Getting to the Exercise Sweet Spot

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Do you realize that five minutes is only 0.3% of a day? Can you really say you can’t at least begin to exercise? “Five minutes isn’t the issue—it’s the 45 minutes a day!” Yes, although 45 minutes is only a whopping 3% of your day, I know it can be hard to work it into your schedule. How about if you could cut the time spent in aerobic exercise in half, from 45 minutes to just over 20 minutes? Interested? Just remember there will be a price to pay.

High-Intensity Interval Training (HIIT)

HIIT as is currently practiced began about 2008 and has been the focus of a lot of research since 2017. The current version alternates very intense intervals from 30 seconds to four minutes with rest periods of at least four minutes; most common is one minute of high intensity and four minutes of rest. Understand that the intensity is an all-out effort, something most sedentary people cannot and should not do—yet.

Remember the price? It’s getting in good enough aerobic condition to be able to handle the increased intensity. When you’re fit enough, four 20-minute HIIT sessions per week can provide you with the exercise sweet spot. Just remember this is only aerobic fitness. Lifting weights, yoga, stretching—that’s all separate.

Intensity

Here’s the real reason I’m getting a knee replacement done: I can’t work hard enough on the exercise bike to reach my target heart rate. Thigh pain above my bad knee hinders me from getting there. I’ve been on the cycle for at least six months, and I’m tired of not getting the workouts I’m used to getting through running.

Although running is not in my future after the knee is replaced, walking will be as well as using the elliptical again. I can replace running with walking uphill in order to achieve the fitness effect I want. It’s not as good but it will give me some variety. I can handle the pain of high-intensity training once I no longer have this level of knee pain. And that’s why I’m doing the knee replacement now.

The Bottom Line

The exercise sweet spot isn’t as precise as I would like, but it does follow a logical progression. Some exercise is better than none; if you’re not exercising at all, start with five minutes. Aspire to at least 30 minutes per day at least four days a week, then work up to 45 minutes.

When you can handle that and your physician says it’s okay, then you can start HIIT training to increase your fitness in less time and still have time to get stronger and more flexible. Even at 45 minutes a day, that’s just 3% of your day committed to exercise. That commitment of time will reduce your risk of just about every degenerative disease, which will help you really live more days of your life and not just struggle through them. Isn’t that worth the investment?

What are you prepared to do today?

        Dr. Chet

Finding the Exercise Sweet Spot

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After last week’s Memos on a sweet spot for food intake, Paula asked if I could do the same thing for exercise. The sweet spot for exercise isn’t so much between not enough movement and too much movement—it’s really between not enough movement and too much time, because most of us never have enough time to do all we need to do. So how can we put in enough time to be healthier but not so much time it becomes unworkable?

If nutrition is complicated, exercise can be more so; that’s why I’m going to stick to just one aspect of exercise: aerobic exercise. While strength, flexibility, and stamina are important, the key to better health is aerobic exercise. How much aerobic exercise is necessary to reduce the risk of all forms of disease, from Alzheimer’s disease to ulcers? There are three answers, depending on your current fitness level.

Riley, our six-year-old grandson, has a motor that doesn’t stop. He would rather be running and jumping, playing tag or battle or anything rather than sitting. Even watching a movie is an aerobic experience for him as he acts out his interpretation of each scene; he does amazing fight scenes! Unfortunately, adults don’t move nearly as much as Riley; most of us no longer have jobs that require moderate or intense physical activity. If you’re sedentary (and even home-schooling three kids is sedentary), then any exercise is better than none. Three minutes is better than two, and 12 is better than 10. Walking, cycling, aerobics—it doesn’t matter. Moving some is better than hardly moving.

Is there a magic number? It’s dependent on exactly how little you move, either due to physical limitations, work, or prior disease. There’s nothing like the precise recommendations similar to nutrition we covered last week.

The ultimate goal? The second answer, based on the current recommendations from every medical and exercise association, is 30 to 45 minutes of aerobic exercise per day most days of the week. There are 1,440 minutes in a day; 45 minutes would represent about 3% of a day. That’s less than the 10% change in diet we talked about last week.

What is the third answer? For those who want to be fitter, I’ll let you know on Saturday. For now, some is better than none. Are you going to begin today?

What are you prepared to do today?

        Dr. Chet

Found: The Dietary Sweet Spot

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Did you have any hot dogs this week after considering the minutes you might lose? How about eating some salmon for what you might gain? If it at least gave you pause, that’s good. The researchers did this study because “research shows that the overconsumption of food detrimental to health and underconsumption of food beneficial for health are leading causes of the health burden in the U.S.” For me it’s a little simpler: finding the sweet spot of nutrition.

