Flu Shots and Alzheimer’s Disease

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One of the benefits of large cross-sectional studies, especially in the age of electronic medical records, is that medical tests and treatments can be examined while examining diagnoses at the same time. The Veterans Health Administration is one of many medical databases that can identify relationships between health factors and the onset of disease.

In a recent study, researchers used a large medical records database called Optum Clinformatics Data Mart. The methodology section was long, but essentially they divided potential subjects into those who did not get a flu vaccination at all and those who got at least one flu vaccination every year or more. They identified their potential subject list and then tracked them for four years to see if they received a diagnosis of Alzheimer’s disease (AD). In case you were wondering, people under 65 were excluded because AD does not manifest itself appreciably until after that age.

The results were more than a little interesting. Those who got at least one flu shot had a 40% reduced risk of getting diagnosed with AD. Before you even think, as I would have, “How many subjects were there?”–there were close to a million subjects in each group. The better question is how would a vaccination reduce the risk of getting AD? We’ll examine that question on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Alz Dis. 88 (2022). 1061–1074. DOI 10.3233/JAD-220361

Timing for Enzymes, Prebiotics, and Probiotics

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My digestive system has undergone changes—it doesn’t work like it used to work. Hence, I’ve been paying closer attention to digestive supplements. My voice had been getting raspy, and I had occasional reflux; I was concerned the two were related. I had an endoscopy and found I was correct. They also found a hiatal hernia.

When your body doesn’t work as well as it should, you look for something to help. In this case, digestive enzymes, probiotics, and prebiotics are where you begin.

Digestive Enzymes

These are products that contain pancreatic enzymes that will help digest proteins, fats, dairy, and several kinds of carbohydrates. For them to be most effective, take them just before or as you begin eating, about five to ten minutes before.

Here’s a change in my recommendations from the past: You can take the digestive enzymes up to an hour after you began to eat. They work all through your small intestine, and that takes hours. They’ll catch up to the food you’ve eaten.

Unless you are taking them only because you know that protein gives you excessive gas or you need them to digest a meal with cheese, take them before every meal. Even snacks? Yes, unless you know the specific food. How do you know? Trial and error.

Will using the supplement cause your body to stop making the enzymes naturally? Apparently your body already isn’t making them, so don’t be concerned. The only other thing to work on is the volume of food you eat. Maybe for you, the amount is the issue, not the enzymes you naturally produce. It’s really trial and error.

Prebiotics and Probiotics

The only real research that’s been done on timing of probiotics and the foods that feed them, the prebiotics, was done with models of the digestive system in test tubes. Based on that, the best time to take probiotics with prebiotics is just before or with meals. Personally, I take my probiotics with a fiber prebiotic any time because the right food for the probiotic is going with them. But if it helps you to remember to take them, take them before, during, or after a meal. Just take them and if it’s with some fruit and vegetables, that’s great—more food for them to eat.

The Bottom Line

Your digestive system changes at various stages of life. That’s not a bad thing; it’s normal. Digestive products can help adapt to changes in your gut, as they helped me.

I’ve tried to give you the best approach for maximum benefits from your supplements. While the timing may be important, nothing is as important as taking them consistently. We tend to stop when we feel better; don’t do that! Remember, these are supposed to be made by our body or obtained from the food we eat. Take digestive supplements consistently to get results.

What are you prepared to do today?

        Dr. Chet

Reference: Benef Microbes. 2011 Dec 1;2(4):295-303. doi: 10.3920/BM2011.0022

Timing May Be Everything

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I’ve recently gotten a few questions on the timing of dietary supplements. That means it’s time for a review.

The first category would be multivitamins-multiminerals (MVMM) and other single- or multi-nutrient vitamin-mineral combinations such as calcium plus magnesium and vitamin D. The best time to take them is during or after a meal. The reason is that food has chelators for minerals and nutrients that can help with absorption.

What if you take a MVMM and want extra calcium? It depends on your objective. If you take them separately, you’ll get better absorption of the calcium and other minerals. As I said, there are substances in food that help absorption. But if you want to take them together, some will pass through but most will be absorbed.

The question is maximal absorption versus convenience. It won’t make a major difference, but consider what would be easier for you to remember; if you consistently forget to take them at separate times, you won’t absorb anything!

Consistency. The body adapts to what you do on a consistent basis. Timing for enzymes and microbes on Saturday.

What are you prepared to do today?

