Body Roundness Index

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The Body Mass Index (BMI) has been used to provide an indication of whether someone is under weight, normal weight, overweight, or obese and the degree to which they are obese. There’s no measure of percentage of body fatness implied, but physicians and other medical professionals have used it for that purpose for a couple of decades. Why? It can be used to assess the potential risk of developing cardiovascular disease, pre-diabetes, and other metabolic conditions.

I happened upon a commentary in JAMA on the Body Roundness Index or BRI for short. It was published in response to a recent study published in a JAMA Network Open by researchers who examined the relationship between BRI and mortality.

Let’s start with this: what is the BRI? The BRI was developed by a mathematician. The reason was interesting; the developer told the commentator that the BMI is based on a “cylindrical” model but when she looked in the mirror, she felt she was more egg shaped. What she did, as a mathematician, was develop a model based on an “ellipse.” Why? She gave a couple of reasons.

The first reason is that BMI can misclassify individuals because it fails to distinguish between individual amounts of fat-free mass (FFM) and fat mass (FM). BMI also does not provide information about the distribution of body fat—specifically, visceral fat versus subcutaneous fat. She developed a mathematical model, to assess body fatness which would indicate where the fat is distributed. With some very complicated math, she developed the BRI. It uses only two measurements: height and waist circumference. The benefit of using the BRI is that it may be a better predictor of body fat than the BMI. Is it? We’ll check out the research study that began this examination of BRI on Saturday, because as Shaq famously said about getting in shape, “Round is a shape.”

The Insider Conference Call is tomorrow night. If you become an Insider by 8 p.m., you can participate in the call to get your questions answered.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408

Expand Your Food World

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Paula and I watch a lot of cooking shows; most are competitions and the styles of cooking vary from diner food to high-end restaurants. The one thing that is prevalent is that you see a lot of foods and cooking techniques from other continents and cultures. This weekend, I’m going to challenge you to try different spices, different vegetables and fruits, and different techniques.

The spice blend that we’ve discovered is fish sauce. It seems like it would be used only in cooking seafood, but it gives a great umami (meat-like flavor) to every sauce, casserole, and soup. The only caution would be that it’s made from shrimp or other seafood marinated in salt for up to two years, so if someone is allergic to seafood, don’t use it. Also, try a little first because you can add more, but you can’t take it out.

A vegetable would be ube or purple yams. It’s one of the foods that is the staple of the Blue Zone areas in southeast Asia. It’s easier to find than it used to be, and you can use it like regular potatoes. One of the fruits Paula and I tried was prickly pear, but I don’t have the patience for it because it’s full of seeds. On top of that, the flavor is subtle so while it’s full of nutrients, it doesn’t have an intense flavor or texture.

One technique to try is to spatchcock a chicken or turkey, also called butterflying. The technique involves cutting out the neck and back with shears and pressing the bird flat; press hard enough to break the breastbone and the bird lies flat. It’s easier to get seasoning on the bird meat under the skin, cooking time is reduced, the skin will be crisp, and it will have the moistest breast meat you’ve ever eaten. Just be sure to check the temperature in the breast to make sure it reaches 160° and it should get to 165° or higher while it rests.

Food is one of life’s great pleasures as well as the source of nutrients we all need. It’s a shame to be bored with food, so I’m challenging you to shake it up a little. The objective this weekend is to eat a food, use a spice or blend, or technique you’ve never tried before. Then let me know how it went.

No time to cook? Try a food from another region of the world you haven’t eaten before—West African, Caribbean, and South Asian all have intriguing spices and flavors that may be unfamiliar. They may be a miss, but if you find something you like, you’ve completed the challenge: expanding your food world, even if it’s only a new dessert.

What are you prepared to do today?

        Dr. Chet

A Little Help from My Friends

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Do you realize that it’s been six months since I introduced a new product? Have I had ideas? Yes—in fact, so many of them, I get stymied at where to begin. Because you are my readers, and therefore potential customers, what would you like from me?

Let me help you get started. I want to do a second edition of the Real-Life Detox book. There are some topics I want to remove and have ideas how to replace them. What would you like to see? Intermittent fasting for detoxing? More recipes? How to detox every week? Would you like it digital only or would some of you like a hard copy?

How about aging with a vengeance? Would you like to see more related information related to that topic? And believe me, there’s a lot more.

How about a revisit to conditions like bone health, digestive health, and on and on?

How about format? Written? More audio? Video? Live presentations? How about beginning the traveling seminar tour I was beginning when covid hit?

Take some time, get your favorite beverage, and tell me what you’d like to read, see, or hear. Then let me know.

What are you prepared to do today?

