La homeopatía sale cara

Desde hoy estamos colaborando con Build Up Dietitians, una red global de dietistas que incluye tanto dietistas americanos como británicos, australianos, etc. que intentan compartir nutrición basada en la evidencia.

Como vamos a estar compartiendo y escribiendo posts para ellos, iremos dejando los enlaces por aquí para que los podáis leer en su página de FB, abierta a todos los públicos No necesitáis tener una cuenta en FB para acceder.

Nuestro primer post va sobre la homeopatía (que es distinto a la suplementación con plantas medicinales, no lo confundamos). Vale la pena investigar un poco nuestra Ley del Medicamento en España, los decretos están disponibles online aquí. 

Link al post

Parece que la FDA va a endurecer la legislación relativa a los productos homeopáticos, especialmente para aquellos que son publicitados para tratar enfermedades graves. En España, según la Ley del Medicamento, para venderse no tienen que demostrar que son efectivos sino que son inocuos. Sí, lo has leído bien. Deben ser inocuos, lo cual no es difícil ya que, según la ley, deben estar disueltos en 1 parte del sustrato madre por cada 10 000.
“A veces el peligro de los productos homeopáticos es que las personas que los toman dejan de tomar aquellos medicamentos que han sido estudiados y que son, en realidad, seguros y efectivos.”

https://tonic.vice.com/…/evmm…/are-homeopathic-remedies-safe

¿Cómo se regula la homepopatía en tu país? (LR)

Oferta de Septiembre

¿Te gustaría comer de forma saludable? 

¿Necesitas un empujoncito para mejorar tus hábitos?

¿O quizás te preocupa que tus hij@s estén aumentando de peso?




SOLO durante el mes de Septiembre te ofrecemos un 15% de descuento cuando contratas 5 sesiones: 

• Dietas personalizadas
• Coaching nutricional
• Plan de ejercicios personalizado
• Medición bioimpedanciométrica
• Recetas
• Soporte mediante whatsaap e email entre consultas
• Educación nutricional
• Y mucho más!

 
Si te gusta lo que lees, escríbenos a info@gabinetederueda.es o llama al 983 08 01 49 para pedir info o cita!

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BCAAs: Are they really worth it?

Branched chain amino acids (BCAAs) are in some way the creatine of the 21^st century, what I mean by that is, that they have become the “go to” supplement for every gym goer. Strength and endurance enthusiasts alike are sold the idea that BCAAs are an essential component of their nutrition regime because they supposedly induce an anabolic/avoid a catabolic state in humans.

Whereas creatine now has decades of convincing research behind it, can we really say the same about BCAAs?

This post will summarise the recent review by Robert Wolfe in the Journal of the International Society of Sports Nutrition. I strongly recommend that you read the full paper (link here) after you have read the main points below.

First, a quick recap on amino acids. There are 20 amino acids in total, 9 are essential and 11 are non-essential. The term “essential” means that the body cannot synthesise these amino acids so we must obtain them from food. Of the 9 essential amino acids (EEAs) 3 of these are called the branched chain amino acids (BCAAs) these are, leucine, isoleucine and valine. 

Muscle protein is in a continued state of turnover, meaning proteins are constantly being broken down and synthesised (built up). The term anabolic state refers to when muscle protein synthesis (MPS) is greater than muscle protein breakdown (MPB), in other words, our muscle tissue is being built up as opposed to being broken down. When muscle protein breakdown is greater than synthesis this is known as a catabolic state. The anabolic state can be achieved by either increasing muscle protein synthesis or by reducing muscle protein breakdown. For MPS to be greater than MPB all 20 amino acids must be present.

We are sold BCAAs under the premise that they stimulate muscle protein synthesis and so we can avoid the dreaded catabolic state. But what does the actual evidence say?

The Evidence 

• The studies that show an increase in MPS after ingestion BCAAs were conducted on rats. Muscle protein studies on rats have little if any relevance to humans.
• These studies also administered the BCAAs intravenously as opposed to orally
• Studies on humans, (who also administered the BCAAs intravenously), actually showed a decrease in MPS
• The human studies also demonstrated a decrease in muscle protein breakdown but overall net effect was that the subjects remained in a catabolic state. 

