Tomás Froes’ Post

Trimethylamine N-oxide (TMAO)-- An Underrated Yet Important Cardiovascular Lab Marker More than 30% (1.38 billion) of the global adult population suffer from hypertension and the leading cause of death worldwide. It is of the utmost importance to have a better understanding of the underlying mechanisms causing hypertension and other cardiovascular events. Although there are numerous factors contributing to hypertension and other cardiovascular issues, one under-rated novel contributor is the incidence of elevated TMAO. A study published in the journal Hypertension looked at the presence of trimethylamine-n-oxide (TMAO), a byproduct from digesting certain meat-based proteins in 100 adults and 22 young adults Trimethylamine N-oxide (TMAO) is derived from foods rich in choline, phosphatidylcholine, and betaine (e.g., red meat, eggs, milk, etc.) The researchers found that meat-eaters' TMAO levels rose significantly with age, as did signs of health-threatening tissue and blood vessel damage. This was independent of the damage excess saturated fat in meats can do to your health. Another study in the Journal of the American Heart Association found that the risk of major cardiovascular events in people with elevated TMAO was 60% greater than for those with normal TMAO. Additional studies have demonstrated that TMAO is important for the development and progression of cardiovascular diseases (e.g., hypertension, atherosclerosis, coronary artery disease, and heart failure) It is commonly agreed that TMAO acts as an independent risk factor and a prognostic index for patients with cardiovascular disease and been found to induce aortic stiffening and increases systolic blood pressure. Studies provide evidence of a causal relationship of TMAO and elevated blood pressure and it is suggested that mediating the production of TMAO would be beneficial for lowering blood pressure. What also concerned me was evidence that elevated TMAO compromises the release of nitric oxide release in endothelial cells thereby interfering with the vasodilatory mechanism which can contribute to hypertension. How to Lower TMAO and Reduce Your Cardiovascular Risk Factors To reduce TMAO levels, you need to minimize and in some people actually eliminate red and processed meats from your diet. In addition, limit lean, skinless poultry to one 3- to 6-ounce serving. Additional recommendations to lower TMAO include diets high in soluble fiber as does supplementation with specific probiotics Instead, eat fish such as salmon and sea trout, which are loaded with heart-healthy omega-3 fats, twice weekly. Focus on a Plant Based-Mediterranean diet Therefore, such dietary-based strategies may help to suppress TMAO production thereby mitigating aortic stiffening and increases in systolic BP. To be quite honest there are some that will state the studies may indeed be empirical studies and not interventional and data simply does not hold up.

The KETO-ADPKD trial studied the effects of ketogenic dietary interventions (KDIs) on patients with autosomal-dominant polycystic kidney disease (ADPKD). The study, which involved 66 participants, demonstrated that KDs not only significantly reduce body weight through fat mass reduction but also increase glomerular filtration rates—a measure of kidney function—which was not observed with repetitive water fasting. Cellular metabolic irregularities are increasingly recognized as significant in Autosomal Dominant Polycystic Kidney Disease (ADPKD). These include an enhanced glycolytic pathway, known as the Warburg effect, along with glutamine dependency for carbon sources in the TCA cycle, malfunctioning mitochondria, and issues with both the synthesis and breakdown of fatty acids. Cells lining the cysts in ADPKD are reliant on glucose and show a lack of metabolic flexibility to switch to other energy sources. Studies on animals have shown that a ketogenic diet, which involves reduced calorie