When Elbow Met Sidewalk

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Riley’s mom, Jamie, slipped and fell on a patch of ice when she got home from work late on Friday. Although she was home, she lay outside in the 10 degree temperature until she could get inside and call me. A former farm girl, she’s no wimp and had fallen off horses plenty of times, but she was in severe pain. Off to the emergency room we went. She had dislocated the radius and had a small fracture at the head of that bone. The orthopedist determined that the fracture was small enough to forego surgery, and that they could get the bone back in its joint. They put her out during the procedure for about five minutes. The pain of resetting the bone is severe, but she remembered nothing.

The pain was back when she woke about 8 a.m. The prescription pain relievers weren’t working and the ice wasn’t helping much. She added another pain reliever they recommended, ibuprofen. As the day progressed, she got some relief. I told her that the swelling would come down rather quickly on the simple fracture, and the pain would decrease to just uncomfortable as long as she didn’t move it. She’s already doing much better.

Jamie has a long road until she teaches dance again, but she’ll be working on rehab soon. Is there anything she can do to heal faster? I’ll give you the answer on Saturday along with other tips to help with this type of injury.

Super Bowl Webinar is This Sunday!

If you want to attend the live version of the Super Bowl Webinar on Aging with a Vengeance: Taking Back Your Muscle, sign up today. About half the spots have been purchased and based on past experience, 60% sign up in the last three days before the webinar. If you don’t get into the live webinar, you’ll still be able to watch the recording at your convenience after it’s posted. Registration is $12.95; Members and Insiders get their usual discounts. Whatever your age, you’ll learn how to keep what you’ve got and take back the muscle you’ve lost. Don’t delay!

What are you prepared to do today?

        Dr. Chet

When Supplements Aren’t Absorbed

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If you take any type of dietary supplement, you want to make sure that you’re getting the active ingredient whether that’s turmeric, the mineral iron, or omega-3 fatty acids. The problem is that whether in its natural form in food or put into dietary supplements, nutrients can be difficult to absorb. In addition, the same holds true for pharmaceuticals as well. Here are some of the reasons why:

  • Taking supplements with food is important for nutrient absorption. If they’re fat-soluble, they need fat present to be absorbed. That’s problematic if someone takes the supplement without food or is on a low-fat diet.
  • I seem to always talk about increasing fiber in the diet, and we should, but fiber can interfere with the absorption of some nutrients. It may be the increased transit time or some form of mechanical blockage, but it happens.
  • Finally, gut health may also impact the absorption of nutrients. Lack of enzymes, too acidic or too alkaline, or lack of a healthy microbiome can also impact nutrient absorption.

All is not lost; the pharmaceutical and supplement industries have been working on ways to help deliver more active ingredients. I’ll cover those on Saturday.

What are you prepared to do today?

        Dr. Chet

Childhood Obesity: A Family Thing

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I hope you took some time to scan the Executive Summary of American Association of Pediatrics Guidelines for Physicians. If you couldn’t, here are the three things that stood out to me.

Screening by Pediatricians and Primary Care Physicians

The focus of the guidelines was to assess risk factors for degenerative disease such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, indicating overweight, and 95th percentile, indicating obesity. The guidelines recommend beginning at 2 years of age and continuing through 18.

Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions.

It Must Be a Family Thing

Without exception, the guidelines recommend intensive health behavior and lifestyle treatment. “Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to twelve-month period.”

That’s not the same as giving Mom and Dad a diet for the child and sending them on their way. Family-based programs have demonstrated great success, but it has to be a family thing.

It’s All About the Money

The summary also talked about obstacles to the family-based treatment approach. The major obstacle is money:

  • Money for training pediatricians and family practice physicians on how to assess childhood obesity.
  • Money for training more people to teach and work with families—it’s labor intensive.
  • Money for public health and community programs that can support the family-based approach.

It’s a situation we’ve seen many times: Everyone knows how important preventive healthcare and early treatment is, but no one wants to pay for it. But maybe we shouldn’t always look to government to foot the bill; maybe schools, community organizations, and churches could offer programs for their members. If what we’ve always done isn’t working, let’s try something different.

