The Spice of Progress

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Last week was about consistency, and this week is about variety, the spice of progress. I recently ran into an orthopedist I know whose first words to me were, “What’s wrong with your ankle?” followed by, “How come you’re not walking properly? You’re not toeing off.” He did an assessment later that day.

The ankle was the result of not walking heel to toe. The walking issue was more complicated. He tested my hip strength a couple of different ways, and I failed miserably. Lying on my side, I couldn’t raise my leg against any type of resistance.

He showed me the exercises to use to gain back that strength, and I’m embarrassed to admit they’re some I stopped doing once I got back the range of motion in my knee. I’ve been focused on getting back my quad and hamstring strength. While that’s fine, I ignored the postural and stabilizing muscles of the lower back and especially the hip. I immediately added those back into my routine. The result was increased soreness as you would expect when you’ve started training again. The change in my normal walking gait was immediate, and I adapted within a week.

Then I got a call from an ex-student.

A Variety of Squats

This was not just any ex-student: Paul still holds the World Powerlifting Organization Record for the Squat at over 1,100 pounds. He mentioned in passing that not everyone is the same when it comes to training. To train more of his gluteal muscles, he squats with his legs four feet apart instead of the typical shoulders-width apart. I’ve tried that kind of squat, and it does activate more of the gluteal muscles.

In addition to foot position, there are squats holding a weight on your shoulders, in front on your chest, with a kettle bell held between your legs, or with a dumbbell in front of you. You can also sit down, almost, and stand back up.

What’s my point? There are two, actually. You can increase the strength of a joint by adding a variety of exercises that stress the joint at different angles. Second, it helps to have an exercise professional guide you through the process so that you’re doing them properly. It’s worth the price of a 30-minute session to add variety. In eating, that would include the cost of taking a healthy cooking class.

The Bottom Line

No matter your age, being consistent is essential to building a foundation. To take your health and fitness to a higher level, consider spicing up your workouts—not necessarily more strenuous exercises, because something low stress such as walking or yoga can make a difference. It takes time and the rewards may not result in documentaries filmed about you, but you have no idea your capacity until you try.

Paula and I are going to take off Labor Day week, so I’ll see you after that.

What are you prepared to do today?

        Dr. Chet

What We Can Learn From “NYC Point Gods”

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We’re watching a little more basketball these days because it’s Riley’s favorite sport. That’s how I discovered a documentary about the glory years of point guards in the 1980s and ’90s in New York City. It may still be a thing, but back then it was special.

One part of the documentary focused on one thing: The Handle. That’s the ability to dribble and create magic with a basketball, and magic it was. But for me that wasn’t the real point. The results were outstanding, but the price was the time it took to get the Handle: years. Dribbling with one hand while bringing home a bag of groceries in the other. As one guard said, some eggs were broken. Dribbling before dawn down the middle of the street. Given the conditions in NYC at the time, it was probably the only smooth surface and was well lit.

What does that have to do with health? Just this—what are you investing in your body to make it better? Are you going to prehab before joint surgery and really working at it? Are you putting in more effort to get back the range of motion after joint surgery?

What about eating better? What have you done to improve your meals? Those herbs we take as supplements can be effective when used in cooking as well.

If you want specific results, you have to invest the time and effort. Everyone can be average, and that’s fine because it helps our health and quality of life. But as we all age with a vengeance, who wants to be average? Average aging means impaired in some way the older we get. What if it could be better? More on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.sho.com/titles/3506971/nyc-point-gods

What Not to Do When You Want to Lose Weight

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How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.

Weight Loss Is Always Possible

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After last week’s Memos, you may think that you have to do something radical to address your body weight or some other health situation, but that’s not the case. You can lose weight under the most extreme conditions, even if you’re completely sedentary. Let me tell you about my mother-in-law, Ruth Jones.

My mother-in-law struggled with her weight for decades. I don’t know what her peak weight was, but I would estimate around 240 pounds. She maintained around 200 pounds for most of the time I knew her. She had severe arthritis in her knees and because she wouldn’t have been able to do the rehab, the decision was made to replace them both at once. She did great at lifestyle and occupational therapy, but she never quite got the complete mobility she thought she would get because the physical therapy was more of a challenge than she could handle. She was able to get around the house but used a wheelchair or scooter in public.

A few years later, she had a very bad reaction to a new statin that damaged a great deal of muscle mass, and she remained in long-term care until she died several years later. But here’s the thing. Even though wheelchair bound, she was able to lose 30 or so pounds; that’s discounting the last few months before she died when she lost interest in eating.

