BE FAST for Stroke

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So what did the Society of NeuroInterventional Surgery (actual brain surgeons) add to the mix? They added the acronym BE, which then makes the entire acronym BE FAST.

What do the new letters stand for?

B: loss of balance. I didn’t see any details about how to test that. It may be self-evident that someone cannot stand upright without tilting to one side or the other. Or it may be the while holding their arms to test their arm strength, they can be moved side to side to see how they respond.

E: loss of eyesight in one eye or blurry vision.

I think adding balance and eyesight are a good idea for the lay public. A physician or other healthcare professional may know to look for balance and eyesight symptoms, but it may not be as obvious to you and me. Here’s the whole list:

BE FAST

B: loss of balance

E: loss of or blurry eyesight

F: face drooping

A: arm weakness

S: speech difficulty

T: time to call 911

Commit those to memory and if you feel that you or someone you care about might be having a stroke, assess those symptoms and most important, take action immediately if necessary. I can’t stress that enough because the sooner treatment begins, the less function a person loses.

Enjoy your holiday weekend, and safe travels if you’re hitting the road. We’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://getaheadofstroke.org/call911/

Suspect a Stroke? Act FAST

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The other day, for no particular reason at all, I got really dizzy for a moment. I wasn’t spinning in circles or doing anything else that might have caused it, so I did what I always do: I acted FAST and looked for signs and symptoms of a stroke. The American Heart Association (AHA) has taught that acronym for years, but recently a group of neurosurgeons added more to it. Today, we review the original acronym FAST. What does it mean?

F: face drooping. Does one side of your face seem to be pulled down? If you smile—a really, really big smile—are you smiling equally on both sides of your face?

A: arm weakness. Typically, you would stand with your arms raised out to the side and parallel to the ground. You can check to see if one arm does not quite make it to parallel with the ground or if it drifts back down. I also grabbed a stick and squeezed as hard as I could.

S: speech difficulty. Try repeating a simple phrase to see if you can remember it and if it sounds clear. For some reason I chose the old “How much wood could a woodchuck chuck…” Not the easiest thing to try to repeat a couple of times, but I did.

T: time to call 911. Do you call if you just have one sign or symptom? Yes! Do you still call if these symptoms seem to resolve themselves shortly? Yes! I didn’t have any symptoms, but I still told Paula. I was going to do a song and dance, but I never could in the first place, so it wouldn’t have gone well.

The reason time is so important is that with today’s medical technology, the sooner treatment begins, the better the outcome to regain all functions. AHA says, “stroke patients who are treated with the clot-busting drug IV r-tPA Alteplase within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability.”

What did the brain surgeons want to add? I’ll tell you on Thursday. It’s Memorial Day weekend and you may need the information if you’re attending any gatherings.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.stroke.org/en/about-the-american-stroke-association/stroke-awareness-month

Sucralose: A Treatment for Auto-Immune Disease?

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In test-tube and rodent research, researchers have found that sucralose given in high amounts may help reduce the immune response, thereby preventing the body from attacking itself, which is the essence of an auto-immune disease. How about that? For all the negative comments about sucralose, wouldn’t it be a kicker if it turns out that this artificial sweetener may actually help people?

But let’s take a closer look at what they found and what they didn’t find. The researchers made sure to point out that when the amount of sucralose necessary in rodents is translated to human amounts, they would be at the top end of the Acceptable Daily Intake (ADI).

In reality, humans don’t normally get that much sucralose. It would be logical to think that perhaps lower amounts of sucralose may be compromising the immune system for normal users, but researchers tested it and didn’t find any issue. They found the blunting of the immune response only in high amounts.

There is a lot of research to go before any clinical trials are done to eliminate or test other factors such as the microbiome. Still what has been cursed by many might be their treatment plan in the future.

The Bottom Line

I think these two studies on sucralose and eyedrops illustrate the unintended consequences of pharmaceuticals and artificial foods and that the consequences may be positive or negative. They just might have a function that can be beneficial to our health beyond what we know today. Of course, we may find out other substances may be more detrimental than we thought. We have to understand both are possible. In the meantime, we still must sustain a good diet and exercise program.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41586-023-05801-6 Received: 15 September 2021

Eyedrops for Alzheimer’s?

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A recent study is looking at eyedrops for glaucoma and the potential prevention or possible treatment for Alzheimer’s disease. I have a vested interest in that because I have glaucoma and use a form of the medication in question for it. The function of the medication is like a localized diuretic; the medication is absorbed into the blood stream and is carried throughout the body.

