NEW HEALTH TIPS

JULY 12

High HDL Cholesterol May Not Protect You from a Heart Attack

  

There are many ways to measure risk factors for having a heart attack, but for more than the last 60 years, the criteria used most by doctors to predict your likelihood to suffer a heart attack was to measure your LDL and HDL cholesterol. However, several recent studies show that high levels of HDL cholesterol are not always associated with preventing heart attacks (Medscape Internal Medicine, July 27, 2018). Today, doctors depend far more on the results of your LDL cholesterol test and how much plaque you have in your arteries. If your LDL cholesterol is greater than 100 and you have other heart-attack risk factors, your doctor is likely to recommend that you take a statin drug to lower cholesterol. If your arteries are loaded with plaques, you need an immediate supervised program to prevent a heart attack and some may even need a medical procedure.

The Difference between HDL and LDL Cholesterol
To help you remember the terms, I call LDL cholesterol “Lousy” and HDL cholesterol “Healthy”. The Lousy LDL cholesterol is harmful because it carries cholesterol into arteries to form plaques that can break off to cause heart attacks. The Healthy HDL cholesterol is supposed to help prevent heart attacks by carrying fats and cholesterol from your arteries and bloodstream into your liver where they can pass into your bile and from your body. HDL is also supposed to reduce inflammation (Circ Res, 2004;95:764-772) and help prevent the clots that eventually cause heart attacks (Circ Res, 2006;98:1352-1364). However, the literature is now full of articles that show that:
• Some people with very high HDL cholesterol levels are at high risk for heart attacks;
• Niacin raises blood levels of the Healthy HDL cholesterol, but does not prevent heart attacks (N Engl J Med, 2014;371:203-212);
• Cholesterol transfer protein inhibitors such as torcetrapib, that raise HDL, do not prevent heart attacks (N Engl J Med, 2007;357:2109-2122); and
• HDL cholesterol may be rendered ineffective by factors that cause the Lousy LDL to become oxidized (Curr Atheroscler Rep, 2007;9:57-63), as in diseases associated with inflammation such as diabetes or during a heart attack.
The explanation for this lack of protection is that the HDL cholesterol is sometimes defective and does not do its job of getting rid of cholesterol by carrying it from the arteries into the liver. These people produce very large amounts of ineffective HDL cholesterol. Some women have a significant increase in HDL cholesterol at the time of the menopause, possibly because of a decrease in estrogen and weight gain that often accompany menopause, which may oxidize HDL to change it from a cardioprotective particle to one that promotes inflammation, oxidation and heart attacks (Am J Cardiol, July 4, 2018). It would be very helpful to measure how effective HDL is in removing cholesterol from your body, but doctors do not have any lab test available to do this.

Tests to Predict Your Risk for a Heart Attack
• Blood lipids: LDL and HDL cholesterol, triglycerides, non–HDL-cholesterol, and cholesterol particle size. Small particle cholesterol is more likely to enter arteries to form plaques. If you have high levels of both HDL and LDL, get an HDL particle size number. Having small, dense LDL and large, fluffy HDL markedly increases risk for a heart attack.
• NT-proBNP: BNP (brain natriuretic peptide) is a hormone released by your brain and heart when your heart muscle is stiff and cannot relax between beats
• Resting heart rate: a heart rate greater than 70 is associated with increased heart attack risk
• Lp(a): a genetic factor that increases risk for clotting and heart attacks
• Homocysteine: associated with increased risk for a heart attack
• HBA1c: a blood test that measures cell damage from high blood sugar levels
• High sensitivity CRP: a measure of inflammation
• High sensitivity treponin T: a measure of heart muscle damage
• Carotid Intima-Media Thickness (CIMT) Test: Soundwaves measure plaques in the carotid arteries in your neck
• CT scan X ray: shows plaques in your heart arteries

Other Heart Attack Risk Factors
• High blood pressure
• Diabetes or prediabetes
• Smoking
• Being overweight or obese
• Storing excess fat in your belly
• Being physically inactive
• Having a family history of early heart disease
• Having a history of preeclampsia during pregnancy
• Eating an unhealthful diet

My Recommendations
You can find out your chances of suffering a heart attack by getting the blood tests for LDL and HDL cholesterol, triglycerides, non–HDL-Cholesterol, and cholesterol particle size. If any of these tests are abnormal, or you have other risk factors for a heart attack, your doctor can measure the amount of plaque in your arteries with either an ultrasound test of the arteries in your neck or a CTscan X ray of the arteries in your heart.

Whatever your test results, I believe that everyone should be on a heart attack prevention program. If you have significant plaques in your arteries, I recommend an immediate program to get rid of these plaques; they are often reversible with strict lifestyle changes.

JULY 9

Calculate Your Fitness Age

VO2max can be used to predict a person’s risk of premature death from a heart attack. Researchers at the Norwegian University of Science and Technology have developed a simple way to estimate a person’s VO2max, his maximal ability to take in and use oxygen (Med Sci Sports Exerc, November 2011;43(11):2024-30).

The researchers had 4637 healthy adults, average age near 50, run to exhaustion on a treadmill and measured their VO2max (a complicated test that measures oxygen and carbon dioxide concentrations). They then developed a formula that correlated very well with the subjects’ actual VO2max, based on their

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* sex and age,

* exercise habits,

* resting heart rate and

* waist circumference.

VO2max Predicts Fitness Age

Now the researchers have figured out the average VO2 max for a healthy person at every age from 20 to 90 and used these numbers to calculate fitness age which predicts how long a person is expected to live. Their Fitness Calculator is available (free) at https://www.worldfitnesslevel.org/#/

Enter your answers to the simple questions: How often do you exercise? How long? How hard? Your age? Waistline? Resting heart rate?

The calculator quickly gives you your estimated VO2max and your fitness age.

How We Fared in 2013

Gabe at 78 had an 81 cm. abdominal circumference and a resting heart rate of 48. His estimated VO2max was 50 and fitness age was 35.

Diana at 71, had a 65 cm. abdominal circumference and a resting heart rate of 50. Her estimated VO2max was 50 and fitness age was 23.

Here is our exercise program: we exercise every day for two to three hours. On Tuesdays, Thursdays and Saturdays, we race flat out on a tandem bicycle for 25 miles. On the other four days Gabe does 30-second intervals with two-minute recoveries until his legs start to stiffen. Diana takes a longer ride with some intervals interspersed.  We still cycle an average of 150 miles per week and use our home strength-training machine every day.

Vigorous Exercise Slows Aging

Studies from all over the world show that intense exercise maintains fitness. People who do not exercise lose 15 percent of their fitness per decade, those who exercise at low intensity lose nine percent, while those who exercise intensely barely lose any fitness at all.

Increasing intensity makes you more fit. If you go out and jog the same two miles at the same pace every day, you will not improve and you will not be very fit. However, if you go faster on one day, feel sore on the next day, go slowly until the soreness disappears, and then go fast again, you will become more fit on every measure of fitness, and also perform better on the tests that measure aging.

However, with increased intensity comes increased risk of injury. Before you start an intense exercise program, and before you start lifting heavier weights, running faster, jumping higher, throwing further, hitting a tennis ball harder, or doing anything that requires increased intensity, check with your doctor. The only problem with this recommendation is that the odds are overwhelming that your doctor won’t know very much about sports, training, or improving physical fitness. But you should at least check with him or her to see if you have any condition that could be aggravated by hard exercise.

JULY 2

Benefits of Time-Restricted Eating

In a recent study of time-restricted eating, a group of 19 people with metabolic syndrome (also called pre-diabetes) ate their usual meals but ate only between 8AM and 6PM (10 hours) and took in no calories during the other 14 hours each day (Cell Metabolism, Dec 5, 2019). They did not change the amounts or kinds of food that they ate or how much they exercised.

The participants used an app called MyCircadianClock to record everything they ate. After a two-week period where they ate in their normal way and got all of the measurements and blood tests to establish their baselines, they spent three months following the 10-hour time-restricted eating program. At the end of the three months, they:

• had eaten nine percent fewer calories per day (without trying),

• lost three percent of their body fat and reduced their belly fat by three percent,

• lowered their high blood pressure, bad LDL cholesterol, fasting blood sugar, triglycerides, and HBA1c (a measure of cell damage from sugar stuck on cells),

• were able to lower their doses of medications to control their high cholesterol and high blood pressure, and

• slept better at night.

Metabolic Syndrome or Pre-Diabetes

Metabolic syndrome or pre-diabetes affects 30 percent of North American adults. It is diagnosed when a person has three or more of the following:

• obesity (BMI >25)

• high blood pressure (systolic blood pressure >120 at bedtime)

• high bad LDL cholesterol (>100)

• low good HDL cholesterol (<40)

• high triglycerides (>150)

• high HBA1c (>5.7)

• excess belly fat (pinch more than 3″ of fat near the belly button).

Various patterns of intermittent fasting (such as alternate-day modified fasting) have become popular since many people find these diets easier to follow than traditional calorie restriction diets. The type of intermittent fasting used in this study, called time-restricted eating, looks very promising for treatment of patients with metabolic syndrome, pre-diabetes, diabetes or obesity. This new study agrees with the findings of an earlier study that compared eating during a six-hour window (8AM to 2PM) with a program of eating between 8AM to 8PM, or 12 hours a day (Obesity, July 24, 2019).

Reasons to Avoid Having a Fat Belly

Storing fat in your belly, rather than your hips, is associated with diabetes because it means that you probably store fat in your liver. When blood sugar levels rise too high, your pancreas releases insulin, which lowers blood sugar levels by driving sugar from the bloodstream into the liver. Fat in your liver prevents the liver from accepting sugar from the bloodstream to keep blood sugar levels high. Most people with a large belly and small hips have excess liver fat and high blood sugar levels after eating, and are at high risk for diabetes and heart attacks. Intermittent fasting markedly helps to decrease belly fat (Translational Research, October 2014;164(4):302–311).

The authors of these studies agree that calories eaten in the morning count less and are healthier than calories eaten in the evening. Skipping breakfast and lunch has been associated with eating more calories later in the day and significantly increasing the likelihood of developing a fatty liver (Euro Soc of Endoc, 2018 annual meeting in Barcelona, Spain). When you sit around or lie in bed after eating, your muscles will not contract enough to remove sugar from your bloodstream. The best time to eat is before or just after finishing exercising, when your muscles will draw huge amounts of sugar from your bloodstream to help prevent a fatty liver that can cause obesity, diabetes, heart attacks, strokes and premature death.

“Fasting” Programs May Not Be for Everyone

The various types of intermittent fasting can be useful for people who want to lose weight, want to maintain their existing healthful weight, or want to keep from depositing excess fat in their liver. However, some conditions can be worsened or complicated by fasting. Discuss your plans with your doctor, particularly if you are diabetic, have low blood pressure, take medications, or are underweight. You will probably be advised not to use intermittent fasting if you are pregnant, trying to become pregnant, or breast-feeding an infant; if you are under age 14; or if you have a history of eating disorders.

My Recommendations

I have used variations of intermittent fasting for several years now, and have recommended them to many others who have been pleased with their success. See Weight Loss with Intermittent Fasting

Why We Use Intermittent Fasting

I am now recommending time-restricted eating (no calories after 6 or 7 PM except on social occasions) to virtually every adult, whether or not they are trying to lose weight, because I feel strongly about not raising your blood sugar just before you go to bed. The results of the study quoted above should be a wake-up call for everyone who has any risk for diabetes, heart attacks or strokes (and that is pretty much all of us.)

Grass-fed vs Corn-fed Meat

  JUNE 29  

Nobody has presented good evidence that eating meat from grass-fed animals is more healthful than the meat from corn-fed animals. The main health arguments for eating grass-fed meat are its lower fat content and higher content of omega-3 fatty acids (Meat Science, January 2014; 96(1):535-540).

Fat: There is no evidence that the small reduction in fat from eating meat from grass-fed cows, in place of corn-fed cows, offers any health advantage. It’s the total fat in a diet, not just the fat in meat, that determines blood test results that check on blood levels of the heart-attack-predicting LDL cholesterol and triglycerides. Reducing dietary fat sometimes lowers LDL, but often raises triglycerides

Omega-3s: As for meat from grass-fed cows having more omega-3 fatty acids, the difference between the diets of people eating the different meats is inconsequential and irrelevant. The difference between four ounces of grass-fed or corn-fed sirloin is 22 milligrams of omega-3s. The same portion of salmon contains 1,270 milligrams of omega-3s. All animals, including humans, get their omega-3s from the food they eat. Ocean fish have lots of omega-3s because they eat smaller fish or plankton that are rich sources of omega-3s. Fresh-water pond fish usually are low in omega-3s because they eat little or no plankton. Cows get a small amount of omega-3 fats from grass or clover, but they get more when they also eat corn.

The argument that grass-fed meat contains less fat and more omega-3s is probably irrelevant because recent studies show that taking extra omega 3s may not help to prevent heart attacks, and many serious scientists believe that other factors will be found to account for the association between eating meat from mammals and increased risk for cancer, diabetes or heart attacks, such as TMAO or Neu5Gc.

Flavor Preferences and Cost
Most people prefer the flavor of corn-fed meat (Nutr J, 2010;9:10) because an increased amount of fat is usually what makes meat taste good and corn fed meat has more fat (Journal of Dairy Science, 97 :1828–1834). Grass-fed meat is usually more expensive, since it takes more land to feed the cows only grass and it takes longer for cows to reach market weight. However, heavy advertising to persuade people that grass-fed meat is healthier can also influence their taste preferences (Int J of Hosp Man, September 2014;42:137–143) and their willingness to pay higher prices.

My Recommendations
You will not prevent heart attacks or diabetes just by choosing meat with less fat. I believe that a healthful diet is low in meats from mammals (fresh or processed), regardless of their fat content. If you want to eat more omega-3 fatty acids, eat ocean fish and a variety of seeds.

JUNE 20

Resting Heart Rates Can Be Too High or Too Low

Your resting heart rate should average between 50 and 70 beats a minute. Athletes can have rates between 30 and 50 and still have healthy hearts, and your heart rate temporarily can go above 70 when you are sick, stressed or sleep deprived, but all people who have persistent resting heart rates greater than 70, non-athletes who have heart rates below 55, and anyone with a heart rate below 60 with heart palpitations, fainting , dizziness or other symptoms may want to check with a doctor. Resting heart rates greater than 70 are associated with increased risk for diabetes (Int J Epidemiol, Jun 2010;39(3):900–906), heart attacks, certain cancers and premature death (CMAJ, Oct 18, 2016;188(15):E384–E392).

The Research

• More than 6000 men were followed for more than 25 years. Those with resting heart rates greater than 73 beats per minute were 140 percent more likely to die from cancer than those with resting heart rates of less than 60 beats per minute (PLoS ONE, published online August 03, 2011).

• Of more than 53,000 men followed for almost 30 years, those with resting heart rates greater than 80 beats a minute were far more likely to suffer heart attacks and cancer than those with fewer than 60 beats a minute (Mayo Clinic Proceedings, 12/12/2013).

• 58 obese men and women exercised five times a week at 70 percent of their maximum heart rate for 45 minutes. In just 12 weeks they lowered their resting heart rates by five to nine beats per minute (Br J Sports Med, 2009; 43: 924-927).

• The Copenhagen Study of 3,000 men followed for 16 years found that those with a resting heart rate between 71 and 80 beats per minute were at a 50 percent elevated risk of death, between 81 and 90 beats per minute had double the risk, and resting heart rates over 90 beats per minute tripled the risk (Glob Cardiol Sci Pract, Oct 9, 2015;2015(3):33). Furthermore, high resting heart rates were associated with lower levels of physical fitness, higher blood pressure, overweight, and higher levels of circulating blood fats. The authors concluded that “a high resting heart rate is not a mere marker of poor physical fitness, but is an independent risk factor for disease.”

A High Resting Heart Rate May Predict Heart Disease

A strong heart pumps lots of blood with fewer beats, while a weak heart has to beat more often to pump the same amount of blood. A high resting heart rate may indicate that arteries are blocked or that there is heart muscle damage so the weakened heart has to pump more often to circulate oxygen to your body.

How a High Resting Heart Rate Relates to Cancer

Telomeres are the end caps of chromosomes that help to protect them from being destroyed when a cell reproduces. The longer your telomeres, the less likely you are to develop cancer, and people who exercise regularly have longer telomeres. Exercise also helps to protect the body from inflammation, a risk factor for cancer. The more intensely you exercise, the lower the heart rate and the greater the protection against inflammation.

How to Check Your Resting Heart Rate

To find out your resting heart rate, check your pulse when you first wake in the morning, before you get out of bed. You can use a heart rate monitor, a blood pressure cuff that includes a pulse check, one of the many fitness trackers that have a heart rate feature, or any watch that shows seconds. If you have a smart phone you can download a free heart rate monitor app. Set your device on your bedside table the night before so you do not have to move around when you wake up. If you are using a watch, place your fingers on the side of your neck where you feel a strong heartbeat. Count the beats for ten seconds and multiply by six. Do this for several days and take an average.

My Recommendations

A morning resting heart rate consistently over 70 is often a warning signal that you have a weak heart and may be headed for serious disease. If your resting pulse rate is over 70 beats per minute and you are not sick or taking stimulants, check with your doctor, particularly if you also have:

• LDL cholesterol greater than 100,

• blood sugar greater than 145 mg/dL one hour after eating,

• systolic blood pressure greater than 120 at bed time, or

• a C-reactive protein greater than 10 mg/L.

Athletes often have exceptionally low heart rates indicating a strong heart, but in non-athletes a low heart rate can be caused by damage to the heart’s electrical conduction system or muscle. If you have a resting heart rate of less than 60 and are not a regular exerciser, or if you are regular exerciser and have a bedtime systolic blood pressure greater than 120 or below 90, chest discomfort, dizziness or fainting, a bad LDL cholesterol greater than 100, or any possibility of an irregular heartbeat, you should check with your doctor.

June 21

Arthritis and Colon Bacteria

A study of 1,388 women with hand arthritis, average age 61, showed that they had higher levels in their colons of the bacteria Bilophila and Desulfovibrio that try to invade their colon cells, as well as a lower level of the genus Roseburia that do not invade colon cells (Arthritis Rheumatol, published online March 24, 2021).

An anti-inflammatory lifestyle has been shown to help grow healthful bacteria in your colon, which can help to treat rheumatoid arthritis (J Rheumatol, 2008;35(8):1477-9). If you have rheumatoid arthritis or any other type of arthritis, anti-inflammatory lifestyle habits should be an important part of your treatment program. For many years, exercise has been recommended as part of the treatment for rheumatoid arthritis, and a recent summary of studies confirms that vigorous exercise is beneficial (Arthritis & Rheumatology, published online April 01, 2019). An anti-inflammatory diet high in plants and low in meat and sugar (Rheum Dis, 2017;76(8):1357-64), and weight control (Arthritis Res Ther, 2015;17:86), also reduce symptoms of rheumatoid arthritis.

Rheumatoid arthritis is a disease in which your own immune system attacks and damages your joints. Nobody knows why some people develop rheumatoid arthritis, while others do not. However, we do know that the joint damage is caused by exactly the same cells and chemicals called cytokines that your body uses to kill germs when they try to invade your body. When your immune system stays active all the time, it is called inflammation (Curr Opin Rheumatol, 2014 Jan;26(1):101-7). Everything that turns on your immune system is called pro-inflammatory and everything that dampens down your immune system is called anti-inflammatory.

Harmful Colon Bacteria May Trigger Rheumatoid Arthritis

You have more than 100 trillion bacteria, of about 1000 different species, living in your colon. Many different studies have shown that what you eat determines which types of bacteria live in your colon and that certain types of bacteria can turn on your immune system to cause inflammation that increases risk for rheumatoid arthritis as well as heart attacks, dementia and certain cancers (J Alzheimers Dis, 2017;58:1-15). Colon bacteria eat the same foods that you do. The healthful bacteria are content to eat what you eat, so they stay in your colon and do not try to cross into your cells and bloodstream, but the harmful bacteria try to find different foods by invading the cells lining your colon. Your immune system tries to defend you by producing huge amounts of white blood cells and chemicals that work to destroy the invading bacteria by punching holes in their outer membranes and trying to kill them. This constant invasion of your colon cells by harmful bacteria can cause your immune system to stay on all the time. Anything that reduces inflammation helps to reduce the pain and destruction of joints in rheumatoid arthritis. That is why almost all rheumatologists treat rheumatoid arthritis with powerful drugs to reduce inflammation, but unfortunately, these drugs can increase risk for infections and certain cancers.

My wife, Diana, was diagnosed with rheumatoid arthritis at age 54 in 1996. She had an extremely high rheumatoid factor, greater than 300 (normal is <15), and other markers of inflammation such abnormal blood tests for c-reactive protein (CRP) or sed rate. We elected not to treat her with conventional immuno-suppression drugs and instead gave her minocycline, an antibiotic. Both of us faithfully followed an anti-inflammatory lifestyle including a vigorous exercise regimen of riding a bicycle more than 100 miles a week and a high-plant diet. Every time I stopped the minocycline her symptoms worsened, and when I restarted the antibiotics, her symptoms improved. Finally after 14 months, when I stopped the antibiotics her symptoms did not come back. Over the years she has had some flare-ups, but today she is 79 years old, rides more than 150 miles on her bike each week and is relatively pain-free, although she does have some of the hand and foot deformities characteristic of rheumatoid arthritis.

