95. Progress Note #7: Erythritol, Ohio Water Contamination & Alzheimer's in a 19 Year Old

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Welcome back everyone, here with progress note number seven. Wow, we've done six of these already. That's pretty crazy to think about, but this one's going to be a little different, right? I mean, we're to we're taking on the roles of like Veney Prasad and Zee Dog here, but this is not a new show as they say, although we're kind of turn to get into a little bit of one. But ultimately, it is, yes, we are evolving. Absolutely. So, kind of the premise now, right, in our previous progress notes, we really just took certain myths based on social media, certain things we saw, and we really wanted to break that down with data. We'll still be doing that somewhat in these progress notes, but we're also just going to be talking about current events and offering our opinions on the science and health current events, and you know, future implications, what it means from our side, what it means for patients, and just kind of how to view these stories. So I think this is going to be a fun little project, and we'll see what the response is. Yeah, I'm excited. I think that, you know, with respect to not necessarily a news outlet, right, that's not what we're doing. Again, we're going to keep it focused much to science and health. We might branch out from now, then because we do have other interests. I mean, this show has taken financial topics, student loan topics. So maybe it is, if it's irrelevant, which I don't know how finances are not relevant to health and business, so not relevant to health, this certainly is, right? It's all connected. It's all connected. Tensegrity. So yeah, I'm excited about this. So I guess we've got a couple things in mind, which order should we take it in? Should we start with the hot button topic that everyone, so what we're recording this March 2nd, everyone's been posting about this last three days. Phil Mansaur is seeing an article about an artificial sweetener, sugar alcohol called a Rithroid Paul. I can never say it. A Rithroid tall. There we go. It ends in a while. That's all I know. But right so I see an article came out showing a link. Well, this is the headline, a link between a Rithroid Paul intake and cardiovascular disease and mortality. Don't take it from there kind of what. Yeah. Is it was CNN the only one or was it the most? I think it was the most. It was the one that flashed up like on my laptop, on my phone, from like an Apple perspective. So, yeah. Yeah, it's interesting. So I think this paper was published in nature, right? Am I correct on that? You might be. Which is. Yeah. Let's quickly check that while I talk about it and you can tell me if I am right or wrong. But I do believe that it was published in nature, which for those who do it don't know. I mean, it's a pretty reputable journal and so you know, it has a high barrier to entry. And so you presume that when the data is reported like that, it is going to be somewhat reliable. And what's interesting about this paper initially, it's, yeah, it's terrifying because we see that you're like, oh my God, Rithroid Paul is available in so many different products that we use. And you know, with the, I think in a previous study, we talked about what the global burden of sugar consumption is on an annual basis and it's astronomical. And so of course, sugar substitutes are very popular. And if you're using any type of supplementation, right, both of us use perching powders, they always, almost always have sugar substitutes. That could be stevia, which can have a little bit of a threshold of monk fruit, which almost always comes with some type of sugar alcohol as well. So you're exposed to that. And so it can be terrifying when you're like, oh, well, what does this mean? High levels of Rithroid and it's logical that if you're consuming something, your body is going to have more of it. But as we'll talk about a little bit more without getting too much into the science of it, that that's not necessarily true. And this paper did not demonstrate that. So you know, essentially what they showed is, I forget what the most of the population was, but like you talked about, there was a correlation that people who were very, very sick and the mortality rate was high. And they had high levels of blood, Rithroid Paul. They did not necessarily check what their dietary intake was. So this is, we've talked about correlation and causation at length before. And so that was really, really interesting is, you know, the first thing I started with is like, oh, my God, I'm consuming all this Rithroid, that means I'm going to have high Rithroid Paul. But that's not what the study showed. And then the article suggests, and it's being shared and reshared millions of times, that high levels of Rithroid consumption is going to equal or high levels of mortality, right? Cardiovascular mortality. And that's not what the study showed. Again, I repeat, that's not what the study showed. So I won't pause there and see what your thoughts are. Yeah. No. So likewise, when I first saw it, I was like, shit, I drink like diet soda because it satisfies my sweet tooth. But then it's also like, it's not every day. But like, you know, once a week, it's like once a