How Isometrics Help Lower Your BP

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If you have a home blood pressure monitor, try a little experiment on yourself. Set up your monitor and cuff and sit quietly in a chair. After five minutes or so, take a deep breath, exhale, and hit the Start button on the monitor while breathing normally as your BP is taken. Record the results. Make sure the cuff deflates completely and continue sitting for another five minutes.

Then repeat the deep breath, exhale, and hit the Start button. This time, I want you to contract the muscle in the opposite arm as much as you can and hold the contraction until the BP is done, breathing normally the entire time. Do you notice a difference in the BP without and with contracting your opposite arm? Unless you lift heavy weights on a regular basis, you probably did.

When you contract the opposite arm, you’re restricting blood flow to that arm, thereby increasing the resistance. When you relax, there should be an increase in blood flow to that tissue. When you do isometric exercises regularly, that’s what happens in every muscle group involved.

How Isometrics Can Lower BP

Let’s return to the study. The researchers did a secondary analysis to see if they could find the exercise that lowered BP the most. The wall sit or wall chair worked best to lower systolic blood pressure, while running lowered diastolic blood pressure the most.

What’s the wall sit? It’s depicted in the photo above. The idea is to stand a foot or so from the wall, lean back until your back contacts the wall, and slide down to a sitting position for five to ten seconds, then slide back up. Repeat ten times several times per day; the key is to never hold your breath while you do it. The quadriceps and the gastrocnemius are a substantial amount of muscle. Restricting blood flow with isometrics will increase the resistance on the heart and blood vessels. The benefit is that you will get a training effect on both that lowers BP.

What’s actually going on with the nervous, cardiovascular, and muscular system isn’t quite clear, but knowing why won’t help you do them. If you don’t have orthopedic issues (and you don’t hold your breath while performing the isometrics), no matter what muscle groups you use, you may help lower your BP. I think the wall sit works the best due to total muscle mass involved, but every muscle group will help.

The Bottom Line

Will isometrics make you super fit? No. Super strong? No. There are also limitations as to the angles where strength will increase due to specificity of training. But there seems to be an emphasis on improving health with short episodes of exercise. Isometrics fit that niche quite well and as the study demonstrated, quite effectively as related to BP. We’re not done yet because two other studies have focused on activities that involve movement. We’ll talk about those next week. In the meantime, have a great Labor Day holiday.

What are you prepared to do today?

        Dr. Chet

Reference: British J Sp Med Online July 2023. doi: 10.1136/bjsports-2022-106503

Isometric Exercise Lowers Blood Pressure

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This summer has seen several studies about exercise, so we’ll just continue with the flow from last week. The first study caught me by surprise: isometric exercise lowers blood pressure. When you do isometric exercises, you increase tension in a muscle without moving the joint, such as holding your leg still while you clench your thigh muscles; if you’ve got a wall, a chair, and a floor, you’ve got all you need. We don’t think of isometric, also called static exercise, as being effective in changing the dynamic flow of blood in the cardiovascular system. Let’s take a look at the study.

Researchers conducted a literature search of all published studies that examined the impact of any type of exercise on systolic blood pressure (SBP) and diastolic blood pressure (DBP.) They conducted a pairwise and network meta-analysis to see which exercise helped BP the most. The most important finding was that every form of exercise significantly reduced SBP and DBP when performed for two weeks and longer: aerobic exercise, dynamic resistance (weight) training, combined training, high-intensity interval training (HIIT), and isometric exercise.

When they compared the efficacy of the different forms, isometric exercise lowered SBP the most, followed, in order, by combined training, weight training, aerobic training, and HIIT.

To me, isometrics are somewhat easy to perform because it removes obstacles such as orthopedic issues or equipment. But why would it reduce blood pressure more than other modes of exercise? We’ll check that out on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: British J Sp Med Online July 2023. doi: 10.1136/bjsports-2022-106503

The Key to Building Muscle

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The mega meta-analysis I talked about on Tuesday found that every combination of resistance, sets, reps, and number of days per week resulted in increased strength and increased muscle size compared to people who did nothing, but there were some combinations that provided the best results.