How? How was she able to do it?

How about you—are you ready to make a change in your weight? Blood pressure? Prediabetes? Then you really don’t want to miss Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

The Price of Obesity

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Continuing with comments made by Bill Maher, he suggests that the prevailing thought is that we can be healthy at any weight. Companies have embraced that thought with workout gear and other products featuring oversized models. Maher then goes on to talk about the ill health associated with being obese. Type 2 diabetes, cardiovascular disease, and cancer are associated with excess body fat. He says being overweight can compromise the immune system and cites statistics on the impact of COVID-19 on people who are obese. I checked them out, and he’s correct as it relates to hospitalizations, ICU placement, and mortality.

Fat and Fit Updated

I have repeatedly made the case that a person could be fat and fit if they exercise at a high level. That’s what the data from the Cooper Clinic demonstrated, and so did my doctoral research. I then add that it doesn’t matter—because very few people could or would do the work necessary. And that was correct, too.

But at 71, I think I was too optimistic in my recommendation even though that’s what the data suggested. The reason is that it’s difficult to maintain a high fitness level the older that you get. What’s possible at 30 years old is not at 50, 60, or 70 years old. The aging body changes.

The Price of Obesity

The cost of obesity is high. You may not have high blood pressure at 250 pounds while you’re younger and fitter, but you’re taxing your heart and cardiovascular system to sustain it. You may delay pre-diabetes and have perfect blood work—for now. And there’s a cost to your joints that may not be realized for decades, but when it hits you, you’ll find your world has shrunk because there are things you simply can’t do any longer.

I’ve been a runner for decades, but those days are over. I wonder if I had decided a decade or so earlier to lose weight and sustain 175 pounds instead of 225 whether my knee would have sustained less damage. Carrying 50 extra pounds generates forces up to ten times greater; that certainly has an impact on hips, knees, ankles, and feet.

Life Is a Struggle

Maher talks about how difficult it is to lose weight. There’s no question that it’s a struggle, but that’s no different than any worthwhile goal. It’s hard to get the weight off and difficult to keep it off. Even as the expert, I know that one well. Life is a struggle.

There is a commercial that we see repeatedly with an overweight woman in her 20s who is walking out her front door to go jogging. I think it’s powerful because she asks herself “What if a sprain my ankle?” and closes with her finishing her run. She’s at the perfect age to add the other components of eating better, eating less, and getting to a weight that is less taxing to her body. That’s aging with a vengeance in action.

The Bottom Line

I’m completely in favor of fat acceptance when it means loving and accepting those around you no matter their size. But if you see people you love trying to exercise and eat healthier, you can quietly let them know you’re rooting for them and will help in any way you can. Let’s not kid ourselves: it’s not the healthiest way to live, and sooner or later, we’ll pay the price.

Maher is a keen observer of the human condition and can be caustic in his commentary. But I think he’s got the tone and tenor just about right in his close:

“And that’s the saddest part. We can do this—I think. But by lying about it and making excuses, psychologically it’s telling ourselves that letting ourselves go is the best we can do. And I gotta believe that as Americans, we can still do better than that.”

What are you prepared to do today?

        Dr. Chet

Reference: https://www.youtube.com/watch?v=yfiWjnStE3w

Feast Mode!

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Comedian and political satirist Bill Maher has been one of my favorites since his first show Politically Incorrect aired over 20 years ago. He is also an outspoken critic of our nation’s health: it’s poor and getting worse. On a recent show, he used the term Feast Mode and explained why it’s a problem.

Feast Mode used to be going on vacation and eating whatever you wanted. It also used to be reserved for holidays such as Thanksgiving where you intended to overeat and then went back to a healthier way to eat, if not in the types of food, at least in the quantities. He suggests that Feast Mode now extends all year long for most Americans. I agree and have the numbers to prove it: close to 70% of us are overweight with 41.9% now classified as obese.

He goes on to talk about the politics of obesity, comparing the psychology of fat shaming to celebrating our fatness. No one should be shamed for being overweight, but that doesn’t mean that it’s healthy to be fat. He suggests that science gets re-written to support what you want it to be instead of reality. I would correct one thing: social science might get re-written, but hard science is based on hard numbers—and however we may feel about it, the number on the scale is the number on the scale. We’re not quibbling about five pounds here; we’re talking about 50 or 100 pounds or more beyond a normal weight.

