility that the non-sugar sweeteners that put the “diet” in diet drinks (and many low-calorie foods), may have been conspiring against me.

Rather than help me maintain a healthy weight, they may have been predisposing me to weight gain and metabolic abnormalities. This research is suggesting that drinks and foods using artificial sweeteners like aspartame may be doing exactly what we thought they should be preventing. At the very least, they do not seem to help people keep weight off.

The study in the Canadian Medical Association Journal searched the literature for randomly controlled studies involving non-nutritive sweeteners. They found a mere seven trials, with a total of only 1,003 people, that evaluated consumption of the substances for more than six months.

The bottom line was that they generally failed to find that sweeteners helped people lose weight. Since most people use sweeteners for the purpose of controlling or losing weight, if they were considered drugs instead of a food substance they would be deemed ineffective based on the best evidence available.

The researchers also looked at 30 observational studies, those that did not involve changing people’s diets, but merely cataloging the diet and determining changes over time. They found that people who consumed these sweeteners were more likely to have increases in weight and waistline, and a higher incidence of obesity, hypertension, metabolic syndrome, Type 2 diabetes and cardiovascular events.

One could argue that people who consume diet foods may have already been predisposed to gaining weight and to these other conditions. Many discount these nonexperimental studies—I know I have done so for years. But now I am taking another look as studies are starting to indicate that diet sweeteners could be hurting, instead of helping weight-loss efforts.

Colleagues at my institution argued in 2015 that such sweeteners are far from inert. They showed an impact on hormone secretion, cognitive processes and gut microbiota—and concluded that all of these effects could counter weight control intentions. Another recent peer-reviewed publication presented animal studies that are disturbing. The effects of these sweeteners seem to vary based on the type, dose and timing. What was clear is that these substances again were linked to weight gain and metabolic disturbances.

A study of one substance called sucralose found that its sweetness affected a different part of the brain than sugar. The point was that even though people perceive the sweetness of sugar and sucralose similarly, the brain sees them differently, which may have implications for hunger and reward.

It is reasonable to ask why these substances were not evaluated as drugs in the first place. Millions of people are exposed to them every day, and yet their long-term effect is uncertain. Could they be actually causing the health problems they were intended to prevent? I don’t know the answer at this point, but it seems to me that the burden of proof is on the manufacturers to show benefit and demonstrate safety through clinical trials.

Meanwhile, I’ve stopped my daily habit of diet drinks and I am slowly removing these substances from the rest of my diet (given their ubiquity, that is not easy). If, in the end, we discover that large-scale consumption of diet drinks and foods helped fuel the obesity epidemic, it would be more than ironic. It would be tragic.

Read the latest Health Report.

The Scary Connection Between Cake and Cancer

Amy Capetta

Yahoo Beauty May 26, 2017

While millions of people claim that desserts are their favorite guilty pleasure, scientists report that certain cancer cells may have an even bigger sweet tooth.

Medical researchers from the University of Texas at Dallas discovered that one specific type of cancer — squamous cell carcinoma (SqCC) — is “remarkably more dependent” on sugar for its energy supply, as compared with other cancers.

Since various studies over the years have found that many cancer cells feed off sugar (in the form of glucose), the investigative team decided to examine the differences in metabolism between two major subtypes of non-small cell lung cancer: adenocarcinoma (ADC) and SqCC. They noted that about one quarter of all lung cancers are SqCC, which have been difficult to treat with targeted therapies.

The investigators collected data regarding 33 types of cancers from more than 11,000 patients. And here’s what they found: A protein responsible for transporting glucose into cells was present in significantly higher levels in lung SqCC than in lung ADC. The protein, called glucose transporter 1 or GLUT1, takes up glucose into cells, where the sugar provides a fundamental energy source and fuels cell metabolism.

The danger of dessert

What is the scary connection between cake and cancer?

These results, which were published in the journal Nature Communications, could lead to new forms of treatment, such as a GLUT1 inhibitor, along with specific dietary recommendations.

According to the American Cancer Society, lung cancer, both small cell and non-small cell, is the second most common cancer in both men and women (after skin cancer). Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.