Consider the enormity of what the researchers did. They not only considered the health benefit of over 5,000 foods but also the environmental impact. They would not have been able to do the calculations without the use of today’s advanced computing power.

Before I go further, a couple of points: a reminder that this is a theoretical study limited by what we think we know about the nutritional contribution of food to health and disease. Some food-disease relationships may change as we learn more. Second, the results are based on today’s data. As more precise data are collected, the HENI scores may change.

The Sweet Spot

Based on the current study, the researchers concluded that changing nutritional intake by just 10% can benefit both our health and the environment. The change has to be targeted and amounts to an average of 190 calories per person. If we can substitute servings of nuts, vegetables, legumes, and some forms of seafood for about a serving of beef or processed meats, it can yield an increase of about 48 minutes per day for a person over the age of 25—not in longevity but in healthy life minutes.

That’s it. Wherever you’re starting from, change 10% of your calories from questionable choices to healthy ones and you can impact your health. You don’t have to become a vegetarian or switch to an all plant-based diet. Just make a few substitutions; order broiled seafood instead of a steak or burger. Have a handful of nuts instead of a candy bar. Get a baked potato, easy on the butter, instead of fries, and a side salad instead of the onion rings—not every time, but at least one out of ten. If you’re starting from a really poor diet, you’ll probably want to add another 10% after you get this one established, but you don’t have to make immediate radical changes to start improving your health. Opt for slow and steady changes that you can maintain.

One more point: this research didn’t examine weight loss. It’s simply a caloric substitution from poorer choices to better ones to improve your health. While eating better may result in losing weight, that wasn’t the point of the study.

The Bottom Line

This study is as close to finding that sweet spot of nutrition as we have right now. While it’s theoretical, it does attempt to quantify the benefits of something I’ve said for years now: eat better. Combine that with eating less and moving more, and you’re bound to see health benefits.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Food. 2021. (2):616–627.

In Search of the Sweet Spot for What You Eat

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After studying nutrition and exercise for so many years, the one thing I’ve tried to find is the “sweet spot” when it comes to what we should eat. I don’t mean how much sugar or sugary foods can we eat; I mean what do we have to eat to be healthy, reduce our risk of degenerative disease, yet still enjoy all kinds of food. One more thing: it has to be something everyone can do. I think being a vegan is great, but I’m not going to do it and it’s more effort than many people are willing to put into eating—plus I don’t think it’s necessary to be healthy.

What I want to find is the sweet spot: how much good food do I have to eat to balance the food that’s not as good?

Researchers at the University of Michigan may have helped begin the process; although it’s a completely theoretical study, it may give us some guidance. The researchers identified each food’s effect on disease, whether beneficial or detrimental, for over 5,000 foods. They also estimated the same risk-benefit ratio associated with the cost to the environment to grow and manufacture the food. Ultimately, they came up with the number of minutes a serving of a particular food would add or subtract from your life. Needless to say it needed a snappy acronym so they call it HENI, the Healthy Nutritional Index.

Love that hot dog on a bun? You lose about 35 minutes. Eat a dish with seafood? Add 35 minutes. It’s theoretical but it gives us an indication of a sweet spot. I’ll let you know all about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Food. 2021. (2):616–627.

The Dog Will See You Now

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The Memo title is from Malcolm Gladwell’s podcast about canine screening of disease, and I would urge you to listen to it. While the focus is on prostate cancer, the logical question comes up: could dogs be used to screen people for COVID-19? The answer is yes. No one knows for certain whether they can they smell the virus, but they can smell the proteins that are being made when the virus replicates in the body. Maybe it’s the spike protein, maybe a different one, but the tests indicate dogs can smell a person’s mask and identify COVID infections immediately with an accuracy of 83% and higher; some dogs approached 99% accuracy.

Will we see dogs checking folks at the door any time soon? I doubt it, whether for COVID testing or any other type of disease. Why not? Let’s take a look.

The Problem with Dogs

Science has shown that dogs can detect odors down to 1.5 molecules per trillion. They don’t even have to be purebred dogs; mixed breeds can be taught to do it. Therein lies the problem: training. It takes time to train the dogs to be able to distinguish that one unique scent among the hundreds of thousands they may encounter in an airport, a school, or a place of business.

They also get tired, not physically but mentally. They’re still dogs that want to run, jump, and play. They love to work, but they’re not like an inanimate testing device that accepts samples and tests them all day long without needing to be fed and given bathroom breaks. Dogs get fatigued, and that means they could make mistakes.

