Poor gut health is Associated With Severe COVID-19

In a review published this week in mBio, microbiologist Heenam Stanley Kim, Ph.D, from Korea University’s Laboratory for Human-Microbial Interactions, in Seoul, examined emerging evidence suggesting that poor gut health adversely affects COVID-19 prognosis. Based on his analysis, Kim proposed that gut dysfunction — and its associated leaky gut — may exacerbate the severity of infection by enabling the virus to access the surface of the digestive tract and internal organs. These organs are vulnerable to infection because they have widespread ACE2 — a protein target of SARS-CoV-2 — on the surface.”There seems to be a clear connection between the altered gut microbiome and severe COVID-19,” Kim said.

American Society for Microbiology. “Poor gut health connected to severe COVID-19, new review shows.” ScienceDaily. http://www.sciencedaily.com/releases/2021/01/210112085347.htm (accessed January 15, 2021).

Journal Reference: Heenam Stanley Kim. Do an Altered Gut Microbiota and an Associated Leaky Gut Affect COVID-19 Severity? mBio, 2021; 12 (1) DOI: 10.1128/mBio.03022-20

Eat more legumes, plants and other sources of dietary fiber.

Eat less meat, dairy, and eggs.

Ultraprocessed Food Again Linked to Increased CVD, Death

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Cite this: Ultraprocessed Food Again Linked to Increased CVD, Death – Medscape – Dec 24, 2020. — https://www.medscape.com/viewarticle/943200?src=rss

After reading the full summary of the study I had some issues with the study findings on pizza. Apparently I’m not alone. From the comment section:

Pizzas were mentioned by the authors and Dr. Walter Willet (for whom I have always had great admiration and consider him among my 3 most valued nutrition resources) as a UPF. However, even as a consistent follower of Mediterranean diet for >40 years, I see nothing wrong with occasional enjoyment of two or three slices of Margherita pizza (which is not covered with any processed meats or extra cheeses).

Dr. Michael Mogadam

Like I’ve said many, many times pizza is a food group and should not be considered an ultraprocessed food. Without pizza life would not be possible. Pass on the chips, sugary drinks, restructured meat (see https://www.sciencedirect.com/topics/food-science/restructured-meat) and other types of junk food.

Don’t pass on the pizza!

Diet modifications (including more wine and cheese) May Help Reduce Cognitive Decline

Participants also answered questions about their food and alcohol consumption at baseline and through two follow-up assessments. The Food Frequency Questionnaire asked participants about their intake of fresh fruit, dried fruit, raw vegetables and salad, cooked vegetables, oily fish, lean fish, processed meat, poultry, beef, lamb, pork, cheese, bread, cereal, tea and coffee, beer and cider, red wine, white wine and Champaign and liquor.

Here are four of the most significant findings from the study:

Cheese, by far, was shown to be the most protective food against age-related cognitive problems, even late into life;

The daily consumption of alcohol, particularly red wine, was related to improvements in cognitive function;

Weekly consumption of lamb, but not other red meats, was shown to improve long-term cognitive prowess; and

Excessive consumption of salt is bad, but only individuals already at risk for Alzheimer’s Disease may need to watch their intake to avoid cognitive problems over time.

Iowa State University. “Diet modifications — including more wine and cheese — may help reduce cognitive decline, study suggests.” ScienceDaily. http://www.sciencedaily.com/releases/2020/12/201210145850.htm (accessed December 13, 2020).

Journal Reference

  1. Brandon S. Klinedinst, Scott T. Le, Brittany Larsen, Colleen Pappas, Nathan J. Hoth, Amy Pollpeter, Qian Wang, Yueying Wang, Shan Yu, Li Wang, Karin Allenspach, Jonathan P. Mochel, David A. Bennett, Auriel A. Willette. Genetic Factors of Alzheimer’s Disease Modulate How Diet is Associated with Long-Term Cognitive Trajectories: A UK Biobank Study. Journal of Alzheimer’s Disease, 2020; 78 (3): 1245 DOI: 10.3233/JAD-201058

Finally some good news.

Covid-19 Jeopardy – Green Tea, Two Varieties of Muscadine Grapes, Cacao Powder and Dark Chocolate

Chemical compounds in foods or beverages like green tea, muscadine grapes and dark chocolate can bind to and block the function of a particular enzyme, or protease, in the SARS-CoV-2 virus, according to a new study by plant biologists at North Carolina State University.

North Carolina State University. “Chemical compounds in foods can inhibit a key SARS-CoV-2 enzyme, study finds.” ScienceDaily. http://www.sciencedaily.com/releases/2020/11/201130131445.htm (accessed November 30, 2020).