And in addition to squamous cell lung cancer, the research team found that GLUT1 levels were much higher in other types of SqCC: head and neck, esophageal, and cervical cancers.

Other research has also indicated a link between sugar and cancer. A 2016 study published in the online issue of Cancer Research stated that high amounts of dietary sugar — which are found in the typical Western diet — may increase the risk of breast cancer and metastasis to the lungs. Also, medical investigators from New York University discovered that consuming sugary drinks, processed foods, and high-carb meals could triple a man’s risk of prostate cancer.

“For many years, it has been thought that most cancers are universally addicted to sugars,” Jung-whan “Jay” Kim, senior study author and assistant professor of biological sciences at the University of Texas at Dallas, tells Yahoo Beauty. “We were very surprised to find that this specific type of lung cancer is particularly reliant on sugar (glucose) for its growth. Identifying and characterizing this kind of unique metabolic changes associated with specific types of cancer will lead to the development of new cancer therapies, which may exploit a particular cancer’s unique sugar needs.”

He adds that there is no effective therapy that specifically targets lung squamous cancers. “So a very interesting further study would be to test if reduction of sugar consumption, which will restrict sugar to cancer cells, can reduce the tumor growth of this highly sugar-addicted lung cancer,” says Kim.

In fact, an upcoming study by Kim’s group will examine the effect of a sugar-restricted diet on the progression of lung cancer in an animal model of the disease. The U.S. Department of Agriculture estimates that in 2015, on average, each American consumed more than 75 pounds of refined sugar, high-fructose corn syrup, and other sweeteners combined.

Drinking Too Much Soda May Be Linked to Alzheimer’s

Two new scientific studies raise questions about whether both regular and diet drinks cause brain disease.
by Deena Shanker

https://www.bloomberg.com/news/articles/2017-04-20/drinking-too-much-soda-may-be-linked-to-alzheimer-s

When it comes to the dangers of regularly drinking soda and other sugar-sweetened beverages, the science is clear. It rots your teeth, makes you fat, and puts you at a higher risk of diabetes, heart attack, and stroke. The list goes on and on—just ask your doctor.

When it comes to diet soda, the science has been less solid. It will lower your overall sugar consumption to switch from Coke to Diet Coke, but it might cause other problems. Artificial sweeteners have been associated with—but not shown to necessarily cause—weight gaindiabetes, and heart disease

On Thursday, two studies by the same group of researchers gave soda drinkers—both diet and regular—a whole new reason to drop the habit entirely.

The first, published in the medical journal Stroke, found that consumption of artificially sweetened beverages was associated with a higher risk of stroke and dementia, including Alzheimer’s disease. The second, published in Alzheimer’s & Dementia, found that higher consumption of sugary beverages was associated with markers for pre-clinical Alzheimer’s disease. 

Led by researchers at Boston University School of Medicine, the authors of the Stroke study conducted a review of data collected through the Framingham Heart Study, a multi-decade observational review that began with more than 5,000 volunteer participants in 1948 and has included their offspring since 1971 and their grandchildren since 2002. The FHS entailed nine examination cycles held approximately every four years; participants logged beverage intake through questionnaires that surveyed their diets over the previous 12 months. In these studies, the researchers looked at the seventh cycle for the offspring, from 1998 to 2001, and the second cycle for the grandchildren, from 2008 to 2011. 

In the study cited in Alzheimer’s & Dementia, the researchers found that higher consumption of sugary beverages was associated with a pattern consistent with preclinical Alzheimer’s, including smaller total brain volume and poorer episodic memory. The authors called the findings “striking” because they were found in a middle-aged sample and withstood statistical adjustment for such factors as physical activity and total caloric intake. The results align with earlier research done with smaller samples, including one with 737 middle-aged participants in the Boston Puerto Rican Health Study, which found that higher sugar intake was cross-sectionally associated with Alzheimer’s-like behavioral patterns.

The Alzheimer’s & Dementia study notes its limitations, including that it doesn’t establish causality, the homogenous population sample didn’t include minorities, and questionnaire-based consumption data are inherently unreliable. 