Finding the Best Approach to Building Muscle

Without question, lifting multiple sets with heavy weights improved strength the most. Even just one day per week showed an improvement in strength, but the most consistent results were found with at least two weight training sessions per week. What was surprising was that two sessions per week of multiple sets with light weights also saw a significant improvement in strength.

When it came to muscle hypertrophy, or more simply put, muscle size, lifting light weights for multiple sets twice per week saw the same improvement as lifting heavy weights multiple sets twice per week. That seems a little odd but may be supported by another recently published study.

In a pilot study with 22 subjects, half the group was put on a low-resistance, high-repetition weight training program while the other half was put on a more traditional heavy weight training program with fewer repetitions. The low-weight, high-repetition group performed sets of 20 to 24 repetitions, while the heavy-resistance group did the more traditional eight to 12 repetitions per set. The results showed similar benefits. There was an increase in muscle strength and muscle size in both approaches. Also the mean age of the subjects was 59 years. That eliminates the “younger people are stronger to begin with” factor.

Volitional Exertion
The pilot study reveals the key: in both approaches, the subjects were trained to push themselves to voluntary or what’s termed in the business as “volitional exertion.” It doesn’t mean barely able to lift the weight without assistance—it means that it would be a challenge to do one more repetition. It wasn’t the weight; it was the effort.

The Bottom Line

Since I talked about the 3/7 weight training program in the last Super Bowl webinar, I’ve favored that approach the most in my recommendations. It would be the low-resistance, high-repetition, two days per week approach. It seems better for beginners because even a two-pound resistance will produce results as long as they go to volitional exertion.

The author of the Washington Post article got it wrong when she said it would be easy to add muscle; it still requires consistency and effort. But it’s easier because it can be done in the comfort of your own home. Now, if we can just get everyone to do that—but that’s a challenge for another day.

What are you prepared to do today?

        Dr. Chet

References:
1. Br J Sports Med 2023;0:1–12. doi:10.1136/bjsports-2023-106807
2. Experimental Gerontology https://doi.org/10.1016/j.exger.2023.112219

Finding the Best Weight Training Program

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This year’s Super Bowl webinar on Aging with a Vengeance focused on muscle mass: hanging on to it or building it up if you’ve lost it, and how to make it happen. The fitness columnist for the Washington Post recently wrote an article on weight training that caught my attention, and I decided to take a closer look at the research behind her commentary about how easy weight training could be. There was one point that was glossed over. Let’s take a look at a recently published study that was the basis for her commentary.

Researchers decided to do what could best be described as a mega meta-analysis reviewing thousands of studies on weight training to see which type of program worked best to build strength and to increase muscle size. There were three main focal points: identify the best resistance (light, medium, or heavy weights), the best combination of sets and reps, and the number of days in a week necessary to accomplish the goals of size or strength. They found 192 studies that fit the profile for inclusion in the review. The results of their analysis were depicted in the graphs that are the graphic for this memo. Amazing.

The thickness of the lines indicates the number of studies that examined a specific type of weight training program; that gives us an indication of where the focus of research on weight training has been. In the results section, every combination of resistance, sets and reps, and days per week demonstrated some benefit. Then the researchers tried to tease out whether the use of light or heavy weight was better. I’ll talk about that on Saturday and also give you the key to determining the best weight training program.

What are you prepared to do today?

        Dr. Chet

Reference: Br J Sports Med 2023;0:1–12. doi:10.1136/bjsports-2023-106807

Ageism in the Mirror

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In today’s society, there is one form of discrimination that is tolerated without question: ageism. It’s easy to get the impression that after a certain age, people become more of a burden than a blessing to themselves and others. Recent research confirms that most people over 50 experience ageism. It happens in stores, restaurants, and most places of business; it certainly happens when driving. No question all forms of media practice ageism on a regular basis.

But perhaps the worst form of ageism is the one we expose ourselves to when we think about ourselves. That’s been categorized as internalized ageism: the negative voice in people’s heads that may push them to take extreme measures to look younger or tell themselves they’re having a “senior moment” every time they forget a name. Every time you tell yourself you can’t now do what you used to do when younger, that’s ageism.