Over the years I have written about the patients with rheumatoid arthritis that I helped and the many studies showing that antibiotics might have a role in treatment of the disease. The recent research on inflammation and gut bacteria suggests that my success in treating rheumatoid arthritis patients with antibiotics may have been due to the effects of altering their colon bacteria. My efforts were not done as a controlled experiment, so further research is needed. We do already have extensive data showing that diet and lifestyle changes can be used to reduce inflammation and that the foods that you eat determine which types of bacteria live in your colon.

Studies on Diet to Treat Rheumatoid Arthritis

People who eat a healthful high-plant diet are at reduced risk for developing rheumatoid arthritis (Nutritional Outlook, Mar 20, 2019;22(2)). Previous studies have shown that a vegan diet is associated with reduced symptoms and reduced progression of the disease (Clin Rheumatol, 1994;13(3):475–82; Rheumatology, 2001;40(10):1175–9; J Altern Complement Med, 2002;8(1):71–5). An excellent review of dietary factors that can increase or decrease joint destruction in rheumatoid arthritis can be found in Frontiers of Nutrition (Nov 8, 2017;4:52). Rheumatoid arthritis patients who ate:

• a healthy plant-based diet had reduced markers of inflammation (CRP and sed rate) and reduced progression of disease compared to those with less healthy diets (Nutrients, Oct 18, 2018;10(10):1535)

• more vegetables, greens, beans, whole grains, dairy and seafood, and less refined grains, salt, and empty calories had less severe symptoms than those who ate less healthful diets (Nutrition and Health, 2017; 23(1):17-24)

• more milk, fried foods, butter and solid oils had more severe symptoms (Clin Rheumatol, Oct 2018;37(10):2643-2648)

• a Mediterranean diet, with lots of fiber, had reduced inflammation and pain (Ann Rheum Dis, 2003;62(3):208–14)

Research on Rheumatoid Arthritis, Gut Bacteria and Antibiotics

Analysis of the bacteria in your colon can predict susceptibility to developing rheumatoid arthritis (Genome Medicine, 2016;8(1). Treating arthritis-susceptible mice with the healthful Provatella histicola bacteria decreased frequency and severity of arthritis, and they had fewer inflammatory conditions associated with rheumatoid arthritis (Arthritis Rheumatol, Dec 2016;68(12):2878-2888). Many papers have reported improvement in rheumatoid arthritis symptoms with the prescription of antibiotics (Klin Med, 2010;89(4):45–8; J Rheumatol, 2008;35(8):1500–5; Ann Rheum Dis, 2003;62(9):807–11; Elife, 2013;2:e01202).

Antibiotics do affect the makeup of colon bacteria in humans, but at this time we do not know enough to suggest that patients with rheumatoid arthritis should be treated with antibiotics to change colon bacteria. A more conservative approach would be to encourage a healthful change in colon bacteria using an anti-inflammatory diet and other lifestyle changes (exercise, weight loss if indicated, avoiding smoke and alcohol, and so forth).

My Recommendations

Most types of arthritis are associated with inflammation, an overactive immune system that attacks and damages your joints and other tissues. Symptoms of rheumatoid arthritis can improve with lifestyle changes to increase healthful bacteria and decrease harmful bacteria in your colon. At this time, there is still uncertainty about how effective an anti-inflammatory lifestyle is in treating rheumatoid arthritis, but I recommend that people who suffer from any type of arthritis should include the following lifestyle habits with their other treatments; check with your doctor.

• A diet that is high in vegetables, unground whole grains, beans, fruits, nuts and and other seeds, and low in red meat, processed meats, fried foods, sugared drinks and foods with added sugars

• A regular exercise program (with your doctor’s approval)

• Maintenance of a healthful weight

• Avoidance or restriction of alcohol

• Avoidance of smoking and second-hand smoke

• Avoidance of other toxic substances and pollutants

JUNE 16

Lack of Vitamin D May Harm Exercisers

A study in mice suggests that having low levels of vitamin D may harm athletes and exercisers by limiting how long they can exercise (Aging, June 2018). Six-month old mice were put on a low vitamin D diet for one year. A six-month-old mouse is equivalent to a 25 year old human and one mouse-year equals 25 human-years. After two weeks, the mice on the low vitamin D diet developed blood levels of vitamin D under 15 ng/ml, (equivalent to low levels in humans), where they remained for the entire study. They did not lose strength, but they lost a lot of their endurance (their ability to sustain exercise). The authors believe that this implies a decrease in their ability to take in and use oxygen. The mice also lost some muscle size. This study may be important for humans because vitamin D deficiency disease is defined as less than 12 ng/ml and vitamin D insufficiency borderline disease is less than 20 ng/ml. More than 35 percent of North Americans have these low levels, particularly in the winter.

Lack of Vitamin D Associated with Muscle and Tendon Injuries

During my competitive running career, I spent more time injured than training because of wintertime muscle injuries in Boston and Washington, D.C. Many years later, I found the probable cause: my wintertime vitamin D3 blood level was below 20 ng/ml (normal for the general population is >20 ng/ml and for athletes may be >30). Since I moved to Florida nine years ago, I have not had even one wear-and-tear sports injury. I now know that people genetically susceptible to vitamin D deficiency are the ones most likely to suffer muscle weakness, injuries and poor athletic performance. Many exercisers and competitive athletes are vitamin D deficient even if they live in the sunbelt.

Vitamin D deficiency is associated with:

• decreased athletic performance (Molecular Aspects of Medicine, June 2005;26(3):203-219),

• muscle weakness (Scandinavia Journal of Medicine & Science in Sports, Oct 2009), and

• increased risk for athletic injuries (Current Opinion in Clinical Nutrition & Metabolic Care, November 2009; Molecular Aspects of Medicine, December 2008; Arthroscopy, Dec 21, 2017).

Genetics and Vitamin D Deficiency

A report from the University of Toronto showed that genetic factors cause some people to develop signs and symptoms of severe vitamin D deficiency (Clinical Biochemistry, July 2009). People who are genetically at increased risk for vitamin D deficiency are at increased risk for injuries when they try to exercise vigorously in the winter. Lack of vitamin D can weaken muscles (Lancet, Mar 1976;20;1(7960):626-9) and taking that vitamin can correct that weakness (Aging-Clinical and Experimental Research, December 2000;12(6):455–460). Vitamin D acts directly on specific receptors in muscles to make them stronger and to help prevent injuries (Scandinavian Journal of Medicine & Science in Sports, April 2010;20(2):182-90).

How Lack of Vitamin D is More Harmful in Older People

As people age, they become increasingly susceptible to muscle weakness and falls caused by lack of vitamin D (Molecular Aspects of Medicine, June 2005). Muscles are made of thousands of individual fibers that are classified into two types: slow twitch fibers that govern endurance and fast twitch fibers that govern primarily strength and speed. Vitamin D specifically helps to maintain the function of the fast twitch strength fibers (Calcif Tissue Int, 2013;92:151–162). With aging, you lose muscle fiber; for example, the vastus medialis muscle in the front of the upper leg typically has about 800,000 fibers in a 20 year old, but only 250,000 in a 60 year old. Vitamin D slows this loss of muscle fibers, preserves muscle strength and helps to prevent falls, while lack of vitamin D increases loss of fibers, muscle weakness and falls (Pediatric Clinics of North America, June 2010).

My Recommendations

You probably do not need to take vitamin D pills if your blood level of hydroxy vitamin D is above 30 ng/ml unless you have a condition that your doctor feels puts you at increased risk for the signs and symptoms of a deficiency. You can take up to 1000 IU/day of vitamin D pills if your blood levels are below 30 ng/ml. Most researchers and clinicians now feel that, with few exceptions, high doses of vitamin D are not beneficial and are potentially harmful. People who could possibly benefit from treating low blood levels of hydroxy vitamin D include those who:

• are inactive and do not go outdoors

• suffer from generalized muscle and joint pain

• are athletes with recurrent injuries and decreased performance

• have weak bones (osteoporosis)

• are diabetic, particularly if LDL cholesterol is over 100

• have an auto-immune disease

• are critically ill or debilitated

• suffer from muscle pain from taking statin drugs

I believe that sunlight offers benefits that cannot be obtained just by taking vitamin D pills, but take proper precautions to avoid skin cancer.

JUNE 9

High-Plant, Low-Salt Diet to Lower Blood Pressure

High blood pressure affects 108 million adults, increasing risk for heart attacks, the leading cause of death in the United States. A Harvard study of 412 adults found that a low-salt version of the DASH diet dramatically lowered both high blood pressure and markers of heart muscle damage in just four weeks (J Am Coll Cardiol, Jun 2021;77(21):2625–2634). The authors showed that those on the low-salt DASH diet had the lowest levels of:

• high sensitivity cardiac troponin I (hs-cTnI), which measures heart muscle damage

• N-terminal pro-brain natriuretic peptide (NT-proBNP), which measures loss of heart muscle strength

Most People with High Blood Pressure Should Be on a Low Salt Diet

This new study and several others have changed my opinion about the importance of salt restriction for people with high blood pressure. Some earlier papers showed that salt restriction lowered systolic blood pressure by less than 5 mm Hg and diastolic blood pressure by only 2.5 mm Hg (JAMA Intern Med, 2014;174(4):516-524). However, the subjects in that study were already on a high-plant diet which, by itself, can lower high blood pressure because plants are loaded with potassium and a high-potassium diet can counter some of the harmful effects of taking in too much salt (JAMA Pediatr, June 2015;169(6):560-568). A review of 85 studies, following participants for up to three years, found that low-salt diets significantly lower high blood pressure (Circulation, Feb 15, 2021), and the new study from Harvard confirms the importance of following both a high-plant and a low-salt diet for patients with high blood pressure.

A low-salt diet does not mean no-salt. In the Harvard study, the low-salt group consumed 50 mmol of sodium per day, which is about 1145mg of sodium or half a teaspoon of table salt. To control how much salt you eat, you will need to prepare most of your own foods rather than relying on processed foods or restaurant meals. You have no way to know how much salt is added to restaurant food, and when you start reading the sodium data on processed foods, you will see how quickly 1145 mg/day will get used up. Almost all processed foods contain sodium, even the ones that don’t taste salty, such as salad dressing. For example, one serving (2 tablespoons) of Newman’s Classic Oil and Vinegar salad dressing is 180mg; one serving (22 Bite Size chips) of plain Tostitos is 115mg. Animal products (meat, seafood, poultry, dairy, eggs) also contain sodium, usually about 100mg or more per serving.

The DASH Diet

The DASH diet was developed in the 1990s by the U.S National Institutes of Health (NIH), and has been studied extensively by the Harvard School of Public Health and many other researchers. The diet is plant-focused, with lots of vegetables, fruits, nuts, seeds, whole grains and heart-healthy fats, and with limited amounts of dairy and lean meats. Serving sizes of different food groups can be adjusted based on calorie needs. The DASH diet is similar to the many healthful Mediterranean-type diets. The original DASH diet was not specifically low-salt, but that change is easy to make.

I have recommended a slightly modified version of the DASH diet for many years, and all of Diana’s healthful recipes are based on it.

Here’s a day on my modified low-salt DASH diet:

• Up to 8 servings of cooked WHOLE grains (not products made from flour)

• At least 5 vegetables

• At least 5 fruits

• Up to 3 servings of plain yogurt or cheese (optional)

• 2 servings of seafood per week (I recommend that you avoid meat from mammals)

• Beans or legumes (no limit)

• A few handfuls of unsalted nuts or snack seeds

• A few tablespoons of olive oil (optional)

(DASH diet serving sizes are typically 1 cup of raw fruits or vegetables, 1/2 cup of other foods)

My Recommendations

Many cases of high blood pressure can be controlled with a high-plant, low-salt diet and other lifestyle changes that include:

• trying to exercise every day

• maintaining a healthful weight

• avoiding alcohol

• avoiding smoking and second hand smoke

• keeping blood levels of hydroxy vitamin D above 30 ng/mL

See Check Your Own Blood Pressure

JUNE 2

Alzheimer’s Disease May Come From an Infection

Nearly fifty percent of people over 85 suffer from symptoms of dementia of which Alzheimer’s disease, a progressive loss of brain cells, is the most common form. The second most common type of dementia comes from repeated strokes. This month researchers offer strong evidence that Alzheimer’s disease may be started by an infection.

The most comprehensive analysis ever of hundreds of Alzheimer’s brains found three strains of herpes virus (human herpes viruses 6A, 6B, and 7) at twice the level found in normal human brains, and the greater the number of damaged nerves, the greater the number of these three viruses in them (Neuron, June 21, 2018). The current theory is that the brains of people with Alzheimer’s disease are destroyed by a protein called beta amyloid. The damaged hippocampus, the part of the brain that governs memory, in Alzheimer’s disease patients contained high levels of the genetic material from herpes viruses. This suggests that the herpes viruses could have caused the human brain cells to make beta amyloid, the substance that destroys human brain cells.

A study from Taiwan followed more than 8,000 people diagnosed with herpes in 2000 and found that they were 2.6 times more likely as the general population to suffer dementia (Neurotherapeutics, Apr 2018;15(2):417-429). Those treated with anti-viral drugs at the time of diagnosis had their risk for dementia reduced by more than 90 percent. Another study showed that herpes viruses can cause mice brain cells to produce beta amyloid plaques (Neuron, July 12, 2018).

Human Herpes Virus-6 is Very Common

HHV-6 causes a very common skin rash called roseola in most young children (Curr Opin Virol, Dec 2014;0:91–96). That means that just about everyone has been infected at some time by HHV-6, but most people infected with this virus do not suffer from Alzheimer’s disease, probably because herpes viruses usually do not cross from the blood into the fluid surrounding your brain. However, it has been shown that herpes viruses can travel from your nose along the olfactory nerve to your brain.

These new studies do not prove that herpes viruses cause Alzheimer’s disease, but they raise important questions that need further study. Hopefully, this will be a wake-up call to the pharmaceutical industry to develop new drugs to treat viral infections. This year, extensive studies of three drugs that were supposed to help treat or prevent dementia all failed. If additional studies strengthen the link between herpes viruses and Alzheimers, perhaps new anti-viral drugs will be found to slow this frightening disease.

JUNE 2

Exercise to Treat Arthritis

If you have joint pains, you should still keep moving. There is increasing evidence that exercise can help to treat and prevent osteoarthritis of the hips and knees and even relieve some of the pain following hip and knee replacements (Exerc Sport Sci Rev, 2021;49(2):77-87).

Inactivity worsens arthritis by preventing joints from healing. If moving your joints hurts, your doctor will check for a cause such as rheumatoid arthritis, psoriatic arthritis, gout, reactive arthritis from an infection or some other known source of joint pain. If none of those are found, you will probably be told that you have osteoarthritis, the most common cause of chronic and progressive joint pain. It can eventually destroy the cartilage in joints, and is among the most prevalent chronic diseases and a leading cause of disability worldwide (JAMA, 2018;319(14):1444-1472). Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. More than 700,000 people in North America have their knees replaced each year, mostly for this condition. If you have sudden locking of your joint that gets better and then recurs, you may have “joint mice,” loose pieces of cartilage that slip between your cartilage to cause horrible pain. This can usually be cured by removing the loose pieces with arthroscopic surgery.

Osteoarthritis used to mean that your doctor had ruled out known causes of knee pain and had no idea what was causing your joint pain, but now we know that people with osteoarthritis have high blood levels of galectins that turn on a person’s immune system to cause inflammation, just as in rheumatoid arthritis or reactive arthritis (J of Immunology, Feb 15, 2016;196(4):1910-1921). Anything that causes inflammation can damage joints (Nature Medicine, published online Nov. 6, 2011), and inflammation is a more common cause of arthritis than wear-and-tear injuries (Bone, 2012;51:249–257). If your immune system stays overactive, the same chemicals and cells that are used to attack germs can attack and destroy the cartilage in your joints. A review of 68 studies showed that osteoarthritis is associated with everything that increases inflammation, such as obesity, high blood pressure, high cholesterol, diabetes and metabolic syndrome (Rheumatology, May 1, 2018;57(suppl_4):iv61–iv74; Rheumatology, Jan 1, 2016;55(1):16–24). Everything that helps to reduce inflammation also helps to reduce pain and joint damage: eat an anti-inflammatory diet, lose excess weight, exercise, lower high blood sugar levels and so forth (Ther Adv Musculoskelet Dis, 2013 Apr; 5(2): 77–94).

Most Arthritics Should Exercise

Many studies show that exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (BMJ, July 20, 2016; N Engl J Med, 2013;368:1675-84). Osteoarthritis almost always worsens with inactivity. Exercise increases cartilage quality in osteoarthritis (Med and Sci in Sprts and Ex, Mar 23, 2017), and a review of 55 studies showed that weight bearing exercise reduced pain and improved joint function (British Journal of Sports Medicine, September 24, 2015). Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, Aug 30, 2016). A review of six studies of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it didn’t make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203). However, you need to be guided by pain. Stop what you are doing if your pain worsens and try another activity.

Running May Make Arthritis Worse

A recent study showed that running can increase joint damage in arthritic mice by increasing inflammation (Ann Rheum Dis, 2019; 78: 787-795), and running appears to increase inflammation with resultant joint damage in mice that have inflammatory arthritis (Annals of the Rheumatic Diseases, 2018;78:6). Researchers found the same results in human runners who had osteoarthritis (PLoS ONE, 2018; 13(10): e0205191). Running is a high-impact sport, and any exercise that puts too much force on a joint can increase joint damage. People with arthritis should not run, jump or participate in sports that involve the strong impact of your foot hitting the ground. Non-impact sports include cycling, swimming, water aerobics, cross country skiing, and use of machines such as ellipticals or stair-steppers where your feet are supported by the equipment as you move.

If you have joint pains and still want to run, take very short steps and if that doesn’t stop your pain, you need to try another sport. You may still be able to run if you can markedly reduce the force of your foot hitting the ground. When you run, both feet are off the ground at the same time, causing you to land with tremendous force that can injure joints, muscles and tendons. Running at a six-minute per mile pace causes your foot to hit the ground with a force equal to three times your body weight. This force is transmitted up your legs to your hips and back, and done repetitively, it can damage joints, shatter bones and tear muscles and tendons (Br J Sports Med, Apr 2016;50(8):450-7; Br J Sports Med, Aug 2007; 41(8):469–480).

The force of your foot hitting the ground is determined most by the length of person’s stride (Scan J Med & Sci in Sports, May 30, 2018). Unnecessarily high impact can be caused by over-striding. It is not important whether you land on the front of your foot or the heel, but the more you over-stride, the more likely you are to land on your heel. A study of the 2017 IAAF World Championships showed that 54 percent of the men and 67 percent of women landed on their heels (Journal of Biomechanics, May 22, 2019). Landing on the front of your foot does not prevent injuries, it is only a marker that you are not over-striding.

My Recommendations

Exercise should be part of the treatment for most cases of arthritis because inactivity increases joint damage. Choose a non-impact sport such as cycling, swimming or cross-country skiing, or use exercise machines that support your feet and do not let you pound on the ground. Always listen to your body and never try to exercise through pain. 

Exercise is just one part of an anti-inflammatory lifestyle that is so important for people with arthritis. You should also:

• Eat an anti-inflammatory diet that includes lots of vegetables, fruits, whole grains, beans, nuts and other seeds, and restricts foods with added sugar, all sugared drinks including fruit juices, meat from mammals, and fried foods.

• Work to lose weight if you are overweight. Excess weight causes inflammation, and obesity is a major risk factor for osteoarthritis (Int J Obes Relat Metab Disord, 2001;25(5):622-627; Osteoarthritis Cartilage, Oct 27, 2015, S1063-4584(15)01364-3; Arthritis and Rheumatism, Sept 15, 2008;59(9):1207-13).

• Keep blood levels of hydroxy vitamin D above 30 ng/mL.

• If you use non-steroidal anti-inflammatory drugs (NSAIDs) to help control pain, take the lowest dose possible. NSAIDs do not cure the problem and can have serious side effects. See my report on NSAIDs and Heart Attack Risk.

• If knee pain becomes so unbearable that it keeps you awake at night, you may want to consider a knee replacement.

MAY 25

Your Muscles Make Your Heart Stronger

When you read about people dying of “natural causes,” it usually means that they died of heart failure because they spent too much time lying in bed. When you become inactive, you lose your skeletal muscles at an alarming rate, and losing skeletal muscle causes loss of heart muscle until your heart can become too weak to pump blood to your brain and you die.

In 1914, Dr. Ernest Starling described what is today known as Starling’s Law, that strengthening skeletal muscles strengthens heart muscle and not the other way around (Circulation, 2002;106(23):2986-2992). When you contract your skeletal muscles, they squeeze the veins near them to pump extra blood back to your heart. The extra blood flowing back to your heart fills up your heart, which stretches your heart muscle, causing the heart muscle to contract with greater force and pump more blood back your body. This explains why your heart beats faster and harder to pump more blood when you exercise. The harder your heart muscle has to contract regularly in an exercise program, the greater the gain in heart muscle strength.

Inactivity Damages Brain and Nerve Cells

Preventing mice from using their hind limbs for just 28 days interfered with normal function of mitochondria in cells so that blood levels of oxygen dropped, preventing the sub-ventricular zone of the brain from maintaining normal nerve function and making new nerves (Frontiers in Neuroscience, May 23, 2018). Many studies show that physical activity is necessary for the healthy growth of new nerves during a human lifetime (J Neurosci Res, 2016;94:310–317). On the basis of these and many other studies, this means that not using your legs and arms causes loss of nerves, which causes loss of muscles (particularly heart muscle), that can eventually lead to heart failure and death.