week, so I'm like, crap, am I taking this with all? Like, I'm already at a genetic predisposition for like heart disease and stuff. So you know, right on boat, looking at the headline, being like crap, okay. Then it was great to see in the article itself from CNN, the primary investigator says, we cannot translate this to general population. And the reason why is, I believe like 70 to 80% of their subjects already had cardiovascular like cardiovascular metabolic health, type 2 diabetes, prior MI's, strokes. So this was not a healthy population to begin with, right? And then Lane Norton beautifully comes out with a video on social media explaining this paper and explaining even something called the pentose phosphate pathway, which we're not going to get into the weeds of it. But essentially, if the sicker you are, you're going to create more of those sugars even at the same dose. So let's say us two, we take 10 grams versus a sicker person with worse cardiac metabolic health also takes the 10, they're going to produce more of that breakdown later on. And so that's what he calls, what he calls reverse causality bias, right? So that we're looking at the end result, this increased plasma level of arithital. And that in itself is related to the fact that these subjects were not healthy to begin with. Right, yeah, no, and he's not actually the first person that I heard talk about this. I think we're probably a little bit behind the apple here because so many people have talked about it. So it's going to be a quick turnaround. So if you haven't heard it, maybe you'll hear it here, but chances are you already have. And a couple of people talked about this reverse causation, right, is again, every single normal person mixes, right? The PPP or pentose phosphate pathway that you talked about is a natural metabolic process. And in sicker states, people who have cardiac metabolic ill health, that process is ramped up or they're the byproduct of arithital is higher. So there's no way for us to know whether the dietary consumption has something to do with it. It is conceivable that if you put more of something into your body, you will have more of it. But that's just completely dismissing how complex and non nuanced metabolism is what your liver is responsible for, what your kidneys are responsible for. And I believe that the liver is primarily where the PPP pathway occurs, somebody can double check me on that. So again, that's, it's again, it's not what the study showed and the first thing you mentioned, the PI of the study clearly stated that this is not to be taken out of context. What's incredibly frustrating about this is some really prominent and smart people on social media just for clickbait just post, oh my god, like this is what this shows, you know, follow my blog for more details. And it's like, no, don't do that, like because they're not going to follow your blog and nobody wants to to read it, TLDR and just say the message right there. And so it's frustrating and, you know, I think that this is an interesting piece of data. And I think that's the reason, right, because it's somewhat novel. I don't remember this ever being reported before, it doesn't mean it hasn't been. And that's one of the reasons why something when something new and interesting, and it's a fascinating study, that's how it gets published into a really prominent journal. And that's the other thing. I think people sometimes have a biases when something gets published to sell or nature or a jamma or something like that. And these are these really high profile journals with high impact factors that automatically assume that it's going to be a good study or it's going to be like meaningful in terms of clinically. And it's the furthest thing from the truth. So I'm glad that a lot of people are posting it. I think a lot of people that you follow have talked about how that's not the case and share the same sentiment we do. But I'm sure equally as many people are posting it and saying, this is why you should avoid it with the tall and just flagging it. It's frustrating. It's whatever fits that person's agenda, right? And I'm hoping this is like, this is funny, because when I saw that CNN article just random night, I just clicked on it because it was health related. I didn't think it'd blow up. I thought it was just like one of those random articles. But I guess like you said, being in nature, maybe a lot of people saw it. But I'm hoping this is the turning point for the general public to realize that like you said, everything that comes out in a publication doesn't necessarily mean it's going to have impact or news media outlets are always going to outstretch the truth, right? Or whatever the study is actually showing. And it's good to see like, like you said, again, a lot of the people that we follow put out the real information out there, you say, I love that you said that, but I think you're just low too optimistic. I don't know if this is going to be the turning point. Yeah. It definitely will not be the turning point. Definitely optimistic. You know what's so funny to me about that is the tribalism is at its highest and it's not even just this. It's a couple of other places. One of the people that I sent you, I won't mention them by name. I was looking at their comments who had