The question is what does Feast Mode cost? I’ll cover that on Saturday.

Tomorrow night is the monthly Insider Conference call. I’ve got a couple of topics related to dietary supplements to cover and then I’ll answer Insider questions. Become an Insider before 8 p.m. tomorrow and join the discussion.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

Teaching Doctors About Supplements, But Not Really

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If you haven’t watched the videos that I talked about Tuesday, please take the time to watch them, preferably before you continue reading—I’d like you to form your own opinion about the videos before you get my perspective. I came away with three opinions about the videos, other than they really focused on dietary supplements not being approved by the FDA. Of course, no legitimate healthcare professional or supplement manufacturer ever said they were; consumers may not know that, but I would hope doctors did.

First, the second video discussed potential drug-supplement interactions. There have been few direct studies on those interactions; most are case studies involving the use of herbs such as St. John’s wort and ginkgo biloba that have been published in peer-reviewed journals. What they don’t say is that very few studies have examined drug-drug interactions either. How do they find out about them? Trial and error from reports to the FDA’s adverse effects reporting system.

That addresses my second opinion. There was a strong focus on reporting adverse events from dietary supplements to the FDA. One would think that’s a good thing, but the list of adverse events they listed included every system in the body. I get reporting an allergic reaction, but how would a physician attribute gastrointestinal or cardiovascular issues to a dietary supplement after putting the person on a new medication? It’s just as likely to be due to the medication. Seems to me like an open door to lots of irrelevant reports.

Finally, they spoke about some supplements interacting with blood tests. The only one I’m aware of is excessive biotin intake affecting the troponin test for potential cardiac events. One would expect an extensive list would be provided; the problem is none exists because that’s the only known interaction.

The Bottom Line

There are 13 vitamins. There are dozens of minerals, most found in trace amounts. There are hundreds of herbs, plus nutrients that don’t fall into any of those categories. All can be found in dietary supplements. If I were a physician who spent time watching the videos, I really wouldn’t know more about those nutrients in supplements than I did before I watched. I would have learned only two things:

  • The FDA does not have the authority to approve dietary supplements.
  • If a patient takes dietary supplements, anything bad that happens in the body should be reported as an adverse event.

A lot of red flags were waved when the issues deserved a yellow flag at most. I can think of only one word: sad. With the lack of training and knowledge about supplements among doctors, I think those two organizations could have spent their money better and created videos that would have really helped doctors and their patients.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Teaching Doctors About Supplements

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In late May, the Food and Drug Administration (FDA) in partnership with the American Medical Association (AMA) released two short videos to teach physicians about dietary supplements, plus a third aimed at consumers.

The first video spent time defining and explaining what a dietary supplement is, the delivery systems companies use such as tablets,  gummies, bars, etc., and the role the FDA plays in the process. The second video focused on adverse events, how to report them, and a sample conversation between a doctor and patient. I encourage you to watch the videos at the links below.

I think there are two important points of the videos. First, the FDA does not approve dietary supplements in the same way that they approve pharmaceuticals—obviously their main point because it was repeated several times. In exchange for allowing supplements to be introduced quickly, companies do not have to prove safety or effectiveness. However, if they make any health claim, they must report that to the FDA within 30 days of making the claim. Those claims are restrictive; a company can’t say on the bottle or promotional materials “cures heart disease” but can say “contributes to a healthy heart.”

Second, you should always discuss the supplements you take with your physician, especially if you take medications. It can be a pain if you take a lot of supplements, but you must do it because there can be interactions. For example, calcium, whether from food or a supplement, interferes with the absorption of thyroid medications. They should not be taken together (which is tricky because it’s recommended thyroid meds be taken at bedtime when you may be taking a calcium-magnesium supplement to aid sleep).

Those are what I see as the positives of these videos that cover supplement companies and patients; there’s no information about how supplements work or which supplements do what. I’ll cover that aspect of the videos on Saturday. In the meantime, take the time to watch both 10-minute videos.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Myths Busted: Eat Your Fruit

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If you’ve watched the video, you know Dr. Berry gave three myths of the sugars in fruit. We addressed Myth One and Myth Two in Tuesday’s Memo. Today let’s examine Myth Three, and then consider whether fruit will cause non-alcoholic fatty liver disease.

Myth Three: Fiber, Vitamins, Minerals, and Phytonutrients Aren’t Important

This myth is sort of grasping at straws to try to prove a point. He claims that the fiber, vitamins, minerals, and phytonutrients in fruit are meaningless because of all the sugar in the fruit. He makes the comparison of adding those nutrients to a 20-ounce cola and then asking if we would feed that to our child.