Maybe you think “After all, I’m not as young as I used to be.” News flash: NO ONE IS! A newborn baby isn’t as young as she used to be 10 minutes ago. When you were 12, you couldn’t wait to get to 13 because you would be a teenager! When you were 15, you couldn’t wait to get to 16 so you could get a drivers permit. But after a few decades have gone by, is getting one more year older something to be avoided? Our bodies change, but let me ask you the key question: what have you done to reduce what you perceive to be decline, either mentally or physically?

It Begins in Your Mind

Based on research, how you think about yourself can impact how long you live by up to 7.5 years. I was amazed to learn that it can also reduce your risk of getting Alzheimer’s disease even if you have the gene to do so.

Changing your attitude about your age can result in taking better care of yourself. Being positive about aging can help you do the things you should do to be healthier, improve your self-confidence, reduce your risk of depression, and reduce the stress on your body.

Will there be things that you can’t do? Of course! You are the sum total of every meal, every twisted ankle, every accident, every stressor you’ve ever experienced. Things wear out. But you can work at being the best version of yourself no matter where you are today. It won’t be you at 20 or 30, but it can be the best version of you possible. That may be pretty terrific if you lose the dread and just ask yourself, “What’s next?”

The Bottom Line

Everything comes at a price. You will need to invest time and effort in yourself. The first step is correcting yourself every time a negative thought about your age creeps into your mind. I’m going to help you along the way with Aging with a Vengeance. The next four Memos will be about doing less and still getting benefit from exercise. If you want to understand the science underlying better aging, purchase the last two Super Bowl webinar replays that address energy and muscle.

The second step is to appreciate all you’ve gained in your days on this planet—all the valuable and useful wisdom and experience you’ve gained. Sad about wrinkles? Heck, no, you’ve earned those stripes!

Time to get your head in the game. What are you prepared to do today?

        Dr. Chet

References:
1. Washington Post 08/17/2023. Negative thoughts about aging can be harmful. Here’s how to reduce them.
2. Experiences of Everyday Ageism and the Health of Older U.S. Adults. JAMA Network Open. doi: 10.1001/jamanetworkopen.2022.17240

Research Update: Omega-3s and Lung Function

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Lung function declines as we age; depending on how we treat our lungs, our habits can determine the rate of decline. Working in toxic situations (or even worse, smoking cigarettes) can accelerate the decline. That’s why a recent study that examined blood levels of omega-3 fatty acids and measures of lung function found that our diet has an impact on lung function. Let’s look at this study.

Increases in Omega-3 Levels Prevent Decline

Of the two studies reported in the paper, I’ll stick to the longitudinal study, although both demonstrated the positive impact of omega-3s on lung function. A couple definitions first.

  • Forced expiratory volume 1 (FEV1) is the amount of air that one can forcefully breathe out in one second. The normal range is 2,500 to 3,250 milliliters.
  • Forced vital capacity (FVC) is the amount breathed out after a normal exhalation. The normal range is 3,700 ml to 4,800 ml.

One more thing: in this study, the mean rate of lung function decline was 36.8 mL per year for FEV1 and 35.8 mL per year for FVC.

Researchers examined a pooled group of studies that were part of the National Heart, Lung, and Blood Institute Pooled Cohorts Study. Studies were chosen because of the repeated measurements of both lung function and plasma phospholipid omega-3 fatty acids. The study found that higher omega-3 fatty acid levels were associated with less decline in lung function for 15,063 participants. The omega-3 that provided the most benefit was the omega-3 fatty acid DHA. In plain English, the more the DHA levels increased over time, the more the decline in lung function was prevented. I know that sounds funny to say it “prevented decline” but to say that it improved lung function would be incorrect.

The Questions

In both studies, nutritional information wasn’t collected, or if it was collected, it wasn’t used in the statistical analyses performed. The assumption seems to be that seafood and plants were the primary sources of omega-3 fatty acids, and that may be true. But it raises a question about the potential for using omega-3s in dietary supplements. Would the same response occur in reducing the risk of chronic kidney disease as it did for the loss of lung function?