When all the evidence is considered, it appears that taking BCAAs alone reduces protein turnover (synthesis and breakdown). The author points out that this may have a negative effect on muscle strength due to a reduction in new muscle fibre construction.

Current evidence suggests that BCAAs (in particular leucine) increase the “signal” for MPS, however an increased signal will not lead to increased MPS if the other EAAs are not available. Think of it as turning the key in the ignition, without fuel the engine won’t start.

In order for MPS to occur all amino acids must be available. After a meal containing sufficient protein, MPS is achievable because the EAAs will be taken from the ingested food. However, in the post-absorptive state (in between meals) the only source of EEAs is from the breakdown of muscle protein. This is why muscle is in a constant state of turn over.

If we take a huge dose of BCAAs we reduce MPB, however, by reducing MPB we reduce the amount of EEAs available for MPS so in turn, both MPS and MPB are reduced.

The Good News (kind of) 

With an increase in anabolic signalling through BCAAs, it appears that it can increase the effect of a protein meal. One study demonstrated that 5g of BCAAs added to 6.25g of whey protein had the same effect on MPS as 25g of whey protein alone.

While this may seem interesting, when you weigh up the cost of BCAAs against the cost of whey protein or (shock horror) real food, are they really worth it? Remember the golden rule, more is not always better, so adding even more BCAAs to your shake will not have a greater effect on MPS.

Another point to remember is, as we mentioned in our amino acids and immune system post, the BCAAs compete for the same site of absorption so when taken in a large dose the amino acid in the greatest concentration (usually leucine) will be absorbed at the expense of the others. 

Conclusion 

Not only is there a lack firm evidence to demonstrate an anabolic effect of taking BCAAs alone, the author concludes that without a supply of essential amino acids (either through food or muscle protein breakdown) it is not possible for BCAAs alone to increase muscle protein synthesis. Our advice as always is ensure you have a diet rich in high quality protein before starting to consider supplements. 

For more info please see www.gabinetederueda.es 

Excercise, Macronutrients and immunology part III Protein and Amino Acids

As the debate about fat and carbohydrate rages on, I think everybody can agree that protein is essential. Even the moderately active individual needs to have a higher than recommended protein intake. This is the final article that summarises the latest evidence on the role of the macronutrients in exercise and immunology (click here and here to read the previous two articles). The article will not look at protein as a whole but on the amino acids that have been researched the most in terms of their effect on the immune system post exercise. These amino acids are the branched chain amino acids (BCAA) and glutamine. Remember that if you want to read about this topic in more detail please consult the Exercise and Immunology review¹.

The branched chain amino acids (leucine, isoleucine and valine) are probably one of the most popular sports nutrition supplements, especially among people who regularly lift weights. During long bouts of exercise the BCAAs are utilised by the working muscles and this causes the plasma concentration of BCAA to fall. Apart from being used for energy, the metabolism of BCAA produces nitrogen which is used for glutamine synthesis. During exercise, a reduction in plasma glutamine has been observed which has been linked to exercise-induced immunodepression. 
It was suggested that BCAA intake could indirectly influence immune response by increasing glutamine synthesis. As we all know, just because something sounds good in theory doesn’t mean it will work in practice. Despite the fact that supplementing with BCAA during exercise did indeed increase both plasma and muscle concentrations, this did not lead to an increase in plasma glutamine. 
There is some evidence that chronic supplementation of BCAA can prevent the decrease in plasma glutamine and other markers of exercise-induced immunodepression.

BCAA, in particular leucine, may have a direct effect on the immune system through their effect on the mTor signalling pathway. mTor stimulates muscle protein synthesis and activates cytokine and antibody production. Again, somewhat predictably, the evidence is lacking and what data there is indicates that BCAA has a greater involvement in muscle protein synthesis as opposed to immune function.

The authors conclude that there is some evidence that BCAA can reduce exercise-induced immunodepression but not enough to recommend its use for athletes in the context of immune function.

It is worth remembering that the BCAA use the same transporter during digestion and that when they are taken in large amounts (for example as a supplement) the amino acid that is in the highest concentration (usually leucine) is absorbed at the expense of the other two². Therefore, I would suggest that BCAA supplementation in general may not be as advantageous as diet rich in high quality proteins.