        Dr. Chet

The Point of Youth Sports

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Malcolm Gladwell, the author of The Tipping Point among many others, published Revenge of the Tipping Point, a look back at what he got right and what may not have turned out to be correct. As I was listening to a new podcast interview, he made a comment on youth sports that stuck with me:

Travel to a game should never take longer than the game itself.

Sport should be fun, not work. Playing on a travel team may seem exciting, but it’s a huge commitment by the entire family, both in time and money. Gladwell’s point was that the quest may not be worth the return. It doesn’t mean that there’s no benefit, but in context, playing to enhance an application for college seven years away is a long shot.

Riley runs like the wind and he can dribble both a soccer and basketball well. But unless he develops a keen interest in the games, playing local makes the most sense. The reason? He’s having fun, staying active, and making friends. I want to see athletics remain a life-long activity rather than watch him burn out chasing the spotlight. To that extent, I agree with Malcolm. If you have a little Tiger Woods or Serena Williams at home, you may decide differently, but the reason you know their names is that their level of talent is extremely rare. Most kids just want to have fun with their friends, and that may be the best lesson they can learn about sports.

What are you prepared to do today?

        Dr. Chet

P.S. If you have a young athlete at home, make sure you’re feeding them the right stuff at the right times; get Dr. Chet on Youth Sports in either MP3 or CD.

Should I Use Folate or Folic Acid?

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In the past few years, there has been a trend toward using folate, the natural form of vitamin B9, versus using folic acid, the synthetic form. Many times I’ve answered the question “Which form is better? I’ve heard…” I said on Tuesday that the study on folic acid, blood lead levels, and autism had a lesson. That lesson is this:

Folic acid from enriched foods or supplements is equivalent to folate from foods or supplements.

The body efficiently converts folic acid to folate, and from that point, there’s no difference in the benefits to the mothers or their babies. Even in women who have the MTHFR mutations, folic acid is still beneficial.

This won’t close the door on people who insist that folate is the better choice, but we know their assertions aren’t based on research. Every study on the impact of folate/folic acid on pregnant women and their offspring used folic acid. That’s the form that was put into grain-based foods beginning in 1998 with the objective of reducing birth defects; the reduction in birth defects has been estimated at 70%. Further research has demonstrated benefits to the children of mothers who supplemented with folic acid, such as reductions in allergies, asthma, and ADHD.

The Bottom Line

The results from the study on the benefits to the offspring of women who may have been unintentionally exposed to lead is that folic acid intake is directly related to prevention of harms to their babies. It also illustrated that megadosing is not required. The lesson is that folic acid, whether added to grain products or in supplements, is an effective form of B9 to accomplish that goal.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Folic Acid, Lead, and Autism

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Every once in a while, a research study provides an important lesson as well as some interesting findings. Let’s begin with the study.

During 2008 through 2011, researchers selected almost 1,900 pregnant women as subjects from 10 cities across Canada for the study. The overall goal was to identify environmental impacts on the mothers and children; this is an ongoing study. In this case, researchers looked at children who were diagnosed with autism, based on standard diagnostic criteria. Understand that autism is on a spectrum, and they used behaviors associated with autism when the children were three or four years old. They also tested maternal lead levels, folate levels, and folic acid intake in early pregnancy.

Researchers found there was an inverse relationship between blood lead levels and folic acid intake—as folic acid intake increased, the blood levels of lead decreased. The autism scores were also lower in the children of mothers who had sufficient folic acid intake, verified by their blood folate levels; 400 mcg intake was sufficient, and taking more folic acid didn’t provide additional benefit.

What does it mean? No one has to megadose folic acid to benefit their unborn children in response to environmental toxins. And even if pregnancy isn’t part of your future, the folic acid had a protective effect; if you suspect you have lead pipes, additional folic acid is a good idea.

What was the lesson? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Do Weekend Warriors Improve Their Health?

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Let’s finish the week with a question no one asked but was the topic of a recent study: what’s better for your health—being a weekend warrior or working out according to established guidelines? The major component of the guidelines is more than 150 minutes of moderate to intense exercise a week spread out over most days of the week. Turns out, they are both effective, but let’s take a closer look.

The Study

The UK Biobank data are connected to the medical records of all people in the UK, making it an excellent source for studies. This observational study used data collected on close to 90,000 subjects who wore an accelerometer for a week sometime between 2013 and 2015; they were tracked for at least six years. Researchers tracked the diagnosis of over 678 conditions and compared those who exceeded the minimum of 150 minutes of moderate to intense exercise, either over a weekend or stretched over a week, with those who exercised fewer minutes.

The weekend warriors had reduced Hazard Ratios for 264 conditions and regular weekday activity had reduced Hazard Ratios for 205. Most of the benefits were associated with cardiometabolic metrics such as hypertension, resting heart rate, and type 2 diabetes. When compared head-to-head, there were no conditions where the weekend warriors and the regular exercisers differed.

