Dr Dingle's Blog
Artificial sweeteners or Non-caloric artificial sweeteners (NAS) are commonly added to food with increasing controversy regarding their potential ability to promote metabolic imbalances and lead to weight gain instead of weight loss and diabetes type 2. Unfortunately, many people see these drinks and additives as being healthy. The research shows the opposite
The first report on NAS interactions with the microbiome dates back to the early 1980s. Since then, diets containing non-caloric artificial sweeteners (including saccharin, sucralose, and aspartame) have been linked to gut dysbiosis and glucose intolerance even at relatively low doses (5–7 mg/kg/d, equivalent to an adult consuming two to three cans of diet soda per day).
A study of Splenda, a nonnutritive sweetener containing 1% sucralose, found that the substance impaired the growth of gut bacteria in rats. Ace-K, like sodium saccharin and sodium cyclamate, belongs to sulfonamides, a chemical class associated with antimicrobial activity. In previous studies, saccharin was recognised to enrich the biosynthesis pathway of lipopolysaccharides (LPS) of the mouse gut microbiome, which is a common trigger of inflammation and leaky gut. Studies have also shown different and healthier bacterial diversity for nonconsumers compared to consumers of artificial sweeteners.
In another experiment where commercial formulations of saccharin, sucralose, or aspartame were added to the drinking water of lean mice for 11 weeks all three NAS-consuming groups developed glucose intolerance. NAS was also shown to induce changes in gut microbiota previously observed in T2DType 2 diabetes; notably, the over-representation of gram-negative Bacteroides and under-representation of gram-positive Clostridiales. Another study of 800 healthy and prediabetics showed variability in their after meal (postprandial) glucose responses to the same foods attributed to differences in gut microbiota. While a study of 345 Chinese volunteers revealed that diabetics have a decrease in butyrate-producing bacteria and an increase in opportunistic pathogens relative to healthy subjects.
On the positive side, the sugar alcohol xylitol inhibits the growth of some negative bacterial species including Streptococcus mutans. It is used as a food additive to prevent dental caries and in rats fed a high-fat diet, xylitol improved lipid/fat metabolism. Dietary supplementation with low- or medium-dose xylitol significantly positively altered the fecal microbiota composition in studied mice.
So what are you having in your next drink??
If you have been to one of my talks you would have heard me emphasize the importance of inflammation and the need to lower your body's chronic inflammation levels. Of course one of the major sources of ongoing chronic inflammation is the gut.
Inflammation is literally the body “on fire” and is a primary immune mechanism response of the body to a range of noxious stimuli. This can include infectious agents, such as bacteria or virus, oxidation or acidosis, damaged or diseased tissues.
The main function of inflammation is a short-term response to resolve infection and to repair damage in order to achieve homeostasis (balance) in the body. The ideal inflammatory response is therefore rapid and destructive, yet specific and very limited. This is the reddening and swelling you see around any infected or injured area. Most of us are familiar with redness, heat, swelling, and pain associated with inflammation. These symptoms are created by the activity of immune cells working to break down injured and dying tissues so that new, healthy ones can replace them.
Unfortunately, we have created a situation in which we now suffer from chronic low-level inflammation over decades of our lives as a result of our unhealthy and unbalanced lifestyles and diet. Chronic inflammation is being shown to be involved in the onset and the development of most, if not all, chronic illnesses that are currently at epidemic proportions in our society. These include atherosclerosis (damaged and blocked arteries), heart disease, stroke, obesity, neurodegenerative diseases, depression, Alzheimer’s, Parkinson’s disease, thyroid disorders, diabetes, asthma, autism, arthritis, celiac disease, eczema, psoriasis, multiple sclerosis, lupus, migraines, periodontal disease, sleep apnea, chronic kidney failure, cancer and ageing. This is a long list, yet these are only the most common conditions.
Even though chronic inflammation in the body is hard to detect, there are some common symptoms for which we should be on the lookout. These include the following:
Chronic pain in the joints and/or muscles
Allergies or asthma
Elevated blood pressure
Fluctuations in blood sugar levels
Gut issues (constipation or diarrhoea)
Aches, pain and sorenessThe inflammatory process is driven by the immune system. In order to reduce the incidence of disease, you must reduce inflammation, and to reduce inflammation you must identify and eliminate immune system trigger(s). The typical approach of allopathic medicine is to treat the symptoms of the disease itself, or the immune system (with immune-suppressive drugs) or inflammation (with anti-inflammatory drugs) directly without addressing the underlying cause of the disease. Sustainable health, on the other hand, looks at identifying and eliminating the sources of the inflammation to address the situation at its cause.