Responded William Dermody Jr., vice president of policy at the American Beverage Association, the chief lobby for soda makers: “The Alzheimer’s Association points out that the greatest risk factors for Alzheimer’s are increasing age, family history of Alzheimer’s, and genetics—not sugar intake, from any source.”

The Stroke study, meanwhile, found an association with artificially sweetened beverages and stroke and dementia, while not finding a similar association for consumption of sugar-sweetened beverages, an observation the authors characterized as “intriguing.” An editorial accompanying the study noted this finding—and that it contradicted other studies that found the opposite. This study, the authors noted, has the same limitations as the Alzheimer’s & Dementia analysis, as well as another important one: The association could be a case of reverse causality, “whereby sicker individuals consume diet beverages as a means of negating a further deterioration of health.”

That concern is based on the way diabetes status partially mediated the association between artificially sweetened beverage consumption and dementia. In other words, having diabetes may be more of a risk factor for dementia than consuming artificially sweetened beverages is. The relationships among beverage consumption, diabetes, and dementia remain unclear.

All this, said Dean M. Hartley, director of Science Initiatives at the Alzheimer’s Association, points to an important reminder: Correlation doesn’t necessarily mean causation. Dermody of the American Beverage Association emphasized this point: “The authors of this study acknowledge that their conclusions do not—and cannot—prove cause and effect.” 

Still, Hartley said, this study provides an important starting point for further studies. “Many of our first understandings of a disease come from associations,” he said. “It’s why it’s critical to get more funding at a national level.” The Alzheimer’s Association has been advocating increased research funding, including a $400 million boost for 2017 through the National Institutes of Health, currently pending before Congress, and at least another $414 million for 2018. (The Trump administration budget proposal calls for a $5.8 billion cut (PDF) to the NIH for 2018, which is about 20 percent.)

Hartley also recommends the association’s 10 Ways to Love Your Brain for proactive steps towards brain health, including exercise, a healthy diet, and keeping up education, and he advises everyone to speak with physicians about their specific health conditions. Still, when it comes to soda—diet or regular—the safest course is to skip it. “I think they’re both bad,” he said. “Pure water is always a very good thing.”

By Jeffrey Eisenber, MD

Natural and Artificial Sweeteners

So if sugar and high fructose corn syrup are toxic when over consumed, where can we turn to satisfy our addiction for sweetness?

How about natural sugar substitutes? They must be a healthy alternative to that Darth Vader sugar… They have the word “natural” attached to it which just exudes safety right? Hmmm...not so fast.

This category of contestants include Agave, Maple syrup, Molasses, coconut palm sugar, and Honey.

Let's discard with Agave first as it is highly processed, and mostly fructose (evil). It wins the prize for the unhealthiest natural sugar substitute. Coconut palm sugar is less processed and may have some nutrients, but it is high in calories and fructose. Maple syrup and Molasses can boast some trace minerals, vitamins, and antioxidants…but they are still sugars which clearly outweigh any of the above benefits.

Honey from the typical grocery store is refined…stripped of any of its natural gifts. If unrefined (usually from health stores or farmer’s markets) it does have antimicrobial, antioxidant, anti inflammatory, and immune benefits along with trace vitamins and minerals. Unfortunately, the catch is the same…it is loaded with calories and fructose.

Ok…the natural sugar substitutes strike out. How about artificial sweeteners? They aren't sugars and they have virtually no calories. Surely they are the preferred alternative…the teachers pet!

Ah, not so fast. Artificial sweeteners are hundreds of times sweeter than glucose. The result: our taste buds are tricked and become dulled…normally sweet foods and drinks become irreparably bland causing us to crave higher and higher amounts of the sweet stuff to satisfy us.

The artificial sweeteners also stimulate the same dopamine brain reward pathway as sugar, cocaine, marijuana, barbiturates, and gambling. But the brain never sees the sugar! And this reward center does not like to be tricked. It responds by directing us to fulfill its anticipated sugar load by loading up on anything sweet it can find. (think “diet drink anomaly” where people who consumed diet drinks on a daily basis gained significant weight)

The artificial sweeteners also lead to an insulin release which lowers our blood sugar levels and increases our cravings for food.