Researchers discovered that an enzyme inhibitor called a carbonic anhydrase inhibitor affect the formation of amyloid bodies in blood vessels. The medication may work inside the mitochondrion in some way to prevent formation of these proteins associated with Alzheimer’s disease. When they administered the medication to mice at about eight months of life forward, the mice didn’t demonstrate the cognitive decline found in untreated mice.

While the actual mechanism of action is not specifically understood yet, if it proves effective in clinical trials in humans, a pharmaceutical developed to help with one condition may benefit people in other ways. Not all intended consequences turn out to be negative. I’ll cover another interesting study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1002/alz.13063

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146

How Popular Diets Impact Your Heart

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When the American Heart Association (AHA) speaks, news organizations tend to report what they say and people tend to listen. It’s doubly true when they rank all the popular diets according to how they relate to heart health. Because we seem to live in a society based on the “see food, eat food” diet, that can be meaningful. Here’s what a group of experts did to evaluate popular dietary approaches to diet and rank them according to AHA guidelines for a heart-healthy diet.

The AHA has ten dietary guidelines for eating a heart-healthy diet, such as “Eat plenty of vegetables and fruits” and “Choose healthy sources of proteins.” For the complete list, click on this link to the article; the scientific statement is open access on the AHA website.

Then the panel selected the most popular diets in the U.S. such as the Mediterranean diet, the DASH diet, several versions of a vegetarian diet, low-fat, paleo, and ketogenic diet. They gave each diet a full point for following each of the AHA guidelines or partial points depending how closely they followed the guidelines.

This was not an arbitrary assignment by a panel of experts; they used the best information available to determine the best heart-healthy diet. Who got the highest score? Mediterranean? Vegan? Ketogenic? I’ll let you know on Saturday along with my thoughts on the diets. One thing’s for certain: eat your fruits and vegetables. You may as well start with that right now.

What are you prepared to do today?

        Dr. Chet

How Fasting Impacts Your Mitochondria

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The research scientist in the webinar focused on mitochondria and aging in his part of the presentation. He has helped research and develop a nutrient that appears to help with mitophagy, the process of removing and replenishing old mitochondria. The naturally produced chemical is called urolithin A. It’s produced naturally by the microbiome in response to eating foods such as fruit, especially pomegranate, and nuts. The problem is that we may or may not produce enough urolithin A, depending on the state of our microbiome. There has been decent research on the supplement, and I talked about the supplement in Aging with the Vengeance: Reclaiming Your Power.

What caught my attention was that intermittent fasting may also help with renewing and replenishing mitochondria. The problem becomes what kind of fasting are we talking about? Complete fasting? Eating during only a few hours per day? I’ll cover the two most popular forms.

Intermittent Fasting

Intermittent fasting is “in” right now. It is especially popular when combined with the Paleolithic or the ketogenic diet. What it essentially means is that you take in no calories by mouth for up to 20 hours per day, often called the 20:4 approach, and then you eat during that four-hour block of time. Research has shown that people lose weight, get better control of their prediabetes, and may even reduce some of the metrics related to cardiovascular disease such as blood pressure and cholesterol levels. But specific to mitochondria, the data are nowhere near as clear.

Fasting Mimicking Diet

I first encountered the fasting mimicking diet, or FMD for short, when I looked at the research of Valter Longo. He’s a scientist who has used periodic fasting with patients undergoing cancer treatment. For one to five days before treatment, they go on an FMD which drops down to 500 calories per day in some cases, and then they go back to their regular diet and go through their normal chemotherapy protocol. The critical factor is that he’s shown an improved quality of life as well as improved outcomes for people who used the FMD during treatment as opposed to those who ate their normal diet.

In research in mice, using FMD has demonstrated a reduction in symptoms of Alzheimer’s disease and dementia. Parkinson’s disease, obesity, type 2 diabetes, and others have also benefited from the FMD approach. Dr. Longo has created a commercial program that is available.

Why FMD? As near as I can gather, the concept utilizes the body’s protective mechanisms that allow energy to continue to be produced at a high enough rate to continue carrying on with life (such as searching for food in other eras) in the absence of food until food can be found. Research in athletes who’ve used FMD versus a normal diet has demonstrated maintenance of strength and endurance after going through a five-day FMD protocol while continuing to work out.

The Bottom Line

In my opinion, FMD makes sense. Fasting for two days and then going back to your normal diet for a couple of weeks just makes more sense than obsessing about when you can eat every day. But you may feel intermittent fasting’s a better way to go for your life, and that’s fine as well. One thing for sure is that I’m going to continue to follow this research.

The whole point to this is that restricting calories for long blocks of time stimulates the body to take good care of our mitochondria; that’s one battle that we have to win if we expect to age with a vengeance. And the great thing is that you can begin at any age.