 Shelton and Miller 2010.
 Schwarzenberg and Sinaiko 2006.
 Taubes 2002; Ridker et al. 1997, 2000.
Sources of chemical pollutants include direct use of chemical based products like laquers, varnishes, cleaning products and aerosol cans as well as off gassing form materials. Offgassing is a form of evaporation which occurs with solid materials. Many manufactured materials contain chemicals which are not stable and these are slowly released into the surrounding air. Pressed wood products, plastics, vinyls and adhesives are common sources of chemical offgassing. Because these contaminants are in a gaseous form they too pass through the thin membranes of your lungs into your bloodstream. From here they circulate throughout your body to your brain, liver, kidneys and other organs. Only 30% of the contaminants inhaled are again exhaled - the remaining 70% must be broken down by your liver or otherwise dealt with by your body.
The resting adult breathes 10,000 to 20,000 litres of air daily. Every day we breathe a largely unknown and unmeasurable cocktail of various chemicals in a gaseous or particle form. Sometimes these emissions are quite obvious in their odour and immediate effects. We may be alerted by a strong smell and suffer irritation of eyes, nose and throat, headaches or nausea. More often than not however, there is no ‘alerting’ odour and as a result we do not take steps to avoid the exposure. In some cases we may even relate the smell to pleasant sensations such as a new car, house or carpet not realising the effects are insidious and that over a long period such exposure may affect our health.
Chemical indoor air pollutants which have been identified as causing health problems are:
volatile organic compounds (VOC's) such as:
This problem of chemical cocktails is exacerbated by the ever-increasing number of chemicals which are introduced into the market place. Many of them have not been well studied and there is scant toxicological information available. There is even less information available on some of the older chemicals which have been around for years.
Previously I have written on the emulsifiers so I hope you have made some changes. The sulfites and other preservatives are considered food additives intended to limit bacterial contamination and are generally regarded as safe. However, as expected, bactericidal chemicals have been shown to damage beneficial bacteria in the human gut. Sodium bisulfite and sodium sulfite have been shown to have negative effects on our beneficial gut microbiota including Lactobacillus species after two hours of exposure at concentrations of sulfites between 250–500 ppm, concentrations typically found in foods.Sulfites are added to beer, wine, juices, dried fruit, processed fish, seafood, meats, and some canned goods and are intended primarily for controlling microbial growth, preventing browning and food spoilage. The sulfite concentration in red and white wine is around 70 mg/L and 122 mg/L respectively. This means that drinking about two glasses of wine (450 mL) a day equates to an intake of 75% to 130% of ADI for a 60-kg person. A glass or two of wine may have a benefit on the gut microbiome but the preservative in it doesn’t. Combined with typical additional intake of sulfites common in a Western diet, the average total dietary exposure to sulfites could come to a total of 294% of ADI for adults, well over the amount generally regarded as safe and a level likely to do harm to the gut microbiota.
 Irwin et al., 2017.
 Leclercq et al., 2009.
Until very recently little research has been done on the impact of food additives on the gut microbiome, despite their widespread use. Food additives are substances intentionally added during production, processing, packaging, transportation, or storage of commercial food products. However, many food additives including emulsifiers, flavor enhancers, non-caloric artificial sweeteners, organic solvents, gluten and nanoparticles are increasingly used in food processing and being shown to negatively impact microbiota composition.
Emulsifiers, a ubiquitous component of processed foods, and often considered inert have been shown to adversely affect the composition of the gut microbiota and lead to low-grade inflammation. In the intestines a multilayered mucus structure covers the intestinal surface allowing the vast majority of gut bacteria to be kept at a safe distance from gut cells that line the intestine. It seems that emulsifiers, which have detergent-like molecules dissolve and damage the mucous membrane leading to bacterial and toxin movement across gut wall.
In experiments the commonly used food additives, carrageenan (407) and carboxymethylcellulose (466) (CMC) are used to develop intestinal inflammation in animal models. Animal and human studies consistently report that carrageenan and CMC induce cell changes that are typical of inflammatory bowel disease while altering the microbiome, disrupting the intestinal lining and stimulating inflammation. Carrageenan is commonly used and has substantially increased over the last 50 years as a thickening and emulsifying food additive to improve the texture of commercial food products. It is found in milk alternatives such as almond and soy milk, processed meats, and soy-based products, dairy products such as chocolate milk, ice cream, cottage cheese, sour cream, and yogurt, mayonnaise and infant formula.