Journal Reference:

  1. Yue Zhu, De-Yu Xie. Docking Characterization and in vitro Inhibitory Activity of Flavan-3-ols and Dimeric Proanthocyanidins Against the Main Protease Activity of SARS-Cov-2. Frontiers in Plant Science, 2020; 11 DOI: 10.3389/fpls.2020.601316

I don’t think this is a game changer but it is interesting nonetheless.

Vegan Diet and Fracture Risk (I’m confused too)

If you’ve been anywhere near the internet I’m sure the headlines caught your eye. But a 43% higher risk of fractures just seemed really high to me with a meat free diet as the cause. I found the following article online. Since most people nowadays can’t get past the headlines you’ll find the second paragraph completely ignored by the media.

Compared with people who ate meat, vegans with lower calcium and protein intakes on average, had a 43% higher risk of fractures anywhere in the body (total fractures), as well as higher risks of site-specific fractures of the hips, legs and vertebrae, according to a study published in the open access journal BMC Medicine. Vegetarians and people who ate fish but not meat had a higher risk of hip fractures, compared to people who ate meat. However, the risk of fractures was partly reduced once body mass index (BMI), dietary calcium and dietary protein intake were taken into account.

The authors caution that they were unable to differentiate between fractures that were caused by poorer bone health (such as fractures due to a fall from standing height or less) and those that were caused by accidents because data on the causes of the fractures were not available. No data were available on differences in calcium supplement use between the different diet groups, and as in all dietary studies the estimates of nutrients such as dietary calcium or dietary protein are subject to measurement error. As the study predominantly included white European participants, generalisability to other populations or ethnicities may be limited, which could be important considering previously observed differences in bone mineral density and fracture risks by ethnicity, according to the authors.

Vegans, vegetarians and pescetarians may be at higher risk of bone fractures — https://www.eurekalert.org/pub_releases/2020-11/bc-vva111820.php

As I was gathering my thoughts the algorithms started doing what they do and this popped up in YouTube.

Let’s discuss the latest paper from the EPIC database. Excuse me eating while working. Not enough hours in day. Short version: this is a database from 90’s. Average fiber intake is 20 gm so not healthiest plant based eaters. Meat eaters got more vitamin D. Also (forgot to mention in video) used hormone replacement therapy up to 50% more. Both associated with stronger bones. Other studies have shown that plant based eaters have great bone health BUT you have to be healthy. Get dark greens. Drink or eat soy (studies show as good dairy for bones). Exercise and use resistance training. And take supplements if needed. I like multivitamins that have K2 as that may be a nutrient vegans are deficient in unless you eat natto 🤮. Definitely vitamin D if deficient. The EPIC Oxford cohort are not the healthiest vegans and vegetarians BUT have less ischemic stroke, weight less, generally better heart and less of certain cancers despite poor supplementation and diet habits.

Dr. Garth Davis YouTube post 11.23.20

I love it when someone else does the work for me. If you have eleven minutes listen to Dr. Davis’ analysis. I am now less confused.

Lower fracture risk with higher BMI because you have more padding when you fall!

Diets Don’t Work so Why Are More Teens Dieting?

Well, my first thought was Body Dysmorphic Disorder (BDD) — https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd. But this is merely an educated guess from an insurance guy who has lost 200 pounds and not a trained licensed practicing clinical psychiatrist.

In 2015, 42% of 14-year-old girls and boys said they currently were trying to lose weight, compared to 30% in 2005.

Lead author Dr Francesca Solmi (UCL Psychiatry) said: “Our findings show how the way we talk about weight, health and appearance can have profound impacts on young people’s mental health, and efforts to tackle rising obesity rates may have unintended consequences.

“An increase in dieting among young people is concerning because experimental studies have found that dieting is generally ineffective in the long term at reducing body weight in adolescents, but can instead have greater impacts on mental health. We know, for instance, that dieting is a strong risk factor in the development of eating disorders.”

University College London. “Dieting and weight worries on rise in teens.” ScienceDaily. http://www.sciencedaily.com/releases/2020/11/201116112855.htm (accessed November 21, 2020). — https://www.sciencedaily.com/releases/2020/11/201116112855.htm

And in case you made it this far on this blog post my estimated BMI at age 20 was 53.1. My current BMI is 25.1.

Nutrition Matters

By many measures, the population of the United States is the unhealthiest of any high-income country despite spending much more money, as a share of the economy, on health care. The incidence of chronic disease is higher and life expectancy is lower.

Many chronic conditions plaguing Americans, such as obesity, diabetes, and high blood pressure, are avoidable with a prudent diet and lifestyle. Today, more than 42% of American adults have obesity, as do 19.3% of children of age 19 and under. The U.S. has the world’s 12th-highest obesity rate, after Kuwait. (The top 10 are all small Pacific island nations.)