Those are just details that can be worked out. Dogs can screen up to 250 people in an hour at an estimated cost (including their handlers) of about $2 per person. Compare that with a PCR test for COVID-19 that can cost $200 per person. The real problem lies with humans.

The Healthcare Complex

It would be easy to criticize the medical community for not wanting to endorse this unconventional approach to medicine. The papers I read thought it was impractical to train dogs to do such screenings.

What they would rather do is develop an artificial neural nose that could do the job instead. One big problem with that: they have no clue what the dogs actually detect when they perform the screening. They admit that “clinical diagnostic techniques, artificial intelligence, and molecular analysis remain difficult due to the significant divide between these disciplines.” It could take years to come up with such an artificial nose, and then you’d need humans to manufacture, operate, and maintain those devices; I don’t even want to think what the costs would be. Dogs are already being trained that can be ready in a couple of months.

I’ll let you draw your own conclusions as to why the healthcare complex is resistant to pursuing the canine screening solutions. But I suspect health insurance companies and other organizations such as school districts that actually pay the bills will pay a lot of attention to the difference in price as well as the timeline.

The Bottom Line

If I could train a dog to identify a vitamin or mineral deficiency by sniffing the breath, the urine, or feces of humans, I wouldn’t waste time—I’d do it right now. It’s not a threat to what I do; it would be a powerful tool to use to help people address their nutritional deficiencies perhaps before they manifest in disease.

Do we want to get kids back in school? I’d love to know a dog was testing Riley and all his classmates, teachers, and staff every day before they walk in the building. Getting the subjects to not play with the testing equipment would probably be the biggest hurdle, but we’ve been teaching Riley to recognize dogs that are working and not to bother them. Yes, we’d need a lot of dogs, but we can get that done if we’re really committed.

Let’s hope the healthcare complex realizes they already have the noses they need to get the job done, and all the bearers of those noses want is to play with a ball as a reward for their hard work. I’ll say it again: it’s time to let the dogs out.

What are you prepared to do today?

        Dr. Chet

References:
1. J Travel Med. 2020 Dec 23;27(8):taaa131. doi: 10.1093/jtm/taaa131.
2. PLoS One. 2021.16(2):e0245530. doi: 10.1371/journal.pone.02455

Diagnosing Disease: The Canine Frontier

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Malcolm Gladwell, one of my favorite authors, recently did a show on his podcast “Revisionist History” concerning the use of dogs in screening for prostate cancer. You probably recognize his name from his many books including “The Tipping Point”; if you haven’t tried his podcast, I recommend it.

If there’s one thing that keeps men from getting their prostate examined, it would be the invasive nature of the prostate exam known as the digital rectal exam. This refers to the old meaning of digital: performed with a finger. If any problems are suspected, the typical follow-up procedures include the protein specific antigen test (PSA) and prostate biopsy. I know first-hand how uncomfortable these exams can be, and I understand why men would put it off whenever possible, even to the detriment of their health. But what if there were another way? Time to let the dogs out.

No, this new method did not involve dogs doing what they always seem to do, which is to sniff behinds; these dogs were trained to identify prostate cancer in urine samples. Exactly what they’re trained to identify is still a mystery, but most likely it’s a protein. How accurate were they? Over 95%. Anyone that tests positive by canine would then be followed up by a human physician.

Will we be making appointments to see our canine diagnosticians anytime soon? Probably not—even though just about every type of cancer you can think of has been canine-tested and found to be accurate. Are there other conditions that canines can identify? Yes, and I’ll cover that on Saturday.

The Insider Conference call is tomorrow night. I’m going to talk about the COVID vaccine as well as answer Insider questions. Become an Insider before 8 p.m. Eastern Time, and you can join in on the call.

What are you prepared to do today?

        Dr. Chet

Reference: Urologiia. 2019 Dec;(5):22-26.

When in Doubt…

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It may shock you to know that there are no U.S. Federal laws that mandate the use of dates on foods or supplements with a single exception: infant formula must carry dates. That makes sense—the nutrient content of formula is important for the growth and development of the baby. Other than that, as long as there’s no attempt to mislead the public in any way, manufacturers can put dates on label. The dates relate to the food quality of the food, not the food safety.

Commonly Used Phrases on Food

“Best if Used By/Before” date indicates when a product will be of best flavor or quality. It’s not a purchase date.

A “Sell By” date tells the store how long to display the product for sale for inventory management.

A “Use By” date is the last date recommended for the use of the product while at peak quality.

A “Freeze By” date indicates when a product should be frozen to maintain peak quality. It’s not a purchase date.

None of the phrases indicate the safety of the food.