What are you prepared to do today?

        Dr. Chet

Dietary Supplements: Certified

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Recently I watched a webinar on mitochondrial health and athletic performance co-sponsored by the American College of Sports Medicine and a nutritional company. The speakers were a clinical researcher and a PhD dietitian for a professional basketball team. I’m going to review what the clinical researcher talked about on Saturday.

Today I’m going to focus on a comment by the dietary specialist. She believes as I do that supplements complement a good diet, but when she started talking about dietary supplements, she said they aren’t regulated by the Food and Drug Administration. At that point, I would typically stop listening because she’s incorrect; both the FDA and the FTC regulate dietary supplements; it’s just done in a different way than over-the-counter medications and pharmaceuticals.

Then she said that whatever supplements she recommends to her players, she looks for products that are certified by NSF or the United States Pharmacopeia (USP). I agree. These are not easy certifications to obtain. It isn’t just that the supplement is tested once and it’s over—it’s an ongoing process that costs a lot of money for the company, but they’re industry standards. Certification is something you should consider when you purchase dietary supplements of any type but especially related to sport performance.

What are you prepared to do today?

        Dr. Chet

How Coffee Relates to CVD

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Researchers in Germany used a unique approach in the Hamburg City Health Study: they selected the first 10,000 volunteers. Volunteers who didn’t drink coffee were eliminated from the study, so they ended up with 9,009 subjects.

The researchers collected dietary data along with a variety of other demographic and physiological variables, integrating lifestyle-related behavior, comorbidities, biomarkers, electrocardiographic and echocardiographic data, and finally major cardiovascular diseases (CVDs). They divided up the subjects by coffee intake: low = less than three cups a day, medium = three or four cups per day, and high = more than four cups of coffee per day.

Results

This epidemiological cross-sectional study resulted in the following:

  • High coffee consumption correlated with slightly higher LDL cholesterol
  • Moderate and high coffee consumption correlated with lower systolic blood pressure and lower diastolic blood pressure
  • Different levels of coffee intake didn’t impact heart rhythms or function
  • Most important, coffee intake did not impact the presence of CVD nor prior cardiac events such as heart attacks and heart failure

Were the results of coffee and LDL cholesterol concerning? No—the difference was just five mg/dl, well within measurement error.

Is Coffee Safe to Drink?

Coffee was always safe to drink; the question was how our bodies responded to consuming it. Neither of these studies was perfect, but they show that even high coffee consumers, including myself, may not be at any significant risk for promoting or advancing CVD or cardiovascular events.

I think for most people coffee and caffeine are closely linked. What most of us don’t realize is that coffee is a complex liquid consisting of more than 1,000 bioactive substances, including phytochemicals that have proven beneficial for many organ systems; it’s not only a nervous system stimulant because of the caffeine content.

The Bottom Line

When it comes to coffee, I think it’s person-specific. Taste aside, some people may process caffeine differently, which may impact how much coffee someone could enjoy. These studies add to a body of work which shows that coffee is safe for the heart and other organs; other benefits or issues require further study. For me, time for another mug of Sumatra Roast.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.nature.com/articles/s41598-023-31857-5

Research Update: Coffee and Heart Rhythms

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In one of the first jobs I ever had, the foreman would pour a half-cup of coffee and fill it up with water; he’d had a heart attack and his doctor told him to limit his coffee intake. Fifty years ago, physicians recommended that people avoid coffee if they had high blood pressure or had a cardiac event such as a heart attack. The thought was to lower the stimulating effect of caffeine to keep heart rate and blood pressure lower. In the interim, some studies showed that coffee contributes to cardiovascular disease and more recently, that it may not. So if you love coffee the way I love coffee, you may be encouraged by a couple of recent studies.

The first study examined the effect of coffee on heart rhythms in 100 subjects with a mean age of 39 who served as their own controls. All subjects had a variety of blood tests as well as genetic tests to determine if they were fast or slow processors of caffeine. They also wore a new-age heart rhythm monitor for the 14 days of the study. I’ve worn that monitor, and it gives accurate EKGs to monitor heart rate and heart rhythm abnormalities such as premature atrial contractions and atrial fibrillation.

The subjects were notified the evening before whether they were going to be on a two-day coffee drinking cycle or two-day caffeine avoidance; the idea was to track immediate impacts. The good news: there were no differences in abnormal rhythms on coffee days versus non-caffeine days and no impact of caffeine processing. One interesting observation: on the days subjects drank coffee, they walked more steps. We’ll look at the impact of coffee on cardiovascular disease events on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: N Engl J Med 2023;388:1092-100.