Two recently studied synthetic dietary emulsifiers polysorbate 80 (P80) and carboxymethylcellulose (CMC) promote inflammatory gut disorders and act directly our microbiome to increase inflammation. As a result the studies suggest that broad use of emulsifying agents might be contributing to increased incidence of obesity, metabolic syndrome and other chronic inflammatory diseases. To support this transferring feces from emulsifier-treated mice to healthy mice resulted in similar host and microbial alterations observed in mice directly treated with emulsifiers including tumor development and low-grade gut inflammation. Carboxymethylcellulose use is widespread throughout the food industry in products typically consumed by children including candy, chewing gum, “snack foods,” ketchup, and various baked goods, and currently, there are no quantitative restrictions on its use nor does its addition to food require to be declared in most countries.
 Lerner and Matthias, 2015.
 Chassaing et al., 2015.
 Johansson et al., 2008.
 Roberts et al., 2010.
 Martino et al., 2017.
 Tobacman et al., 200; Borthakur et al., 2007.
 Borthakur et al., 2007.
 Chassaing et al., 2017.
 Viennois et al., 2017.
 Swidsinski et al., 2009.
Many studies have been done on psychosocial factors and their impact on our health and even how long we live. More recently some of these have been able to show that having a sense of purpose can have many health benefits from lowering stress to reducing the risk of cardiovascular disease cancer and even living longer and it doesn’t matter how old you are. The benefits of perceiving and living a life directed toward a broader purpose are widespread and feeling that you have a sense of purpose in life may help you live longer, no matter what your age.
At a biological level having a sense of purpose has been shown to be associated with more positive body biochemistry and lower cortisol (stress) levels and lower levels of proinflammatory cytokines 1, the chemicals linked to cancer, heart attacks and chronic disease which represents one possible mechanism through which purpose in life influences mortality.
Having a purpose in life provides individuals with a sense of direction and goals for the future, as well as a marker of flourishing and a life well-lived. A strong sense of purpose buffers us from the storms of life. It like the roots of a tree, keeping us steady and grounded even in stormy weather. It provides us with a greater sense of controlling our direction in life, are more motivated and may even feel inspired. However, our sense of purpose is not to make money it has to be directed at something greater than yourself.
In research among teens and young adults having a sense of purpose enabled them to look beyond themselves to appreciate their role in the world and to build the psychological resilience necessary to overcome adversity. There is evidence that focusing on personally meaningful and valued goals can buffer the negative effects of stress by allowing individuals to reinforce a sense of who they are and that creating opportunities for individuals to cultivate a sense of purpose is important as we move forward as a society2.
Having a high sense of purpose in life has also been associated with lower risk of heart disease and stroke. In a review of 10 relevant studies with the data of more than 137,000 people they defined purpose in life as a sense of meaning and direction, and a feeling that life is worth living. Previous research has linked purpose to psychological health and well-being and this study found that a high sense of purpose is associated with a 23 percent reduction in death from all causes and a 19 percent reduced risk of heart attack, stroke, or the need for coronary artery bypass surgery or a cardiac stenting procedure. This is better than any drug and has multiple other benefits.
Previous studies have suggested that finding a purpose in life lowers risk of mortality above and beyond other factors that are known to predict longevity. Purposeful adults tend to outlive their peers and experience a diminished risk for both cognitive decline and disability in older adulthood. Moreover, having a purpose in life appears to lead to unique health benefits relative to other aspects of psychological well-being, such as having positive relations with others. In this study of 749 people with an average age of 60 found that the participants’ sense of purpose was positively associated with multiple positive health qualities including vigorous and moderate activity, vegetable intake, flossing, and sleep quality 3.
In another study of 6985 adults between the ages of 51 to 61 and a follow up for 14 years life purpose was significantly associated with all-cause mortality. Those with the strongest sense of purpose almost 2 and a half times more likely to be alive comparing those in the lowest life purpose category. Particularly compelling was the reduction in deaths from heart, circulatory, and blood conditions. Purpose had similar benefits for adults regardless of retirement status, a known mortality risk factor. And the longevity benefits of purpose in life held even after other indicators of psychological well-being, such as positive relations and positive emotions, were taken into account. These findings suggest that there's something unique about finding a purpose that seems to be leading to greater longevity 4.
These findings point to the fact that finding a direction for life, and setting overarching goals for what you want to achieve can help you actually live longer, regardless of when you find your purpose. So the earlier someone comes to a direction for life, the earlier these protective effects may be able to occur.
So what is your sense of purpose?
Write it down
1 Ryff CD, Singer BH, Dienberg Love G. Positive health: connecting well-being with biology. Philos Trans R Soc Lond B Biol Sci. 2004;359(1449):1383-1394.