Diet makes a difference. Nearly half of all deaths in the U.S. from heart disease, stroke, and type 2 diabetes are associated with diet, such as the over-consumption of processed meats and sugar-sweetened beverages and insufficient intake of fruits, vegetables, and whole grains.

Make America healthy again by paying more attention to nutrition — https://www.statnews.com/2020/11/04/nutrition-make-america-healthy-again/?utm_campaign=rss

Presented without the usual snarky comment from yours truly. Read the full article. You’ll find more links for your reading pleasure.

Cost effectiveness of dietetic intervention in management of type 2 diabetes — Journal of Human Nutrition and Dietetics Notes

Siopsis et al., JHND Early View Background The management of diabetes costs in excess of $1.3 trillion per annum worldwide. Diet is central to the management of type 2 diabetes. It is not known whether dietetic intervention is cost effective. This scoping review aimed to map the existing literature concerning the cost effectiveness of medical […]

Cost effectiveness of dietetic intervention in management of type 2 diabetes — Journal of Human Nutrition and Dietetics Notes

Of 2387 abstracts assessed for eligibility, four studies combining 22 765 adults with type 2 diabetes were included. Dietetic intervention was shown to be cost‐effective in terms of diabetes‐related healthcare costs and hospital charges, at the same time as also reducing the risk of cumulative days at work lost to less than half and the risk of disability ‘sick’ days at work to less than one‐seventh.

Conclusions: The findings highlight the importance of advocacy for medical nutrition therapy for people with type 2 diabetes, with respect to alleviating the great global economic burden from this condition. Further studies are warranted to elucidate the factors that mediate and moderate cost effectiveness and to allow for the generalisation of the findings.

First published: 14 October 2020
https://doi.org/10.1111/jhn.12821

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/early/2020/10/09/gutjnl-2020-322786?rss=1

Diet. That’s it. That’s my post.

COVID-19 and Diabetes, Sub-types of DM2, B Vitamins in Diabetes Incidence and more

This article provides an overview of the clinical evidence on the poorer clinical outcomes of COVID-19 infection in patients with diabetes versus patients without diabetes, including in specific patient populations, such as children, pregnant women, and racial and ethnic minorities.

COVID-19 and Diabetes: A Collision and Collusion of Two Diseases — Diabetes 2020 Oct; dbi200032. https://doi.org/10.2337/dbi20-0032

In the article above the researchers reviewed nearly 90 studies.

Novel diabetes subtype characteristics. Overview of distribution and characteristics of subtypes generated by clustering based on clinical parameters in the Swedish ANDIS cohort.

Type 2 diabetes (T2D) is defined by a single metabolite, glucose, but is increasingly recognized as a highly heterogeneous disease, including individuals with varying clinical characteristics, disease progression, drug response, and risk of complications. Identification of subtypes with differing risk profiles and disease etiologies at diagnosis could open up avenues for personalized medicine and allow clinical resources to be focused to the patients who would be most likely to develop diabetic complications, thereby both improving patient health and reducing costs for the health sector. More homogeneous populations also offer increased power in experimental, genetic, and clinical studies. Clinical parameters are easily available and reflect relevant disease pathways, including the effects of both genetic and environmental exposures. We used six clinical parameters (GAD autoantibodies, age at diabetes onset, HbA1c, BMI, and measures of insulin resistance and insulin secretion) to cluster adult-onset diabetes patients into five subtypes. These subtypes have been robustly reproduced in several populations and associated with different risks of complications, comorbidities, genetics, and response to treatment. Importantly, the group with severe insulin-deficient diabetes (SIDD) had increased risk of retinopathy and neuropathy, whereas the severe insulin-resistant diabetes (SIRD) group had the highest risk for diabetic kidney disease (DKD) and fatty liver, emphasizing the importance of insulin resistance for DKD and hepatosteatosis in T2D. In conclusion, we believe that subclassification using these highly relevant parameters could provide a framework for personalized medicine in diabetes.

Subtypes of Type 2 Diabetes Determined From Clinical Parameters — Diabetes 2020 Oct; 69(10): 2086-2093. https://doi.org/10.2337/dbi20-0001

Not just potential for personalized medicine in the treatment of diabetes but perhaps a framework for better risk stratification and selection in life insurance.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study

RESULTS During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B6 or vitamin B12, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2–5 were 0.85 (0.67–1.08), 0.78 (0.60–1.02), 0.82 (0.62–1.09), and 0.70 (0.51–0.97; Ptrend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (Ptrend < 0.01) and insulin (Ptrend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (Ptrend < 0.01).

CONCLUSIONS Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study — Diabetes Care 2020 Oct; 43(10): 2426-2434. https://doi.org/10.2337/dc20-0828

Folate is a B vitamin that occurs naturally in foods such as green leafy vegetables, citrus fruit, and beans. So eat your greens and beans. Taking a supplement can’t hurt either. My multivitamin has plenty of folate.