What Should I Do?

I wouldn’t change anything you’re currently doing as long as you’re getting more than 150 minutes of moderate to intense exercise every week. We don’t know the activities involved in either—just that the accelerometer showed they were moving.

What it can mean is that for those who are playing basketball or soccer for a couple of hours a day on the weekends, you’re getting some benefit. It also means if you have a two-hour trail walk you like to do on weekends, it can help reduce your risk of cardiometabolic diseases.

The Bottom Line

What I really think it illustrates is that any movement is good movement, and if you can’t work in as much exercise as you’d like during the week, you can make up for it on the weekend. I would have liked to have seen the different activities involved and any orthopedic injuries associated with the activities, but let’s take the win. Just get moving and stay moving during the week or packed into a weekend. Or—maybe—both! Go get ’em, you warriors!

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1161/CIRCULATIONAHA.124.068669

What About Fiber?

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Here’s one more thing you might want to add to your smoothie: fiber. In this case, it depends on the type of fiber more than anything else. Let me illustrate. My grandson Riley and I have something we call “soup” almost every night. It has two kinds of fiber as well as a probiotic mixed with water.

Riley can be pokey when he eats and sometimes, it carries over to when he drinks liquids. One evening, when I wasn’t paying attention, he didn’t drink his soup quickly enough, and it turned into a jelly-like consistency. The reason is that one of the fibers I put in the blend is ground psyllium husks, and while it’s great fiber, that’s one of its characteristics. It will do the same thing if you take too long to drink your smoothie.

There are some fibers that don’t turn to gel quite as fast as psyllium husks such as inulin, pectin, guar gum, and digestion-resistant maltodextrin. These fibers function differently than psyllium fiber. I don’t know that I would prepare them the night before and let them sit in the fridge overnight, but hey, if you’re willing to give it a try, go for it.

The Insider Conference Call is tomorrow night. The topic of the night is a look at the benefits of blood orange on metabolism as well as answering Insider questions. You can join in by becoming an Insider by 8 p.m. Wednesday evening.

What are you prepared to do today?

        Dr. Chet

Should You Put Probiotics in Your Smoothie?

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Continuing with smoothies and shakes, another popular ingredient most people want to add are probiotics, either from yogurt or a supplement. Would there be any issue with adding probiotics to smoothies? No, as far as I could find. It’s the same idea as with the digestive enzymes: the probiotic will start to do its job, which is to ferment once it’s fed. Starches, prebiotics like inulin and dextrin, and fructooligosaccharides (FOS) are the preferential foods for the microbes.

Adding fruit or vegetables to the smoothie would be adding some FOS as well as some naturally occurring fibers. Again, just like the digestive enzymes, the shake would have to be left out a long time for any reasonable fermentation to occur. One more thing: while the probiotics would have fluids and food, the one thing they would not have in a smoothie is heat. Probiotics are not likely to start fermentation when they’re closer to refrigerator temperature than internal body temperature.

And one more thing. Would putting the probiotics in a blender at high speed damage the bacteria? The answer appears to be no based on comments from scientists who do research on bacteria. Imagine slicing a mosquito with a chainsaw; the blender’s blades aren’t small enough to slice and dice the bacteria, and the heat the blades generate isn’t enough to damage a significant amount of probiotics.

The one thing that will destroy probiotics is heat over 165 degrees, so don’t put them in soup or hot drinks. More to come.

What are you prepared to do today?

        Dr. Chet

What Do You Want to Know?

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I’m back from a weekend in Louisville where I talked to many, many people about their nutrition questions. One of the great advantages of these trips is that I know which nutrition questions are most important to people right now. So let’s talk about shakes.

I prefer chewing my food. I’ve tried shakes and smoothies, and they just don’t do it for me, but it’s become a convenient and nutritious way of life for many of you. I’ve gotten a number of questions on what you should and maybe shouldn’t put into smoothies, so let’s cover several of them as well as other questions in the next few memos.

Let’s begin with digestive enzymes. The typical digestive enzyme supplement has several different enzymes to digest food. There are proteases to digest protein, lipases to digest fats, several enzymes that can break down different classes of carbohydrates, and many also have lactases to digest lactase, the milk sugar.

What would putting digestive enzymes in smoothies do? Some enzymes require stomach acids to activate. More than likely, other enzymes would start to breakdown the nutrients they’re designed to digest. Is that a bad thing? Not necessarily, unless you leave the smoothie to sit for hours—which is exactly what you probably wanted to avoid. It may change the flavor if it sits too long but otherwise, it should be fine.

More on Saturday. And if you have any questions about nutrition or supplements, let me know and if I think it applies to lots of other people, your question could star in an upcoming Memo!

What are you prepared to do today?

        Dr. Chet