2 A. L. Burrow, P. L. Hill. Derailed by Diversity? Purpose Buffers the Relationship Between Ethnic Composition on Trains and Passenger Negative Mood. Personality and Social Psychology Bulletin, 2013; DOI: 10.1177/0146167213499377
4 . P. L. Hill, N. A. Turiano. Purpose in Life as a Predictor of Mortality Across Adulthood. Psychological Science, 2014; DOI: 10.1177/0956797614531799
Diet has a profound impact on gut microbiota composition and function including the role of food additives.
The study found that TiO2 could alter the release of bacterial metabolites in the gut and affect the distribution of the commensal bacteria. They also found reduced expression of the colonic mucin 2 gene, a key component of the intestinal mucus layer, and increased expression of the beta defensin gene, indicating that TiO2 significantly impacts gut homeostasis. These changes were associated with gut inflammation and an increase in the rick of colon cancer.
These findings collectively show that TiO2 is not inert, but rather impairs gut homeostasis which may in turn prime the host for disease development.
Glyphosate is an active ingredient of the most widely used herbicide Roundup. Human exposure to glyphosate among the participants has increased by 500 percent in the past two decades. In the years of 1993-1996, only 12 percent of participants had detectable levels of glyphosate in their urine. By 2013-2016, this number increased to 70 percent. The researchers also found a thirteen-times increase in glyphosate concentrations between the two collection periods.
Although glyphosate was designed to kill weeds, it also kills susceptible bacteria that have biochemical pathways similar to plants and weeds. Glyphosate impacts the intestinal microbiome through the residues from spraying, since glyphosate was shown to have negative effects on the composition of the intestinal flora of glyphosate from contaminated food. Even at incredibly low environmental concentrations (0.1 ppb) glyphosate had an impact on rat gut microbiome composition. In particular, it lowered the diversity of many of the beneficial microorganisms in experimental rats which enabled the proliferation of opportunistic E. Coli strains. These gut microbiome disturbances showed a substantial overlap with those associated with liver dysfunction in other studies. Several studies have also proposed that it may be a cause of autism through its impact on the gut microbiota.
Medical statistics are often used to justify the overuse of pharmaceuticals because they use different types and they are hard to understand then there is even a simpler number which is used in medicine, the Number Needed to Treat (NNT). This is how many people you need to treat to stop one negative outcome occurring. The negative outcome might be heart attack, stroke, cancer or even recurring ear infection. The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. In this case the higher the number the worse it is and the lower the number the more effective the medication. So an NNT of 1 is fantastic and an NNT of 100 is absolutely useless.
If a new drug reduced the death from heart attacks by say 50% (absolute statistics) then the number needed to treat is around 2 (NNT =2). So you only need to treat two people to have a benefit and save one life. This is great. If the new drug cuts the heart attack rate by only 25%, that is 1 in 4 then the NNT is 4. If the drug is only one percent effective which means of the 100 people given the drug it will only potentially (remember we are not even considering the side effects here) save one life, like the statin drugs, then the NNT is 100.
Fortunately the NNT is well established in medicine but not widely promoted. One website however TheNNT.com puts all this information in one place. Even for the most skeptical GP’s and specialists and it is available free to everyone. Just as important it is a group of physicians, medical doctors, that have collected the information. They only use the highest quality, evidence-based studies (frequently, but not always Cochrane Reviews), and they accept no outside funding or advertisements so they are independent of pharmaceutical companies.
In addition, for every therapy they review, they provide a color-coded summary for you to use (borrowed from the traditional stoplight). Unlike most sites this group also report harm that may be caused by the drug or the procedure and then they rate them into a stoplight colour coded. They have developed a framework and rating system to evaluate therapies based on their patient-important benefits and harms. The therapies rated green are the best you can get – there is clear evidence of benefits which clearly outweigh any associated harms. For example: Steroids for Asthma Attack: if you give steroids to 8 patients with asthma attack in the emergency department, you prevent one from having to be admitted to the hospital. There are definitely side effects to steroids – high blood sugar, hyperactivity – but are considered minor in comparison. The NNT for this treatment is 8. Remember the lower the number the better. Therapies rated yellow require more study because they don't think the data is conclusive or substantial enough to be able to give a clear rating yet. So they are not recommended but if you do use them go with caution. Red suggests that while there may be some benefits, they are far outweighed by the harms. One extreme example: if a medicine were to save 2% of people's lives, but cause strokes in 10% of people, it's hard to say that this medicine clearly is overall helpful. Black is the "worst" or "lowest" rating. Therapies rated black have very clear associated harms to patients without any recognizable benefit. What is frightening is that most of the major medications and procedure used for cardio vascular disease fit into the black.