• The larger your skeletal muscles, the stronger your heart and the lower your chance of suffering heart attacks and heart disease (J Epidem & Comm Health, Nov 11, 2019).

• The less you exercise, the weaker your heart and the more likely you are to become diabetic (Diabetes Care, 2002; 25:1612–1618).

• The larger your muscles, the less likely you are to die of heart diseases (Am J of Cardiology, Apr 15, 2016;117(8):1355-1360).

• A study of almost a million adults with no history of heart disease followed for 10 years found that those who did not exercise were at 65 percent increased risk for strokes and heart attacks, the same rate as that found for smoking (Euro J of Prev Cardiology, Feb 10, 2020).

• A study of 900 heart failure patients found that those who did not exercise were twice as likely to die within three years (Am J Cardiol, 2016 Apr 1; 117(7): 1135–1143).

• A study of 51,451 participants, followed for 12.5 years, found a strong association between exercise and decreased risk for heart failure (J Amer Col of Cardiol, Mar 2017;69(9)).

• A study of 378 older adults showed that the smaller the muscles in their arms, legs and trunk, the smaller and weaker the upper and lower chambers of their hearts (J Am Geriatr Soc, Dec 2019;67:2568-2573).

• Low skeletal muscle size predicted death in people who had chronic heart failure (Cardiology, March 25, 2019).

Severe Loss of Muscle with Aging is Common

Between 25 and 50 percent of North Americans over the age of 65 suffer from severe loss of skeletal muscle (sarcopenia) that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80–85). A regular exercise program is the best way to slow down this loss of strength and coordination, but even if you exercise regularly, you will still lose muscle as you age (Aging Male, September-December 2005). After age 40, people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Am J Epidemiol, 1998;147(8):755–763; Nutr Rev, May 2003;61(5 Pt 1):157-67).

The people who lose the most skeletal muscle are usually the ones who die earliest. They are also most at risk for falls and broken bones. Muscles are made up of hundreds of thousands of individual fibers, just as a rope is made up of many strands. Each muscle fiber is innervated by a single motor nerve. With aging you lose motor nerves, and with each loss of a nerve, you also lose the corresponding muscle fiber that it innervates. For example, the vastus medialis muscle in the front of your thigh contains about 800,000 muscle fibers when you are 20, but by age 60, it probably has only about 250,000 fibers. However, after a muscle fiber loses its primary nerve, other nerves covering other fibers can move over to stimulate that fiber in addition to stimulating their own primary muscle fibers. A regular exercise program can help to slow the loss of muscle fibers and improve mobility (Physiol Rev, Jan 1, 2019;99(1):427-511). Lifelong competitive athletes over 50 who train four to five times per week did not lose as many of the nerves that innervate muscles and therefore retained more muscle size and strength with aging than their non-athlete peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Lifelong competitive runners over 60 can have almost the same number of muscle fibers as 25-year-olds.

Researchers reviewed eight studies using accelerometers to follow 36,383 adults, 40 years of age and older, for six years and found that exercising regularly in adulthood, regardless of intensity, is associated with reduced risk for early death, while sitting for more than nine hours a day is associated with increased risk for premature death (Brit Med J, August 21, 2019). The death rate dropped progressively as light physical activity increased up to five hours per day and moderate activity increased up to 24 minutes per day. Examples of:

• light intensity included walking slowly, cooking and washing dishes;

• moderate activity included brisk walking, vacuuming or mowing the lawn; and

• vigorous activity included jogging or carrying heavy loads.

Lack of physical activity doubled a person’s chances of suffering a heart attack, while a regular exercise program helps prevent it (Eur Heart J, January 15, 2019).

Preventing Muscle Loss

Resistance exercise increases muscle size and strength in older people, but with aging you need to work longer to gain the amount of strength that a younger person would get with the same program (Med Sci Sports Exerc, 2011;43(2):249–58). Competitive masters athletes, 40 to 80 years old, who train four to five times per week, lose far less muscle size or strength than their non-exercising peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Eighty-year-old men who still compete in sports have been found to have more muscle fibers than inactive younger men (Journal of Applied Physiology, March 24, 2016). Inactivity causes rapid loss of muscle size and strength. If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Prolonged periods of inactivity due to bed rest, injured nerves, casting or even decreasing the force of gravity (in astronauts) causes loss of muscle tissue which leads to insulin resistance, higher blood sugar levels and increased risk for diabetes (Med Hypotheses, 2007;69(2):310-21).

My Recommendations

A key to prolonging your life and preventing disease is to keep on moving. Lying in bed for many hours each day is a certain way eventually to kill yourself. Each day that you spend not moving your muscles weakens your heart until eventually you can die of heart failure.

• Exercise will prolong your life, but you do not have to have a specific exercise program. You just need to keep on moving for a large part of each day. It is harmful just to sit or lie down all day long. It is healthful to mow your lawn, wash your dishes, make your bed, vacuum your house, go for a walk, and participate with your friends in activities in which you are moving your arms and legs — dancing, cycling, swimming, running, nature walks and so forth.

• To gain maximum health benefits from your skeletal muscles, you should include some sort of resistance exercise. If you are not already doing strength-training exercise, first check with your doctor to make sure you do not have any condition that may be harmed by exercise. Caution: Exercise can cause a heart attack in a person who has blocked arteries or heart damage.

Then join a gym and ask for instructions on how to use the weight-training machines. Since lifting heavier weights is far more likely to injure you than lifting lighter weights, I recommend that you lift lighter weights with far more repetitions. Older people, in particular, can use each specific weight machine and lift and lower a lighter weight up to 100 times in a row. Stop that exercise when the muscles start to feel tight or hurt.

MAY 18

Excess Fat in the Liver Causes Type II Diabetes

More than seventy percent of North Americans adults will become diabetic or prediabetic; diseases that are curable with lifestyle changes and not curable by drugs. Insulin insensitivity (failure to respond to insulin) causes the majority of all cases of type II diabetes and prediabetes, and insulin insensitivity is caused by excess fat in the liver (J Clin Invest, May 19, 2020). This study shows that the ability of insulin to lower high blood sugar levels is best in people who are skinny and have normal livers. As people gain weight, they become insulin insensitive, even if they do not have excess fat in the liver. When they have excess fat in both the body and the liver, they are already insulin insensitive and therefore diabetic or prediabetic.

How Excess Body Fat Leads to Diabetes

• After you eat, your blood sugar level rises

• Your pancreas releases insulin

• Insulin lowers blood sugar by driving sugar from your bloodstream into your liver and muscles

• Your liver and muscles can store only a limited amount of sugar

• So all extra sugar that cannot be stored is converted to fatty triglycerides

• Extra triglycerides damage your blood vessels, so insulin drives triglycerides from your bloodstream into your liver, fat cells and muscles

• Your fat cells fill up with fat and you become fat

• Your liver cells fill up with fat and you develop a fatty liver

• Fat in your liver prevents your liver from accepting sugar from your bloodstream, so you stop responding to insulin and become insulin insensitive (Gastroenterology, 2008;134(5):1369–1375)

• The more fat you have in your liver, the greater your insulin resistance (Gastroenterology, 2008;135(1):122–130)

• The higher your insulin levels, the more fat you deposit in your liver (Hepatology, 2014;59(6):2178–2187) because insulin resistance causes even more fat to be deposited in your liver (J Clin Invest, 2020;130(3):1453–1460)

• Insulin resistance causes you to deposit fat in your belly so that you end up looking like an apple with a large belly and small buttocks (J Clin Invest, 1986;78(6):1648–1657)

• Since sugar can’t get into a fatty liver, your blood sugar rises higher and higher and you are diabetic. It is the liver fat, and not muscle fat, that causes diabetes (Proc Natl Acad Sci USA, 2009;106(36):15430–15435)

• Being fat without having excess fat in your liver does not cause diabetes (Obesity, 2010;18(8):1510–1515)

• A high blood sugar causes sugar to stick to the outside membranes of cells and damage them

• Insulin resistance and the resultant high blood sugar levels can damage every cell in the body to cause inflammation that causes heart attacks and cancers (Diabetes, 1992;41(3):368–377)

• As a person loses weight, liver fat is reduced and the person becomes better able to respond to insulin (Cell Metab, 2016;23(4):591–601)

My Recommendations

If you want to prolong your life, you should get excess fat out of both your fat cells and your liver. Just about everyone who has a big belly and small buttocks is already diabetic or pre-diabetic as they preferentially store fat in their livers. To prevent fat from getting into your liver, you have to prevent blood sugar levels from rising too high after meals. You can do this by:

• Exercising before or after you eat. Contracting muscles remove sugar from your bloodstream without needing insulin.

• Basing your diet on vegetables, fruits, whole grains, beans, nuts and other seeds.

• Severely restricting foods with added sugar and all sugared drinks including fruit juices, mammal meat, processed meats, and fried foods. If you are overweight, also restrict sources of refined carbohydrates such as bakery products, pastas, white rice, milled corn, and most dry breakfast cereals.

MAY 13

Muscle Pain While Taking Statins for High Cholesterol

More than one hundred million North Americans have taken statin drugs that help to save lives by lowering cholesterol and preventing heart attacks. Ten to 20 percent of people who take statins have been reported to have suffered muscle pain (NEJM, March 8, 2012), but a recent study from the UK claims to show that statins are no more likely than a placebo to cause muscle pain (BMJ, Feb 24, 2021;372:n135). I believe that this study should not be used to contradict the results of a large number of studies that show that statins can cause muscle pain and muscle damage:
• The researchers did not perform blood tests to measure muscle damage. These tests can be performed routinely in any doctor’s office.
• They used a very low dose of atorvastatin (brand name Lipitor) that would miss the muscle damage that has been reported repeatedly with higher doses, which would have caused far more muscle pain and damage.

Statin-Related Muscle Pain in Exercisers
People who take statins usually do not suffer muscle pain unless they exercise (Exerc Sport Sci Rev, 2012;40:188-194)). Heavy exercisers and competitive athletes appear to be at increased risk for statin-induced muscle damage (Amer J of Med, May 2006;119(5):400-409). Athletes train by “stressing and recovering”: taking a hard workout that damages muscles, feeling sore on the next day, and taking easy workouts until the soreness disappears and muscles heal. Statins can increase muscle damage normally caused by exercise (Am J Cardiol, January 2012;109(2):282-7), and can delay muscle recovery (Wiener Klinische Wochenschrift, 2002;114(21-22):943-944), so you are not able to take as many intense workouts on statins. This prevents athletes from competing at their best or gaining the most health benefits from exercising. Statins are also associated with increased tiredness during exercise. (An of Intern Med, June 11, 2012).

Statins can interfere with the energy sources for muscles (J Am Coll of Cardiol, Jan 2013;61(1):44) by inducing a potentially harmful SR Ca2+ leak from muscle fibers that might trigger muscle pain in susceptible individuals, but could be prevented by moderate exercise (JACC: Basic to Translational Science, Aug 2019;4(4):509-523). Statin drugs can cause muscle injuries in exercisers, and the people most likely to suffer muscle pain are the ones who exercise the most (Muscle and Nerve, Oct 2010;429(4):469-479). In one study, 13 percent of patients with muscle pain required hospitalization for muscle damage (Arch of Intern Med, Dec 12, 2005;165(22):2671-2676). Most patients recover from this muscle pain soon after stopping statins, but on rare occasions, the muscles can burst and release large amounts of myoglobin that can travel to the kidneys to cause kidney failure.

Treatment for Statin-Related Muscle Pain
• A 2020 review concluded that CoQ10 supplements did not reduce statin-induced muscle soreness (J. Atherosclerosis, Apr 2020;299:1-8)
• You may need to switch to other drugs to lower cholesterol, such as ezetimibe, to reduce cholesterol absorption; fibrates, to reduce blood triglycerides and increase high-density lipoprotein (HDL); nicotinic acid, to raise HDL cholesterol; or bile acid sequestrants.
• Check your hydroxy vitamin D vitamin D3 level. If it is below 30 ng/mL, you are deficient and should take vitamin D3 at a dose of about 2000 IU/day for a month (Scand J of Med & Sci in Sprts, April 2010). Low levels of vitamin D increase risk for muscle damage (J of the Internat Soc of Sports Nutrition, Nov 11, 2020;17(53)).
• Ask your doctor to check your thyroid function.

My Recommendations
Statins do prevent heart attacks and save lives. If you are on statins to treat high cholesterol, realize that they can cause muscle pain and weakness. If you develop muscle pain while on statins, do not stop your medication but call your doctor immediately. Stopping statins can raise cholesterol levels and increase risk for clotting and heart attacks. Your doctor may try reducing the statin dose or prescribing a less potent statin. You should also avoid alcohol and be checked for low vitamin D and low thyroid function.

Many people are able to lower their high cholesterol without taking drugs:
• Eat a plant-based diet with plenty of vegetables and fruits
• avoid red meat, sugared drinks, sugar-added foods and fried foods
• lose excess weight
• exercise daily
• keep blood levels of vitamin D above 30ng/mL
See Statins and Alternatives to Lower CholesterolNote: I did another radio show this week on WRTA in Altoona PA. You can listen here:
https://www.lightnercommunications.com/episode/podcast-dr-gabe-mirkin-may-2021-wrtas-the-11th-hour-with-doug-herendeen/

Muscle Pain While Taking Statins for High Cholesterol

More than one hundred million North Americans have taken statin drugs that help to save lives by lowering cholesterol and preventing heart attacks. Ten to 20 percent of people who take statins have been reported to have suffered muscle pain (NEJM, March 8, 2012), but a recent study from the UK claims to show that statins are no more likely than a placebo to cause muscle pain (BMJ, Feb 24, 2021;372:n135). I believe that this study should not be used to contradict the results of a large number of studies that show that statins can cause muscle pain and muscle damage:
• The researchers did not perform blood tests to measure muscle damage. These tests can be performed routinely in any doctor’s office.
• They used a very low dose of atorvastatin (brand name Lipitor) that would miss the muscle damage that has been reported repeatedly with higher doses, which would have caused far more muscle pain and damage.

Statin-Related Muscle Pain in Exercisers
People who take statins usually do not suffer muscle pain unless they exercise (Exerc Sport Sci Rev, 2012;40:188-194)). Heavy exercisers and competitive athletes appear to be at increased risk for statin-induced muscle damage (Amer J of Med, May 2006;119(5):400-409). Athletes train by “stressing and recovering”: taking a hard workout that damages muscles, feeling sore on the next day, and taking easy workouts until the soreness disappears and muscles heal. Statins can increase muscle damage normally caused by exercise (Am J Cardiol, January 2012;109(2):282-7), and can delay muscle recovery (Wiener Klinische Wochenschrift, 2002;114(21-22):943-944), so you are not able to take as many intense workouts on statins. This prevents athletes from competing at their best or gaining the most health benefits from exercising. Statins are also associated with increased tiredness during exercise. (An of Intern Med, June 11, 2012).

Statins can interfere with the energy sources for muscles (J Am Coll of Cardiol, Jan 2013;61(1):44) by inducing a potentially harmful SR Ca2+ leak from muscle fibers that might trigger muscle pain in susceptible individuals, but could be prevented by moderate exercise (JACC: Basic to Translational Science, Aug 2019;4(4):509-523). Statin drugs can cause muscle injuries in exercisers, and the people most likely to suffer muscle pain are the ones who exercise the most (Muscle and Nerve, Oct 2010;429(4):469-479). In one study, 13 percent of patients with muscle pain required hospitalization for muscle damage (Arch of Intern Med, Dec 12, 2005;165(22):2671-2676). Most patients recover from this muscle pain soon after stopping statins, but on rare occasions, the muscles can burst and release large amounts of myoglobin that can travel to the kidneys to cause kidney failure.

Treatment for Statin-Related Muscle Pain
• A 2020 review concluded that CoQ10 supplements did not reduce statin-induced muscle soreness (J. Atherosclerosis, Apr 2020;299:1-8)
• You may need to switch to other drugs to lower cholesterol, such as ezetimibe, to reduce cholesterol absorption; fibrates, to reduce blood triglycerides and increase high-density lipoprotein (HDL); nicotinic acid, to raise HDL cholesterol; or bile acid sequestrants.
• Check your hydroxy vitamin D vitamin D3 level. If it is below 30 ng/mL, you are deficient and should take vitamin D3 at a dose of about 2000 IU/day for a month (Scand J of Med & Sci in Sprts, April 2010). Low levels of vitamin D increase risk for muscle damage (J of the Internat Soc of Sports Nutrition, Nov 11, 2020;17(53)).
• Ask your doctor to check your thyroid function.

My Recommendations
Statins do prevent heart attacks and save lives. If you are on statins to treat high cholesterol, realize that they can cause muscle pain and weakness. If you develop muscle pain while on statins, do not stop your medication but call your doctor immediately. Stopping statins can raise cholesterol levels and increase risk for clotting and heart attacks. Your doctor may try reducing the statin dose or prescribing a less potent statin. You should also avoid alcohol and be checked for low vitamin D and low thyroid function.

Many people are able to lower their high cholesterol without taking drugs:
• Eat a plant-based diet with plenty of vegetables and fruits
• avoid red meat, sugared drinks, sugar-added foods and fried foods
• lose excess weight
• exercise daily
• keep blood levels of vitamin D above 30ng/mL
See Statins and Alternatives to Lower CholesterolNote: I did another radio show this week on WRTA in Altoona PA. You can listen here:
https://www.lightnercommunications.com/episode/podcast-dr-gabe-mirkin-may-2021-wrtas-the-11th-hour-with-doug-herendeen/

MAY 3

Protein Shakes for Muscle Building May Not Be Safe

People who want to grow larger muscles spend more than 10 million dollars a year on whey protein shakes. A new study on mice shows that these whey protein shakes contain very high levels of branched-chain amino acids (BCAAs), which can reduce certain brain hormones to increase risk for obesity and premature death (Nature Metabolism, May 1, 2019;1:532–545).

All proteins are made up of 20 building blocks called amino acids. Humans need to get only nine of the amino acids from the food they eat because they can make the other 11 amino acids from those nine (called the essential amino acids). Of the nine essential amino acids, three are called BCAAs: leucine, valine, and isoleucine. The BCAAs are the only amino acids that can be converted into sugar, and in large amounts they can cause high blood sugar levels, which increase risk for obesity and diabetes (J Diabetes Investig, 2015 Jul; 6(4): 369–370).

The Study

Researchers fed double the usual amount of BCAAs in whey protein to mice that normally ate a high carbohydrate, low-fat diet. The mice fed the high-BCAA diet developed very high blood levels of the three BCAAs (leucine, valine, and isoleucine) that competed with another amino acid called tryptophan to enter into the brain. Tryptophan is essential to make an important brain hormone called serotonin that makes you feel happy and feel full when you eat (Curr Drug Targets, 2005;6:201–213). The high levels of BCAAs dropped brain levels of serotonin significantly, which caused the mice to overeat so they became obese and died prematurely.

Previous studies have shown that high levels of BCAAs increase fat deposition in the body (Nat Chem Biol, 2016;12:15–21). High levels of BCAAs increase insulin resistance (Metab Syndr Relat Disord, 2017;15:183–186) to increase risk for developing diabetes (Int J Epidemiol, 2016;45:1482–1492). Decreased consumption of BCAAs helps to increase insulin sensitivity, which helps to treat and control diabetes (Cell Rep, 2016;16:520–530). Large amounts of BCAAs also caused liver damage in mice (EBioMedicine, Nov 2016;13:157–167).

Extra Protein Does Not Grow Muscles

You need a certain amount of protein to build muscles, but taking more than that does not grow larger muscles. Taking large amounts of whey protein and BCAAs have not been shown to help enlarge muscles beyond just taking in an adequate amount of protein (J Int Soc Sports Nutr, 2017;14:30). The increased risk for heart attacks and diabetes seen in retired National Football League lineman may well be due to their massive intake of protein supplements and meat (The American Journal of Cardiology, May 1, 2008;101(9):1281-1284).

My Recommendations

Resistance exercise, not protein loading, causes muscles to grow larger and stronger. The healthiest way for athletes (and everyone else) to meet their protein requirements is with unprocessed whole foods from the grocery store. Before you decide to follow a high-protein diet or take protein supplements, realize that your body cannot store excess protein. Any unused protein is burned for energy or stored as fat, and this process can stress your kidneys and liver.

Extra Protein Does Not Enlarge Muscles

APRIL 30

Recreational Exercise Better Than Physically Active Jobs

A new study from Denmark shows that while leisure-time physical activity is associated with reduced heart attack risk, occupational physical activity is associated with increased risk (European Heart Journal, April 14, 2021;42(15):1512–1515). The Copenhagen General Population Study followed 104,046 participants for 10 years and found that compared to low levels of leisure-time physical activity, moderate, high and very high volumes of leisure-time physical activity reduced risk for heart attacks and death significantly, but the opposite was true for physical activity on the job. Participants with leisure-time physical activity had a 15 percent reduced risk for heart attacks, while those with heavy physical activity at work had a 35 percent increased risk.

Differences Between Leisure-Time and Work-Time Physical Activity
People who have physically demanding jobs often believe that they do not need to exercise because their work keeps them moving much of the time. However, there are differences between work and leisure activity:
• Recreational exercise is usually more intense and sustained for aerobic endurance, whereas work activity is usually repetitive motions of short duration at low intensity, such as standing for hours, walking up and down steps, moving arms to load boxes and so forth.
• Leisure time exercise improves cardiorespiratory and metabolic fitness and health, while physical activity on the job is associated with fatigue, insufficient recovery, elevated blood pressure and elevated heart rates.
• Heavy manual job workers are more likely to be stressed by noise, air pollution and other poor working conditions, and they may be too tired from their jobs to exercise after work.