Moving away from BCAA as a precursor to glutamine and to glutamine itself. Glutamine is the most abundant amino acid in the body and was originally thought to be non-essential. However, during times of stress to the body the requirement increases so it has been renamed conditionally essential. It is synthesised, stored and released mainly in the skeletal muscle, and among the numerous cells that utilise it are the immune cells, such as, macrophages, neutrophils and lymphocytes. As mentioned before, prolonged exercise results in a decrease in plasma glutamine concentration, a decrease in immune function is simultaneously observed.

As with BCAA supplementation, the rationale is sound but disappointingly, the results from studies of glutamine supplementation do not live up to the expectation.

In conclusion, while there are some encouraging signs that BCAA and glutamine may influence immune function, the evidence is not currently strong enough to promote the supplementation of either. As I stated before, what is essential is that you have a diet rich in high quality protein. 
Before even considering supplementation of any kind you should always evaluate the quality of your diet and address any issues. If you would like to know more about our sports nutrition packages please contact us on info@gabinetederueda.es 

References 
1.Berman S et al. (2017) Immunonutrition and Exercise Consensus Statement. Exercise and Immunology Review: Vol 23
2. Gropper, S.S & Smith, (2013) J.L Advanced Nutrition and Human Metabolism 6th Edition. Wadsworth Cengage Learning 

Intolerancias alimentarias y los IgG

Hoy en día en el mundo de la salud y de la nutrición muchas enfermedades son atribuidas a los alimentos. En general somos más conscientes de que la dieta puede afectar a la salud positiva y negativamente.

En algunos casos es evidente que un alimento es el causante de una determinaba enfermedad, por ejemplo en alergias. Pero hay casos en los que no es tan obvio. Este es un área gris que muchos aprovechan. Defienden que pueden emparejar nuestros síntomas con determinados alimentos presentes en nuestra dieta y utilizan varias “pruebas” para establecer un diagnóstico. El problema es que muchas de estas pruebas no tienen ningún fundamento científico.

Una de éstas es la prueba IgG. Esta prueba consiste en tomar una muestra de sangre que se analiza para medir la presencia de IgG específica para determinados alimentos (ej. IgG y huevo, IgG y leche de vaca, etc). Con esto obtendrás unos valores de IgG específicos para cada alimento, más bajos o más altos. Sería a los valores más altos a los que supuestamente tendrías intolerancia y deberías evitar. Normalmente te los presentarán en un sistema de semáforo: rojo para los que debes evitar, ámbar para los que puedes tolerar en ciertas cantidades y verde para aquellos alimentos que puedes comer sin problemas.

¿Qué nos dice la evidencia científica?

IgG es un tipo de anticuerpo. Es el más abundante en seres humanos y tiene 4 subtipos. Cada tipo de anticuerpo nos protege de distintas maneras; las IgG hacen la opsonización: marcan a los patógenos para que otras células del sistema inmunitario los maten. IgG1 y IgG3 activan el sistema de complemento, que ayuda a la eliminación de patógenos (1).

Sabemos que las IgG están relacionadas con la auto-inmunidad y que las IgE están involucradas en las alergias. Sin embargo, a partir de un estudio que mostró que las IgG4 podrían inducir la liberación de histamina (2), la gente se empezó a preguntarse si las IgG podrían mediar en algunas reacciones a ciertos alimentos que no eran alergias. Esta idea empezó a tener mejor pinta después de que unos cuantos estudios (3-5) mostraran que quitando los alimentos a los que la prueba IgG había  salido alta de la dieta(marcado en rojo), los síntomas de los pacientes con Síndrome del Intestino Irritable (SII) mejoraban notablemente.

A primera vista todo parece que tiene mucho sentido, pero no debemos caer en la trampa de confundir asociación con causa. Por ejemplo, hace unos años hubo un artículo que señalaba como "a mayor tamaño de TV, mayores posibilidades de tener diabetes de tipo 2". ???

Nos preguntamos, el hecho de que estos pacientes mostraran una mejoría de sus síntomas después de evitar los alimentos con IgG alta ¿es una asociación o una relación causa-efecto?