reshared this article and said, oh, this is why I'm going to pay very close attention to the withdrawal and it shows this link and this is a scientist. This is a physician. And in the comments, somebody said, I had just started following you and now I will be unfollowing you. It's like, what? Who cares? That person didn't know who that you existed until you made that announcement. And you know, like no offense to that person, but that's the other interesting thing. It's like the reason it's not going to be the turning point is because everybody will say, oh, your thoughts all of a sudden do not align with my bias and therefore I will unfollow you and I will only follow the people who are saying what I already believe to be true. And it's so annoying. Right. I have a discussion about it. Or putting a meaningful comment, yeah, yeah, yeah, meaningful, right, right, right, right. Yeah. Anyways, you know what's going to be the turning point this when people hear this podcast episode? That's what I wanted. I'm excited. I'm excited. I won't hold my breath, but I'm excited. But I think that's enough. I think we spent 10 minutes on it. Let's move on. Okay. So second story, which I'm sure many, many have heard is about the Ohio Water Incident, right, in East Palestine, Ohio. This has been getting a lot of news coverage for the right reasons too, right? So this is a classic kind of government versus citizen battle that's been going on. So just to recap the story on February 3rd, there was a train derailment in Eastern Ohio. And this train was carrying a lot of chemicals. And so the question is, what do you do with those chemicals, right? And so the agency of the company decided to kind of bury these chemicals underground and then burn them so that they could release. And that way their hope was that these chemicals can be away from general population and life itself. Unfortunately, that did not happen. And the citizens of East Palestine were starting to see their tap water look funky. They were starting to see dead animals. People were starting to get migraines and fevers and headaches and just not feeling right out of the blue. And it has now come to light that these toxins that were burning underground were seeping through the water system. And so there are a lot of crazy videos out there. If anyone just wants the Google like water Ohio toxic or something, they'll see a woman near a stream throw a rock. And the rock will drop down and you see those concentric waves. And the rock I guess is displacing some of the water. And then within like a few seconds, you see bubbles rise and you see this sleek oil sheen on the river and it's just it's it's it's absolutely wild to see that it's literally just oil in a river. And then another video I saw too was just a lady opening up her tap water faucet and pouring a glass and was like, what is this? And it was just pure like gray hazy. So just very disheartening to see, but that's kind of the news story we're going to we're going to be covering here. This is insane. It's just like when you started off the story and this is to for disclosure, I was only familiar with this because you know, you mentioned to me or I think I was more shocking to story or me telling you I don't listen to any news and I don't click on anything like that because I don't because it's it's more and more ridiculous and you know, sometimes it's just better to stay away from that. Yeah, it's just the idea that hey, we're going to bury this in just light on fire. I mean, who comes up? Who is responsible for these things and things that these are going to, I mean, if scientists were leading that, like, how is that not going to dissolve, right? How is that not going to be exposure and if we're just going to light up chemicals and that it's not going to expose people through the air is now I don't specifically know what chemicals are there, but clearly if people are, I mean, are there any ones that that come to to mind that you can talk about? Yeah, vinyl, vinyl chloride was the primary toxic toxin that was on that train, which is what you see in PVC pipes. So for a lot of you that may have heard why PVC pipes are bad, it contains that vinyl chloride and when you burn that or have exposure to it, I mean, hormone disruption is probably the most common thing we see with toxicity from toxins. Right. Something that is not found in nature at all, it's a man-made chemical. Right. Yeah, so lots of people are just basically drinking PVC pipe is kind of what you're telling me. Yeah. Right. And this was precursors to it at the very least. Right. And so, you know, people who have been on this podcast, you guys may have heard Dr. Yvonne Berkart, we just got done recording an awesome episode with Dr. Trubot, Wendy Trubot, which will be released in a couple of weeks. You know, we're going to be talking about toxins and how to diagnose it, how to treat it, how to remove these toxins and why also they're important, right? I don't think these are something to dismiss, which is why those, the good people of East Palestine are worried about their health and future children's health. This is toxins don't readily leave your body right away. So currently, you know, and we're not going to make this a political show, but there's a back and forth now right now trying