intake and induces ketosis, may slow the growth of kidney cysts in Polycystic Kidney Disease (PKD). This has led to preliminary research in humans through retrospective studies and trials, suggesting that ketogenic diets could be practical and beneficial for ADPKD patients. The KETO-ADPKD clinical trial aims to address the lack of comprehensive data from long-term, controlled human studies by rigorously testing the safety and effectiveness of ketogenic diets for ADPKD in a controlled clinical environment to establish if such dietary interventions could indeed be beneficial for patients. The trial showed promising results: → A significant number of participants reported the diet as feasible. → The KD led to a reduction in body fat and liver volume. → A notable finding was the improved kidney function in the KD group, contrasting with the decline typically seen in ADPKD patients, which was the case in the control and water fasting groups. Side effects associated with the KD were mostly mild and included initial flu-like symptoms, but these were temporary. The safety of the diet was further confirmed through NMR lipid profile analyses. Given these results, the trial suggests a need for a long-term study to establish the lasting benefits and safety of KDs for patients with ADPKD. — Cukoski, S., Lindemann, C. H., Arjune, S., Todorova, P., Brecht, T., Kühn, A., Oehm, S., Strubl, S., Becker, I., Kämmerer, U., Torres, J. A., Meyer, F., Schömig, T., Große Hokamp, N., Siedek, F., Gottschalk, I., Benzing, T., Schmidt, J., Antczak, P., Thomas Weimbs, Grundmann, F., Roman-Ulrich Müller (2023). Feasibility and impact of ketogenic dietary interventions in polycystic kidney disease: KETO-ADPKD—a randomized controlled trial. Cell Reports Medicine. Link to study: https://lnkd.in/erHjmjh6 Follow for more research news! #keto #ketogenicdiet #nutritionaltherapy #research #kidneydisease

Cancer is a leading cause of mortality globally, and metabolic and nutritional alterations can impact the survival and recovery of cancer patients. Malnutrition is highly prevalent in cancer patients, affecting 40-80% during the disease and influencing treatment outcomes. Cancer patients should aim to consume a well-balanced diet that provides sufficient protein, energy, and micronutrients to support their nutritional needs during treatment and recovery. 𝐇𝐞𝐫𝐞 𝐚𝐫𝐞 𝐬𝐨𝐦𝐞 𝐫𝐞𝐚𝐬𝐨𝐧𝐬 𝐰𝐡𝐲 𝐧𝐮𝐭𝐫𝐢𝐭𝐢𝐨𝐧 𝐢𝐬 𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐟𝐨𝐫 𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥𝐬 𝐮𝐧𝐝𝐞𝐫𝐠𝐨𝐢𝐧𝐠 𝐜𝐚𝐧𝐜𝐞𝐫 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭: 𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐧𝐠 𝐌𝐚𝐥𝐧𝐮𝐭𝐫𝐢𝐭𝐢𝐨𝐧: • Cancer-associated malnutrition is caused by anorexia and metabolic disturbances, leading to weight loss and hindering nutrient supplementation. • Proper nutrition helps prevent malnutrition and ensures the body has the nutrients to support overall health. 𝐑𝐞𝐝𝐮𝐜𝐢𝐧𝐠 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭-𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬: • Cancer and its treatments such as chemotherapy, radiation therapy, and surgery can often lead to loss of appetite, weight loss, and fatigue. • Proper nutrition is vital for patients to tolerate and recover from treatment. 𝐒𝐮𝐩𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐈𝐦𝐦𝐮𝐧𝐞 𝐅𝐮𝐧𝐜𝐭𝐢𝐨𝐧: • Cancer treatments can weaken the immune system, making patients more susceptible to infections. • Adequate nutrition supports the immune system, helping the body fight off infections and aiding in recovery. 𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐧𝐠 𝐌𝐚𝐥𝐧𝐮𝐭𝐫𝐢𝐭𝐢𝐨𝐧: • Cancer-associated malnutrition is caused by anorexia and metabolic disturbances, leading to weight loss and hindering nutrient supplementation. • Proper nutrition helps prevent malnutrition and ensures the body has the nutrients to support overall health. 