Stable Plaques: A Possible Explanation
The authors of the Copenhagen study did not pursue reasons why there would be higher rates of heart attacks among people with high physical activity at work, but here is my opinion. Heart attacks are not caused by plaque buildup on the inner lining of arteries; they are caused by a sudden complete obstruction of the blood flowing to part of the heart muscle. The sudden complete obstruction of blood flow to a part of the heart muscle is usually caused by a plaque breaking off, followed by bleeding where the plaque broke off. Then clots form at the bleeding site, and the clot extends to block completely the flow of blood to the part of the heart muscle supplied by that artery. The part of the heart muscle deprived completely of blood flow then dies, to cause a heart attack.

Older endurance athletes may have more plaques in their arteries than non-exercisers, but they often have the type of plaques that are far less likely to break off to cause heart attacks (Circulation, April 27, 2017;136:138-148; May 2, 2017;136:126-137). They have:
• low 10-year-history risk scores for suffering heart attacks (Framingham study data),
• greater plaque thickness,
• more calcium in their plaques,
• wider and more dilated arteries that are far less likely to be blocked, and
• more stable plaques that are far less likely to break off to cause heart attacks.
A study of 21,758 men, average age 51.7 years, followed for an average 10.4 years, showed that men who exercised the most can have more plaques in their arteries, but did not suffer more heart attacks or deaths than those with less heart artery calcification (JAMA Cardiol, Jan 30, 2019). The least active men with excessive arterial plaques were twice as likely to die of heart disease. Compared to low-level exercisers, the heavy exercisers without increased plaques had half the risk of dying during the study period. See Stable Plaques: Why Exercisers Have Fewer Heart Attacks

How to Measure Plaque Stability
Your doctor can help to predict your risk for a heart attack with a test called a Calcium Score, which is a special CT X ray or sound wave test that measures the thickness of plaques on the inner lining of arteries. A CT scan can also show how stable a plaque is. It can show the difference between stable plaques that are usually safe and those that are unstable and more likely to break off to cause heart attacks (American Journal of Roentgenology, March, 2015;204(3):W249-W260). Signs of plaque stability include extensive calcification, less lipid-rich areas, increased fibrous areas and structural changes.

My Recommendations
We do not know why leisure-time exercise appears to give you stronger protection against suffering a heart attack than having a job that requires you to be physically active. It is my opinion that the recreational activity is usually more intense and sustained than repetitive-motion movements at work and therefore may be more likely to stabilize plaques so they do not break off to cause a heart attack. The Copenhagen study suggests that even if you have a job that involves a lot of physical effort, you should still have a program of recreational exercise that gives you the benefits of aerobic activity.

APRIL 27

Belly Fat Predicts a Heart Attack

You are at high risk for a premature death if you can pinch more than three inches in your belly. Even people who are not overweight are at high risk for a heart attack and diabetes if they store most of their fat in the belly instead of in the buttocks, hips and thighs (Annals of Internal Medicine, November 10, 2015). Having extra belly fat is associated with high cholesterol, high blood pressure, high blood sugar, inflammation, arteriosclerosis (plaques in your arteries), heart disease, strokes, kidney damage, diabetes, dementia, impotence, peripheral nerve damage and some types of cancers. More than 40 percent of North Americans already have high blood sugar levels that damage every cell in their bodies (JAMA, Sept 8, 2015;314(10):1021-1029).

What Excess Belly Fat Means

Storing fat primarily in your belly is a strong indicator that you also have fat stored in your liver. Your liver is supposed to prevent blood sugar levels from rising too high. When a healthy person eats,

• blood sugar rises,

• the pancreas responds by releasing insulin into the bloodstream, and

• insulin lowers blood sugar by driving sugar from your bloodstream primarily into your liver.

However, if you have a lot of fat stored in your liver,

• your liver cannot accept the extra sugar,

• blood sugar levels remain high, and

• this causes sugar molecules to attach to the outer cell membranes.

Once sugar is stuck on the outside surface membrane of a cell, it can never get off. It is converted by a series of chemical reactions from glucose to fructose and eventually to sorbitol that destroys the cell. This process causes all of the horrible side effects of diabetes.

If you can pinch three or more inches of fat on your belly, you probably have high blood sugar levels. Check with your doctor, who will do tests for the markers of diabetes:

• fasting blood sugar greater than 97,

• blood sugar two hours after eating greater than 120,

• triglycerides greater than 150,

• good HDL cholesterol less than 40,

• HBA1C (sugar stuck on cells) greater than 5.5,

• sonogram test showing extra fat in the liver.

Lifestyle Changes Are More Important than Drugs

Lose weight: If you have any of these risk factors for diabetes, or if you are already diabetic, you should immediately work to lose weight until you are down to one inch or less of fat over your belly. A seven percent reduction in body weight reduces diabetes risk by almost 60 percent (Diabetes Care, Dec, 2002;25(12): 2165–2171). I recommend that you try intermittent fasting to lose weight and keep it off.

Avoid Sugar-Added Foods: Sugar-added foods cause much higher rises in blood sugar than the sugar in fruits and vegetables. Even moderate doses of sugar added to foods can raise blood pressure and increase risk for diabetes, heart attacks, and premature death (British Medical Journal, December 10, 2014). Epidemiological studies in humans and experimental trials in animals show that added sugars increase blood pressure, blood pressure variability, heart rate, the heart’s needs for oxygen, inflammation, insulin resistance and high blood sugar levels.

Avoid Drinks with Sugar: Sugared drinks, including fruit juices, cause the highest rises in blood sugar levels. When you take sugar in a drink, it passes directly from the stomach into the intestines where it is absorbed almost immediately. People who drink fruit juice daily have higher blood pressures than those who drink it only occasionally (Appetite, January 2015; 84(1):68–72). Quench your thirst with water or other non-sweetened beverages.

Eat Lots of Plants: Fruits and vegetables contain antioxidants that help to prevent the inflammation that can cause insulin resistance.

Restrict Refined Carbohydrates; Eat WHOLE Grains: Whole grains are seeds of grass that have a tough outer coating like a capsule. When you grind grains into flour, you destroy the capsule and create a powder that can be quickly digested and absorbed, so foods made from flour cause high rises in blood sugar. Restrict bakery products, pastas and refined breakfast cereals and eat whole (unground) grains instead. My favorite whole grain food is long-cooking oatmeal (rolled oats or steel-cut oats). Other whole grains that are widely available are barley, wild rice, brown rice and quinoa. More at Eat Whole Grains, Not Flour

Eat Nuts: Eating nuts is associated with a reduced risk for diabetes and heart attacks (Coron Artery Dis, May 2016;27(3):227-320) and premature death (Br J Nutr, Jan 28, 2016;115(2):212-25 and JAMA Intern Med, May 2015;175(5):755-66). Nuts are rich in fat, but the fat in nuts is inside cells and you lack the enzymes to break down the fat cells in nuts. Most of the fat in nuts passes to your colon where bacteria have these enzymes, so you absorb some of the fat there while the rest passes out undigested.

Avoid Red Meat and Processed Meats: Meat is a rich source of nitrites and nitrates which block insulin receptors. Processed meats have even higher levels of nitrates because they are added as preservatives. Red meat contains high levels of extremely absorbable heme iron that can damage the beta cells that produce insulin. North Americans who eat red meat are at increased risk for diabetes (Am. J. Clinx Nutr, 2011;94:1088–1096). In one study, eating red meat daily increased risk of diabetes by 19 percent and eating processed meat (such as a hot dog or two slices of bacon) daily increased risk by more than 50 percent, while substituting other protein sources for red meat markedly reduced diabetes risk (Am. J. Clin. Nutr, October 2011). A diet high in meat and low in fruits and vegetables markedly increased risk for diabetes (Clin Nutr, April 2016;35(2):453-9). Meat-eating adults are four times more likely to develop diabetes than vegetarians in just two years of follow-up (Nutrition, Metabolism & Cardiovascular Diseases, published online October 10, 2011). Women who eat red meat daily are at increased risk for diabetes and weight gain (Diabetes Care, September 2001;24(9):1528-1535 and Arch. Intern. Med, 2004;164:2235–2240).

Avoid Fried Foods: Fried foods are associated with increased risk for diabetes (Am J Clin Nutr, June 18, 2014). Cooking without water causes sugar to bind to proteins to form Advanced Glycation End products (AGEs) that increase risk for diabetes, heart attacks and cancers. Fried potatoes in particular are associated with increased risk for diabetes (Am. J. Clin. Nutr, 2006;83:284–290).

Try to Exercise Every Day: Any muscle movement, even when muscles are moved passively on a motor-driven stationary bicycle, lowers blood sugar and increase insulin sensitivity (Med Sci Sports Exerc, published online April 6, 2016). Exercise helps to prevent high rises in blood sugar and increases insulin sensitivity, which helps to cure diabetes and prevent heart attacks. Contracting muscles lower blood sugar by drawing large amounts of sugar from the bloodstream. Exercise empties the liver and muscles of their stored sugar so you have more places to store sugar safely in your body. The increased sensitivity to insulin caused by exercise lasts only about 17 hours, so you need to exercise every day to get this benefit.

Summary of My Lifestyle Recommendations

Losing your excess belly fat quickly reduces your risk for a heart attack and diabetes, so check with your doctor and get started on these lifestyle changes immediately.

• lose weight until you have less than one inch of fat on your belly

• avoid sugar-added drinks and foods

• restrict refined carbohydrates

• avoid red meat, processed meats and fried foods

• eat plenty of whole fruits, vegetables, grains, beans, nuts and other seeds

• avoid smoking, alcohol and recreational drugs

• keep your blood levels of hydroxy vitamin D above 30 ng/mL

• exercise every day

APRIL 23

Vitamin B12: One Supplement You May Need

In the last year, I have seen two experienced cyclists who suffered recurrent numbness and tingling of their hands when they rode long distances. Both had low blood levels of vitamin B12 and one was cured by taking 1000 mcg per day of vitamin B12 pills, the other by eating fish. If you suffer these or any other symptoms of nerve damage, you should get a blood test for vitamin B12 and if it is below 300 pg/mL, you probably need further tests and may be cured just by taking vitamin B12 pills. Vitamin B12 deficiency must be treated as soon as possible, since the nerve damage it causes can become permanent if you wait too long to start treatment.

Signs of B12 Deficiency

Vitamin B12 deficiency in North America occurs in six percent of people under 60 and 20 percent of those over 60 (BMJ, Sept 4, 2014;349:g5226). Vitamin B12 deficiency can cause signs of nerve damage anywhere in your body:

• forgetfulness or decline in mental ability

• daytime sleepiness, tiredness or chronic fatigue

• muscle weakness

• blurred or double vision

• numbness or tingling

• irritability, depression or anxiety (Psychopharmacology, Jul 2010;211(1):55–68)

• abnormal behavior (Psychiatry, Jan 21, 2013)

• heart palpitations

• shortness of breath

• constipation or diarrhea

• loss of appetite

• unexplained weight loss

• excessive intestinal gas

• dizziness or feeling faint

• headaches

• abnormal gait

• tremor

• restless legs syndrome

• paranoia

• psychosis

Vitamin B12 deficiency can also cause a yellow skin tone from bilirubin released by broken red blood cells, pale skin, a red smooth tongue or a sore tongue, and mouth ulcers.

How Your Body Handles Vitamin B12

All animals contain B12, so you get it when you eat meat, poultry, seafood, dairy products or eggs. Plants do not contain B12. Some breakfast cereals and other foods made from plants are fortified with vitamin B12.

After you eat a food containing B12, your stomach produces hydrochloric acid which separates vitamin B12 from that food. Then your stomach produces a protein called “intrinsic factor” that binds to B12 to help it to be absorbed in your upper intestines (Cell Metab, Nov 4, 2014;20(5):769–778). Older people are unusually susceptible to B12 deficiency (Annu Rev Nutr, 1999;19:357-77) because they often have decreased amounts of stomach acid (Curr Opin Clin Nutr Metab Care, 2010 Jan; 13(1): 24–27). Some people develop B12 deficiency (pernicious anemia) because they lack intrinsic factor.

Human feces may contain large amounts of vitamin B12 because some intestinal and colon bacteria can make B12. At least two groups of intestinal bacteria, Pseudomonas and Klebsiella sp., make B12, but this is of little or no benefit for you since B12 is absorbed only in the upper intestinal tract, not in the lower intestine or colon. (Nature, Feb 21, 1980;283(5749):781-2).

Risk Factors for Vitamin B12 Deficiency

• Aging. The frequency of B12 deficiency increases as you age because your stomach loses some of its ability to produce acids that helps you absorb B12 (Am J Clin Nutr, 2009;89:1981S–1996S). Almost 40 percent of older North Americans become deficient in vitamin B12

• A vegetarian diet: B12 is found only in animals; it is not found in plants. Research on meat has encouraged many people to stop eating or cut back on eating animal products, which increases risk for B12 deficiency.

• Mis-diagnoses: conditions such as restless legs syndrome, fibromyalgia and chronic fatigue syndrome may be caused by B12 deficiency.

• Medications that decrease absorption of B12, such as chloramphenicol (an antibiotic), proton pump inhibitors or histamine receptor antagonists for excess stomach acidity (cimetidine, famotidine, or ranitidine), or metformin for diabetes. Almost 10 percent of diabetics taking metformin have low levels of B12 (Endocr Connect, Oct 2019;8(10):1324–1329).

• Stomach or intestinal surgery: People who have had bypass surgery or other stomach and intestinal surgery may no longer produce enough intrinsic factor.

• Intestinal diseases, such as celiac disease, Crohn’s or ulcerative colitis.

• Pregnancy: Pregnant women should be checked for B12 deficiency.

APRIL 19

Anti-Inflammatory and Pro-Inflammatory Foods

Harvard Magazine did an excellent review of research on inflammation, showing how pro-inflammatory foods can cause diseases and anti-inflammatory foods can help to prevent them (Harvard Magazine, May-June 2019, 40-52). Chronic inflammation increases risk for heart disease, diabetes, Alzheimer’s disease, certain cancers, and many other diseases. The more anti-inflammatory foods you eat, the greater your protection from chronic inflammation and the diseases it causes.

What is Inflammation?

When germs invade your body, your immune system sends out cells and proteins to kill the invading germs. Your immune system responds with exactly the same cells and proteins in the same way when cells in your body are injured, to remove damaged tissue and start the healing process. As soon as the germs are conquered, or tissues heal, your immune system stops sending out huge amounts of these cells and proteins. However, if your immune system stays overactive, you develop inflammation in which these same cells and proteins attack and damage your own cells. Chronic inflammation damages healthy tissues in the body to cause many diseases and chronic health problems.

How Foods Affect Inflammation

Your immune system is turned on by the surface proteins on the cells of germs that try to invade your body, by anything that damages cells in your body, and by substances in foods that look the same as the surface proteins of germs. The pro-inflammatory foods turn on your immune system to cause these cells and proteins to attack and damage your own normal cells, while the anti-inflammatory foods dampen down this response to protect your cells from damage from an overactive immune system.

The pro-inflammatory foods include sugar-added foods, sugared drinks, unfermented dairy products, mammal meat, processed meats, and fried foods.

• When sugar-added foods and other refined carbohydrates cause a high rise in blood sugar, the excess sugar sticks to the outer membranes of cells and destroys them. Your immune system is turned on by this cell damage (inflammation).

• All drinks with sugar in them, including fruit juices, cause high rises in blood sugar to cause cell damage. However, whole fruits are anti-inflammatory despite their sugar content.

Milk, butter and other non-fermented dairy products contain the pro-inflammatory sugar called galactose.

Mammal meat contains a surface sugar-protein called Neu5Gc that acts just like a germ invading your body to turn on your immune system.

Processed meats usually also contain Neu5Gc, and may have added nitrates that combine with proteins to form nitrosamines that damage cells in your body and increase cancer risk.

• In fried foods and other foods that are cooked at high temperatures without water, sugars bind to fats, proteins and DNA to form chemicals called advanced glycation endproducts (AGEs). AGEs have been shown to turn on your immune system to cause inflammation.

Why Do Plants Have Polyphenols?

A study from the University of Liverpool showed that fruits and vegetables are anti-inflammatory because they contain polyphenols that help to protect you from chronic inflammation (Br J Nutr, May 28, 2016;115(10):1699–1710). The authors showed that inflammation was reduced by substances such as isorhamnetin, resveratrol, curcumin, and vanillic acid found in onions, turmeric, red grapes, green tea and açai berries. Polyphenols such as these are found in virtually all fruits and vegetables.

Since fruits and vegetables cannot run away from their enemies — insects, bacteria, viruses, fungi, animals and humans — they protect themselves by producing large amounts of poisons called oxidants that can harm the invaders. To protect themselves from their own oxidants, plants produce antioxidants called polyphenols. When you eat fruits and vegetables, you get the benefits of these polyphenols, which include helping to protect you from your own immune system and keep it from remaining too active (called inflammation). This particular study showed that the polyphenols tested helped to reduce the release of pro-inflammatory chemicals in people who were at risk of chronic inflammation.

Anti-inflammatory foods include:

• vegetables

• fruits

• nuts

• whole (unground) grains

• beans

• coffee and tea

• oily fish such as salmon, mackerel, tuna, sardines

Pro-inflammatory foods include:

• sweetened beverages and sugar-added foods

• foods made with flour and other refined carbohydrates

• meat from mammals

• processed meats

• milk, butter, margarine, shortening, lard

• fried foods

My Recommendations

A healthful anti-inflammatory diet is high in vegetables, unground whole grains, beans, fruits and nuts; and low in the pro-inflammatory foods (sugar-added foods, sugared drinks, most animal products, and fried foods). Try to follow this pattern most of the time and adapt it to your special needs and preferences.

APRIL 16

The More Vegetables, The Better

Researchers followed 38,981 adults for 16 years (1999-2014) and found that those who ate the most vegetables and the widest variety of vegetables, particularly dark green vegetables, had the lowest rate of heart attacks and heart disease (Nutrition Journal, July 10, 2018;17:67). For more than 60 years, research has shown that a high-fiber diet helps to prevent heart attacks and many other diseases (American Journal of Epidemiology, Dec 1, 1987;126(6):1093–1102). Studies show that many of the impressive health benefits from eating vegetables, beans, whole grains and fruits come from the short chain fatty acids produced when bacteria in your colon ferment soluble fiber from plants.

Short-Chain Fatty Acids from Soluble Fiber

Vegetables, fruits, beans, nuts and whole grains all contain fiber. Insoluble fiber passes through your body without being absorbed into your bloodstream, but breakdown products from soluble fiber can be absorbed even though humans lack the enzymes necessary to digest soluble fiber. Soluble fiber is not absorbed in your upper intestinal tract, so it passes to your colon where bacteria do have the enzymes to break it down into short-chain fatty acids (SCFAs). SCFAs reduce inflammation to help prevent diabetes, heart disease, certain cancers and other life-shortening diseases (Front Microbiol, Feb 17, 2016;7:185).

The Bacteria in Your Gut

Your colon contains more than 13 trillion bacteria that help to control your immunity, digestion and just about everything that happens in our body. You have good bacteria that help to keep you healthy and bad bacteria that can make you sick. As a general rule, the good bacteria are happy to eat the same foods that you do and do not try to invade the cells lining your colon, while the bad bacteria try to invade the cells in your colon. The invading bad bacteria turn on your immunity that tries to kill them and prevent these harmful germs from getting out of your colon and into other parts of your body.

What you eat determines the types of bacteria that thrive in your gut. Soluble fiber in plants promotes the growth of the good bacteria, so when you eat lots of plants, you will have a large colony of these bacteria to convert soluble fiber into SCFAs that have immense health benefits (J Lipid Res, Sept 2013;54(9):2325-40). The good bacteria produce large amounts of SCFAs that feed the more good bacteria and help them to multiply. The SCFAs also:

• reduce inflammation

• help to lower high levels of blood sugar and cholesterol

• possibly reduce hunger

• cause your intestinal linings to produce the beneficial mucous that lines your colon to help prevent the bad bacteria from growing there.

The more vegetables and fruits you eat, the higher the stool levels of SCFAs (Gut, Nov 2016;65(11):1812-1821).

How SCFAs Help to Prevent Disease

Heart Disease: Many studies show that high-fiber diets help to prevent and treat heart disease by reducing inflammation. Your immunity helps to protect you by producing white blood cells and cytokines that kill invading germs when they try to enter your cells. As soon as the invading germ is gone, your immunity is supposed to dampen down. However, if your immunity stays active all the time, it uses the same white blood cells and cytokines to attack your own cells. It can punch holes in the inner lining of arteries to start plaques forming there to increase risk for a heart attack. A constantly active immunity is called inflammation and SCFAs help to reduce inflammation (Nutrients, 2011 Oct; 3(10): 858–876).

Diabetes: After three months on a high-fiber diet, the bacteria in the colons of diabetics changed to be dominated by the 15 known strains of bacteria that convert soluble fiber into SCFAs that lower high blood sugar and cholesterol levels (Science, Mar 9, 2018:359(6380):1151-1156). Diabetics placed on a high-fiber diet had lower fasting blood sugar levels, far lower blood sugars after eating, a greater drop in blood levels of HbA1c that measures cell damage from diabetes, and significant weight loss. Even though fruits are high in sugar, limited amounts of fruit can help to prevent and treat diabetes because their soluble fiber is converted to SCFAs (Diabetes Care, July 2008).