The Bottom Line

The guidelines introduce a couple of new approaches for those with the most severe weight problems, but the focus is on intensive nutrition and behavior-change training for the entire family. That’s not just “Here’s a diet and exercise program, and I’ll see you next year.” The guidelines give a reasonable approach to help the future health of the nation. The approach is simple: Eat less. Eat better. Move more. What they’re saying is that healthcare professionals need training to be able to do that effectively as a team in a reasonable family-based approach. That’s the right approach as I see it.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-060641

New Guidelines on Childhood Obesity

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If you pay attention to health news, you know the American Association of Pediatrics issued new guidelines on how to treat childhood obesity. Depending on where you read or listened to how those guidelines were presented, all you may have heard is that kids over 12 can get medications to help with weight loss and teens over 14 can have gastric by-pass surgery.

Then the experts weighed in (no pun intended). One pediatric physician predicted doctors would just pull out the prescription pad and not address the root cause of obesity. Psychological experts said this is going to cause increases in disordered eating, which includes anorexia and bulimia.

This story hits home for me because food was love in a Polish household like mine. I’ve been overweight since I was around eight years old, and it’s been a life-long struggle to get to a normal BMI. But even at my heaviest, I was nowhere near the weight many kids are today.

Is that all that was in the guidelines? You can read the summary at the link below. Then on Saturday I’ll break them down to get the bottom line.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-06064

Almonds to the Rescue!

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Delayed-onset muscle soreness (DOMS) is common in sedentary people who overdo it—the weekend warriors who catch up on all the yard work in one day or people who have to shovel out a long driveway after a big snow. Researchers wanted to test what benefits these occasional exercisers may get from eating almonds compared to a cereal bar.

Researchers recruited a group of sedentary volunteers between the ages of 30 and 65. They wanted to examine the effect of eating two ounces of almonds every day for four weeks on measures of pro-inflammatory hormones and oxylipins, which are oxidized fats that can have pro- or anti-inflammatory effects. The control group ate a cereal bar with the same caloric content.

After 28 days, all subjects performed a 90-minute workout session designed to damage muscle that included a bout of maximal aerobic exercise, weight training, jumping, and other activities. Did they damage their muscles? Absolutely, based on the blood levels of enzymes indicating DOMS as well as standardized questionnaires assessing pain after exercise. The subjects who ate almonds every day had more anti-inflammatory oxylipins after exercise while the controls had an increase in pro-inflammatory oxylipins. Most important, the almond eaters appeared to recover a little faster.

Almond skins are a treasure of phenolic compounds. While this was a small study (69 total subjects), there were benefits to eating almonds every day for non-exercising weekend warriors. Could other high-phenolic foods have the same benefit? Time will tell. Almonds are also a treasure trove of omega-3 fatty acids, fiber, and protein, so substituting almonds for some other snack may prove beneficial. How about you regular exercisers? I’m betting you’ll get some benefit as well. It’s all part of eating better.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Nutr. 9:1042719. doi:10.3389/fnut.2022.1042719

Research Update: Exercise in Short Bursts

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High-intensity interval training (HIIT) has become very popular due to the possibility of gaining fitness in a short amount of time, but when done correctly workouts still take 20 to 40 minutes. A group of researchers examined the United Kingdom Biobank data to see if a sub-group of subjects who wore accelerometers might benefit from short bouts (one or two minutes) of intense physical activity independent of a regular exercise program. Researchers termed the exercise bouts “vigorous intermittent lifestyle physical activity” (VILPA) and they were not part of an intentional exercise program. They just happened with people who were going about their daily routines.

They tracked the subjects for almost seven years to see if there was any reduction in their death rate. The data showed that as few as two or three short bouts or approximately three to four minutes of VILPA per day were associated with substantially lower all-cause, cardiovascular, and cancer mortality risk. More VILPA sessions per day resulted in a greater reduction, but the greatest reduction occurred in three to four minutes per day. The reduction was a 38% to 40% reduction in all-cause and cancer mortality risk and a 48% to 49% reduction in CVD mortality risk. One more thing: the average age of the over 25,000 subjects was 61.8 years.