𝐌𝐚𝐣𝐨𝐫 𝐧𝐮𝐭𝐫𝐢𝐞𝐧𝐭𝐬 𝐰𝐡𝐢𝐜𝐡 𝐩𝐥𝐚𝐲 𝐚 𝐫𝐨𝐥𝐞 𝐢𝐧 𝐜𝐚𝐧𝐜𝐞𝐫 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭: • 𝐏𝐫𝐨𝐭𝐞𝐢𝐧 needs to increase muscle strength, while carbohydrates, such as whole grains and complex carbs, promote sustainable energy and nutrient-dense foods. • 𝐀𝐧𝐭𝐢𝐨𝐱𝐢𝐝𝐚𝐧𝐭𝐬: Vitamin C, E, beta-carotene, and selenium neutralize free radicals and protect cells from chemotherapy and radiation therapy damage. • 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 𝐃: Studies have suggested that adequate vitamin D levels may be associated with a reduced risk of certain types of cancer, including breast, colon, and prostate cancer. • 𝐅𝐢𝐛𝐞𝐫: High-fiber foods support digestion, lower colorectal cancer risk, and prevent constipation due to chemotherapy and opioid pain medications. Cancer patients require personalized nutrition plans based on their type, stage, treatment type, and individual factors, requiring collaboration with healthcare professionals. KONNECT DIAGNOSTICS #NutritionAndCancer #CancerCare #DietAndCancer #CancerNutrition #NutritionTherapy #Wellytics

After my recent post on the alarming rise of fatty liver disease in India, I've been flooded with inquiries about effective prevention strategies. Drawing from my experience working with patients and witnessing disease reversal, I'm excited to share tried-and-true methods to combat this issue head-on. Fatty liver disease, a global concern affecting countless lives, finds its solution not in pills, but in proactive lifestyle changes. While medical advancements continue, let's unlock the potential of prevention and even reversal through the following comprehensive strategy for optimal liver health: 1. Alcohol in Check:Whether limiting or abstaining, controlling alcohol consumption is vital. For those with alcoholic fatty liver disease (AFLD), total abstinence is the key to halting progression. 2. Weight Well-Managed: Shedding excess weight stands tall among interventions. Prioritize gradual, sustained weight loss via a balanced diet and regular exercise. 3.Nourishing Diet: Elevate your diet with vibrant fruits, veggies, whole grains, lean proteins, low-fat dairy, and healthy fats. Elevate fiber intake to support liver function. 4.Calories Under Control: Cut calorie-heavy foods with mindful portions. Steer clear of high-calorie indulgences that contribute to the issue. 5.Salt Smartly: Mind your sodium intake to champion overall health and blood pressure control. Sidestep overly salty, processed temptations. 6.Choosing Healthy Fats: Swap out trans fats and cap saturated fats from fried and fatty foods. Opt for nourishing sources like nuts, seeds, and olive oil. 7. Caffeine: Embrace black coffee ☕️ without sugar potentially aiding liver health. Scientifically, coffee has shown potential in reducing liver disease risk. 8.Hydration Heroes: Amplify water intake for detoxification and hydration, bolstering liver function and overall well-being. 9. Active Lifestyle: Engage in 30 minutes of moderate exercise most days. Movement fuels weight loss and turbocharges metabolic health. 10. Blood Harmony: Monitor blood sugar and cholesterol levels to thwart metabolic imbalances underlying fatty liver disease. 11. Diabetes Control: Tend to diabetes with diligence, adhering to treatment plans and preempting liver complications. 12. Shielding Vaccines: Safeguard your liver from viral foes by getting hepatitis A and B vaccinations. Regular hepatitis C screenings are essential. 13. Vitamin E Exploration: While vitamin E supplements show potential in liver marker improvement, consulting your doctor is imperative. 14. Raw Shellfish: Minimize infection risk by avoiding raw or undercooked shellfish, a small step with a significant impact. Preventing fatty liver disease isn't just about shielding the liver; it's about invigorating overall vitality. Rally behind these proactive steps to sculpt a health-forward lifestyle and revel in a life of vibrancy. Let's propagate this crucial knowledge to empower others in their pursuit of enduring liver health.