Colon Cancer: A high plant diet is associated with a marked reduction in colon cancer (Epidem Reviews, Jan 1, 1993;15(2):499–545). SCFAs prevent colon cancer in laboratory animals (Mutat Res, Jul-Aug 2009;682(1):39-53). Placing mice on a high-fiber diet that markedly increased SCFAs reduced colon cancer risk by more than 75 percent, but only if the mice had SCFA-producing bacteria in their guts. This study suggests that soluble fiber does not help to prevent colon cancer unless you also have lots of the good bacteria in your gut to convert it to SCFAs (Cancer Discov, Dec, 2014;4(12):1387–1397).

Obesity: SCFAs promote weight loss in animals (Diabetes, 2009 Jul; 58(7):1509–1517) and possibly in humans by decreasing fat storage (J Lipid Res, Sep 2013;54(9):2325-40.)

SCFAs from Plants, not Supplements

If SCFAs have so many benefits, why not just take SCFA supplements? Nobody has shown that SCFA supplements are an effective substitute for eating plants that contain lots of soluble fiber. SCFAs are readily absorbed throughout your entire intestinal tract, so SCFAs in pills will be absorbed in your upper intestinal tract and never reach your colon (PNAS, October 28, 2008;105(43):16767-16772). Therefore, SCFA supplements have not been shown to help colonize healthful bacteria in your colon as soluble fiber in plants does.

My Recommendations

This study suggests that whatever else you choose to do with your diet, you should eat a large amount and a wide variety of vegetables. I believe that everyone should eat lots of plants — vegetables, fruits, beans, whole grains, nuts and any other edible plant parts. Among their many benefits, plants help to prevent disease and prolong lives by increasing colonic bacterial production of SCFAs that reduce inflammation.

APRIL 14

How Excess Salt Affects You

Two excellent studies from Germany and Vanderbilt University in Tennessee tell us that us excess salt:

• causes hunger, rather than thirst

• breaks down muscle and fat

• may be a primary dietary factor in the high rates of obesity, diabetes, heart attacks and strokes in North America because it raises blood levels of adrenal hormones (cortisol)

(Journal of Clinical Investigation, April 17, 2017).

The common belief is that increasing salt intake increases urination and the more you urinate, the more fluid you have to drink to replace the fluid that you have lost. However, in 2011, these researchers studied Russian cosmonauts in a human space flight simulation program in Moscow, and were astonished to find that the cosmonauts actually drank less water when their daily salt intake was doubled (from 6 to 12 grams per day). Their follow-up studies, published last month, show that:

• The reason that extra salt decreases thirst and causes you to drink less fluid is that extra salt breaks down the muscles and fat in your body and these calories are used to supply energy for your body.

• Converting muscles and fat in your body to energy produces tremendous amounts of water because the end products of the chemical reactions that produce energy for your body are calories, water and carbon dioxide. The more body muscle and fat you break down, the more water is produced by your body and the less fluid you need to drink.

• When you take more salt than your body needs, your body responds to the loss of muscle and fat by needing extra calories to replace those that are lost, so extra salt makes you hungry and you eat more food.

The researchers propose that the extra food you eat because of excess salt can cause you to gain weight and increase risk for diabetes, heart attacks and strokes. The breakdown of muscle caused by excess salt may also increase risk for sports injuries.

Explanation of the Mechanism

The authors showed that extra salt stimulates your adrenal glands to increase your body’s production of glucocorticoids (cortisol, cortisone, etc.) that break down muscle protein that your liver uses to make and release urea into the bloodstream. Urea helps to retain the water that you lose through your kidneys from taking in extra salt. The glutocorticoids can also raise blood sugar, make you hungry, weaken bones and form plaques in arteries. This research was meticulously designed, published in a very prestigious medical research journal and done by 21 authors. However, further studies are needed to confirm their findings and the amounts of salt that may be associated with increased risk for obesity, diabetes, heart attacks and so forth.

My Recommendations

While we await further data, I recommend that you continue to follow the heart-healthy diet that I have recommended for many years. This way of eating is relatively low in salt because you eat lots of plants and fresh foods that have not been altered by food manufacturers. See Heart-Healthy Diet: New Studies

• Base your diet on fresh fruits, vegetables, whole (un-ground) grains, beans, nuts and other seeds.

• Restrict processed foods that often have added salt (and sugar).

• Don’t add a lot of salt to your food unless your doctor has advised you that you need extra salt. Some medications or medical conditions can cause excessive loss of salt.

• Sometimes you need to take extra salt, such as when you exercise for more than three hours in hot weather, drink too much water especially during exercise, are dehydrated or have severe vomiting or diarrhea. Symptoms of salt deficiency include weakness, fatigue, headache, nausea and vomiting, muscle cramps or spasms, confusion and irritability. Check with your doctor, who can draw blood tests for sodium, chloride and potassium.

APRIL 7

Which Burns More Calories, Running or Cycling?

Have you wondered whether you burn more calories when you run or when you ride a bicycle? The standard comparison is that one mile of running equals a little more than three miles of cycling, but that’s lousy science. It all depends on how intensely you exercise. Running requires the same amount of energy per mile at any speed (generally 110 calories per mile), but cycling is slowed so much by wind resistance that the faster you ride, the harder you have to pedal and more energy you use. This means that you have to compare your running and cycling at different cycling speeds.

If you hate math and don’t want to crunch the numbers yourself, you can use this handy online calculator

If you want to understand the math, Dr. Edward Coyle of the University of Texas in Austin has made the calculations easy by providing conversion factors for different riding speeds. First he determined average values of oxygen consumption by cyclists to estimate the approximate caloric equivalence between running and cycling. For example, riding 20 miles at 15 mph causes you to burn 620 calories (20 miles X 31 calories per mile = 620 calories). To find the same value for runners, take the 620 calories and divide them by 110 calories per mile for running and you get 5.6 miles to burn the same number of calories. So riding a bicycle 20 miles at 15 miles per hour is equal to running 5.6 miles at any speed.

Dr. Coyle’s conversion factors for different cycling speeds are:

• 10 MPH (26 calories per mile) = 4.2

• 15 MPH (31 calories per mile) = 3.5

• 20 MPH (38 calories per mile) = 2.9

• 25 MPH (47 calories per mile) = 2.3

• 30 MPH (59 calories per mile) = 1.9

Divide the number of miles ridden by the conversion factor for your riding speed to tell you the equivalent miles of running at any speed. Thus, for 20 miles ridden at 10MPH, divide 20 miles by 4.2, which tells you that your ride is equivalent to 4.8 miles of running.

This formula is for an average-size adult who weighs approximately 155 pounds. A larger cyclist would divide by a slightly higher number; a smaller cyclist, by a slightly lower one. Wind and hills are not accounted for, nor is drafting (riding behind another cyclist), which can reduce your energy expenditure by up to one-third.

Other Factors to Consider When Comparing Running and Cycling

Running causes more wear-and-tear injuries: If you exclude getting hit by a car, it is safer to cycle than to run. Cycling is done in a smooth rotary motion with almost no impact force. On the other hand, runners are far more likely to become injured than cyclists because of the high impact of their feet hitting the ground. When you run at a six-minute-per-mile pace, your foot hits the ground with a force equal to three times your body weight. This force is transmitted up your legs to your hips and back, and done repetitively, it can shatter bones and tear muscles and tendons (Br J Sports Med, Apr 2016;50(8):450-7). Runners who are injured frequently are likely to benefit most by shortening their strides, which then coincidentally increases likelihood of their landing on the front part of their feet, rather than on their heels.

Cycling does not strengthen your bones: The high impact force of running strengthens bones and helps to prevent osteoporosis. Cycling has not been shown to prevent osteoporosis because it has little or no impact force. Cyclists need to add a resistance training program (weight lifting) to gain the bone-strengthening benefits of exercise.

My Recommendations

All aerobic exercise makes your heart stronger and helps to prevent heart attacks, and exercising intensely is more effective than just casual exercise. Everyone should try to exercise every day to help prolong life and prevent disease. Choose running, cycling, or any other aerobic exercise that you enjoy and will do on a regular basis. If you exercise with a partner or make other friends who share your love of your sport, you will be more likely to continue to exercise faithfully as you age.

APRIL2

Your Muscles Make Your Heart Stronger

When you read about people dying of “natural causes,” it usually means that they died of heart failure because they spent too much time lying in bed. When you become inactive, you lose your skeletal muscles at an alarming rate, and losing skeletal muscle causes loss of heart muscle until your heart can become too weak to pump blood to your brain and you die.

In 1914, Dr. Ernest Starling described what is today known as Starling’s Law, that strengthening skeletal muscles strengthens heart muscle and not the other way around (Circulation, 2002;106(23):2986-2992). When you contract your skeletal muscles, they squeeze the veins near them to pump extra blood back to your heart. The extra blood flowing back to your heart fills up your heart, which stretches your heart muscle, causing the heart muscle to contract with greater force and pump more blood back your body. This explains why your heart beats faster and harder to pump more blood when you exercise. The harder your heart muscle has to contract regularly in an exercise program, the greater the gain in heart muscle strength.

Inactivity Damages Brain and Nerve Cells

Preventing mice from using their hind limbs for just 28 days interfered with normal function of mitochondria in cells so that blood levels of oxygen dropped, preventing the sub-ventricular zone of the brain from maintaining normal nerve function and making new nerves (Frontiers in Neuroscience, May 23, 2018). Many studies show that physical activity is necessary for the healthy growth of new nerves during a human lifetime (J Neurosci Res, 2016;94:310–317). On the basis of these and many other studies, this means that not using your legs and arms causes loss of nerves, which causes loss of muscles (particularly heart muscle), that can eventually lead to heart failure and death.

• The larger your skeletal muscles, the stronger your heart and the lower your chance of suffering heart attacks and heart disease (J Epidem & Comm Health, Nov 11, 2019).

• The less you exercise, the weaker your heart and the more likely you are to become diabetic (Diabetes Care, 2002; 25:1612–1618).

• The larger your muscles, the less likely you are to die of heart diseases (Am J of Cardiology, Apr 15, 2016;117(8):1355-1360).

• A study of almost a million adults with no history of heart disease followed for 10 years found that those who did not exercise were at 65 percent increased risk for strokes and heart attacks, the same rate as that found for smoking (Euro J of Prev Cardiology, Feb 10, 2020).

• A study of 900 heart failure patients found that those who did not exercise were twice as likely to die within three years (Am J Cardiol, 2016 Apr 1; 117(7): 1135–1143).

• A study of 51,451 participants, followed for 12.5 years, found a strong association between exercise and decreased risk for heart failure (J Amer Col of Cardiol, Mar 2017;69(9)).

• A study of 378 older adults showed that the smaller the muscles in their arms, legs and trunk, the smaller and weaker the upper and lower chambers of their hearts (J Am Geriatr Soc, Dec 2019;67:2568-2573).

• Low skeletal muscle size predicted death in people who had chronic heart failure (Cardiology, March 25, 2019).

Severe Loss of Muscle with Aging is Common

Between 25 and 50 percent of North Americans over the age of 65 suffer from severe loss of skeletal muscle (sarcopenia) that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80–85). A regular exercise program is the best way to slow down this loss of strength and coordination, but even if you exercise regularly, you will still lose muscle as you age (Aging Male, September-December 2005). After age 40, people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Am J Epidemiol, 1998;147(8):755–763; Nutr Rev, May 2003;61(5 Pt 1):157-67).

The people who lose the most skeletal muscle are usually the ones who die earliest. They are also most at risk for falls and broken bones. Muscles are made up of hundreds of thousands of individual fibers, just as a rope is made up of many strands. Each muscle fiber is innervated by a single motor nerve. With aging you lose motor nerves, and with each loss of a nerve, you also lose the corresponding muscle fiber that it innervates. For example, the vastus medialis muscle in the front of your thigh contains about 800,000 muscle fibers when you are 20, but by age 60, it probably has only about 250,000 fibers. However, after a muscle fiber loses its primary nerve, other nerves covering other fibers can move over to stimulate that fiber in addition to stimulating their own primary muscle fibers. A regular exercise program can help to slow the loss of muscle fibers and improve mobility (Physiol Rev, Jan 1, 2019;99(1):427-511). Lifelong competitive athletes over 50 who train four to five times per week did not lose as many of the nerves that innervate muscles and therefore retained more muscle size and strength with aging than their non-athlete peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Lifelong competitive runners over 60 can have almost the same number of muscle fibers as 25-year-olds.

Researchers reviewed eight studies using accelerometers to follow 36,383 adults, 40 years of age and older, for six years and found that exercising regularly in adulthood, regardless of intensity, is associated with reduced risk for early death, while sitting for more than nine hours a day is associated with increased risk for premature death (Brit Med J, August 21, 2019). The death rate dropped progressively as light physical activity increased up to five hours per day and moderate activity increased up to 24 minutes per day. Examples of:

• light intensity included walking slowly, cooking and washing dishes;

• moderate activity included brisk walking, vacuuming or mowing the lawn; and

• vigorous activity included jogging or carrying heavy loads.

Lack of physical activity doubled a person’s chances of suffering a heart attack, while a regular exercise program helps prevent it (Eur Heart J, January 15, 2019).

Preventing Muscle Loss

Resistance exercise increases muscle size and strength in older people, but with aging you need to work longer to gain the amount of strength that a younger person would get with the same program (Med Sci Sports Exerc, 2011;43(2):249–58). Competitive masters athletes, 40 to 80 years old, who train four to five times per week, lose far less muscle size or strength than their non-exercising peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Eighty-year-old men who still compete in sports have been found to have more muscle fibers than inactive younger men (Journal of Applied Physiology, March 24, 2016). Inactivity causes rapid loss of muscle size and strength. If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Prolonged periods of inactivity due to bed rest, injured nerves, casting or even decreasing the force of gravity (in astronauts) causes loss of muscle tissue which leads to insulin resistance, higher blood sugar levels and increased risk for diabetes (Med Hypotheses, 2007;69(2):310-21).

My Recommendations

A key to prolonging your life and preventing disease is to keep on moving. Lying in bed for many hours each day is a certain way eventually to kill yourself. Each day that you spend not moving your muscles weakens your heart until eventually you can die of heart failure.

• Exercise will prolong your life, but you do not have to have a specific exercise program. You just need to keep on moving for a large part of each day. It is harmful just to sit or lie down all day long. It is healthful to mow your lawn, wash your dishes, make your bed, vacuum your house, go for a walk, and participate with your friends in activities in which you are moving your arms and legs — dancing, cycling, swimming, running, nature walks and so forth.

• To gain maximum health benefits from your skeletal muscles, you should include some sort of resistance exercise. If you are not already doing strength-training exercise, first check with your doctor to make sure you do not have any condition that may be harmed by exercise. Caution: Exercise can cause a heart attack in a person who has blocked arteries or heart damage.

Then join a gym and ask for instructions on how to use the weight-training machines. Since lifting heavier weights is far more likely to injure you than lifting lighter weights, I recommend that you lift lighter weights with far more repetitions. Older people, in particular, can use each specific weight machine and lift and lower a lighter weight up to 100 times in a row. Stop that exercise when the muscles start to feel tight or hurt.

MARCH 30

Muscle Cramps: Prevention and Treatment

Muscle cramps occur most often at night when you are sleeping, but they also can occur when you exercise vigorously, tear a muscle, or keep one leg in an awkward position, such as sitting in a chair in the same position for a long time. Muscle cramps are classified into those that occur during exercise and those that can occur at any time not related to exercise, usually at night.

Cramps That Occur During Exercise

Lack of electrolytes is a more common cause of muscle cramps during exercise than lack of water (BMJ Open Sport Exerc Med, Mar 5, 2019;5(1):e000478). Electrolytes are minerals that are essential for body functions, including sodium, potassium, calcium, bicarbonate, magnesium, chloride, and phosphate. Having low blood levels of sodium (salt) is a well-known cause of muscle cramps (Clin J Am Soc Nephrol. 2007;2:151–161). Dehydration, by itself, is a far less common cause of cramps (Br J Sports Med, 2013 Jul;47(11):710-4). You can be salt deficient and still have normal blood levels of electrolytes.

Researchers in Australia studied runners who drank either plain water or an electrolyte solution before and after exercise. They found that the runners were at increased risk for suffering muscle cramps when they drank plain water, probably because water dilutes the electrolyte concentration in the body and doesn’t replace what they lost through sweating (J Int Soc Sports Nutr, Mar 15, 2021;18(1):22). In this study, 10 men ran multiple sessions on a downhill treadmill in a hot (95 degree F) room for 40 to 60 minutes, to sweat enough to lose 1.5-2 percent of their body weight (about two pounds). They were then tested before, immediately after and 40 minutes after exercising, with two trials: first, drinking plain water; and second, drinking an electrolyte solution. The tests used a special device that electrically stimulated their calf muscles enough to cause muscle cramps. The runners developed muscle cramps on much lower electrical stimulation frequencies after drinking plain water than after drinking the electrolyte solution. These results suggest that lack of electrolytes is more likely to cause muscle cramps than just lack of water (dehydration).

Cramps are more likely to occur in hot weather because muscles fatigue earlier with higher temperatures. Cramps are more likely to occur during intense exercise that requires you to use your fast twitch strength fibers that fatigue earlier than your slow twitch endurance fibers.

Night-Time Leg Cramps

Up to 60 percent of North American adults suffer from occasional night-time leg cramps, a sudden painful contraction usually of the calf muscles that can last from a few seconds up to 10 or more minutes. Doctors do not know what causes these cramps, but most of the time, they are not caused by dehydration or lack of minerals. The leading theory is that most night-time leg cramps are caused by lack of a normal nerve reflex that causes a muscle fiber to relax when it is held in contraction (J Sports Sci, 1997 Jun;15(3):277-85). That is why people who suffer recurrent leg cramps should be checked for:

• all conditions that can cause nerve damage, including lack of vitamin B12 and diabetes

• all conditions that can cause blood vessel damage such as arteriosclerosis

• partially obstructed blood vessels

• pinched nerves in the back

• muscle damage

• abnormal mineral levels

• abnormal hormone levels such as low thyroid

• kidney disease

• arthritis

• dehydration

• use of several medications such as statins, birth control pills, diuretics, steroids, asthma medication such as albuterol, raloxifene, naproxen, or teriparatide (BMJ Clin Evid, 2015:1113).

If you have recurrent night-time leg cramps, check with your doctor.

What Causes Leg Cramps?

When you turn during sleep, you contract your calf muscles which stretches their tendons. This stimulates nerve stretch receptors in the tendon and sends a message back to the spinal cord, telling the calf muscles to contract. After you contract a muscle, reflex messages are sent along nerves to the spinal cord to relax that muscle. If the message to relax that muscle is blocked, the muscle stays contracted and you develop a cramp. Cramping during sleep is usually due to an exaggeration of the normal muscle reflex that causes the muscle to stay contracted and hurt. Older people and those who do not exercise are at increased risk for leg cramps because they have smaller and weaker muscles.

Preventing Night-Time Leg Cramps

If you do not have a serious cause, you can often prevent night cramps by:

• exhausting the stretch reflex before you go to bed by stretching your calf muscles (using wall pushups or a similar exercise)

• applying a heating pad for 10 minutes before you go to sleep

• starting a regular supervised exercise program to strengthen your calf muscles. If you are a non-exerciser, I recommend a stationary bicycle.

The only drug that has been shown to be effective in preventing night-time leg cramps is quinine (Brit Med J, Jan 7, 1995;310(6971):13-17), but the U.S. Food and Drug Administration stopped over-the-counter marketing of this remedy because of concerns about irregular heartbeats. Doctors can still prescribe quinine pills for relief of leg cramps, but since they can cause birth defects and miscarriages, they should never be taken by a pregnant woman. Quinine can also cause ringing in the ears, headache, nausea, disturbed vision, chest pain, asthma and other problems. Some people may benefit from calcium channel blockers, such as amlodipine, or Carisoprodol (a muscle relaxer that blocks pain).

Treating a Leg Cramp

When you get a leg cramp, stop whatever you are doing and try to gently walk it out while you massage the contracted muscle with your hands. Never put force on the contracted muscle because you may tear it. If the cramp continues, apply cool compresses, which can relax the contracted muscle and numb pain. Keep on gently massaging the muscle.

My Recommendations

Most leg cramps are harmless, but frequent muscle cramps can be a sign of serious medical conditions. If you suffer leg cramps only during exercise, eat salty foods or drink electrolyte solutions, not plain water, before and after you exercise. If that doesn’t stop the cramps, you need a complete medical work up. People who suffer frequent night-time leg cramps that do not respond to the simple steps listed above also need a detailed medical work up. Check with your doctor.