to figure out what they can do for the health of these people. Yeah. And I think it's a bit soon, right? So it's where exactly about a little under 30 days out from the event is what the case is, and you know, I've even seen some stuff come across that there are people on the outskirts, right? In the state of Pennsylvania, who were starting to see some effects and they are not really getting the same protections because it happened in Ohio, and so you have got local state regulations. Again, it's hard not to talk about this without it sounding somewhat political, but these are the facts, right? And so Pennsylvania is not going to be protected, I mean, on a federal level, there is going to be some protections and some arguments and some back and forth if it's going to be between the citizens and the companies and the folks responsible for it. But there is going to be, there are going to be a lot of people affected and there are going to be manifestations that are, we don't know if they're going to be acute, if they're going to be chronic, if they're going to be a delayed reaction. And so I think that something that we said earlier tonight and something that we've said time and time again, and other guests who've come on the show have said is you are responsible for your own health. So we have to be vigilant. So what can we do? Okay, so I'm very blessed and I'm lucky and so are you. I think that we're not anywhere near to it. You're closer to it than I am. But especially if you have something like this happen, I suppose maybe if we're being optimistic, maybe we could talk about what are some strategies people can use to protect themselves and how can they be vigilant? And these would be things that we've talked about on the podcast before, but I'll let you take away on that. Yeah, for sure. So I think I forget what episode it was, but we had Tracy Deuce come on, probably in the 20s and she's like a water expert, right? So she's actually the one who's probably convinced me to get a pretty solid water filter. And so I use a burky filter. Now again, this is going to range from people's price points. There are different filters you can use. There are hard carbon filters, which is like the burky, which you pour water and then it will drain out the water and leave the minerals and things behind or not the mineral, sorry, the chemicals and things, toxins behind. There's reverse osmosis, which is almost essentially producing distilled water. So you have the adjoin minerals. That's a very expensive process, very lengthy process. But then there's also faucet, right? Filters that you can use or things like brida that you can use, which are just it handled or a jug filter. So any of these will work. Obviously there are going to be some that are better than others. But the most important thing is looking at your budget, making that first step, right? We can talk about this today. Yes, there's a price to everything, right? And I say everything, and I'm going to emphasize everything, right? Because yes, there's a price to buying these products, but there's also a price to not buying these products. And it depends on what's more important to you. The initial assessment now to feel better to make sure you're taking that step to trust yourself and not necessarily agencies or other people that are telling you something versus getting sick or potentially getting sick and then having those costs really add up later in life. Yeah. No, I love that. I think just for the audience, 35, episode 35 with Trissy Dews, it's a little bit later. Okay. But yeah, I as well use Birke, and you know what's frustrating, man, actually, just getting to prime those filters, man, that's hard. You guys really have the right faucet to be able to prime those filters as struggled with that recently. Anyways, back to the topic, again, Dr. Wendy Trebo recently talked, we just talked about when we're talking about these toxin exposures, depending on where you believe there are on the pyramid, I think it's, it's silly to say that they don't matter. They might matter more for some people than others, clearly the people in Ohio right now near East Palestine, they matter a lot more and some people in the outskirts closer to the border, depending on if they matter a lot more than it does for me, but I might have exposure to other things. So I think step one is assess, right, assess before you can think about correcting. And so I think in that episode, or maybe one of the lessons learned episode, subsequent episode from Trissy Dews, we talked about resources you can go into your local state government and see what type of exposures and what things have been highlighted and pointed out. I think EWG is a website that comes up time and time again. They have somewhat of a database for a lot of cities and towns, probably bigger cities that talk about the water and the commonly identified chemicals in that. Of course, that data is going to need to be updated at some point. It's going to take a long time when that data is updated with final chloride or whatever else was in there. But those people need to be vigilant. And so whatever you can do, whatever your budget allows as you talked about, start somewhere, right? Protect yourself because we don't know what the effects are going to be, again, more