Vitamin Deficiencies in Humans: "Macronutrients deficiencies could cause kwashiorkor, marasmus, ketosis, growth retardation, wound healing, and increased infection susceptibility, whereas micronutrient – like iron, folate, zinc, iodine, and vitamin A – deficiencies lead to intellectual impairment, poor growth, perinatal complications, degenerative diseases associated with aging and higher morbidity and mortality"(National Institutes of Health, Oct 2022). "Furthermore, an energy-rich and nutrient-poor diet might lead to 'hidden hunger' condition, which is characterised by micronutrient inadequacies despite having sufficient or excessive amount of calories. These micronutrient inadequacies could ultimately cause various chronic diseases like cancer, osteoporosis, and cardiovascular diseases"(National Institutes of Health, Oct 2022). "Vitamin B12 For humans, animal products like dairy and meat are the only dietary source of vitamin B12. In early stages, cobalamin deficiency is secondary to the maternal deficiency among breast-feeding mothers following strict or moderate vegan diets. The main causes of vitamin B12 deficiency mostly are inadequate intake, inborn errors of metabolism or transport, and malabsorption. Elder individuals, people with psychiatric illnesses, vegans, and their breastfed infants are at higher risk of vitamin B12 deficiency because of the insufficient intake"(National Institutes of Health, Oct 2022). "Vitamin D, also called calciferol, is a fat-soluble secosteroid that is essential for the intestinal absorption and metabolism of calcium, magnesium and phosphorous. Vitamin D stimulates the osteoclasts to release calcium and phosphorus, and activates the synthesis of enterocyte calcium channel, which enhances the absorption of calcium. Vitamin D sources are fish and fish oils (which contain the highest proportion of available vitamin D), eggs, shiitake mushrooms, liver, and fortified foods (like orange juice and milk) [2]. Vitamin D deficiency causes hypocalcemia and hypophosphatemia, which lead to osteomalacia among adults and rickets among children. Furthermore, vitamin D deficiency is associated with immunomodulatory disorders, cardiovascular diseases, hypertension, and insulin resistance in adults"(National Institutes of Health, Oct 2022). "Omega-3 and Omega-6 are polyunsaturated and essential fatty acids (EFA). Clinical symptoms of EFAs deficiency include diminished growth in children and infants, scaly dry rash, reduced wound healing, and increased infection susceptibility"(National Institutes of Health, Oct 2022). "Several observational and research studies have reported the association of lower omega-3 index with higher risk of mortality by coronary heart disease" (National Institutes of Health, Oct 2022). Omega-3 fatty acids are mainly found in fish or fish oils but there are other sources with them too. References: National Institutes of Health, Oct 2022 - https://lnkd.in/eaezVtFJ

A web-based low carbohydrate diet intervention significantly improves glycaemic control in adults with type 2 diabetes: results of the T2Diet Study randomised controlled trial Key points: Dietary modification is important for individuals with type 2 diabetes mellitus (T2DM) to achieve and maintain glycemic targets and optimise health outcomes, and carbohydrate reduction is an established approach for improved glycemic control in T2DM. However,challenges remain in providing dietary education and support to people with T2DM due to limited resources, location, and cost. Web-based interventions have the potential to overcome these barriers and support T2DM management. The intervention in this study involved a 16-week web-based programme called T2Diet, which aimed to educate participants on healthy low-carbohydrate diets. The programme recommended a carbohydrate intake of 50–100 g per day, focusing on nutrient-dense lower carb foods and reducing intake of starches, sugar, and discretionary foods.Protein and fat intake were not specifically prescribed, but nutrient-dense sources were encouraged. The results showed that the web-based programme, when combined with standard care, led to significant reductions in HbA1c, weight, BMI, and anti-glycemic medication requirements compared to standard care alone. Although the intervention was not