It also raises another question. Many studies on the benefits of omega-3 supplements on heart health and other organs are often less than overwhelming. Could it be that there is a nutrient or nutrients in fish that, together with omega-3s, could contribute to benefits? Or could it be there’s a factor that helps with digestion, absorption, and utilization in the actual form of omega-3s used as supplements? We don’t know at this time.

The Bottom Line

While the benefits of omega-3s, specifically DHA, were small, the fact that they prevented decline over years contributes to aging with a vengeance. I think having a diet that includes the regular intake of fatty fish is the key to a healthy lifestyle, and I still think regular use of fish oil supplements may prove to be beneficial as the research continues. I’ll keep you posted.

What are you prepared to do today?

        Dr. Chet

References:
1. Am J Respir Crit Care Med. 2023 Jul 20. doi: 10.1164/rccm.202301-0074OC
2. BMJ 2023;380:e072909. doi: 10.1136/bmj-2022-0729092

Research Update: Omega-3s and Chronic Kidney Disease

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Two recently published articles examined the link between omega-3 fatty acids from fish and two conditions; let’s begin with a study on fish consumption and chronic kidney disease (CKD). By definition, CKD is the loss of kidney function over time. The kidneys are the major blood filtering system, so continued decline can impact the entire body.

Researchers selected 19 studies from 12 countries to perform a meta-analysis. The key variables were measurement of omega-3 fatty acid levels and types—EPA, DHA, and DPA from seafood, plus ALA from plant sources—together with the estimated glomerular filtration rate (eGFR). The researchers identified 25,570 participants that met the criteria and were included in the analysis.

Over a median of 11.3 years of follow-up, 4,944 (19.3%) developed CKD. Higher levels of total seafood omega-3s were associated with a lower CKD risk. In comparing categories of omega-3 levels, subjects with total seafood omega-3 level in the highest quintile had a 13% lower risk of developing CKD compared with those in the lowest quintile. The association appeared consistent across subgroups by age, eGFR, and diagnosis of hypertension, diabetes, and coronary heart disease at baseline.

While this was an observational study, there appeared to be an inverse relationship between blood levels of omega-3s from seafood sources and the development of CKD. Do we know if this included supplementation with omega-3s? That wasn’t assessed in this study. We’ll look at another recent study on omega-3s on Saturday and ask the big question.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2023;380:e072909. doi: 10.1136/bmj-2022-0729092

The Final Question on Ultra-Processed Food

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Here’s what we found out so far: When we eat ultra-processed food (UPF), we tend to eat way too much of them, upwards of 500 more calories per meal. We absorb more of those calories; the absorption starts sooner in the small intestine because of the simple carbohydrates in the UPF. Finally, we found out that we do not lose as many calories in our stool as we would if we had more fiber and more resistant starch in our foods.

But we need to answer one more question.

Is a Calorie Just a Calorie?

Despite the research that’s been done, all the clinical trials on UPF are on small groups of subjects. I’d like to see one more study similar to the one comparing the microbiome-beneficial diet with the Western diet high in processed foods. If researchers could do the same study on a group of overweight people and put them on one of two calorie-restricted diets—one following the microbiome-beneficial diet while the other used an ultra-processed food diet—we could see if there were differences in weight loss and other health markers between the two groups. Then we’d know whether there were any real differences between the types of calories we put into our bodies.

When thinking about weight loss, I always go back to the Minnesota Starvation Experiment. The subjects, all conscientious objectors, were given only the foods that would be available after WWII in war-ravaged Europe: bread, potatoes, and other root vegetables, little to no protein, and little fat. Normal-weight men lost weight and continued to do so for the entire six months of the study. If it’s just about the calories, then substituting UPF for the starvation diet and adjusting it on a weekly basis would get the same results today. But I don’t see that study happening any time soon.

Are UPFs Healthy?

Not in my opinion because of what they don’t have. No fiber. No resistant starch. No phytonutrients. Then add artificial flavors and colors and throw in sodium and umami flavoring to make us want to eat more of them. No, I don’t think they’re healthy. But if they’re a part of a total diet and consumption is controlled, then, while the research is not in yet, a calorie could be just a calorie.

