Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Growth hormone HGH, muscle building, exercise performance

Sports enthusiasts and athletes believe that human growth hormone (HGH) builds muscles and increases athletic performance. However, the safety and efficacy for increasing muscles, exercise stamina and exercise performance by growth hormone have been mired in debate due to conflicting literature.

Dr. Liu and colleagues from Stanford in California, examined the evidence thus far about the effects of human growth hormone (HGH) on muscle building, athletic stamina and performance in physically fit subjects. Their study titled, “Systematic review: the effects of growth hormone on athletic performance” was published in the journal Annals of Internal Medicine (2008).

The authors reviewed trials examining effect of HGH on muscles and exercise stamina and performance. The data from the combined studies yielded 44 articles and 303 participants receiving human growth hormone. This represented 13.3 person-years of HGH treatment. The average dose of growth hormone used was 36 mcg/kg per day while average duration was 20 days.

The authors found that lean body mass increased in subjects getting growth hormone as compared to those who did not. However, this was not accompanied by an improvement in muscle strength or exercise stamina and performance. Subjects receiving HGH also suffered from more soft tissue swelling and fatigue.

The authors concluded that HGH does not improve athletic stamina and performance. To the contrary, the data suggested that HGH may actually worsen exercise capacity with deleterious side effects.

Caveats: The HGH dose/frequency of HGH used by the athletes is probably much greater in real world than used in the clinical trials and thus the trials do not mimic real world situations. In addition, many athletes and power muscle-builders actually use HGH along with other products like steroids and insulin. Even more importantly, many athletes take use HGH because of healing powers of human growth hormone by “hastening recovery from injury”; this issue was not addressed in the study.

Do you or someone near you uses HGH for building muscles and enhancing athletic performance? Do you think people should use it for this purpose? Please share your thoughts.

Fish type, mercury and heart benefits

Fish, omega-3 fatty acids and heart: Fish contain high amounts of omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) which have been proven to be cardioprotective, i.e. good for heart. They prevent heart attacks.  Studies suggest that there is 29% reduction in mortality over 2 years inpatients who have had heart attacks.

The evidence is strong enough for the American Heart Association to recommend increased intake of omega 3-fatty acids. The good news is that mercury content of all the fish is not the same. The mercury content of predatory fish is much higher because they eat other fish containing mercury and indirectly attain much higher levels mercury than the fish at the lower end of the food chain.

The beneficial effect if fish intake can be demonstrated with as few as 1 fish per week, and greater intake provides even greater protection.

Fish, mercury and toxicity: The benefits of fish intake are tempered by the concern over mercury intake through fish and the resultant potential for neurotoxicity.

Low versus high mercury fish: The good news is that mercury content of all the fish is not the same. The mercury content of predatory fish is much higher because they eat other fish containing mercury and indirectly attain much higher levels mercury than the fish at the lower end of the food chain.

Identifying low versus high mercury fish: Sardines, salmon, and shrimp have lower mercury content than the predatory sharks, tuna, sword fish and orange roughy.

Farmed fish: Even more importantly, the farmed fish have the lowest mercury content while providing the same benefit.

Limiting the mercury content: The exposure to mercury can be lowered by limiting the amount of fish ingested and eating the fish with lower mercury content.

Recommendations for fish intake: Institute of Medicine provides conservative recommendations regarding fish consumption. Non-pregnant persons may eat 1 predatory fish meal and 2-3 low mercury fish meals per week. Pregnant women should not eat more than 1 predatory fish meal per 2 weeks; however they may eat other fish 2-3 times per week.

Both wild and farmed fish are beneficial.

Above is based on an article in Nature Clin Practice (2008).

Apple a day, keeps colon cancer away

Does apple help health or is it a myth? Can it help against cancer? Do apple pectin and juice extract produce anticarcinogens during the fermentation in the colon? The answer seems to be yes.

Dr. Waldecker and colleagues in the journal Nutrition 2008 studied the fermentation supernatants from incubation of human fecal slurry with apple pectin and apple juice extracts. The Inhibition of the enzyme histone deacetylase (HDAC) seems to play a central role in these anticancer effects. The authors found that  fecal slurry from fermentations with pectin was rich in butyrate and very active in HDAC inhibition in colon tumor cell lines.

The HDAC-inhibitory potency from pectin-rich fermentations correlated with the butyrate levels. Fecal slurry from fermentations with apple juice extract had lower butyrate yields but similar HDAC inhibition and potentially similar anticarcinogenic effect.

This is how it works: Apple fermentation leads to increase in short chain fatty acids like butyrate. Butyrate is a chemopreventive metabolite that can prevent the occurrence of colorectal cancer. The mechanism is via inhibition of histone deacetylase leading to retarding the carcinogensis, the process of tumor formation.

The authors concluded that apple products exert anticarginogenic effects in the colon.

What are your thoughts about fruit in general and apple in particular? Are you going to go more for fruits or apples in the grocery store? Please share your thoughts.

Organic food heals Crohn’s disease

Organic food—expensive! Should we eat this expensive organic food for better health in Crohn’s?

Would organic diet be better for healing Crohn’s?

Gasche and colleagues from Austria tested the hypothesis that organic diet is better for treating Crohn’s disease.

Patients with Crohn’s received organic diet or a control diet (low-fiber, low-fat, and high-carbohydrate). Outcome measures included MRI, endoscopy, Crohn's Disease Activity Index (CDAI), and the Inflammatory Bowel Disease Questionnaire (IBDQ).

Organic food diet showed improvement in their intestinal lesions not seen in patients assigned to a high-carbohydrate diet. The investigators concluded that food as part of the modern Western lifestyle may cause persistence of intestinal Crohn's lesions.

Diet and environmental have been linked to risk for Crohn’s disease. Diet and environment are not mutually exclusive. The increase in incidence of Crohn’s disease in recent decades suggests environmental risk factors associated with a Western lifestyle may contribute to Crohn’s disease.

What kind of diet do you prefer? Would you be willing to spend more for organic food in your diet based on this study?

Diet Crohn’s disease risk

Diet as risk for Crohn’s disease?

Over the years, some dietary foods predominant in vegetables and fruit have been thought of as protective. In contrast, fatty foods have been thought as increasing the risk for Crohn's disease. The literature however has been inconsistent. As such, the controversy continues as the precise cause of Crohn’s disease remains an enigma.

Dr. D’Souza and colleagues from Canada reported the results of their study in Inflammatory Bowel Diseases 2008. They examined the dietary patterns and risk for Crohn's disease in children in a case-control study fashion. Subjects included newly diagnosed Crohn’s disease compared with population and/or hospital-based controls.

Dietary patterns were assessed using a food frequency questionnaire. The study comprised of 149 cases of Crohn’s disease and 251 controls.

Girls consuming diet consisting of meats, fatty foods, and desserts had an increased risk by 4.7 fold. In contrast, boys and girls enjoying diet consisting of vegetables, fruits, olive oil, fish, grains, and nuts had a the risk decreased substantially.

The authors concluded that specific dietary patterns could be associated with higher or lower risks for Crohn’s disease in children.

Do you or someone you know has Crohn’s disease? What are your thoughts on the relationship of diet and Crohn’s disease or ulcerative colitis?