designed for weight loss, participants in the intervention group lost more body weight, with a significant proportion achieving at least 5% weight loss, which is recommended for T2DM patients. Overall, this study provides valuable evidence for the effectiveness of web-based LCD programmes in improving health outcomes for individuals with T2DM. Implementing this programme through primary care recommendations could have a significant impact on T2DM management and assist GPs in their crucial role in supporting and monitoring these patients. Dening, J., Mohebbi, M., Abbott, G. et al. A web-based low carbohydrate diet intervention significantly improves glycaemic control in adults with type 2 diabetes: results of the T2Diet Study randomised controlled trial. Nutr. Diabetes 13, 12 (2023). https://lnkd.in/eUsSRpd7

Iatrogenic Diseases and Hemp Diets... A hemp diet, rich in hemp seeds and hemp-derived products, can offer several potential benefits for individuals dealing with iatrogenic (medically induced) disorders. Here are three iatrogenic disorders and how a hemp diet may assist with each: Iatrogenic Osteoporosis: Detail: Iatrogenic osteoporosis can result from the long-term use of medications like corticosteroids. These drugs can weaken bones and increase the risk of fractures. Hemp Diet Discourse: Hemp seeds are an excellent source of minerals like calcium and magnesium, crucial for maintaining bone health. Incorporating hemp seeds into the diet can help counteract bone loss induced by corticosteroids. Additionally, hemp seeds contain omega-3 fatty acids that possess anti-inflammatory properties, potentially reducing inflammation associated with osteoporosis. Iatrogenic Diabetes: Detail: Some medications, particularly certain antipsychotic drugs, can lead to weight gain and insulin resistance, increasing the risk of diabetes. Hemp Diet Discourse: Hemp seeds are a rich source of dietary fibre and protein, which can help regulate blood sugar levels and improve insulin sensitivity. The presence of gamma-linolenic acid (GLA) in hemp seeds may also assist in managing inflammation associated with diabetes. A hemp diet can contribute to weight management, reducing the risk of iatrogenic diabetes. Iatrogenic Cardiovascular Disease: Detail: Certain medications, such as corticosteroids or some immunosuppressive drugs, can elevate blood pressure, cholesterol levels, and increase the risk of cardiovascular problems. Hemp Diet Discourse: Hemp seeds are known for their high content of heart-healthy omega-3 fatty acids, which can help lower blood pressure and reduce cholesterol levels. They also contain arginine, an amino acid that promotes blood vessel relaxation, potentially counteracting the cardiovascular effects of iatrogenic medications. Furthermore, hemp's anti-inflammatory properties may mitigate inflammation contributing to heart issues. It's important to note that while a hemp-rich diet may offer potential benefits, individuals with iatrogenic disorders should always consult with their healthcare providers. Dietary changes should be part of a comprehensive treatment plan and should consider individual health needs and medication interactions.

Prolonged ingestion of a cholesterol- or saturated fatty acid-enriched diet induces chronic systemic inflammatory responses resulting in significant health problems such as cardiometabolic diseases, and contributing to early death worldwide. The most common dietary sources of cholesterol are animal derived foods, which also contain saturated fats. Plant-derived sources of saturated fatty acids are palm, palm kernel and coconut oils. There is no cholesterol in plant cells. Researchers studied how dietary cholesterol initiates intestinal inflammation in epithelial cells and showed that exposure to high-fat (HFDs) or high-cholesterol (HCDs) diets develop acute innate inflammatory responses within hours, reflected in the localized interleukin-1β-dependent accumulation of myeloid cells in the intestine. Extended HCD was also shown to impair intestinal motility (peristalsis), and induce hepatic steatosis (i.e. fatty liver). "Study reveals direct pro-inflammatory effect of ingested cholesterol through inflammasome activation in the intestinal epithelium, leading to inflammation in the intestine. Inflammasome activation