        Dr. Chet

Another Theory of Obesity

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It’s been a while since someone has proposed a new theory of obesity. I’m still a believer in “a calorie is a calorie” but it’s always good to find out what may be driving us to overeat.

The latest addition is the Fructose Survival Hypothesis for Obesity. The diagram above was taken from an article published in the journal Obesity. The authors claim that their new theory explains and is consistent with the other theories that include the energy-balance hypothesis, the carbohydrate-insulin model, the protein-leverage hypothesis, and the seed-oil hypothesis. They’re depicted in the large red circles and also include genetics and the microbiome. It all seems complicated, to say the least.

Fructose Survival Theory Simplified

Let’s just focus on the fructose in the blue box and follow those arrows. The arrow that goes up simply suggests that people who eat more fructose-containing food and drinks increase their food intake and gain weight. Simple.

The arrow that angles down to mitochondrial stress leads to a whole host of metabolic changes, all of which result in the decrease or blockage of production of ATP and the increase in fat storage. The result is obesity, altered blood lipids, and a fatty liver.

This pathway is apparently related to getting ready for hibernation, but one gene with the ability to store fat to protect against starvation kicks in and we just gain weight. Of course, it’s more complicated with multiple enzymes involved, but in reality it just goes back to one thing: eating and drinking too much of, in this case, refined carbohydrates.

Questions about the Fructose Theory

We know how this potential theory of obesity involving fructose metabolism seems to work. There are at least three questions:

1. Does the source of fructose matter? In other words, is high-fructose corn syrup (HFCS) more likely to impact weight more than the fructose in grapes or watermelon? The research in animals and a human trial involved eating and drinking the calories in prepared mixtures, but what about real food?

2. They suggest a pathway where glucose can be made into fructose by being exposed to salt, umami, and dehydration. In the animal trial, I couldn’t find total body water ascertained nor what type of sodium might be more hazardous: table salt? MSG? Pink salt?

3. Would the theory apply to normal weight people eating just enough to maintain their weight as it is, regardless of diet composition? Or would people gain weight even while not overeating, regardless of diet? They tested for outcomes in animals and people who were overweight to begin with, but there’s no evidence that people couldn’t lose weight if they cut calories even while eating a high-fructose diet.

Chemical drivers of food behavior such as those proposed must be studied, if for no other reason than to see if there are negative effects for people who don’t follow the mainstream dietary recommendations and yet maintain a healthy body weight. All this research has led to the research group being awarded a patent on a pharmaceutical that would interfere with a specific enzyme called fructokinase. We’re interfering with what they claim to be a natural process against starvation. Is that safe?

The Bottom Line

The researchers and drug developers have spent over a decade researching the fructose theory of obesity and spent millions of research dollars. They have a patented pharmaceutical that may address the issue. But the one question that they must answer, besides discovering any harms in clinical trials, is this: would someone who ate a diet high in fructose and sodium be able maintain a normal body weight? Is a calorie a calorie? Until then, I’m not convinced.

What are you prepared to do today?

        Dr. Chet

References:
1. Obesity. 2023. https://doi.org/10.1002/oby.23920
2. Phil.Trans. R. Soc. B 378:20220230. https://doi.org/10.1098/rstb.2022.0230

Your BMI and Shrinkage

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I received several interesting questions regarding the loss of height and its impact on BMI: should you use your current height or your tallest height? I checked the research and found some interesting ideas, but there’s no direct answer.

While it may change slightly over time, your current height should be used to estimate BMI. You’re measuring shorter than you were when you were younger not because you’re stooping (or melting like the Wicked Witch of the West), but because the vertebrae lose bone mass and the disks between them lose fluid and get smaller. You’ve also probably lost muscle mass, but that can be regained; when bones and discs degrade, it’s not reversible as far as we know. That may mean that a person, including yours truly, has a lower target to get to normal weight for his current height.

A new theory of obesity on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Am Geriatr Soc. 2012. https://doi.org/10.1111/j.1532-5415.2011.03832.x

The Bottom Line on the Blue Zones

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The docuseries on Blue Zones demonstrated that it really isn’t complicated to live to 100: find a purpose, a reason to get up every morning, remain physically active, eat reasonably with a focus on plant-based sources for food, and develop a social group that can provide support through the various stages of life.

The docuseries ended with the writer working to create Blue Zones in different cities throughout the USA. That part is complicated because it involves community buy-in from government, health and healthcare officials, as well as professionals from nutrition, exercise, and community planning.