While there are many drugs and procedures listed I will start with some of the common procedure for cardio vascular disease as this is the biggest killer and there is just not enough space here to cover all the listings on TheNNT.com web site. For statin drugs for acute coronary syndrome the NNT is 0% in other words no person who took the drug were helped (life saved; heart attack, stroke, or heart failure prevented) however, an unknown number were harmed (medication side effects/adverse reactions). This was put on the black list. Statins Given for 5 Years for Heart Disease Prevention (With Known Heart Disease) NNT was 83. In fact they reported 96% saw no benefit however 1% were harmed by developing diabetes and 10% were harmed by muscle damage, just two of the side effects. This is also put on the black list as the harm outweighs any insignificant benefit of the drugs. Statin Drugs Given for 5 Years for Heart Disease Prevention (Without Known Heart Disease) also put on the black list and has a NNT of 104 for non-fatal heart attack but they reported 0% life saved and 1 in 100 were harmed, they develop diabetes and 1 in 10 had severe muscle damage. In contrast, they reported the Mediterranean Diet for Secondary Prevention After Heart Attack got the green light and a NNT of 30 for mortality and no negative side effects and as low as 1 in 18 were helped. Not to mention the other benefits in other conditions such as cancer and diabetes.
Beta Blockers for Acute Heart Attack (Myocardial Infarction) are also commonly prescribed by specialists are put on the black list and listed with no benefit, but 1 in 91 were harmed by cardiogenic shock. Hormone Replacement Therapy for Cardiovascular Prevention of a First Heart Attack or Stroke, black list and no benefit found but 1 in 250 were harmed (heart attack due to HRT oops, exactly what they were supposed to prevent), 1 in 200 were harmed (stroke due to HRT) and 1 in 100 were harmed (blood clot in the leg/lung). To support this a recent study which investigated 27 trials found only one trial showing a 0.7% benefit and 26 trials that suggest no aggregate mortality benefit to beta-blockers. All the more recent, and larger, trial that utilized double-blind techniques (COMMIT, 2004) found no benefit.
Even putting a stent (a little piece of artificial artery) in an artery got on the black list. In the case of Coronary Stenting for Non-Acute Coronary Disease Compared to Medical Therapy none were helped, that is no life saved, no heart attack prevented, and no symptoms reduced, however, 1 in 50 were harmed including complications such as bleeding, stroke, kidney damage. Coronary Artery Bypass Graft Surgery (Heart Bypass) for Preventing Death over Ten Years was marginally better. The NNT was 25 to prevent death however, 1 in 83 died, 1 in 100 had stroke, 1 in 43 had kidney failure, 1 in 28 in the operation, 1 in 14 required extended life support and get this, 1 in 3-5 had cognitive decline. Not such a good outcome if you look at the whole picture and any wonder it was put on the black list
Aspirin Given Immediately for a Major Heart Attack (STEMI). Got the green light. So if you have a heart attack taking an aspirin straight away has some benefit. The NNT was 42 for mortality as 1 in 42 were helped (life saved) but 1 in 167 were harmed (non-dangerous bleeding). However, with Aspirin to Prevent a First Heart Attack or Stroke the NNT was 1667 for cardiac benefit, that is 1 in 1667 were helped (cardiovascular problem prevented), 1 in 2000 were helped (prevented non-fatal heart attack) and 1 in 3000 were helped (prevented non-fatal stroke). But no deaths prevented and 1 in 3333 had a major bleeding event.
The NNT for Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes were 125, 1 in 67 prevented stroke, and 1 in 100 prevented heart attack. However, 1 in 10 had side effects and stopped taking the drug. Treatment of Mild Hypertension for the Primary Prevention of Cardiovascular Events was given the yellow light and the there was no NNT as no benefit was found. However, 1 in 12 experienced medication side effects.
On a positive note oral anticoagulants (warfarin) for primary stroke prevention (no prior stroke) got the green light and the NNT was 25 for prevented stroke and 1 in 42 were helped (preventing death from any cause). However, 1 in 25 were harmed (having bleeding), 1 in 384 were harmed (intracranial hemorrhage).
It seems we spend billions of dollars, even trillions of dollars on drugs and procedures that don’t work and and are likely to be doing more harm than anything just because of trust and a lack of knowledge on statistics. While I am likely to criticized for presenting this information and you might question your doctor or specialist, remember I am just the messenger presenting factual numbers. See for yourself www.TheNNT.com.