resulted in an accumulation of inflammatory leukocytes around the intestine and in the longer term, still consequent to cholesterol binding, local and systemic pathologies. This model, demonstrating clearly the inflammatory effects of dietary components, extends our knowledge of how dietary choices can influence processes involved in chronic inflammatory disorders." #lifestylemedicine #healthylifestyle #healthyeating #wholefoodplantbased #obesity #insulinresistance #nafld #ibd #inflammatoryboweldisease #inflammation #hearthealth #metabolichealth #health #diabetes #cholesterol #ketodiet #cardiovascularhealth #cardiovasculardisease https://lnkd.in/dsd9gH8S

Gluten intolerance is a HOT topic in nutrition over the last decade. 🤔 Is it a real thing? 🤔 Can you be sensitive to gluten even if you don’t have Celiac disease? 🤔 How can you know if you’re reactive to gluten? ⠀ 🌾 In our series on gluten reactivity, we're tackling your burning questions surrounding this dietary dilemma. ⠀ Today we start with the most infamous form of gluten reactivity: celiac disease. ⠀ 📈 In total, Celiac affects <1% of the population! Sounds small, right?  Considering it’s a chronic condition with serious implications, one out of every one hundred people is actually quite a high incidence rate. ⠀ Plus, a 2020 meta analysis determined its prevalence is on the rise “beyond diagnostic improvements, most likely due to environmental factors.” [1] ⠀ Celiac disease is an autoimmune condition in which the villi of the small intestine are damaged, making the body unable to break down the gluten protein. ⠀ 🚨 If this condition goes undiagnosed and/or an individual continues eating gluten, celiac disease can result in serious medical complications such as infertility, reduced bone density (osteopenia/osteoporosis), neurological disorders, some cancers, and other autoimmune diseases. ⠀ 😱 Unfortunately, a whopping 83% of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions. And it takes an average of 6-10 YEARS to be correctly diagnosed [2]. So the chances of long term damage are quite high. ⠀ If you suspect Celiac or other forms of gluten sensitivity, testing is critical. The standard celiac testing markers include: 🧪 Secretory IgA 🧪 Gliadin IgA+IgM 🧪 Transglutaminase IgA+IgM 🧪 Epithelial biopsy (to confirm CD) ⠀ Stay tuned as we unravel more mysteries of gluten sensitivity in the coming editions!  ⠀ Sources: 1. King JA, et al. Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2020 Apr;115(4):507-525. 2. Daniel Leffler, MD, MS, The Celiac Center at Beth Israel Deaconess Medical Center)

Reducing intrahepatic triacylglycerol (liver TG) content is important to address metabolic disturbances and mitigate liver disease progression. Weight loss is the primary intervention, with limited pharmacological options available. In this small study, a eucaloric low-carbohydrate/high-fat (LC) diet led to a 35% reduction in liver triacylglycerol (TG) content in overweight/obese male participants within four days.   London, A. et al. (2024) ‘The Impact of Short-term Eucaloric Low-Carbohydrate and High-Carbohydrate Diet on Liver Triacylglycerol Content in Males with Overweight and Obesity; a Randomized Cross-Over Study’, The American Journal of Clinical Nutrition [Preprint]. Available at: https://lnkd.in/dcYqZuA7.   Overview: The participants were assigned to different diets, with the low-carbohydrate (LC) diet consisting of 11% carbohydrates, 70% fat, and 17% protein, and the high-carbohydrate (HC) diet consisting of 65% carbohydrates, 16% fat, and 16% protein. The results show that the LC diet led to a significant decrease in liver TG content, while the HC diet did not. The study demonstrated that a modest reduction in dietary carbohydrates replaced by fat effectively lowered liver TG content, regardless of whether participants had metabolic associated fatty liver disease (MASLD) or diabetes. Despite efforts to maintain a eucaloric state, a modest decrease in body weight was observed during the LC diet, which was independent of changes in resting metabolic rate or hydration status. Study findings reflect that the LC diet had an impact on hepatic insulin clearance, fasting plasma insulin concentrations, and hepatic glucose production, which suggests improved hepatic insulin sensitivity.