They also alter our gut Microbiome and diminish the signals from our gut that tell us we are full.

Who are these not so fab-five artificial sweeteners? Aspartame, Sucralose, saccharin, xylitol, and ACE K.

Bottom line: natural and artificial sweeteners are not the teacher’s pets with regards to sugar substitutes and improved health…they are imposters. We have to retrain our taste buds to accept healthier food choices that may seem bland at first but are packed with the nutrients and vitamins our cells crave. With our taste buds retrained, we won't have to douse our palate with processed food. The real food, the stuff that Mother Earth produces, will be appreciated in a whole new and healthier light.

 

By Dr. Jeffrey Eisenberg, MD

Telomeres

A telomere is a sequence of DNA at the end of our chromosomes. These end caps are protective as they preserve genetic information. However, telomeres shorten with each cell division. They burn down like a candlewick, leaving the chromosomes vulnerable to damage. Eventually the telomere length “runs out” and the cell can no longer rejuvenate. The result is cellular death!

It is hypothesized that humans can live to be 122 years old based on the study of telomere length. So why do the overwhelming majority of us fall so short of these expectations? Well, it turns out that inflammation, stress, and sugar accelerate the rate at which telomeres shorten. This speeds up the rate of biological aging, and is linked to heart disease, obesity, Diabetes,, cancer, and neurodegenerative disease.

The American Journal of Public Health (10/16/14) was the first study to show that soda consumption is associated with telomere shortening and cellular aging. It is based on the work of Elizabeth Blackburn, a USCF researcher who received the Nobel Prize in 2009, who calculated that the daily consumption of a 20oz sweetened sugary beverage (SSB) was associated with 4.6 years of accelerated biological aging. (Comparable to the effect of smoking)

So telomere length is epigenetically influenced by nutrition! If we can eat more healthily,  (avoiding excess sugar and processed carbohydrates while maximizing our exposure to antioxidants and anti-inflammatories) we may be able to slow down the rate of telomere shortening, repair damaged telomeres, and even lengthen these same telomeres. Be like a Vulcan: “ Live long and prosper! “

By Dr. Jeffrey Eisenberg, MD

Sugar and Mood

Dopamine is an example of a “feel good” hormone. When this neurotransmitter is released and binds with the dopamine receptors in a particular part of our brain, we experience euphoria and a desire to pursue and repeat a specific pleasurable pathway.

Sugar happens to be one of the most powerful triggers of Dopamine release. It lights up that part of the brain like a pinball machine…similar to the effect one feels when addicted to alcohol, cocaine, amphetamines, marijuana, and gambling. That feeling of well being that sugar facilitates is called the “sugar high”.

With repetitive stimulation however, the Dopamine receptor sites down regulate themselves so that larger amounts of Dopamine are needed to achieve the same “high”. This is what we call “tolerance”, the first step to full blown addiction.

So how does excess sugar consumption contribute to mood fluctuations? Well, it turns out that sugar and processed carbohydrates influence the blood levels of the very amino acids (tryptophan and tyrosine) that form our feel good hormones: dopamine and serotonin.

When we consume sugar, our blood glucose levels rise, resulting in an increased release of insulin. This allows the passage of those amino acids into the brain that form our feel good hormones. We then experience that all to familiar sugar rush and feeling of euphoria. However, as our blood sugar level continues to rise with excess consumption of sugar, the resulting hyper-secretion of insulin leads to a precipitous decline in that blood sugar level resulting in a rapid drop in our neurotransmitters (dopamine and serotonin). What follows is a feeling of depression, anxiety, or other mood fluctuations.

 Unstable blood sugar levels lead to unstable neurotransmitters and subsequently to significant fluctuations of mood! This is a particularly precarious situation for patients who are already anxious, depressed or bipolar. So cut out the excess sugar and feel better both physically and mentally!