MARCH 25

Sugared Drinks Linked to Type II Diabetes, Obesity, Heart Attacks and Cancers

A study from the University of Zurich found that drinking sugared drinks three times a day more than doubles the amount of fat produced by your liver, to increase chances for suffering from a fatty liver that markedly increases risk for Type II diabetes, obesity, heart attacks and certain cancers (J Hepatol, Mar 5, 2021;S0168-8278(21)00161-6). The study found that sugared drinks (80 grams/day) did not increase the total calories taken in, since those who took the sugared drinks ate fewer calories from other sources. Table sugar contains sucrose, formed by glucose and fructose bound together in a single molecule. The authors found that drinks containing fructose and table sugar (glucose bound to fructose), but not glucose by itself, caused this marked increase in fat production by the liver. For a more complete discussion on glucose and fructose, see How Eating and Drinking Sugar Can Cause Diabetes

Sequence from Sugared Drinks to Fatty Liver
• After you eat, your blood sugar level rises
• Your pancreas releases insulin
• Insulin lowers blood sugar by driving sugar from your bloodstream into your liver and muscles
• Your liver and muscles can store only a limited amount of sugar
• So all extra sugar that cannot be stored immediately is converted to triglycerides, which are pure fat
• Extra triglycerides damage your blood vessels, so insulin drives triglycerides (fat) from your bloodstream into your liver, fat cells and muscles
• Your fat cells fill up with fat and you can become obese
• Your liver cells fill up with fat and you develop a fatty liver
• Fat in your liver prevents your liver from accepting sugar from your bloodstream, so you stop responding to insulin and become insulin insensitive (Gastroenterology, 2008;134(5):1369–1375)
• The more fat you have in your liver, the greater your insulin resistance (Gastroenterology, 2008;135(1):122–130)
• The higher your insulin levels, the more fat you deposit in your liver (Hepatology, 2014;59(6):2178–2187), because insulin resistance causes even more fat to be deposited in your liver (J Clin Invest, 2020;130(3):1453–1460)
• Insulin resistance causes you to deposit fat in your belly so you end up with a large belly
• Since sugar can’t get into a fatty liver, your blood sugar rises higher and higher and you become diabetic.

Why Skinny Buttocks and Thighs are Signs of Diabetes
A study from Cambridge University in England showed that not being able to store excess fat in your buttocks and thighs can cause diabetes (Nature Genetics, November 14, 2016). An international team studied more than two million genetic variants in 200,000 people and found 53 regions of genes associated with insulin resistance, diabetes and heart attacks. They then did CT scan X rays on 12,000 people to see where they stored fat and found that people who are genetically susceptible to diabetes lack the ability to store much fat in their thighs and buttocks. That means that if you genetically lack the ability to store much fat in the lower part of your body, you are at increased risk for storing most of your fat in your liver and becoming diabetic if you gain any excess weight at all.

Overweight people who are shaped like pears, with a flat belly and large buttocks, are at far less risk for heart attacks and diabetes than people who are shaped like an apple, with a big belly and small buttocks. You are likely to be prediabetic or diabetic if you:
• can pinch more than three inches of fat under the skin at the front of your belly, even if you are thin everywhere else
• have a high fasting blood sugar (>95)
• have high blood sugar one hour after eating (>145)
• have high triglycerides (>150)
• have low good HDL cholesterol (<40)
• have a high HBA1C (>5.5), a test that shows too much sugar stuck on cells
• have a lot of fat in your liver (shown on a sonogram)

Skinny People Can Store Too Much Fat in the Liver
If you have excess fat in your liver, you can be at great risk for Type II diabetes, even if you are not overweight. Several recent articles show that:
• Storing fat in your belly is a stronger risk factor for diabetes than just being overweight, and is arguably the most common cause of diabetes in North America today (BMC Public Health, November 18, 2019). Eleven percent of 5,228 non-obese people had excess belly fat and these normal-weight people with big bellies had significantly higher levels of blood pressure, fasting blood sugar, total cholesterol and triglyceride levels, indicating increased risk for diabetes and heart attacks.
• Measuring a person’s waist circumference is a simple and efficient way to see if people who are not overweight are still at increased risk for diabetes (Arch Med Sci Civil Dis, July 22, 2019;4:e64–e71). Men are at increased risk for being diabetic if their waist circumference is greater than 38 inches, and women if it is greater than 36 inches.
• People with excess fat in the liver are at increased risk for being deficient in iron, which causes them to become anemic and have less energy, be less active and far less likely to exercise than people with normal amounts of liver fat (Clinical Gastroenterology and Hepatology, Dec 1, 2019).
• Diets that restrict added sugars and other refined carbohydrates in foods such as bakery products, pastas and most dry breakfast cereals, help people to reduce the amount of fat in their liver, decrease insulin resistance and lower triglycerides and cholesterol (Metab Syndr Relat Disord, 2019;17(8):389-396).

My Recommendations
More than seventy percent of North Americans adults will become diabetic or prediabetic, diseases that are curable with lifestyle changes and are not curable by drugs alone. Insulin insensitivity (failure to respond to insulin) causes the majority of all cases of type II diabetes and prediabetes, and insulin insensitivity is caused by excess fat in the liver (J Clin Invest, May 19, 2020). The ability of insulin to lower high blood sugar levels is best in people who are skinny and do not have a fatty liver. As people gain weight, they become insulin insensitive. When they have both excess body fat and a fatty liver, they are insulin insensitive and therefore are diabetic or prediabetic. See Beat Diabetes By Getting Fat Out of Your Liver and Muscles
Prevent Diabetes with Exercise and a Plant-Based Diet

MARCH 24

Can You Eat Too Much Fruit?

Many scientific studies show that eating whole fruit is healthful, even for people who are diabetic. However, some people, especially those who are overweight, prediabetic or diabetic, may be harmed by eating very large amounts of fruit. Most fruits are full of sugar, and after eating 12 to 15 oranges or clementines a day for several months, my blood triglyceride level was 460 (normal is under 150). For me, eating that much fruit had raised my blood sugar level so high that it caused a high rise in triglycerides that can increase risk for heart attacks and premature death. Two weeks after cutting back to eating one or two oranges a day, my triglycerides dropped to 146.

Some people may need to limit the amount of fruit they eat, even though many scientific papers show that eating fruit can help to prevent and treat diabetes and obesity. The main benefit of eating whole fruit may come from its soluble fiber, which passes unabsorbed to the colon where bacteria convert it to short chain fatty acids (SCFAs). These SCFAs help to lower high blood pressure (Nutrition, Metabolism and Cardiovascular Disease, January 2018;28(1):3–13), cholesterol (The American Journal of Clinical Nutrition, Jan 1, 1999;69(1):30–42), blood sugar and diabetes (Diabetes Care, Dec 1991;14(12):1115-25), and inflammation (Am J Clin Nutr, April, 2006; 83(4):760–766).

How Eating Too Much Fruit Can Raise Triglycerides

Your body stores sugar only in your liver and muscles. When your liver and muscles are full of sugar, all additional sugar is converted to a type of fat called triglycerides. A high rise in blood triglycerides is usually due to a high rise in blood sugar that has been converted to fat (Eur J of Int Med, Feb 7, 2014). As your blood levels of triglycerides rise, you use up your good HDL cholesterol to carry the triglycerides from your bloodstream to your liver so your good HDL cholesterol goes down. Then the triglycerides collect in your liver to cause a fatty liver that can lead to diabetes. When your liver is full of fat, it loses its ability to clear your blood of high blood sugar levels.

When you eat, blood sugar levels rise. Your pancreas releases insulin which lowers high blood sugar levels by driving sugar from the bloodstream into the liver, but if you have a fatty liver, it will not accept sugar from your bloodstream. The progression toward becoming diabetic is:

• A high rise in blood sugar after meals — blood sugar greater than 140 one hour after you eat (Atherosclerosis, Nov 17, 2016;256:15-20)

• A high rise in insulin to lower the high blood sugar levels

• A high rise in triglycerides — fasting blood triglycerides greater than 150

• A drop in the good HDL cholesterol — fasting good HDL cholesterol below 40

• A fatty liver, which can be diagnosed with a sonogram that will show if your liver is full of fat (Nutrition, Metabolism & Cardiovascular Diseases, 12/30/2015)

Research Showing that Fruit is Good for Everyone, Even Diabetics

Various studies have shown that the health benefits of fruits outweigh the potential harm from their high sugar content. In one classic study, people who took in more than 20 fruits a day for six months suffered no adverse effects on body weight, blood pressure, insulin levels, or cholesterol levels (S Afr Med J, 1971 Mar 6;45(10):253-61). Eating 20 fruits per day appeared to help prevent heart attacks and diabetes by not increasing weight, blood pressure or triglycerides and by lowering the bad LDL cholesterol by 38 points (Metabolism, April, 2001;50(4):494-503). The amount of sugar in 20 fruits is approximately 200 grams or the amount in eight 12-ounce cans of soda.

A high rise in blood sugar after eating can damage every cell in your body and fruits are usually full of sugar. However, overweight diabetics who markedly reduced their intakes of fruit for 12 weeks gained no advantage in body weight, belly circumference or HbA1c, compared to those who ate a lot of fruit (Nutr J, Mar 5, 2013;12:29). HbA1c measures cell damage in diabetics. Just getting diabetics to eat more foods containing soluble fiber for six weeks lowered fasting blood sugar, average blood sugar, high insulin levels, total and bad LDL cholesterol, fasting triglycerides, and sugar in the urine (N Engl J Med, May 11, 2000;342(19):1392-8).

Why Sugar in Fruit is Safer than Sugar in a Cookie

When you eat a cookie made with sugar, the sugar is absorbed quickly and your blood sugar rises to high levels unless your liver can remove the added sugar. Fruits contain soluble fiber, a gel that binds to some of the sugar and helps to prevent the sugar from being absorbed in your upper intestinal tract. The sugar that is bound to soluble fiber passes to your colon where bacteria there break down the soluble fiber to release the sugar and much of the sugar is absorbed many hours after you have eaten the fruit. When you eat a cookie, your blood sugar level will rise more than twice as high as it would have had you eaten a fruit with the same amount of sugar in it (J Agric. Food Chem, 1990;38 (3):753–757).

However, my experience with eating large numbers of oranges has shown me that not enough of the sugar in fruit may bind to the soluble fiber to prevent a high rise in blood sugar. This may be particularly true of the juicy fruits, those that release a lot of liquid during the chewing process, such as oranges, watermelon or grapes. Eating these fruits in large quantities may have almost the same effect as drinking fruit juice.

Sugar in Drinks is the Most Harmful

Drinking fruit juices and soft drinks increases diabetes risk by more than 130 percent (Arch Intern Med, 2008;168(14):1487-1492), while eating whole fruits helps to prevent diabetes (Diabetes Care, July 2008). You get the same high rise in blood sugar after drinking orange juice as you do after drinking a Coca Cola. No solid food is allowed to pass into your intestines. If solid food could enter your narrow intestines, it would cause an obstruction that could kill you. As soon as solid food reaches your stomach, your pyloric sphincter at the end of the stomach closes and only a liquid soup is squeezed past it. Fruit juice causes an almost immediate rise in blood sugar, while a whole fruit can take as long as five hours after eating to empty from your stomach into your intestines.

My Recommendations

Eating whole fruit is healthful and can help to prevent diabetes. It is normal for blood sugar to rise moderately 20 to 40 minutes after you eat fruit and drop back down in less than an hour (Lancet. Oct 1,1977;2(8040):679-82). However, pre-diabetics, diabetics and obese people are at increased risk for developing high blood sugar levels if they eat large amounts of fruit.

A normal fasting blood sugar below 100 does not rule out diabetes. To find out if you are pre-diabetic, get a blood sugar level exactly one hour after eating a full meal. If your sugar is >140, you are prediabetic or diabetic. If you are overweight, diabetic, or prediabetic or have triglycerides >150, good HDL cholesterol below 40, or a fatty liver, you may be harmed by eating more than five fruits a day.

My recommendations for preventing and treating diabetes include:

• lose excess weight

• avoid drinking anything with sugar in it, including fruit juices

• avoid sugar-added foods

• limit fruit to no more than five servings per day, and eat your fruit with other foods

• restrict meat from mammals and processed meats

• restrict fried foods

• eat lots of vegetables, whole grains, beans, nuts and other seeds

• keep blood levels of hydroxy vitamin D above 20 ng/ml

• check with your doctor about starting or increasing an exercise program

See Treat Diabetes with Diet and Exercise

How Eating and Drinking Sugar Can Cause Diabetes

Why Meat May Increase Risk for Diabetes

MARCH 16

Ultra-Processed Foods

In our North American diet, more than 90 percent of the sugar and almost 60 percent of the calories from sugar are consumed in “ultra-processed foods” (BMJ Open, March 9, 2016;6(3)). The U.S. government recommends that you get no more than 10 percent of your calories from added sugars. Yet 71 percent of North American adults take in more than 15 percent of their calories from added sugars. Excess sugar intake leads to weight gain, obesity, diabetes, heart attacks, strokes, certain cancers and tooth decay.

The researchers analyzed the diets of more than 9000 people and found that on average, 20 percent of the calories they ate came from sugar in ultra-processed food products. The percentage of sugar was much higher in those who ate the most ultra-processed foods. Some of the people got more than 80 percent of their calories from the sugar in processed foods. They estimate that only people who severely restricted processed foods were able to reduce their sugar intake to the government-recommended level of less than 10 percent of their total calorie intake. See my report on Hidden Sugars.

Ultra-processed foods include soft drinks, most dry breakfast cereals, frozen pizzas, frozen meals and entrees, breads, cakes, pies, cookies, snack bars including power bars, diet bars and energy bars, candy, crackers, salty snack foods such as potato chips, corn chips and pretzels, processed meats including those made from poultry or seafood, instant soups and noodle bowls, bottled juices, salad dressings and many others. To make ultra-processed foods taste good, manufacturers add salt, sugar, oils, fats, artificial flavorings, emulsifiers, preservatives, colorings, sweeteners and other additives.

Study Recommendations

The authors recommend cutting way back on ultra-processed foods to reduce intake of added sugars, and getting most of your calories from nutrient-rich unprocessed foods including vegetables, fruits, beans, nuts, whole grains and other seeds.

Definitions 

The authors of this study define ultra-processed foods as “Formulations of several ingredients which, besides salt, sugar, oils, and fats, include . . . flavors, colors, sweeteners, emulsifiers and other additives used to imitate sensorial qualities of unprocessed or minimally processed foods  . . . or to disguise undesirable qualities of the final product.

Unprocessed foods are those that are recognizable parts of plants (leaves, stems, roots, fruits, seeds) or animals (cuts of meat, poultry or seafood, eggs)

Minimally processed foods are parts of plants or animals that have been factory-cleaned and packaged and may have been ground, chopped or otherwise reduced to small particles; blanched or pre-cooked; and/or frozen, canned or dried.  Non-flavored dairy products including cheeses and plain yogurt, and simple prepared foods such as pastas or fresh-baked bread can also be considered to be minimally processed.   If the package has a very short list of ingredients (1-4), the food is probably minimally processed, but check for added sugars.

MARCH 1

Omega-3’s from Fish and Plants Help to Prevent Heart Attacks

People who had higher blood levels of omega-3 fatty acids at the time of a heart attack were far less likely to die or to have repeat heart attacks within three years, compared to those who had lower levels (J Am Coll Cardiol, Nov, 2020;76(18):2089-2097). The sources of omega-3s in the 944 heart attack patients in this study included both fish and plants.

Omega-3 fatty acids can help to lower high triglycerides, which may help to prevent heart muscle damage before and during a heart attack (Circulation, Aug 2, 2016;134(5):378–391). Omega-3s also significantly lower inflammation, an overactive immunity that increases heart attack risk (Cardiovasc Res, 2009;82:240-249). People whose diet includes deep-water fish are at a reduced risk for suffering and dying from a heart attack (Circulation, 2018;138:e35-e47).

Possible Benefits from Prescription Fish Oil Pills

If you have high blood levels of triglycerides (>150mg/dL), a major risk factor for heart attacks and diabetes, you may benefit from taking high-dose prescription fish oil omega-3 pills. Vascepa was the first FDA-approved drug to reduce cardiovascular risk among patients with elevated triglyceride levels, as an add-on to statin therapy (FDA press release, December 13, 2019). In a study of 8,179 patients over age 45 with a history of heart disease or diabetes, those who received Vascepa were significantly less likely to have a cardiovascular event such as a stroke or heart attack. Vascepa’s active ingredient is eicosapentaenoic acid or EPA, an omega-3 fatty acid derived from fish oil. Other prescription fish oil products approved by the FDA include Lovaza, Epanova and Omtryg.

The prescription sources of omega-3s appear to be preferable to over-the-counter fish oil pills because they are more concentrated and contain only EPA, while over-the-counter products contain both EPA and DHA (docosahexaenoic acid), which may raise LDL cholesterol. The prescription pills may also be less likely to be rancid or contaminated (Cardiovasc J Afr, 2013;24:297-302). However, they are expensive and will only be covered by insurance if you have the high triglycerides that they are approved to treat. Check with your doctor.

Get Your Omega-3s from Foods

The possible benefits of over-the-counter fish oil pills are controversial (Clinical Nutrition, May 19, 2017) and I believe that you should be able to get enough omega-3s from eating oily fish (such as salmon or sardines) and a wide variety of plants. Some foods are marketed as particularly rich sources of omega-3s — flaxseeds, chia seeds, hemp seeds, soybeans, seaweed, algae, perilla oil and so forth — but you can get plenty of omega-3s in your regular diet if you eat lots of ordinary vegetables, nuts, beans and other seeds. Omega-3 fatty acids are classified into short chain fatty acids found in plants and long chain fatty acids found in fish. The health-promoting benefits of omega-3s come primarily from the long chain omega-3s, but some of the short chain omega-3s in plants can be converted to long chain omega-3s, so you can get the heart attack preventing benefits with a healthful plant-based diet (J Am Coll Cardiol, 2020;76(18):2098-2101).

Issues with Over-the Counter Fish Oil Pills

• A review of ten large randomized studies that followed 77,917 people, average age 64, for an average of 4.4 years, showed that taking fish oil pills did not prevent heart attacks, heart diseases, or major clotting events such as strokes (JAMA Cardiology, Jan 31, 2018). These studies were done with healthy people and on those with prior histories of heart attacks, diabetes, high blood cholesterol, or taking statin drugs.

• More than 21 studies have shown that fish oil pills do not prevent or treat any form of heart disease (Curr Cardiol Rep, Jun, 2017;19(6):47).

• From 2005 to 2012, 22 studies showed no benefit in preventing heart attacks or strokes in high-risk populations including people who were obese, did not exercise, ate meat daily, smoked, had a history of heart disease, had high cholesterol, had high blood pressure or had Type 2 diabetes (JAMA Intern Med, 2014;174(3):460-462).

• A review of 28 studies showed that fish oil pills did not help to prevent heart attacks (Clinical Nutrition, May 19, 2017).

• A clinical trial of 12,000 people found that fish oil pills did not reduce the rate of death from heart attacks and strokes (N Engl J Med, May 9, 2013; 368:1800-1808).

The debate over possible benefits from fish oil pills probably occurs because there is no way to monitor the quality of the pills taken by the people in these studies. Stale omega-3 oils in pills can be harmful and increase heart attack risk, which would cancel out any benefits that might be shown. If you decide to take fish oil pills, cut open the first capsule in the bottle and smell it. If it has a strong fish-oil odor, get rid of them. See Check Those Fish Oil Pills

My Recommendations

• The evidence that eating fish twice a week helps to prevent heart attacks is so strong that I believe everyone should do that.

• If you don’t like fish and want to take omega-3 pills instead, realize that they may not be beneficial, and remember to test for rancidity by breaking open a capsule from each bottle you purchase. If they smell fishy, throw the whole bottle out, since rancid fish oils increase risk for heart attacks and certain cancers.

• If you are a vegan who eats no seafood, be sure to eat a wide variety of plants and include lots of seeds (beans, nuts, whole grains, seed oils and so forth). Also take vitamin B12 pills to prevent nerve damage caused by lack of that vitamin.

FEB 23

How Exercise Helps to Prevent Some Cancers

A review of 170 animal and human studies showed that regular exercise is associated with reduced cancer risk, particularly for the types of cancers that are associated with unhealthful lifestyles, such as those of the breast, colon, prostate, lung and endometrium (J Nutr, 2002 Nov;132(11 Suppl):3456S-3464S). Exercise helps to prevent cancer by reducing causes of inflammation: overweight, excess calorie intake, high blood sugar, high insulin and insulin-like growth factor-1, high estrogen, and overactive and depressed immune function.

The most likely reason why exercise reduces cancer risk is that it reduces an overactive immunity (Exerc Sport Sci Rev, 2015;43(3):134-142). Many studies show that exercise reduces markers of an overactive immune system that are also necessary for cancer growth: interleukin-6, tumor necrosis factor-a, and monocyte chemoattractant protein 1.

• Exercise was shown to reduce inflammation that caused mice to develop colon cancer (Int. J. Oncol, 2014; 45(2):861–8) and breast cancer (Cytokine, 2011; 55(2):274–9).

• Exercise helped to prevent breast cancer in rats (Cancer Prev. Res (Phila), 2012; 5(3):414–22) and mice (Cytokine, 2011; 55(2):274–9).

• Exercise reduced inflammation in humans to increase survival from colon cancer (Gut, 2006; 55(1):62–7).

• Exercise is associated with reduced pre-cancerous polyps in humans (BMC Res Notes, 2012; 5: 312).

My Recommendations

If you do not exercise, I recommend that you start an exercise program that may protect you from certain cancers and will also help to protect you from obesity, diabetes and heart attacks. Be aware that exercise can cause heart attacks in people who already have blocked arteries, so check with your doctor, particularly if you have any markers for arteriosclerosis: high blood pressure, cholesterol or blood sugar, or a lot of belly fat (more than three inches when you pinch the skin over your belly).

Start out Slowly

If you haven’t exercised for a while, just go out every day and walk, jog or cycle for a short time, until your legs start to feel heavy or sore, and then quit for the day. Try to do this every day, but take days off when your legs feel sore. As you continue to move a little each day, you will gradually be able to increase the time you can spend exercising until you are able to exercise at low intensity every day for 30 minutes without feeling sore.