En un estudio en Noruega (6), estudiaron las diferencias en los niveles de IgG entre los pacientes con SII y la población normal. Según los resultados no hubo diferencias entre los dos grupos en los niveles de IgG. Curiosamente, encontraron que niveles bajos de IgG específicos para huevo y ternera estaban asociados con mayor severidad de síntomas mientras que niveles altos de IgG específica para el pollo también lo estaban.

Si lo pensamos un momento, esperaríamos que los niveles más elevados de IgG causaran mayor severidad de síntomas y que los enfermos de SII tuvieran niveles más elevados en general. Los autores descubrieron que los pacientes con SII consideraban que el huevo y la ternera son comidas “problemáticas” y las evitaban, mientras que consideraban el pollo una comida “segura” y la consumían de manera frecuente.

Esto les llevó a concluir que era poco probable que los síntomas de SII estuvieran mediados por IgG y que la presencia de este anticuerpo simplemente reflejaba la dieta de cada uno. 

En otras palabras, cuanto más comas un determinado alimento, mayor será tu IgG específica a él.

Un artículo en el Journal of Gastroenterology and Hepathology que revisó la evidencia disponible sobre SII concluyó que no podían recomendar dietas de exclusión basadas en IgG debido a la falta de evidencia científica y eficacia limitada de estas dietas (7).

Otro artículo estudió la relación entre IgG y la sensibilidad al gluten sin encontrar una relación causal (8).

En 2008 la Academia de Alergia e Inmunología Europea (EAACI) publicó un documento en el que explicaban su posición en el uso de las pruebas de IgG4 para el diagnóstico de intolerancias alimentarias (9). Su conclusión fue “Las pruebas de IgG4 específicas a alimentos son consideradas como irrelevantes en los tests de laboratorio para alergia alimentaria o intolerancia y no deben realizarse en el caso de molestias relacionadas con alimentos”. En este documento declaran que:

• No hay evidencia de que las IgG4 causen síntomas en seres humanos.
• El estudio que mostró que las IgG4 causan la liberación de histamina (2) fue realizado bajo condiciones muy específicas de laboratorio que sería muy difícil que ocurrieran en un ser humano.
• La presencia de IgG4 indica que el individuo ha sido expuesto repetidamente a un alimento y que su sistema inmunitario lo ha reconocido como extraño pero inofensivo.
• La presencia de IgG4 no debe utilizarse como un marcador de hipersensibilidad o intolerancia sino como un marcador de tolerancia inmunológica.

Como conclusión: no existe evidencia científica que apoye el uso de las pruebas de IgG4 para diagnosticar una intolerancia alimentaria. Si sospechas que tienes una intolerancia, acude a tu médico o dietista.

Referencias:

1. Owen J, Punt J, Stranford S, Jones P. Kuby Immunology. Seventh ed: MacMillan Higher Education; 2013.

2. Parish WE. Short-Term anaphylactic IgG antibodies in human sera. Lancet 1970; 2: 591-592  

3. Atkinson W et al. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised control trial. Gut 2004; 53:1459-1464 

4. Zar S et al. Food specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome. Am J Gastro 2005; 100: 1550-1557

5. Zar S et al. Food specific IgG4 antibody-guided exclusion diets improve symptoms and rectal compliance in irritable bowel syndrome. Scan J Gastro 2005; 40 :800-807

6. Ligaarden et al. IgG and IgG4 antibodies in subjects with irritable bowel syndrome: a case control study in the general population. BMC Gastro 2012; 12:166-174

7. Philpott H et al. Alternative investigations for irritable bowel syndrome. JGHF 2012; 28; 73-77

8. Francavilla R et al. Clinical, Serologic, and Histologic Features of Gluten Sensitivity

in Children. Journal of paediatrics 2014; 164: 463-467 

9. Stapel S et al. Testing for IgG4 against foods is not recommended as a diagnostic

tool: EAACI Task Force Report*. Allergy 2008; 63: 793-796  

When Paleo isn't Paleo

The world of health and fitness is often very similar to the world of fashion. Each year there is a must have food and/or diet and then eventually they will fade into obscurity, replaced by another diet, sometimes to reemerge a few years later. I often wonder what happened to the Metabolic Typing Diet. When I first left university and ventured into the world of fitness training this was THE diet to follow according to certain fitness "experts". Of course, it came and went, it was replaced by the Alkaline Diet, Zone Diet, Blood Type diet, the Fasting Diet, and the reemergence of the Atkins Diet, tweaked and now called LCHF, so on and so on. As I've said before in our Alkaline Diet post, a lot, if not the majority of these diets can be dismissed as nonsense, the Blood Type Diet being a good example, however, there are some of these diets that are actually OK. A good example of these is the Alkaline diet, in terms of the actual content of the diet anyway, not the reasons they give for following it.