acute, subacute and chronic long-term effects are going to be with this type of stuff. So yeah, yeah, I mean, my heart goes after those people, the ones who are suffering from this stuff. And yeah, it sucks. Yeah. Absolutely. All right. Well, we did that. Third topic. I want to talk about people may have heard in China, there was a 19-year-old diagnosed with Alzheimer's. And again, diagnosis doesn't mean it's confirmed. It's just what they're diagnosed with. That's what the doctor is. Eliminary. Thank you. Yes, yeah. So interesting, very interesting. So a 19-year-old male started having progressive dementia, progressive memory loss. And that's not typical for people thinking, well, it couldn't be like depression, ADHD, like typical teenage, young adult behavior, sure, but you're not going to see it to the extent that this guy had. He was losing his short-term and long-term memory. So they ran some tests on him, and for Alzheimer's, the typical thing you see is a build-up of misfolded proteins. Right? So you'll see these plaques as well as tau proteins getting built up. And essentially, when they looked at his brain for the plaques and the proteins, they found the precursor protein for the tau protein elevated. So he didn't necessarily have plaques, he didn't necessarily have the fully formed tau protein, but he had the elevated precursor. So now the next, you know, for most people thinking about Alzheimer's, you're like, okay, this is obviously a disease more of the old, right, maybe 60, 70 years old and onwards. So maybe there was some genetic component. So you know, the most common genetic markers we use are the 8 before, but then we'll also use pre-central int, right, 1 and 2, negative for those as well. Right. 8 before. 8 before. Yes. Right. So now that he doesn't have any genetic markers, this has led researchers to say, hmm, this is a mystery. He's obviously got the increased tau, and so they're going to label it as Alzheimer's. Big topic, right, brain health is becoming more and more nuanced, we're understanding it a little bit better. There's a lot of people talking about it. So your thoughts on just kind of this story that took people to say, huh, interesting. Yeah, that word right there, exactly, and nothing more. Wow, interesting. You know, it's very cool, and I don't mean cool in like a sick, demented way, right? I mean, we're medical providers, and it's an interesting case report, right, that's what it is. Again, we talked about, you know, for those Alzheimer's, it's a neurodegenerative disease, and like any other degenerative disease, it takes time for degeneration to happen, right? And so that's why we see older folks together. There is some sense of early onset Alzheimer's, which would still be in your 60s, probably maybe 50s at the earliest, and those are the genetic components that we're talking about, but still they're modifiable, right? Disney's latest series, limitless with Chris Hemsworth, give this a lot of attention, because did he have two copies of APOE4? I forget. I think he had one copy of APOE4, which increased his chances by like almost 10 fold. And if you have, I think, two copies, I could be wrong with that, but significantly increases your likelihood of getting that, but he also had family history, and those are his moral factors. So yeah, a 19 year old with some precursors is fascinating, but again, that's the key word that you talked about, right? And so the other interesting thing that you talked about is still being worked on. So it is soon to tell, but we see one-offs all the time, which is why people write these things up and report these cases. But I think that people start freaking out, and we talked about this with one of our recent guests, Dr. Austin Perimutter, about all the people in their anxiety and APOE4 and what to make of it, whether those kinds of things need to be tested and stuff like that, and fast forward to another guest, and we talk about how our brain or anxiety or psychology can actually affect physiology, right? This placebo effect that people talk about is just in your mind, what turns out that your mind is so powerful that it can physiologically cause some changes in a lot of people, which can be responsible for the changes. Well, again, going back to Austin Perimutter's point, right? If you're going to have ramped up psychology because of things like this, you can potentially cause your brain state to change, and could that accelerate some type of stress, you know, cause vascular disease, accelerate vascular dementia. You mentioned to me that around a patch we've talked about this recently as well. So all these things are intertwined, and I just wouldn't get up in arms about it. I wouldn't lose any sleep over it because, again, ironically, that's going to lead to problems in Alzheimer's. Yeah, absolutely. So Alzheimer's, a lot of people might be thinking, is there a cure? No, there is not, right? So what they recommend right now is a healthy lifestyle. And like you just said, Rhonda Patrick just came out with a podcast episode on it talking with a prominent researcher, and he's pretty optimistic that within the next 10 years, we might have some good drugs on the market to really prevent or also less than the progression. So give you about 10 years, maybe more of life when you have