By Dr. Jeffrey Eisenberg, MD

Fat is the preferred fuel of the body

Our body will burn whatever we offer it when it comes to burning fuel. It has no choice... unless we give it that choice. When we were hunters and gatherers we flourished on healthy fat (in the form of free roaming antibiotic free meat, seeds, and nuts) along with any fruits and vegetables we could find. When food was sparse we broke down our fat stores and used this quite efficiently and successfully as fuel until the next meal could be obtained. Obesity, heart disease, and Diabetes did not exist.

Fast forward a few hundred years and what we now burn as fuel is predominantly sugar and processed carbohydrates. Our food choices are overwhelmingly laden with added sugar…and we are addicted to this sweet but not so innocuous molecule. One of the interesting results of the overconsumption of sugar is the resulting staggering increase in our insulin levels. If one measures the fasting insulin levels in the Maasai and Inuit cultures, where there is no access to added sugar or processes carbs, their levels range between 2.0 and  5.0. The average fasting insulin level in the U.S. Is 9.8. The majority of the levels I obtain in my overweight and obese patients are between 20 and 50! We are walking around with insulin levels that are orders of magnitude higher than our predecessors. And we spend a trillion dollars/yr combating the metabolic consequences of our diet in the form of those diseases our ancestors avoided.

While it is true our brain primarily relies on glucose to function, it can do quite well using the stores of glycogen in our liver, from gluconeogenesis (the production of glucose from protein),  and from ketones (the break down product of fatty acids).  We don't need carbohydrates to survive…they are not essential. I believe our body wants to burn fat as a fuel. It can achieve this cleanly and efficiently and without the health risks associated with our current sugar/carb rich diet.

One last caveat. If you want to lose weight you must lower your insulin levels. Insulin is your storage hormone. It locks excess energy in the form of fat in your fat cells…and it throws away the key! You cannot access that fat as energy as long as your insulin levels are elevated. As insulin falls (by avoiding the overconsumption of sugar) you can utilize that “freed” fat as energy. The more keto-adaptive you become the more weight you will lose; you are on your way to a longer, healthier, and more productive life!

By Dr. Jeffrey Eisenberg, MD

Which blood test to order and how to interpret them

When I am caring for a child or young adult who is overweight or obese there are specific lab tests that are appropriate to obtain. In particular, I need to know how many criteria of the Metabolic Syndrome this patient may have, as this correlates with future risks of chronic disease. What criteria determines the Metabolic Syndrome?

-fasting blood glucose > 105

-blood pressure > 135/90

- triglycerides > 150

-HDL <40(male), <35(female)

*waist circumference >40in (male), >35in (female)

A patient with 3 of the 5 above criteria has Metabolic Syndrome. More than 1/3 of Americans satisfy this diagnosis, increasing their risk for diabetes, heart disease, obesity, cancer, and neurodegenerative disease.

Notice that total cholesterol is absent from the above criteria. Remember, 90% of the cholesterol in our blood is produced by the liver; the level is relatively unaffected by dietary intake. Unless you suffer from one of the hereditary forms of hyperlipidemia, cholesterol levels correlate poorly with subsequent risk of heart disease. (50% of patients with myocardial infarction have normal cholesterol and 50% of patients with abnormal cholesterol levels have normal hearts). In fact, barring other lipid abnormalities, studies show that people with higher cholesterol levels live longer with less dementia, Alzheimer’s disease, or neurodegenerative disease. Too many patients are reflexively placed on statins for an elevated cholesterol level. (white males with previous heart disease have been shown to benefit from statins). We need cholesterol for our cell membranes and for our myelin sheaths that allow communication between neurons. This is a topic for future blogs but the over prescription of statins leads to side effects such as fatigue, muscle aches, a loss of libido, and all the symptoms associated with low Vit D. Only the pharmaceutical companies prosper.

Traditionally, HDL has been considered your “good” cholesterol while LDL has denoted your “bad” cholesterol. However this nomenclature, while easy to remember, is not quite accurate as there are particle subsets of both categories that are both good and bad. Healthy fat consumption increases the good subsets of HDL and LDL while sugar consumption increases the bad subsets. Most labs aren't set up to differentiate the particle subsets of HDL and LDL.