The Most Important Thing

After giving it a lot of thought, I’ve come to the conclusion that the most important thing that anyone can do to live well to 100 is this: get to a normal body weight and stay there. Not everyone who actually was 100 years and older was thin, but they had already made it to 100.

Getting to a normal weight reduces your risk of just about every degenerative disease and reduces the stress on your joints; Paula adds that it also greatly expands your clothing choices. You may never be able to do the splits like the man in the photo, but you’ll be able to do more than you do right now. Genetics is always there to blindside us, but even with that unknown, we can be in a better position by being a normal body weight and maintaining it.

The Blowback Was Instant

I spent last weekend with several thousand people, and I enjoyed every moment. I was asked many times what is the most important thing to be healthy, and my answer was always the same: find a healthier way to eat that you’re willing to stick to for the rest of your life, get to a normal weight, and stay there.

Some replied that “if I got to that weight, I’d look like a skeleton.” Then they would tell me what weight they think they can get to; I gave no quarter, no permission to say that’s good enough. How long that takes you to do could be one, three, maybe ten years. If you’re 43, that means you’ll be 53 and that’s just when everything begins to decline body-wise. You’ll be better able to handle it.

Here’s a simple way to start that you can begin this minute: cut out sugary and ultra-processed foods as much as you can. Then you can go on to find more vegetables you like, learn to cook with less fat, and so on, but you can say no to that donut or cookie right now.

What should you weigh? Here’s a link to the BMI chart at drchet.com. Note that there are guidelines to determine whether you’re big-boned or small-boned, and that affects your goal weight.

The Bottom Line

I would ask nothing of others that I wouldn’t do myself. Getting to a normal weight within a year is my goal; redistribution of that weight may take another couple of years. So what? I don’t know if I have the genes to live to 100, and I don’t know whether that’s my goal. I just want to be able to live like I want every day I’m alive.

No matter your age today, you can help yourself live well longer, and it starts by getting to that normal weight. I know you can do it.

What are you prepared to do today?

        Dr. Chet

Blue Zones: Social Groups

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As I said on Saturday, when I began watching the Blue Zones docuseries, I would have wagered that either nutrition or exercise would be the most important factor in living longer. What we eat and how much we move are important, but the key to living well to 100 are the interactions we have with people.

That can take many forms. Your spouse can be the most important person you interact with along with family members who live close by: grandparents, parents, children, grandchildren, aunts, uncles, and cousins, can all be part of your social group. Business groups such as Toastmasters and Chamber of Commerce, fraternal and sororal organizations, volunteer groups, and church groups all add to your social circle. An unstructured group that gets together to have coffee, make cookies, or play cards can also provide social interaction.

It’s more difficult in much of the world today because families often spread out due to school and jobs. Families may see each other during holidays but don’t have the frequent personal interactions that provide a support network. COVID also interfered with our ability to socialize; once regular social interaction was blocked, sometimes it never came back. Research has shown that the isolation was devastating to many. The governments of Japan and the UK were so concerned, they appointed Ministers of Loneliness.

I don’t have answers to how you increase your social interactions other than to seek them out; Facebook and texting are better than nothing, but being together is better. So my challenge to you is to take action to reconnect with friends and family:

  • Join a club or create one of your own, like a neighborhood walking group
  • Make a lunch date with someone you haven’t seen in a while
  • Call a friend in another city or state to catch up
  • Invite the neighbors over for dinner
  • When someone invites you to go to a movie or to meet for a drink after work, find a way to say yes

You may find that a few relationships can’t be rekindled, but you also may find yourself with a more stimulating social life—and that’s good for your health. I do know that if you want to live well to 100, social interaction is the most important lesson from the Blue Zones series. I’ll give you my final thoughts on Saturday.

Tomorrow night is the Insider conference call. There’s some interesting research I’ll share as well as answer Insider questions. Become an Insider by 8 p.m. tomorrow night and you can join in.

What are you prepared to do today?

        Dr. Chet

Blue Zones: Eat Reasonably

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As I continued to consider the four areas that make up the health habits related to living to 100, I would have thought that nutrition was going to be the key. After much reflection, it’s not. However, it doesn’t mean you should live on a diet of sweets, deep-fried foods, and a lot of ultra-processed foods.

Eat a Selective Plant-Based Diet

Do I mean you have to be a vegan? No. But as North Americans, we just don’t eat very many minimally processed vegetables. By minimally processed I mean you cut them up, season to taste, and cook. It can be stews, soups, side dishes, or whatever.