Alzheimer's. And so they're, they're, they're mainly looking at it as a vascular disease. So let's just as people have heard of leaky gut, their thing of leaky brain or the blood brain barrier becomes a little more permeable. And one of their best things you can do to prevent that is exercise and consistent exercise. And then people may have also heard of it as type 3 diabetes because there's a link to it with glucose metabolism and insulin level. So, yeah, absolutely. Yep, exercise, sleep. And you know, one of the interesting things is that people have talked about is the strong link between nutrition. Some people are so sold on the fact that nutrition can directly affect our brain states. I haven't seen data to support that at least. And that's another interesting point that we bring up or at least I bring up is that sometimes, you know, people, their interpretation of the data is, and they come conclusively knowing one thing and, you know, another person's interpretation of the data suggests something else. Like when I look at the data in terms of its effect on brain health, I don't take away the fact that nutrition is the strongest influencer. Do you mean mood or like what do you mean by brain state when you look at those stuff? Yeah. I guess good question. We got to tease that out. Talking about structural issues, such as neurodegenerative stuff, vascular disease, dementia, et cetera. Now, dementia, it's very interesting, right? Because if it's just a memory thing, yeah, like you talked about its anxiety, depression can change that and make it very, very difficult. The thing, one of the things you learn as a medical student early on is, you know, adults can be confused with dementia and depression and that kind of stuff when, in fact, they're depressed. I think that's really, really hard to tease out for them, but I meant specific structural stuff. Gotcha. Yeah. I wonder if Chris Polymer, you know, Chris, like he's talking about a lot of a keto. Yeah. Is he looking into any of that? I know he's doing more of the depression and like fibromyalgia and the psychiatric more disorders. I wasn't sure if he's looking at more of the mechanical thing. No, I'm not sure. I do know that, oh, my God, what's his name? Max Luke Arve, I don't know how to say his last name, but the genius life and genius foods. Yeah. Look at Barry. Yeah, sure. If that's right. Yeah, he does talk a lot about in terms of our diet and how that can affect it and there are some foods and we do talk about these foods as super foods, like blueberries out there, have some effect on cognition and memory. Again, we know that glucose has a role and then, you know, depending on what type of glucose and how it's releasing and you already talked about insulin type three diabetes and how that affects our brain. But again, that's, it's, it's early, the type of diabetes concept, at least mainstream and more people talking about it's relatively early. Like, we don't have enough strong human studies to even look at those proposed mechanisms. Not saying it's, it's not going to be true, I'm just saying at this point, I don't know the data suggests that. So that's kind of why I, you know, I question that. Yeah. Fair enough. Cool. Well, hey, this was our first news episode. Pretty fun. I enjoyed that. Yeah. We'll see what the audience says. Yeah. Yeah, guys. As always, I mean, we, this is evolving as we said in the beginning and so if this is the template that you guys like, let us know. We're happy to go back and tell you guys how some people are bananas and that's, that still might happen from time to time because it can be frustrating, but for now, I'm happy to just share that off the mic with you on a personal note because people say more ridiculous things on a daily basis than ever, but that's not going to change. But either way, feedback for us on any social media platform or med redefined at gmo.com. We'd love to hear from you. As a reminder, we're back on Mondays for popular demand. So yeah, you'll be tuning in in the morning and check it out. Awesome. Sounds good, man. Everybody. Till next time. Yep. Thanks for listening to another episode of medicine redefined. If you enjoyed this type of progress note with a little bit of a different format where we break down certain news articles or certain recent events, let us know. I think it's a cool way for us to share our opinion on the ever evolving world and kind of how to think about it. A lot of times these news articles and things flash in our newsletters or emails or kind of just across our TV or computer screens, but we don't really give much thought to it. So ultimately, I hope to provide some sort of insight in terms of how to navigate the news and the current events that we see. All right. Thanks to our team consisting of Harita Yepori, Iman Vashiri, and Ethan Zhu for the production of this podcast. And of course, our medical disclaimer, everything in this podcast is for educational purposes only. It is not constantly the price of medicine, but we are not providing medical advice. No physician patient which was formed and anything discussed in this podcast is not represented by these bar employers. We recommend that you see the guidance of your personal physician regarding any specific health-related issues. We'll see you next week.