Now You Can Start to Pick Up the Pace

Fitness requires some degree of intensity. Whenever I see people reading while walking on a treadmill, I just shake my head. You have to damage muscles to make them larger and stronger, and you have to get short of breath to increase your ability to take in and use oxygen.

On the first day, warm up by walking, jogging or pedaling at a very slow rate for five to 10 minutes. Then gradually pick up the pace and when your legs start to burn, hurt or feel heavy, slow down. Do not use a clock, but when your legs feel recovered, pick up the pace again. Slow down at the least sign of discomfort. Do this until your legs start to feel heavy or tired and then quit for the day.

On the next day just go very slowly, or take the day off if your legs feel unusually sore.

Try to establish a training regimen in which on one day, you take a harder workout by alternating intervals of slow and fast movement, and on the next day, you go slow. Try to exercise for about half an hour each day. These alternating stress-and-recover workouts can make you very fit, help to prevent disease and prolong your life.

Preventing Injuries

• Most people need to allow 48 hours between intense workouts. Take more recovery days if you need them.

• Your legs should feel a little sore when you wake up each morning. They will usually feel sore when you start your workout also. If your legs still do not feel fresh after you warm up by exercising slowly for five to 10 minutes, take the day off.

• If you feel pain in one spot that increases with exercise, stop the workout immediately and take the rest of the day off. Your body is telling you that you are headed for an injury if you continue to exercise.

More References

• A review of more than 50 studies showed that exercise can reduce risk of colon cancer by 30 to 40 percent, and those who were most active gained the greatest protection (Sports Medicine, 2004; 34(4): 239–252).

• More than 60 studies showed that women who exercise are 20 to 80 percent less likely to develop breast cancer (Cancer Epidemiol. Biomarkers Prev, 2006; 15(1):57–64).

• Time spent sitting is associated with increased breast cancer risk (Breast Cancer Res. Treat, 2011; 130(1):183–94).

• More than 20 studies showed that women who exercise have a 20 to 40 percent reduced risk for cancer of the inner lining of the uterus (Cancer Epidemiology and Prevention, Oxford University Press, 2006).

• A review of 21 studies showed that exercise reduces risk for lung cancer (Cancer Causes and Control, 2005; 16(4):389–397).

• In a review of 36 studies, most found an association between exercise and reduced risk for prostate cancer (Archives of Internal Medicine, 2005; 165(9):1005–1010).

• Exercise increases survival rate in breast cancer (JAMA, 2005; 293(20):2479–2486) and colorectal cancer (Journal of Clinical Oncology, 2006; 24(22):3527–3534).

FEB 18

Sleep to Recover from Hard Exercise

Sleeping can help to prevent exercise injuries. Healthy U.S. soldiers in training are less likely to suffer exercise-related injuries such as fractures, sprains and muscle strains when they sleep at least eight hours at night (Sleep Health, February 13, 2020). Compared to soldiers who slept eight hours a night, those who slept for fewer than five hours a night suffered double the rate of injuries. The average college athlete gets 6.5-7.2 hours of sleep each night (J Sci Med Sport, 2014;18), and increasing their sleep duration to eight or more hours per night improves performance in many different sports (Sleep, 2011 Jul 1; 34(7): 943-950).

Athletes who train for competition in sports that require endurance learn sooner or later that after exercising long and hard, they feel sleepy and need to go to sleep to recover (Eur J Sport Sci, 2008;8:119-126). Older people may need even more sleep after intense exercise than younger people. If you don’t get lots of extra sleep when you do prolonged intense exercise, you don’t recover as quickly and are at increased risk for injuring yourself. It works both ways: regular prolonged exercise helps insomniacs fall asleep more quickly (Sleep Med, 2011;12(10):1018-27; 2010;11(9):934-40). Sleep is necessary for healing your brain and your muscles (Front Physiol, 2014 Feb 3;5:24). You sleep to catch up on the energy that you lose being awake, both moving and thinking. Your brain uses more than 20 percent of your total energy, and the energy supply to your brain and nerves is regulated to a large degree by a chemical called ATP (Front Neur, Dec 27, 2011;2:87). When you are sleep deprived, levels of ATP drop (Prog Neurobiol, 2011;95:229-274), and when you go to sleep, brain levels of ATP rise significantly (J Neurosci, 2010;30:9007-9016).

Get Off Your Feet

• Athletes in intense training recover faster by getting off their feet after they finish their hard workouts and not even walking around until it is time for the next day’s recovery workout.

• Intense exercise damages muscles, which causes your pituitary gland to produce large amounts of human growth hormone (HGH) that helps to repair injured tissues, and you produce the largest amounts of HGH when you sleep. A ninety-minute recovery nap after you exercise also improves your ability to reason and think (Sleep, April 12, 2019;42(1):A71-A72).

• Runners who slept after a morning workout were able to run much faster all out in the evening (European Journal of Sport Science, May 31, 2018;18(9):1177-1184).

• Napping for more than 20 min after exercising improves mental preparation for subsequent performance (Sports Med, 2018;48:683-703).

Excessive Napping Can Signal Health Problems

Napping is healthful unless a person’s brain or heart is damaged so they require a lot of extra sleep (Heart, Sep 2019;105(23):1793-1798). People who take naps lasting longer than two hours are far more likely to suffer serious heart disease than those who take shorter naps or no naps at all (Sleep, 2015;38:1945-53), and people who nap longer than two hours have increased risk for diabetes as well as for heart attacks (Sci Rep, 2016;6:1-10). Excessive total sleep time appears to be a marker for serious heart disease and brain disease. Those who take daytime naps in addition to sleeping more than six hours every night are more likely to suffer heart attacks than nappers who sleep less than six hours at night (Eur Heart J, 2019;40:1-10). See my recent report, Is Napping Healthful?

Signs of Overtraining

A regular exercise program is supposed to make you feel good, increase your energy level, and help to control your weight, but exercising too much can affect your brain as well as your muscles. Athletes and dedicated exercisers often suffer from an overtraining syndrome in which their performance drops, their muscles feel sore and they are tired all the time. You may be exercising too much if you:

• feel irritable, tired during the day and unable to sleep at night

• lose your appetite

• see no improvement in your athletic performance over an extended time

• feel no enjoyment from exercising

• have frequent colds

• have persistent muscle soreness

In particular, muscle soreness on one side of your body or localized discomfort in one part of your body are major signs of an impending injury. For my personal story of overtraining syndrome, see Avoiding Overtraining

My Recommendations

Getting enough sleep is just one of the keys to recovery from intense exercise.

• Immediately after a hard workout, eat whatever sources of carbohydrates and protein you like best. I eat oranges and nuts to help me recover faster for my next workout.

• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off.

• If you feel pain in one spot that does not go away during a workout, stop that workout immediately. Otherwise, you are likely to be headed for an injury.

For more of my recommendations, see Recovery: the Key to Improvement in Your Sport

Caution: Before you start or increase the intensity or duration of your exercise program, check with your doctor to make sure that you do not have any health conditions that may be harmed by vigorous exercise.

FEB 12

Organic Foods May Not Be Worth the Extra Cost

Organic fresh produce sales in 2020 were $8.54 billion, an increase of over $1 billion from 2019. A very sobering study of 55 rice types found that organic rice contained significantly more arsenic than non-organic rice. More than half of the rice samples were “unfit to feed to infants” (Ecotoxicology and Environmental Safety, July 1, 2020;197(1):110601).

Compared to conventionally-grown foods, organic foods usually cost more and have not been shown to be safer, provide more or better nutrients, or be more likely to have been grown at a small local farm. In 2018, the Food Marketing Institute reported that the average price for organic produce was 54 percent higher than for non-organic produce; organic milk cost 72 percent more, and organic eggs cost 82 percent more. Organic foods cost more to produce because they require:
• more land to grow the foods,
• more workers to prepare and harvest the crops, and 
• more work to control weeds and insects.
Many North Americans are willing to pay this extra price because 50 percent of them believe that organic foods are more healthful for you (Pew Research Center, published online November 19, 2018). Manufacturers have taken advantage of this belief and sell organic clothes, cigarettes, water, soap, condoms, lipstick, perfume, mattresses, and just about anything that touches your body, as well as all categories of foods. However, U.S. government control over the use of the label “organic” is lax because there are few government agencies or contractors to check the production of organic products.

Definition of Organic
An organic product is defined as something that is made or grown naturally, without use of fertilizers, pesticides or herbicides manufactured by humans. To be recognized as “organic,” foods and other products are supposed to be grown with:
• No synthetic fertilizers or pesticides (with some exceptions)
• No antibiotics or growth hormones for livestock
• No genetically modified ingredients
• No artificial flavors, colors or preservatives
• No sewage sludge
• No radiation of foods

Both conventional and organic fruits and vegetables are grown with pesticides, but organic growers use “natural” pesticides (such as ground-up chrysanthemums), while conventional growers use “artificial” pesticides that are often copies of the pesticides found in nature. Your body cannot distinguish between “natural’ and artificial pesticides or fertilizers. For example, organic growers can feed plants nitrogen from animal manure, but not use fertilizers that contains the same nitrogen from a factory. This makes no sense because nitrogen is a chemical element and therefore is the same regardless of its origin. Other chemical elements such as arsenic, chromium, or nickel are toxic and are found naturally in soil.

Strong evidence exists that many pesticides and herbicides used regularly today, both natural and artificial, can harm you by increasing your risk for cancers. From the 1950s onward, the government set maximum allowable residue levels on foods. In the 1970s, the EPA banned DDT and other insecticides. Some farmers, but certainly not all, have responded by using insecticides only after safer methods have failed. Examples of safer insect control include using healthful insects to help control crop-damaging ones and improving plants genetically to resist insect damage (which is ironic since genetic modification is supposed to disqualify a food from being labeled organic).

“Organic” is Difficult to Regulate
The demand for organic foods has increased so much that more than 80 percent of organic foods now come from very large farms producing very large amounts of organic products that are sold in large commercial establishments such as Walmart, Costco, and Kroger. Less than eight percent is produced by small farmers.

The U.S. Department of Agriculture (USDA) tries to regulate farms or handling operations by having them certified by a state or private agency accredited by USDA. Farms and handling operations that sell less than $5,000 worth per year of organic products are exempt from certification. Before a product can be labeled “organic,” a government-approved company is supposed to inspect the farm to assure that it is following all the rules. Companies that handle or process organic food before it gets to your local supermarket or restaurant are supposed to be certified, too. You can imagine how expensive and time-consuming this process is, and in reality, only a small percentage of the producers actually get inspected repeatedly to see that they are following the rules.

No Data to Show That Conventional Produce is Harmful
We know that chronic exposure to large amounts of pesticides can harm you (Interdiscip Toxicol, Mar 2009;2(1):1-12), but we have no proof that eating conventional produce is harmful to humans. All of the available evidence is that the people who eat the most fruits, vegetables, whole grains, beans, nuts and other seeds are at markedly reduced risk for heart attacks, diabetes, strokes, certain cancers and premature death, regardless of whether their food is conventionally grown or organic (Amer J of Clin Nutr, Aug 2013;98(2):454-459).

If you are concerned about pesticide levels and have a tight budget or do not have good sources of organic produce, you may be interested in the findings of The Environmental Working Group (EWG). Their good news is that the following non-organic foods have very low levels of pesticides: onions, avocados, sweet corn, pineapples, mangoes, peas, asparagus, kiwi fruit, cabbage, eggplant, melons, grapefruit, sweet potatoes, papayas, sweet peas, cantaloupe, broccoli, cauliflower, mushrooms and cabbage. Fruits and vegetables that are eaten with their skin usually contain higher pesticide levels, but I do not recommend removing edible skins from produce just to reduce pesticide exposure, because the skins are concentrated sources of nutrients and fiber. Washing fresh fruits and vegetables under running water can help to remove bacteria and chemicals from the surface of fruits and vegetables, whether they are organic or conventionally grown.

My Recommendations
Diana and I support organic farmers for their efforts to solve environmental problems, and we often buy organic produce. However, if budget is an issue, it’s more healthful to eat a lot of conventionally-grown fruits and vegetables than a small amount of organic fruits and vegetables or none at all. The scientific literature shows that it is more healthful to eat lots of fruits and vegetables from any source than to replace them with the processed foods that crowd our supermarket shelves.
• The label “organic” does not mean that a food is healthful. Organic white flour, organic sugars and organic junk foods, such as cookies, crackers, chips or ice cream, are still junk foods.
• Wash all fruits and vegetables before you eat them, even though washing does not remove all pesticides. Remove the outer leaves from lettuce, cabbage and other leafy greens.

FEB 9

Nitrates: One Reason to Eat Lots of Vegetables

Nitrates from the foods you eat can be converted in your body to nitric oxide, which widens blood vessels to increase blood flow throughout your body, to improve exercise tolerance and to help prevent heart disease (Med Sci Sports Exerc, Feb 1, 2021;53(2):280-294; Scand J Med Sci Sports, Oct 1, 2012) and to lower high blood pressure (Nitric Oxide, Nov 1, 2018;80:37-44; Hypertension, 2010;56:274-81). Doctors prescribe nitrates to treat angina to increase blood flow to the heart. Older people, in particular, should increase their intake of nitrate-rich vegetables, since aging decreases the body’s ability to make nitric oxide.

Population studies have repeatedly shown us that vegetable-rich diets are associated with reduced risk for high blood pressure, strokes and heart attacks (Am J Clin Nutr, 2013;98:1514-1523), and many other diseases (J Am Heart Assoc, July 2016;5(7):e003402). In particular, leafy green vegetables appear to be the foods that offer the most protection against strokes and heart attacks (Ann Intern Med, 2001;134:1106-1114) and leafy green vegetables are the foods that are among the highest dietary sources of nitrates (Am J Clin Nutr, 2009;90:1-10). The best vegetable sources of nitrates are those in which you eat the leaves, stems or roots: celery, lettuce, radishes, beets, spinach, broccoli, Chinese cabbage, onions, endive, kohlrabi, leeks, parsley, carrots, and so forth (Am J Clin Nutr, 2009 Jul;90(1):1-10)

You Don’t Need Beet Root Juice

Some bicycle racers drink beet root juice because a study showed that beet root juice before a time trial helped racers go 2.8 percent faster over both 4K and 16K courses (Med Sci Sports Exerc, June 2011). Beet root juice contains nitrates and the dose of nitrates used in the study (6.2 mmol) was 4-12 times greater than what the average person takes in each day. Nitrates have been shown to reduce the oxygen cost of cycling (J Appl Physiol, 2009;107:1144-55), increase power of knee extensor exercise (J Appl Physiol, 2010;109:135-48), and help athletes run faster (J Appl Physiol, 2011;110:591-600). However, athletes can get their nitrates just by eating lots of vegetables (Med Sci Sports Exerc, 2014;47:1643-1651); beet root juice does not have any special benefits.

Why Nitrates in Meat May Be Harmful

Additives such as sodium nitrate are used to preserve meats and give them their pink color, and nitrates in processed meats have been associated with increased risk for heart attacks and certain cancers. Nitrates are known to help suppress the growth of harmful bacteria but they have also been linked to potential cancer-causing effects. Nitrates are relatively inert and do not react with chemicals around them, but nitrates can be converted by bacteria in the mouth to nitrites, which pass to the stomach where the strong stomach acids convert nitrites to known chemical carcinogens called nitrosamines. This occurs abundantly only when there is a rich source of ammonia and other amines found in high-protein foods, such as meat, fish and chicken. So while the nitrates in vegetables are healthful, nitrates in meats may be harmful. Cooking meats at high temperatures also creates nitrosamines. The potential link between cancers and nitrates, nitrites or nitrosamines from meats is controversial, and has been seen only with eating meat daily; occasional meat eating has not been associated with increased risk for cancer.

Do Not Take Nitrate Pills or Drink Stale Cooking Liquids

Excessive nitrites can accumulate and prevent oxygen from attaching to red blood cells. This rare condition, called methemoglobinemia, can prevent you from even being able to move and can be fatal. This condition could be caused by taking nitrate pills or by drinking very large amounts of stale juice from cooked spinach or other vegetables high in nitrates that have not been refrigerated. Boiling vegetables reduces nitrate content (Toxicol Lett, 2008(Oct 1);181(3):177-81), but bacteria in old, stale vegetable juices can convert the healthful nitrates to the potentially-harmful nitrites. Fresh vegetables are usually resistant to bacterial infections, but once a vegetable is cooked, bacteria can multiply in the cooking liquid. Refrigerate leftover cooked vegetables and eat them within a few days. Freezing inactivates bacteria, so commercially frozen cooked vegetables should have low levels of nitrites. You can also freeze your own cooked leftover vegetables.

My Recommendations

If you want to get all of the benefits from the right kinds of nitrates, eat a widely varied diet with at least five servings a day of vegetables and fruits. Read the list of ingredients on processed meats and other processed foods, and limit or avoid those that list additives such as “sodium nitrate.”

FEB 5

Nitrates: One Reason to Eat Lots of Vegetables

Nitrates from the foods you eat can be converted in your body to nitric oxide, which widens blood vessels to increase blood flow throughout your body, to improve exercise tolerance and to help prevent heart disease (Med Sci Sports Exerc, Feb 1, 2021;53(2):280-294; Scand J Med Sci Sports, Oct 1, 2012) and to lower high blood pressure (Nitric Oxide, Nov 1, 2018;80:37-44; Hypertension, 2010;56:274-81). Doctors prescribe nitrates to treat angina to increase blood flow to the heart. Older people, in particular, should increase their intake of nitrate-rich vegetables, since aging decreases the body’s ability to make nitric oxide.

Population studies have repeatedly shown us that vegetable-rich diets are associated with reduced risk for high blood pressure, strokes and heart attacks (Am J Clin Nutr, 2013;98:1514-1523), and many other diseases (J Am Heart Assoc, July 2016;5(7):e003402). In particular, leafy green vegetables appear to be the foods that offer the most protection against strokes and heart attacks (Ann Intern Med, 2001;134:1106-1114) and leafy green vegetables are the foods that are among the highest dietary sources of nitrates (Am J Clin Nutr, 2009;90:1-10). The best vegetable sources of nitrates are those in which you eat the leaves, stems or roots: celery, lettuce, radishes, beets, spinach, broccoli, Chinese cabbage, onions, endive, kohlrabi, leeks, parsley, carrots, and so forth (Am J Clin Nutr, 2009 Jul;90(1):1-10).

You Don’t Need Beet Root Juice
Some bicycle racers drink beet root juice because a study showed that beet root juice before a time trial helped racers go 2.8 percent faster over both 4K and 16K courses (Med Sci Sports Exerc, June 2011). Beet root juice contains nitrates and the dose of nitrates used in the study (6.2 mmol) was 4-12 times greater than what the average person takes in each day. Nitrates have been shown to reduce the oxygen cost of cycling (J Appl Physiol, 2009;107:1144-55), increase power of knee extensor exercise (J Appl Physiol, 2010;109:135-48), and help athletes run faster (J Appl Physiol, 2011;110:591-600). However, athletes can get their nitrates just by eating lots of vegetables (Med Sci Sports Exerc, 2014;47:1643-1651); beet root juice does not have any special benefits.

Why Nitrates in Meat May Be Harmful
Additives such as sodium nitrate are used to preserve meats and give them their pink color, and nitrates in processed meats have been associated with increased risk for heart attacks and certain cancers. Nitrates are known to help suppress the growth of harmful bacteria but they have also been linked to potential cancer-causing effects. Nitrates are relatively inert and do not react with chemicals around them, but nitrates can be converted by bacteria in the mouth to nitrites, which pass to the stomach where the strong stomach acids convert nitrites to known chemical carcinogens called nitrosamines. This occurs abundantly only when there is a rich source of ammonia and other amines found in high-protein foods, such as meat, fish and chicken. So while the nitrates in vegetables are healthful, nitrates in meats may be harmful. Cooking meats at high temperatures also creates nitrosamines. The potential link between cancers and nitrates, nitrites or nitrosamines from meats is controversial, and has been seen only with eating meat daily; occasional meat eating has not been associated with increased risk for cancer.

Do Not Take Nitrate Pills or Drink Stale Cooking Liquids
Excessive nitrites can accumulate and prevent oxygen from attaching to red blood cells. This rare condition, called methemoglobinemia, can prevent you from even being able to move and can be fatal. This condition could be caused by taking nitrate pills or by drinking very large amounts of stale juice from cooked spinach or other vegetables high in nitrates that have not been refrigerated. Boiling vegetables reduces nitrate content (Toxicol Lett, 2008(Oct 1);181(3):177-81), but bacteria in old, stale vegetable juices can convert the healthful nitrates to the potentially-harmful nitrites. Fresh vegetables are usually resistant to bacterial infections, but once a vegetable is cooked, bacteria can multiply in the cooking liquid. Refrigerate leftover cooked vegetables and eat them within a few days. Freezing inactivates bacteria, so commercially frozen cooked vegetables should have low levels of nitrites. You can also freeze your own cooked leftover vegetables.

My Recommendations
If you want to get all of the benefits from the right kinds of nitrates, eat a widely varied diet with at least five servings a day of vegetables and fruits. Read the list of ingredients on processed meats and other processed foods, and limit or avoid those that list additives such as “sodium nitrate.”

JAN 30

10 Meals To Struggle Getting older And Maintain You Lifting Longer

Make sure you’re at your peak regardless of your age with these dietary suggestions.