While the types of plant-based foods vary by culture, there are several foods in common:

  • Beans, lentils, and nuts of all types are an important source of fiber and protein. Soups and salads are perfect delivery systems, but so is chili—as spicy as you like it.
  • Root vegetables are important: potatoes, especially sweet potatoes and yams, carrots, and purple yams called ube.
  • Green, leafy vegetables: lettuces, cabbages, and greens of all types, such as coleslaw or collard greens with bacon. Eat some every day.
  • Lean meats for additional protein.
  • Wine, if you drink it, even though it’s a processed grape.

Make those the foundation of your diet along with healthy oils such as olive oil and some whole grains, and that’s it. Remember, this isn’t a weight loss program; it’s a way to eat for life.

Two More Important Points

Don’t overeat. Eat just enough and no more. The Okinawans eat to feel 80% full and that’s where they stop.

Get to a normal body weight, no matter what it takes or how long it takes, and stay there. It’s easier to move around if you’re leaner, and you’ll have fewer complications of degenerative disease.

The Bottom Line

What you eat is important to live well, whether to 100 or not. It’s not difficult, but it may force you to think about how you can do that until it becomes a habit. The sooner you figure that out, the more time you get to live well. Next week I’ll finish this up with the most important secret of living to 100, Blue Zones or not. It surprised me.

What are you prepared to do today?

        Dr. Chet

Blue Zones: Keep Moving

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Continuing our look at the lessons from Secrets of the Blue Zones, the next point that stood out to me was that everyone was physically active. I mentioned tai chi, but that’s organized activity. The Blue Zone secret is that the people were physically active throughout their day.

In some zones, they tended to gardens for part of the day. Or they got together in groups to prepare food. They didn’t stop at the grocery to pick up a rotisserie chicken and a bag of salad—they butchered the chicken, plucked the feathers, put it on the spit, turned the spit, and so on. Bread was made from scratch and pasta as well.

One scene struck me: the people who lived in Sardinia were always walking either uphill or downhill to visit friends, to go to the market, to church, or to get an espresso. In general, people who lived to 100 never really stopped physical activity.

In more modern areas such as Loma Linda and Singapore, there were parks and walking paths close by. However, whenever they could, they walked to get where they were going.

Did they also do more conventional workouts, alone or in groups? Absolutely, but the real key is that they moved throughout their day. Conventional exercise is important for a lot of reasons; for example, Paula sent me a quote yesterday that sedentary middle-aged Japanese women found that 16 weeks of regular exercise improved the elasticity and structure of their skin.

If you’re serious about living well regardless of age, find a way to move more every day.

What are you prepared to do today?

        Dr. Chet

Blue Zones: Where Are You Going?

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Why do you get up in the morning? If you’re a parent with small children, it’s obvious. If you work outside the home, easy to understand. But what happens when you decide to retire, or even retire early? If you want to live well to 100, what are you going to do for the next 30+ years? One of my questions to people who say they want to retire is “to do what”—be first in line for a supermarket’s free sample day?

Purpose

People who live well to 100 in Blue Zones have some sort of purpose. It’s more than just a positive attitude, although that appears to help. For some, it’s an opportunity to socialize: to meet someone for a walk and talk, or to get together with old friends to get coffee with their senior discount at the fast-food joint and tell stories.

For others, it’s volunteer activities, the desire to serve others: food banks, delivering meals, teaching, and so on.

Having faith in something greater than this world is important to many centenarians. That also provides purpose to many.

They still work. One gentleman gets up, gets on his horse, and moves cattle from one pasture to another.

The purpose can be as different as there are people, but everyone seems to have a good reason to get up in the morning.

Stress

One thing that they seem to learn is how to deal with stress. It may be playing games in a group, group exercise such as tai chi or yoga, or even preparing meals from scratch. Stress never goes away; it may be that with age comes the experience that stress is usually temporary, and often you’ve seen worse. Finding ways to deal with it is important.

The Bottom Line

Secrets of the Blue Zones doesn’t provide answers; it provides directions. Communities are laid out differently in modern countries than in most Blue Zone cities and towns. We want space; we value independence. But what price do we pay in our longevity by taking away access to friends, families, churches, and community centers? Having a purpose is not just a goal sheet with a to-do list; it’s the need to serve others in some meaningful way. More next Tuesday.

What are you prepared to do today?

        Dr. Chet