LDL type A: large buoyant fluffy; travel through blood vessels harmlessly

LDL type B: small dense; excavates vessel walls leading to inflammation and plaques

HDL 2: large buoyant; anti inflammatory and protective

HDL 3: small dense: inflammatory

Thus if a patient’s LDL is elevated, one way to determine if the elevation is due primarily to the good or bad particle fraction is to examine the triglyceride to HDL ratio. A ratio less than 2.0 is an indicator the LDL level is good; a ratio greater than 3.0 suggests the LDL level is bad and is a predictor of insulin resistance. In my practice for example, it is quite commonplace for an obese patient to have triglyceride levels of 180 and HDL levels of 35, yielding a very unhealthy ratio of > 5.0. These patients need to be monitored closely for all those disease states resultant from the Metabolic Syndrome.

In addition to lipid analysis ( triglycerides, HDL, LDL, and cholesterol) it is prudent to check for pre-diabetes as 37 % of Americans fall into this category. Typically a physician will order a fasting glucose and HGB-A1C. The later test is an average of the patient’s last 3 months of blood glucose. Unfortunately, these tests can miss the pre-diabetic patients because their pancreas is pouring out oodles of insulin to keep these labs in the normal range! A better test to pick up patients who will ultimately show signs of diabetes is the fasting insulin level. The higher this level the harder your pancreas is working to counter what would otherwise be elevated glucose levels. If one looks at insulin levels from from cultures and tribes who have no access to sugar or processed carbohydrates (Maasai, Kitava, Inuit) they are routinely <5.0. The average american’s fasting insulin level is 9.8. My patients who are obese have fasting insulin levels between 20 and 40! (Incidentally, the quoted upper normal ranges for fasting insulin are way too high and should not be considered a target goal) We have become a society dependent on sugar and processed food and we have insulin levels that are orders of magnitude above normal. Hyperinsulinemia is associated with a host of disease states ranging from diabetes to hypertension, obesity, cancer, nonalcoholic fatty liver disease, hyperlipidemia, reflux……

Other lab tests to consider:

-ALT: a liver function test that correlates with fatty liver disease

-CRP: assesses inflammation and cellular damage

-fibrinogen: assesses inflammation and cardiovascular disease

-ferritin: assesses cardiovascular disease

-homocysteine: associated with heart disease and alzheimer’s disease

-Uric acid: correlates with fructose consumption… associated with Metabolic Syndrome (HTN)

-Vitamin D: associated with osteoporosis, heart disease, diabetes, obesity, cancer, immunity….

So next time you are due for blood work ask your physician which labs are appropriate for your current health profile!

By Dr. Jeffrey Eisenberg, MD

Sugar and Reflux

Americans spent 13 billion on acid reducers in 2006. GERD (gastroesophageal reflux disease) can lead to esophageal scarring, constriction, ulceration, and cancer. Physicians prescribe these antacids to lower the acid content in the stomach so that when reflux occurs the resultant backwash into the esophagus becomes less harmful. However, there are problems associated with the chronic use and promotion of antacids.

You see, the stomach is supposed to have an acidic environment. It needs that low ph to properly digest food and absorb nutrients. Chronically low stomach acid from antacid use is associated with serious health complications since the stomach is no longer sterile; harmful bacteria are allowed to survive! Sugar intake can lead to the “leaky gut syndrome “ whereby undigested proteins and harmful bacteria leak into our circulation causing a cascading effect of inflammation, ultimately leading to autoimmune disease and a host of other maladies.

GERD is associated with dysfunction of the lower esophageal sphincter (LES). This valve is supposed to be “one way”, allowing food from the esophagus to enter the stomach. So in people with a “leaky” LES what is the driving force that propels the stomach acid to go the “wrong way”, backwards into the esophagus? And shouldn't physicians direct their attention and treatment of reflux to this actual force, rather than prescribing chronic antacids to mitigate the side effects of acidic backwash?

I first became interested in this causal effect when I noticed that my reflux symptoms all but abated when I stopped consuming excess sugar. I was able to stop my antacids for the first time in over a decade! A review of the literature suggested a plausible answer: it turns out that excess sugar is fermented into hydrogen gas. This accumulation of hydrogen gas results in increased pressure in the stomach and is the propellant that drives the acid contents backwards into the esophagus. People with GERD frequently admit to excess belching.