As we’re getting up in age, all of us want we had the instruments to fight the results of the growing old course of.

Neglect in regards to the sagging pores and skin, slower stamina, a weakened immune system, and weight acquire are the enemies right here. There are numerous mechanisms to assist stall these growing old realities.

Holding a wholesome life-style with a sound weight loss plan and exercise routine are a given. End the method with these nutritious, muscle-preserving meals.

Pomegranate

This superfood does all of it from elevating nitric oxide ranges to stopping illnesses attributable to its excessive antioxidant profile. This fruit can be filled with vitamin C, serving to stop wrinkes from solar harm. But unknown to many, the juice that’s discovered within the seeds comprise two of probably the most highly effective compounds: ellagic acid and punicalagin.

Ellagic acid fights off free radicals, and punicalagin is a supernutrient that may improve your physique’s capability for maintaing collagen. Collagen is accountable for making your pores and skin look plump and clean.

Salmon

Wealthy in omega-3 fatty acids, salmon can assist enhance the integrity of your pores and skin’s cell membrane — serving to lock in moisture.

Omega-3 fatty acids have additionally been linked to lowering weight and having coronary heart well being properties — finally selling longevity.

Inexperienced Leafy Greens

Any darkish, inexperienced leafy greens comprise the unique group of antioxidants referred to as, phytonutrients. These compounds assist defend your pores and skin from any solar harm. Spinach, particularly, is excessive in beta-carotene and lutein — two compounds that promote pores and skin elasticity.

Inexperienced Tea

Inexperienced tea is the final superfood as a result of it has been seen to pack on all kinds of well being advantages.

The catechins discovered on this brew can assist keep off these undesirable brown spots which can be brought on by the solar. And the polyphenols which can be discovered on this tea can assist reverse the results of growing old.

Olive Oil

The “good fat” in olive oil have a myriad of health-promoting growing old advantages. Specifially, the omega-3 fatty acids which can be current assist to enhance blood circuation all through the physique — giving your pores and skin that rosey coloration.

Additionally, the “good fat” work to boost t-levels, which not solely enable you to attain your health objectives but additionally make you’re feeling youthful.

Beans

As you become old, hair loss will occur, however consuming meals which can be excessive in protein and iron can provide hair follicles a lift.

Protein is really the constructing block for hair. Lentils can truly play a key position in hair upkeep — serving to thicken hair cells.

Cranberries

Ingesting cranberry juice has been recognized to stop and deal with bladder issues due to it’s anti-bacteria properties.

These properties have additionally been tied to defending your tooth from cavities. Research have proven that cranberry juice can stop unhealthy micro organism from sticking to your tooth — stopping the formation of plaque. One caveat is that cranberries are excessive in sugar, which is an element that may contribute to cavities.

So subsequent time you’re grocery purchasing, decide up weight loss plan cranberry juice.

Avocado

Avocados are loaded with monounsatured fat — the “good fat” — which may enhance mind perform and pores and skin texture. Bonus: avocados are excessive within the mineral, boron. Boron helps to soak up calcium — bettering bone density.

Turmeric

Taste up a meal with this anti-aging spice. Turmeric has been seen to stop most cancers because of the compound curcumin, and it may well enhance mind perform and stop effective traces from showing. Curcumin can be a typical joint-frendly supp for lifters.

Purple Wine

This fountain of youth listing wouldn’t be full without purple wine. Purple wine accommodates the compound, reservatrol — lowering the chance of creating warmth illness and making you’re feeling younger.

JAN 26

Added Sugars Linked to High Blood Pressure

A review of studies on sugar-added foods shows that people who take in 10-25 percent of their calories from sugared beverages and foods suffer a 30 percent higher risk for heart attacks, compared with people who take less than ten percent of calories from added sugars (British Medical Journal: Open Heart, Dec. 11, 2014). The review also found that:

• higher added-sugar intake was associated with increases in systolic and diastolic blood pressure of 6.9 and 5.6 mm Hg.

• the more sugared foods you eat, the higher your bad LDL cholesterol.

• sugars occurring naturally in foods, such as fruit, did not appear to increase risk for high blood pressure or heart attacks.

Another review of twelve scientifically-dependable studies involving 409,707 participants showed that sugar-sweetened beverages are associated with increased risk for high blood pressure, a major risk factor for diabetes and heart attacks (The American Journal of Cardiology, February 2014).

What is High Blood Pressure?

You have high blood pressure if your systolic blood pressure is greater than 120 before you go to bed at night and just after you wake in the morning. That is when your blood pressure is at its lowest level. You may also have high blood pressure if your systolic pressure is greater than 140 after resting for 5 to 10 minutes during the day.

What Causes High Blood Pressure?

More than 90 percent of North Americans will develop high blood pressure. Kidney damage or an overactive adrenal gland can cause high blood pressure, but these causes occur so rarely that most doctors do not even order a renin level to look for kidney damage, or an aldosterone level to look for adrenal problems.

Many doctors believe that a high-salt diet is a major cause of high blood pressure, but low-salt diets reduce systolic blood pressure by less than 5 mm Hg in most adults with hypertension, and the average reduction in diastolic blood pressure associated with a low-salt diet among adults with high blood pressure is 2.5 mm Hg (JAMA Intern Med, 2014;174(4):516-524). Low-salt diets are associated with increased risk for death in people who also have diabetes.

The people who are most likely to get high blood pressure from taking in too much salt are those whose cells are insulin resistant. Their cells do not respond well to insulin (Hypertension, Jan 2013), so the pancreas keeps on releasing large amounts of insulin to try to lower high blood sugar levels. High levels of insulin constrict arteries to cause high blood pressure. People with high insulin levels are the ones who get high blood pressure when they take in too much salt (Am J Hypertens, 1998 (Apr);11(4 Pt 1):397-402). For them, a high salt intake increases blood pressure, insulin and blood sugar.

How Sugar-Added Foods Can Cause High Blood Pressure

More than 80 percent of people who have high blood pressure also have insulin resistance, an inability to respond normally to insulin. This means that when they eat or drink sugar-added foods, their blood sugar levels rise, causing their insulin levels to rise which constricts arteries to cause high blood pressure (British Medical Journal: Open Heart, Dec. 11, 2014).

How Can You Tell if You are Insulin Resistant?

People who are insulin insensitive usually have what is called metabolic syndrome. You probably have metabolic syndrome if you have any three of the following:

• storing fat primarily in your belly

• having small hips

• being overweight

• having blood triglycerides (>150)

• having blood HDL cholesterol (<40) • having high blood pressure • having a fatty liver • having a fasting blood sugar >100 (HbA1c> 5.7)

• having high insulin levels

Lifestyle Changes, Not Drugs, Can Cure High Blood Pressure

You cannot cure high blood pressure with drugs; you can only control it as long as you continue to take drugs (Hypertension, 2002;40(5):612-618). Most of the time, your blood pressure cannot be controlled with just one drug and most people end up with three or more drugs to treat their high blood pressure.

Lifestyle Changes to Lower Blood Pressure

• Restrict sugared drinks and sugar added to foods.

• Restrict refined carbohydrates. Whole grains are seeds with a fiber coating that forms a thick capsule which cannot be broken down efficiently in your intestines, so blood sugar and insulin levels barely rise after you eat them. However, when you grind whole grains into flour, you break the capsule so the starches can be absorbed quickly. Foods made from flour, such as bakery products or pasta, cause a high rise in blood sugar and insulin.

• Eat large amounts of fruits, vegetables and seeds. Unprocessed vegetables, whole grains, nuts, other seeds and most fruits contain complex carbohydrates and fats that are not released rapidly into the bloodstream. These nutrient-rich foods do not cause a high rise in blood sugar and insulin.

• Exercise. Resting muscles draw no sugar from the bloodstream. On the other hand, contracting muscles draw sugar rapidly from the bloodstream and don’t even need insulin to do so. The more intensely you exercise, the less insulin is needed by muscles to withdraw sugar from the blood and this effect lasts for up to 17 hours after you finish exercising.

• Avoid overweight. Your liver controls blood sugar levels. When blood sugar levels rise, insulin drives sugar from the bloodstream into the liver. However, the more fat you have stored in your liver the harder it is for sugar to enter liver cells in response to insulin. A fatty liver will raise blood sugar levels even higher by releasing stored sugar from its cells into the bloodstream.

• Avoid smoking. Smoking damages every cell in your body.

JAN 15

How Pre-Diabetes Increases Risk for Dementia

One of the definitions of pre-diabetes is a high rise in blood sugar after meals, and a recent study suggests that many cases of dementia are linked to these high rises in blood sugar (JAMA Netw Open, Jan 8, 2021;4(1):e2033012). This study of 3889 adults found that people who suffer from loss of mental function and dementia have much higher levels of Advanced Glycation Endproducts (AGEs) in their skin. AGEs form in your body when your blood sugar rises too high after you eat, causing the sugar to stick irreversibly to proteins, fats, or nucleic acids (Diabetologia, 2001;44(2):129-146). The AGEs turn on your immune system to cause inflammation that can damage all types of cells in your body and increase risk for dementia, heart attacks, strokes, and certain cancers (World J Cardiol, Apr 26, 2012;4(4):90-102).

This new study is the first to show that high levels of AGEs in the skin may be used to predict future loss of mental function and dementia. Many previous studies show that AGEs can accumulate in the brains of people who suffer from dementia (Biochem Biophys Res Commun, 1997;236(2):327-332), and researchers can measure the amount of AGEs in the skin to determine the amount of AGEs in the brain (Diabetologia, 2004;47(7):1324-1330). Measuring the amount of AGEs in the skin can also be used to demonstrate increased amounts of AGEs in arteries to predict risk for heart disease (Arterioscler Thromb Vasc Biol, 2014;34(12):2695-2699). Doctors use a blood test called APOE4 to check for genetic susceptibility for dementia. AGEs may well be the link to this dementia as people with this genetic susceptibility for dementia have higher levels of AGEs in their brains (J Gerontol A Biol Sci Med Sci, 2020;75(10):1899-1905).

Dementia Associated with a High Rise in Blood Sugar After Meals
Pre-diabetics have a high rise in blood sugar after meals and are at very high risk for episodic loss of memory, decreased executive function, and loss of verbal fluency, processing speed, cognitive flexibility, and cognitive control (Lancet, 2012;379:2291-2299). Blood sugar control can help to preserve brain function (J Gerontol A Biol Sci Med Sci, 2016;71(Suppl 1):S62-S71).

Everyone’s blood sugar rises after they eat. If your blood sugar rises too high, sugar sticks to cells to form AGEs. To prevent blood sugar from rising too high, your pancreas is supposed to release insulin, which lowers blood sugar by driving sugar from the blood into the liver and muscles. However, if your liver is full of fat, it does not accept the sugar and blood sugar levels rise even higher. This is called insulin resistance. You can also have high blood sugar from lack of, and failure to respond to, insulin.

Clues That You May Be Pre-Diabetic
Having a normal fasting blood sugar (less than 100 mg/dL) does not rule out diabetes. You are probably pre-diabetic and are at increased risk for Type II diabetes if:
• you can pinch more than two inches of fat under the skin near your belly button
• you have a big belly
• you have small buttocks compared to your belly
• you have an HBA1c blood test higher than 5.7
• your blood sugar one hour after a meal is greater than 145 mg/dL
• your triglycerides are greater than 150 mg/dL
• your HDL is less than 40 mg/dL
• you have small-particle lipids
See The Hidden Epidemic of Early Diabetes

Preventing and Curing Type II Diabetes
Many people are susceptible to develop diabetes because they genetically store fat primarily in their belly. Skinny people can be diabetic just because their liver is full of fat (“fatty liver“). A simple sonogram of your liver can show if you have a fatty liver. To reverse the progression toward diabetes, you need to lose enough weight to get the fat out of your liver.
• lose weight by whatever means works for you (I recommend intermittent fasting)
• try to exercise for at least 30 minutes every day
• eat plenty of vegetables, whole un-ground grains, beans, nuts, and whole fruits (not fruit juice)
• restrict or avoid meat from mammals, processed meats, sugar-added foods, fried foods, and all refined carbohydrates (found in foods made from flour and many processed foods)
• drink only water, coffee or tea with no calories or artificial sweeteners

My Recommendations
At age 45, you have a 20 percent chance of developing dementia as you age (Dementia, 2015;11(3):310-20), and more than 35 percent of North Americans over the age of 85 have early or full-blown dementia. More and more studies are showing that a high rise in blood sugar is a major risk for dementia. If you have any of the risk factors for diabetes, you should immediately begin a program to lower the rise in blood sugar after you eat.

JAN 13

Exercise Treats Insulin Resistance

Up to 70 percent of North Americans adults will develop diabetes or pre-diabetes, usually from insulin resistance caused by excess fat in the liver and muscles. Exercise helps to empty fat from the liver and muscles, so exercise helps to prevent and treat diabetes.

Nearly 69,000 men and women with no diabetes or heart problems were tested for heart fitness by running on a treadmill (American J of Medicine, January 9, 2020). Insulin resistance was measured by a fasting blood sugar greater than 100 mg/dL and triglycerides greater than 150mg/dL. Compared to non-obese fit people, those who were:

• unfit women and men who were not overweight had more than double the risk of insulin resistance

• fit but obese women had 11 times the incidence of insulin resistance

• unfit and obese women had more than 20 times the incidence of insulin resistance

• fit but obese men had 7.4 times the incidence of insulin resistance

• unfit and obese men had 12.9 times the incidence of insulin resistance

Definition of Insulin Resistance

Insulin drives sugar, fat and protein into cells. Insulin resistance means that the cells do not respond to insulin, so sugar builds up in the bloodstream. Everyone’s blood sugar rises after they eat, but if blood sugar rises too high, sugar irreversibly sticks to cells and can destroy every kind of cell in your body. To prevent blood sugar from rising too high, your pancreas releases insulin into your bloodstream, which lowers blood sugar by driving sugar from the bloodstream into the liver. However, if the liver is full of fat, it does not accept the sugar and blood sugar levels rise even higher. Insulin resistance can be reversed by emptying fat from the liver and muscles.

Use Both Aerobic Exercise and Resistance Exercise to Combat Insulin Resistance

• The larger your muscles, the less likely you are to become insulin resistant. High blood sugar causes loss of muscle size (JCI Insight, February 21, 2019;4(4)).

• Six weeks of resistance exercise improves insulin sensitivity in young, overweight men (Experimental Physiology, Feb 1, 2019).

• A review of 105 studies shows that a regular exercise program lowers fasting blood sugar and HBA1c (which measures the amount of sugar stuck on cells) in both diabetics and non-diabetics, and that each additional 100 minutes per week of physical activity was associated with a mean average decrease of 2.75 mg/dL of fasting blood sugar (Acta Diabetol, (2017) 54:983).

• Strength training lowers high blood sugar levels and liver fat, even before weight loss occurs (Journal of Endocrinology, Apr 2019;241(1):59–70).

Intense Exercise Lowers HBA1c

• A review of eight studies on 235 participants who exercised from 12 weeks to six months found that the greater the intensity of exercise, the greater the lowering of HBA1c, a measure of cell damage from high blood sugar levels (Acta Diabetol, June 17, 2016).

• A review of 47 studies of 8,538 patients who exercised more than 12 weeks for more than 150 minutes per week, showed a significant reduction of HBA1c (JAMA, Nov 24, 2010;304(20):2253-62; JAMA, May 4, 2011;305(17):1790-9).

• A study of 262 sedentary middle-aged men and women, with type 2 diabetes and HBA1c levels of 6.5% or higher, found that a combination of aerobic and resistance training (three days a week for nine months) improved HBA1c levels, compared with a non-exercising control group. This was not achieved with aerobic or resistance training alone (JAMA, Mar 2, 2011;305(9):892).

• A review of 12 studies of 2-6 months of exercise in diabetics found that aerobic exercise reduced HBA1c more than resistance exercise, and the greater the weight loss, the greater the drop in HBA1c, peak oxygen consumption, and maximum heart rate. The authors felt that aerobic and resistance exercises were equal in helping to prevent heart attack risk factors (Sports Med, Apr 2014;44(4):487-99).

My Recommendations

Most cases of diabetes are caused by insulin resistance which usually comes from excess fat in the liver and muscles. Both aerobic and resistance exercise help to prevent and treat diabetes by helping to empty the liver and muscles of excess sugar. Exercise helps to reduce excess weight, high blood pressure, high LDL cholesterol, and high triglycerides. Exercise also helps to increase healthy HDL cholesterol, strengthens muscles and bones, and combats depression

JAN 12

Recreational Runners and Cyclists Should Lift Weights

To preserve muscle and bone size and strength, recreational runners and cyclists should do upper body and core weight lifting and resistance training. Everybody will lose muscle and bone size and strength with aging. Your bones weaken progressively after age 30, and between ages 35 and 50, about 28 percent of North American men and women suffer from bone weakening called osteopenia (J Amer Osteo Assoc, June 2019;119:357-363). By age 65, 25 percent of women and six percent of men are at high risk for breaking their hips or spine with minor falls (CDC/National Center for Health Statistics, August 2015).

The people who lose the most muscle are usually the ones who are most at risk for falls and broken bones. Any prolonged period of inactivity, such as bed rest, injured nerves, wearing a cast or even living in a decreased force of gravity, will cause loss of muscle tissue (Med Hypotheses, 2007;69(2):310-21). If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Just one year of lifting weights can strengthen the bones enough to help protect people from fractures (Bone, Oct 2015;79:203-212).

The hard ground impact of fast running may slow bone loss (BMC Med, Dec 20, 2012;10:168), but cycling does not prevent age-associated osteoporosis. A review of 22 scientific studies shows that adding a resistance program such as lifting weights to endurance sports such as running or cycling can markedly slow this loss of muscle and bone, and actually increase muscle size and strength, with greater benefit from low volume, high-resistance weight lifting than high volume, lower-resistance exercise (Human Movement, July 23, 2020;21(4);18-29).

Strength Training May Not Help Competitive Cyclists or Runners Go Faster

Studies show mixed results on whether runners and bicycle racers can run and cycle faster with added strength training, but most studies show limited benefit of strength training for endurance athletes because strength training does not improve your ability to take in and use oxygen. The limiting factor for how fast an endurance athlete can run or cycle over distance is the time it takes to move oxygen into muscles, and that is improved only by training that involves creating an oxygen debt (becoming short of breath). Lifting weights and doing other resistance exercises do not increase VO2max, the maximal amount of oxygen that a person can take in and use (Med Sci Sports Exerc, 2002;34(8):1351–1359; Sports Med, Aug 2016;46(8):1029-39). Competitive runners and cyclists can do their leg strength training just by running or pedaling their intervals faster (Scand J Med Sci Sports, Oct 2010;20(Suppl 2):11-23 and Nov 2010;38(11):1965-70).

Leg Strength Training Can Cause Injuries in Runners and Cyclists

Most runners and cyclists should do resistance training only for their core and upper body, and use their legs only for running and cycling. A major problem with adding a weight lifting program for the legs to running or cycling is a marked increase in risk for leg injuries. Ideal training for endurance is to go more intensely on one day, damage your Z-lines in your muscle fibers, and feel delayed onset muscle soreness (DOMS) on the next day. (DOMS is necessary for gaining strength.) The day after you do weight training with your legs, your leg muscles will be weaker and this would interfere with any attempted intense endurance workout or resistance exercise (Sports Med, Nov 2017;47(11):2187-2200). You are supposed to exercise slowly and easily for as many days as it takes for the soreness to lessen before you do your next intense workout. Therefore you should not do resistance training for your legs on a day when your legs are recovering from the previous day’s intense workout.

For at least a day after lifting weights, an athlete is at high risk for tearing muscle fibers if he attempts an intense endurance workout. Thus you would need to do your intense endurance workouts and your resistance exercises on the same day, and this increases risk for injuring yourself. If you want to add leg resistance exercises to a leg endurance program, you must learn to recognize the signs of overtraining and back off when your muscles feel excessively fatigued or sore.

My Recommendations

• Non-competitive runners and cyclists should alternate faster and more intense days with slower recovery days, do strength training only for their core and upper body, and not do resistance training on their legs. Combining endurance and strength training on the same muscle groups increases risk for injury. Most competitive athletes should also follow this program.

• Elite runners and cyclists may want to combine leg strength training with leg endurance training, but they should do the strength training not more than twice a week, only on hard days (after an intense endurance workout), and never on recovery days. They should skip the weight workouts when their muscles feel excessively sore or tight, stop the strength training workouts during their competitive season, and hope that they do not suffer injuries.

• If you are not already doing strength-training exercise, first check with your doctor to make sure you do not have any condition that may be harmed by exercise. I have always recommended joining a gym and using the weight training (Nautilus-type) machines there, but until COVID-19 is under control, you will want to find a way to do resistance exercises at home. Resistance exercise can increase muscle size and strength in older people, but with aging you need to work longer to gain the amount of strength that a younger person would get with the same program (Med Sci Sports Exerc, 2011;43 (2):249-58). Since lifting lighter weights many times is less likely to cause injuries, I recommend lifting lighter weights with more repetitions.

• Stop immediately if you feel severe pain or if you have pain that does not go away as soon as you stop lifting the weight. Pain in a muscle or tendon is often the first sign of an impending injury.

• Take the day off if your muscles feel sore or fatigued after a 5-10 minute pre-workout warmup.

• Just using and contracting your muscles in any activity offers health benefits, but you can gain additional benefits by adding intensity with some form of