By Alan Safdi, M.D., FACG
Dr. Alan Safdi is past chairman of the Section of Gastroenterology at Deaconess Hospital and served as co-founder and president of the Ohio Gastroenterology and Liver Institute. Dr. Safdi is board certified in internal medicine and gastroenterology, and is a Fellow of the American College of Gastroenterology. He is the former chairman of the Crohn’s and Colitis Medical Advisory Board in Cincinnati and still serves as president of Consultants for Clinical Research. He was also co-founder of eMerge Health Solutions, Consultants for Clinical Research, and outpatient GI and anesthesia programs.
In this article we tackle six commonly talked about medical “facts.” Are they really facts, or myths? We uncover the whole story from aspirin as a miracle drug to new diets and more.
Aspirin was first introduced in 1899 by the drug and dye firm Bayer. Aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) do not generally change the course of the disease process when they are used for symptomatic relief.
Low doses (typically 75 to 81 mg/day) are sufficient to irreversibly acetylate platelets, which helps to prevent clots. Cardiovascular disease (CVD) and cancer are the leading causes of morbidity and mortality worldwide, representing 24% and 13% of all deaths, respectively. For patients who have survived a heart attack or stroke, aspirin produces statistically significant and important reductions in morbidity and mortality. The problem is that many healthy people take aspirin thinking it will keep them healthy. And that’s not the case.
A recent study of mostly healthy older people showed the mortality rate from all other causes – but especially cancer — was higher with a daily dose of aspirin. I do not believe that aspirin offers meaningful benefits in primary prevention and it carries substantial bleeding risks. Unless the cardiovascular risk is very high (more than 20% over ten years), prophylactic aspirin results in more harm than good. In secondary prevention, the absolute benefits on occlusive (clot) events are far greater than the absolute risks of major bleeding.
What you eat matters. We know that older adults consume 40% less dietary fiber than is recommended. Not getting enough fiber could have negative consequences for things you don’t even think about, such as brain health and inflammation in general. Dietary fiber is known to reduce the incidence of diabetes and cardiovascular disease.
Eating fiber-rich foods—such as broccoli, nuts, oats, beans, and whole-grain bread—might help delay brain aging by triggering the production of a short-chain fatty acid that has anti-inflammatory properties. Microglia, a major type of immune cell in the brain, tend to become hyperactive and chronically inflamed with age, one of the main causes of memory loss and cognitive decline in old age. Butyrate, which is a short-chain fatty acid that is produced in the colon when bacteria ferment fiber in the gut, can improve memory and reduce inflammation in mice. A high-fiber diet reduced inflammation in the brain’s microglia. The researchers suspect that this was achieved by diminishing the production of a pro-inflammatory chemical known as interleukin-1β, which some studies have linked with Alzheimer’s.
A balanced unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life. The “ketogenic diet”– very low in carbohydrates, moderate in protein, and very high in fats – is the latest fad diet. The “classic keto” diet consists of only 4% carbs, 6% protein, and as much as 90% fat. By starving the body of carbohydrates (ie, glucose, our typical energy source), the diet forces the body to burn fats as its main fuel. To get to this point, the body must not only use up its glucose, but also deplete its stored glycogen. After a few days of strict dieting, the metabolism switches into a state of ketosis, in which it burns up fats at a high rate. The fats are then converted into fatty acids and ketone bodies, which are used as energy in place of the missing glucose. This is what gives the keto diet its reputation for fat-burning weight loss.
Research shows that the ketogenic diet can accelerate weight loss. But the diet is meant to be followed for only a few weeks at a time, not year-round. So, whether patients can keep the weight off is another story. One meta-analysis found that people on a ketogenic diet did have long-term weight loss, but it was only about 1 kg (about 2.2 lbs).
What are the risks? According to two recent studies, athletes and people with type 2 diabetes should probably avoid the keto diet. Nutritionists at Saint Louis University found that the diet reduced exercise performance, especially for anaerobic activities. This finding has clear performance implications for athletes, especially those who participate in high-intensity, short-duration sports. There may be an increased risk of insulin resistance with this type of diet that may lead to type 2 diabetes. Researchers in Zurich, Switzerland, found that mice on a ketogenic diet had decreased glucose tolerance to a greater degree than mice fed a typical Western high-carb, high-fat diet.
A recent study in The Lancet shows that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12% of deaths in males between the ages of 15 and 49. The findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems.
Studies show that alcohol contributes to:
•Cardiovascular diseases: atrial fibrillation and flutter, hemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy;
•Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal;
•Other non-communicable diseases: cirrhosis of the liver, diabetes, epilepsy, pancreatitis, and alcohol use disorders;
•Communicable diseases: lower respiratory infections and tuberculosis;
•Intentional injuries: interpersonal violence and self-harm;
•Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries; and
This study did not explore extremely low levels of alcohol ingestion.
Sodium, commonly consumed as sodium chloride (table salt), is a major component of our food supply. Based upon data from the National Health and Nutrition Examination Survey, estimated average sodium intake in United States among adults remains high, approximately 3600 mg/day, and exceeds both the recommended upper limit of 2300 mg/day set by the 2015 United States Dietary Guidelines and the more stringent limit of 1500 mg/day set by the American Heart Association. Average intake is approximately 4200 mg/day in men and approximately 3000 mg/day in women.
Research from the Prospective Urban Rural Epidemiology (PURE) study shows increased risks for stroke or cardiovascular disease (CVD) only in communities where mean sodium intake exceeds 5 g per day (that’s 5000 mg/day). It appears that blood pressure and stroke increase with salt intake, but heart attack and mortality do not. Moreover, foods with high potassium, such as fruits, vegetables, and nuts are protective, even in those with high salt intake. Do we need to bring sodium consumptions to moderate levels and to relax the old recommendations? One problem with this research is that only about 10% of the population studied had both hypertension and high sodium consumption (greater than 6 grams per day).
Good news for ice cream lovers and French chefs: A recent observational study showed a heart benefit from full-fat dairy products, and even saturated fat appears acquitted. Consumption of more than two servings of dairy per day (compared to no intake) was linked with a lower risk of death or a major cardiovascular event, including death from cardiovascular causes, non-fatal MI, stroke, and heart failure. Did the dairy have to be low fat? The findings were the same for both whole-fat and low-fat dairy. This study suggests that consumption of dairy products should be encouraged in low-income and middle-income countries where dairy and meat consumption is low. It may be that the study simply fixed calorie deprivation in the subject population. If a well-fed industrialized population were studied, would the result be the same? Food for thought!
If you are interested in learning more from Alan V. Safdi MD, FACG, check out these articles:
This article was written by Alan Safdi, M.D., FACG:
The information included in my posts are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in my posts does not create a physician-patient relationship.
Alan V. Safdi MD, FACG
Co-founder Emerge Healthcare Solutions and Consultants for Clinical Research
Past President Ohio Gastroenterology and Liver Institute
President Nominations Committee Ohio GI Society
Served as Chairman Section of Gastroenterology at. Deaconess Hospital
President Consultants for Clinical Research
Past Chairman Cincinnati Crohn’s & Colitis Medical Advisory Committee
Former Medical Director Tri-State Endoscopy Center
Served as President of the Ohio Gastroenterology Society
Lectures Nationally and Internationally on Health and Wellness