The Bottom Line

It’s easy to be a demagogue and condemn UPFs as so many others have, but remember that protein powder is a highly processed food, whether from animal or plant sources. So is stevia, the “natural” sweetener. How about almond milk? Have you ever seen an almond teat? Neither have I.

What we need for good health today, not in 1900, 1930, 1950, or even 1970, is a balanced approach to nutritional intake. It’s as simple as eat better, but not perfect. Eat less, but don’t starve yourself on foods you don’t enjoy. And move more. It’s as simple as that.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41467-023-38778-x

Ultra-Processed Foods: Losing Calories

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In our examination of the research on ultra-processed food (UPF), we’ve found out that we consume more calories and that we absorb more calories if we eat UPF. The final question is probably going to seem a little unusual. Do we actually lose more calories if we eat less UPF? In other words, do we actually eliminate calories if we eat a diet favorable to our microbiome? This is really interesting: we may actually not absorb every calorie we consume! I must admit that this one surprised me; I didn’t realize that we lost calories in our stool under healthy conditions.

Researchers wanted to test whether diet could influence the number of calories lost in feces among a variety of other variables. The researchers recruited 17 healthy, normal-weight to overweight men and women with an average age of 31. They designed a diet that could enhance the microbiome by feeding the healthy microbes that reside in the colon. They matched the diet for percentages of calories and macronutrients with a Westernized diet. The major difference was the fiber content and level of resistant starch; the Western diet included more highly processed foods.

At different points in the study, on both types of diets, they measured the exact calories consumed, calories used in exercise, rest, and sleep, and collected all urine and stool for 24 hours. The most interesting result was that the microbiome-friendly diet increased the calories lost in the stool by an average of 116 calories per day. The bacteria were using the fiber and resistant starch to manufacture more metabolizable calories, but they were lost in feces. They weren’t absorbed, so those calories do not apply.

What does it all mean? More than that, what is the question that hasn’t been answered by any study on ultra-processed food? I’ll cover that on Saturday.

And here’s one more reason to limit UPF, according to an article in the Washington Post: “…eating more pro-inflammatory foods, such as processed meats or sugary sodas, was associated with a higher risk of fecal incontinence. The authors hypothesized that pro-inflammatory foods could have negative interactions with the gut microbiome and diminish the function of the muscles and nerves of the pelvic floor.”

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41467-023-38778-x

Are Ultra-Processed Foods Absorbed Faster?

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The next question to consider with UPFs is this: Do you absorb more calories from UPFs than you would from minimally processed food? The answer appears to be yes, but requires some explanation.

Keep in mind that UPFs have been mechanically and chemically altered during the manufacturing process. The original grains of wheat, corn, or even something such as carrots bear no resemblance to their original form. The components, especially the fiber, have been torn apart. What’s the big deal? The normal chemical bonds that make up the food matrix are no longer in the same form as they were. Therefore, they require less digestion and potentially can be absorbed much faster starting in the small intestine.

That can mean a couple of things. The higher the proportion of UPFs in the diet, the more calories from carbohydrates can enter the bloodstream and get there faster. Blood sugar goes up more quickly; if the calories aren’t immediately used, the extra calories can be converted into fat for storage, and don’t we all love that!

It also means that the food that could have fed our microbiome is no longer present—we’ve taken in plenty of calories, but our microbiome is starving. What nutrient is missing? Fiber in the form of resistant starch. What does it resist? Digestion and absorption. That’s the food for probiotics in the microbiome, and without it, our microbiome is starving and not as healthy as it could be. The more UPFs you eat, the more you need a fiber supplement.

There is one more question that needs to be addressed, and I’ll do that in the next Memo. In the meantime, how about a bowl of steel-cut oats, bean soup, or a nice salad? Your microbiome will be so happy!

What are you prepared to do today?

        Dr. Chet

References:
1. https://doi.org/10.1016/j.cmet.2019.05.008
2. https://doi.org/10.1038/s41467-023-38778-x