The facts that struck me was whether a person exercised or not, or ate a high amount of vegetables and fruit or not, they had a reduction in mortality. To be safe, you and your doctor should discuss whether you can try a minute or two of intense physical activity a few times per day. Maybe it will happen organically as part of your day, like sprinting up a flight of stairs to get to a meeting, or running to catch a bus, or chasing a toddler. Or maybe that exercise bike you’ve been using as a clothing rack can be put to use as it was intended. Find your spots and do what you can. You may have years to gain.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2022; 28 (12):2521–2529

Will Ultra-Processed Food Harm You?

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Use of ultra-processed food (UPF) has risen over the past 20 years; that’s clear from a recent study that examined eating trends. Using data from nine cycles of the NHANES (National Health and Nutrition Examination Survey) study, there has been a steady rise in the percentage intake of UPF from 53% to 57%. Over the same period, there has been a decline in minimally processed meat, chicken, and dairy products with an increase in UPF meats.

As you saw if you looked at the NOVA categories (first reference below), the largest component of the UPF are breads and sodas of all types, together with confectionary products such as cakes and pies. The first question: what has this rise in UPF done to our health?

UPF and Mortality

Researchers tracked adult participants in the 1988–1994 NHANES study. Over a median follow-up of 19 years, individuals in the highest 25% of servings of UPF per day had a 31% increase of mortality from all causes. Curiously, the increase in mortality was not from CVD—but dead is still dead, so it doesn’t really matter what caused it.

Recently published research associated UPF with type 2 diabetes, Alzheimer’s disease, and maybe most important, changes in the microbiome. That’s where the immune system begins, so the low fiber in UPF may actually be the root cause of the rise in mortality. Finally, as the servings of UPF went up, so did the caloric intake compared with the lower quartiles—an additional 600 calories per day.

One Nagging Question

I’ve talked about the sweet spot before: How many vegetables and fruits can we eat to offset some of the poor food choices we make? The data showed that minimally processed vegetable intake stayed constant at less than one serving per day and fruit and fruit juices declined over the nine NHANES survey periods. The researchers in both studies could have analyzed the data by intake of healthier food to see if that had any impact. Not that I believe we should increase our UPF intake, but for those who do, what can we do to offset some of negative impacts?

The Bottom Line

As 2023 continues, rather than tell you to reduce your UPF intake—which is a good idea—I’m going to propose that you add one vegetable or fruit serving to your daily diet every month, and do it early in the day. You might naturally reduce your UPF intake as a result. Because the recommendation never changes in our trio: eat less, EAT BETTER, and move more.

What are you prepared to do today?

        Dr. Chet

References:
1. https://educhange.com/wp-content/uploads/2018/09/NOVA-Classification-Reference-Sheet.pdf
2. Am J Clin Nutr 2022;115:211–221
3. Public Health Nutr. 2019. 22(10):1777–1785. doi:10.1017/S1368980018003890

What Are Ultra-Processed Foods?

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Several studies have been published recently that demonstrate the hazard of eating too much processed food: digestive issues, type 2 diabetes, cardiovascular disease, early mortality, and even premature Alzheimer’s disease. Today I’ll focus on some definitions and look at the research on Saturday.

Many of the studies that have examined ultra-processed food have used the NOVA four categories of processed foods developed at the University of Sao Paulo’s School of Public Health in Brazil:

“Ultra-processed foods are industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors, and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, moulding, and preprocessing by frying. Beverages may be ultra-processed.”

Doesn’t that sound appealing? Actually, hot dogs, mac and cheese from a box, and just about every dessert bought in a typical grocery store fits that bill. For the complete list, check out the link in the Reference below.

Now that we know what we’re talking about, I’ll talk about what the research says about ultra-processed foods and assess our risk in the real world. In the meantime, try choosing more foods from the first group for the next few days; that’s healthy eating.

What are you prepared to do today?

        Dr. Chet

Reference:https://educhange.com/wp-content/uploads/2018/09/NOVA-Classification-Reference-Sheet.pdf

Is It Worth It?

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At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

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It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619