Let’s get the facts straight. A 3.3 ounce orange contains a total of 8.5 grams of sugars with all the associated nutrients that he’s saying aren’t important, and he’s comparing that to a 20-ounce cola with 65 grams of high-fructose corn syrup with some of those nutrients added. While the molecules may be identical (Myth Two), there are differences in metabolism between sucrose and high-fructose corn syrup he doesn’t seem to understand. A better way would have been to use equivalent serving sizes. Even better, don’t force an issue that’s marginal, at best, and uses observational science as the foundation.

Okay, I’ve used the term “observational science” several times—what does that mean? Dr. Berry appears to be a very good physician who has helped many people overcome type 2 diabetes and other metabolic disorders using a ketogenic diet. He deserves credit for that, but when you use what you observe as the basis for recommendations for everyone, that’s stretching it.

According to an observational rooster, his crowing makes the sun rise every morning. Observation alone isn’t enough basis for these kinds of recommendations. Unless you have documentation that someone eating 3.3 ounces of lemon containing a total of 2.3 grams of all sugars will spike her insulin and glucose levels, the argument is baseless. In fact, every example he gave should have actual examples to support it, not from the published science but from actual experience. (That would be easy enough to do just by feeding subjects the food in question and then checking their blood sugar at certain intervals.) And it should be published as a case study in a medical journal, because that metabolic response would be unusual to say the least. Until then, it’s observational science and is not meaningful applied to anyone else. Leave the observational science behind unless you have the data to support it.

The Bottom Line

In doing the background research, I found that eating fruit does not appear to be a cause of non-alcoholic fatty liver disease or even a fatty liver. Obesity always seems to precede metabolic disorders that lead to a fatty liver in the vast majority of people. The DASH Diet and the Mediterranean diet, which both recommend fruit, are often recommended to treat a fatty liver, and research shows they work—and that’s the complete opposite of what he recommends.

If you’re concerned about a fatty liver, don’t give that banana or bowl of berries a second thought; focus instead on weight reduction. As always, the key is the calories. Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. Br J Nutr. 2020 Jul 14; 124(1): 1–13.
2. Iran J Public Health. 2017 Aug; 46(8): 1007–1017.

Fruit and Fatty Liver Disease

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Non-alcoholic fatty liver disease (NAFLD) is on the rise in the U.S. and around the world. Estimates are by 2030, NAFLD will be the primary cause of liver transplants in the world. NAFLD is caused by obesity; associated conditions such as type 2 diabetes and metabolic syndrome are contributing factors. But does fruit intake contribute to NAFLD? According to one physician it does; that inspired him to record a video titled “Secret Sugar in Fruit” or as he calls it, the Three Myths of Fruit. He’s an advocate of the ketogenic diet, as many people are today, but is he correct about fruit? I thought I’d check it out.

Myth One: Fruit Contains Only Fructose

His opening statement about fruit is that nutritionists and Internet gurus are suggesting that fructose is the only sugar in fruit. He gives examples of the breakdown of sugars in five fruits, based on the USDA Food Database. No problem with that. But to say that most nutritionists don’t know that fruit contains a variety of sugars means he’s never had a basic nutrition class on macronutrients, because it’s certainly taught in those classes. Anyone who’s ever looked up any type of fruit on the database would clearly see there’s more than one type of sugar.

He also claims that the sugar in some small servings of fruit with as little as two grams of glucose or sucrose will spike blood sugars and insulin levels and that five grams of fructose will cause a fatty liver. He offers no evidence to support those claims.

Myth One contains some accurate facts but is more observational science than fact. Myth One: busted.

Myth Two: The Chemical Structure of Sugars

According to Dr. Berry, nutritionists claim that the chemical structure of glucose, fructose, and sucrose are different in fruit than soda. Not exactly true; they’re chemically identical, but there’s more to it than that. Myth Two: mostly busted.

I’ll cover the third myth on Saturday and set the record straight on fruit and NAFLD. You can watch the short video at the link below. He’s a personable guy, committed to keto, but reliant on observational science. We’ll talk about why that’s a problem next time.

What are you prepared to do today?

        Dr. Chet

References:
1. Gastroenterology. 2020 May;158(7):1851-1864.
2. https://www.youtube.com/watch?v=URMLzoK95V4