Another good example is the Paleo diet. Taken at first glance, the Paleo diet consists of everything that the human would eat in their natural environment, so, meat, fish, fruits, vegetables, nuts and seeds. This is a sound base for any diet and we also recommend that the majority of our patients' diets are made up of fresh produce and to try and limit man made or processed products as much as possible. The idea behind Paleo is that we humans made a mistake by starting agriculture, that is farming grains, making breads etc. and that we should have stuck to our "natural" diet. There are arguments both for and against this and as I've said before the actual content of the Paleo diet or at least the idea behind it isn't too bad, if a little impractical. I always think that there must have been a reason why we went from hunter-gatherer to farmer, less chance of starving to death was probably a major factor. However, now food is abundant (in the western world at least) maybe going "back to the primitive" is a good idea.

The problem I have with the Paleo diet and to be honest nearly all diets, is not the actual diets themselves but the tsunami of products that are targeted at followers of that particular diet. By it's very nature the Paleo diet should be fairly simple to follow. Putting aside the issue of organic for one moment, you should be able to go to the supermarket and buy your food from the fresh produce aisles only. Obviously things become a little more difficult and not to mention expensive when you factor in organic produce. Of course, we promote organic, local and seasonal where possible but we have to be aware that not everyone has the budget  for that.

The question followers of the Paleo diet have to ask is, is my diet really Paleo?

If we are to be strict about it, the Paleo diet will not have any of the following

• Tea and Coffee
• Alcohol 
• Oils
• Sugar 
• Flours and breads (all types)
• Salt and therefore 
• Processed and/or cured meats
• Dairy 
• Dairy alternatives such as almond milk, soy milk etc. 
• Chocolate
• Sauces 
• Sports nutrition products 
• Any liquid that isn't water 

All of the above have come about from the human moving away from hunter-gatherer and towards agriculture. Paleo human would have only eaten what they dug up from the earth, picked from a tree, hunted or scavenged. However, after a quick google search for Paleo products, top of the list is a  website that recommends 23 "paleo products" you have to try and they include,

• Bacon (not Paleo)
• Prosciutto (basically bacon so not Paleo)
• Coconut oil (not Paleo)
• Coconut and almond flours (not Paleo) 
• Butter and Ghee (not Paleo) 
• Sparkling water (not Paleo) 
• Tea (not Paleo) 

Things get really amusing when you browse through the enormous list of Paleo protein bars and Paleo protein powders! Maybe I'm wrong but I'm fairly certain that archaeologists are yet to find any fossilised protein shakers from the Paleolithic period. Just because a bar contains dried fruit instead of sugar or a powder is using hemp protein instead of whey, the fact it is a processed man made product means it is NOT Paleo. The same can be said for flours and oils, almond flour is still a flour, it's processed, as is coconut or any other oil. 

So What?

Who cares right? Maybe I am just being pedantic but this where my issue with "diets" comes from. The food and supplement companies are not stupid and they can spot a gold mine when they see one. They know that if they slap the word Paleo on the wrapper of a product they can hike the price up and people will pay it, especially as the Paleo diet is known for not being cheap and so people already expect to pay a bit more. But if you are buying any of those products you are not following a Paleo diet you are paying over the odds for products that you could buy ordinarily at a fraction of the price.  

It boils down to the question of why are you following the Paleo diet? If you really want to eat like a cave man/woman then unfortunately anything off that list above is out of bounds. Or if you simply want to decrease the amount of processed or man made foods in your diet you can do so without having to buy overpriced products. 

Our advice is, buy local, buy seasonal and avoid anything that has Paleo on the wrapper!  

If you want any help or advice regarding Paleo or any diet, drop a comment below or contact us on Facebook/Twitter or info@gabinetederueda.es 

References 

http://wickedspatula.com/23-paleo-items-you-have-to-buy-at-trader-joes/