So, GERD diminishes if one avoids excess sugar consumption. While more research is ongoing in this area, it seems wise to at least highlight the association. We, as a nation, can save billions in drug related costs and become healthier “gut wise” if we decrease our reliance and dependence on sugar!

By Dr. Jeffrey Eisenberg, MD

Microbiome

Did you know we have 100 trillion bacteria in our gut? Yep, over 10,000 species of these little critters…some of them transient nomads and some permanent residents. It's not an area most of us dwell on, but our Microbiome supports every conceivable aspect of our health. It is an organ in and of itself and determines if we live robustly to a ripe old age.

So what do these bacteria do for us?

(1). Aid in digestion and the absorption of nutrients

(2). Create a physical barrier against potential invaders

(3). Act as a detoxification machine preventing infection

(4). Influences our immune system (80% of our immune system is in the gut)

(5). Produce vitamins (B12) and neurotransmitters (serotonin)

(6). Helps fight inflammation

Clearly, we don't want our gut overrun by unfriendly bacteria. We want the good guys....diverse,  beneficial bacteria!

What forces can derail our Microbiome?

(1). Exposure to chemicals in food ( gluten, sugar) and drugs like antibiotics

(2). Poor nutrition ( low fiber, low healthy fats, high sugar)

(3). Stress and inflammation

You see, anything that interferes with the integrity of our intestinal wall creates havoc. Have you heard of the “leaky gut syndrome”? Our intestinal lining is only one cellular layer of thickness. When that tight junction becomes permeable, the gatekeepers can no longer protect us and bacterial pathogens, undigested proteins, and lipopolysaccharides (LPS) gain entrance into our circulation. And this results in a firestorm of inflammatory diseases:

(1). Arthritis

(2). Inflammatory bowel disease ( crohns and ulcerative colitis)

(3). Asthma, eczema, food allergies

(4). Celiac disease

(5). Alzheimer's and cognitive impairment

(6). Mood disorders (anxiety and depression, chronic fatigue)

(7). Autoimmune disease

So how do we keep our gut happy and functioning properly?

(1). Probiotics: live good bacteria found in fermented foods (kefir, sauerkraut, Kimchi, yogurt, Tempeh, pickles, Kombucha)

(2). Prebiotics: nondigesible fiber that act as food or fuel for the good bacteria (acacia gum, chicory root, Jerusalem artichoke, dandelion greens, garlic, leeks, onion)

(3). Go Low- carb, high quality fat

(4). Polyphenols: powerful antioxidants found in black and green tea, red wine, dark chocolate

(5). Intermittent fasting (a topic of intense recent interest)

Remember, a healthy gut leads to a more healthy, more productive, and longer life.  Treat those good bacteria well and they will return the favor a thousand fold!

How Much Sugar Can You Avoid Today?

Sunday Review | Op-Ed Columnist

By DAVID LEONHARDT DEC. 30, 2016

The typical American diet includes far too much added sugar. Can you stay under a healthy limit?

I’ve recently tried to reduce the sugar I eat, having been persuaded by the research on its damages — and alarmed by how much sugar has snuck into our diet. To give you a sense of how common it is, we’ve created a challenge: Construct a day’s worth of eating, from items at a typical supermarket we visited, that meets the guidelines for added sugars.

Health experts recommend most adults eat no more than 50 grams (that’s 12-and-a-half teaspoons) of added sugars per day — and, ideally, closer to 25. Unfortunately, food companies aren’t (yet) required to disclose how much added sugars are in their products. They must disclose only total sugars, including the natural ones in fruits, vegetables and dairy.

But that still lets you make good decisions. That’s because while the reality is that natural sugars aren’t much healthier than added sugars, experts focus on added sugar because Americans don’t tend to overeat fruit and vegetables. A useful rule of thumb is: Don’t worry about anything with only natural sugar. (In this challenge, we haven't.)

So get to work. Pick food for three meals and, if you’d like — and have the sugar to spare — a snack and dessert. Good luck!