Our Oldest Food

Because Paula and I went through the pantry a couple of years ago, I was sure there wasn’t anything with a “Use-By” date from 20 years ago like the last time we did it. But I did find some Marmite with a 2015 date on it. I did a little checking and while they put a date on it, Marmite could be good for 60 or 70 years. If you don’t know what Marmite is, it’s a product from the United Kingdom and is about the saltiest spread you can put on bread or crackers. It’s chock full of B vitamins especially B12. The salt prevents the growth of bacteria so it can stay on your shelf for years.

The Bottom Line

The dates put on foods and supplements are about quality, not safety. What affects quality? Temperature, humidity, and light are the major factors. If you store your boxed or canned foods and your dietary supplements in cool and dark conditions, the quality will be sustained for longer, sometimes, much longer, than the “Best if Used By” date. I’ve mentioned our six-year-old Marmite and will have no issue eating it again. I also have a supplement that I use only occasionally that has a date of 2009 on it, and I wouldn’t hesitate to use it.

The only thing time can do is to cause food to spoil or to lose quality. Determining if food is spoiled is easy because you notice the change in odor and whether it’s moldy or not. Quality may impact the flavor and quantity of nutrients because some are less stable than others, but the item would still be safe to use. But here’s one rule that won’t lead you astray: when in doubt, throw it out. If you’re not comfortable, don’t use it or eat it.

What are you prepared to do today?

        Dr. Chet

Reference: Food Product Dating. USDA. https://bit.ly/3twQxUt

Best If Used By

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Here’s a question I’m often asked about dietary supplements as well as food: What should we do with a food or supplement once it’s past the expiration date? One of my health newsfeeds had a title that mentioned milk going bad, so my mind was off and running! What does “Best If Used By” actually mean? Do we have to toss the food or not? We’ll get to that.

Americans discard about one-third of the food they purchase. Fresh food is discarded because it spoils, but a significant contributor to the total foods that are thrown away is those that have reached their “date.” That can include fresh foods as well as foods that are boxed or canned. Is it necessary? In a word, no. I’ll explain why not in Saturday’s Memo.

Until then, here’s a challenge for you. Go into your pantry or wherever you store your dry and canned goods. Search around until you find the box, bottle, or can with the oldest “Best If Used By” date you can find. I did a quick search and found one from 2015. Then let me know what you find. Is it still good? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Food Product Dating. USDA. https://bit.ly/3twQxUt

By Any Means Necessary, Part 2

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About a year ago, I wrote about the reasons we buy food pouches for Riley. He’s six and a half, and we’re still using them, because my thinking is I’m going to get those fruits and veggies into him by any means necessary. And the battle continues.

Some evenings we have a battle royal over eating vegetables. Riley would rather eat pasta and nothing else almost every night. While he will eat pouches with just about any vegetable in it but broccoli, he won’t eat the same vegetables on his plate. The other night it was green beans. He’s eaten them before, but he’s demonstrating a rebellious streak lately. We’re not insisting he clean his plate, just eat a few green beans. Paula will wait him out; she’ll sit at the table and read a book on her Kindle until he’s done eating them.

Me? Not so much. I decided we will enhance the flavor of the green beans. Hot sauce—which I knew wouldn’t make it onto his plate. Cinnamon sugar. Whip cream. Paula thought of a savory flavor and added a sandwich sprinkle blend. The winner? Close between the cinnamon sugar and the whipped cream with ketchup, which doesn’t taste nearly as bad as you might think. Even the sandwich sprinkles got a thumbs up. All the green beans were gone in short order.

I know that’s not a traditional approach to getting kids to eat vegetables. And yet, people who would never touch an onion will eat a deep-fried one with fat imploded into it and a creamy sauce to dip it into; compared to that, I think a dusting of cinnamon sugar is just fine. My philosophy is: by any means necessary. The benefit of the vegetable outweighs the little bit of sugar or whipped cream in my opinion, especially for a kid in the 4th percentile of BMI for his age.

It’s a long holiday weekend so we’ll be back with the Memo in a week. Be safe if you’re traveling. If you’re going to spend the weekend with picnics and such, don’t forgot about eating those vegetables—by any means necessary.

What are you prepared to do today?

        Dr. Chet

Why Errors in Food Intake Matter

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What is the big deal about errors in food intake in studies most people never hear about? It’s a problem because decisions on gaps in the diet, impact of nutrient intake, and the potential benefit or hazards of food and supplement intake are based on studies that use these techniques. I’ll give you a couple of examples, but let me start with something that has become common knowledge.

Obese subjects underreport food intake at a greater rate than subjects who are normal weight. Female obese subjects are more likely to underreport food intake than male obese subjects. Don’t assume they intend to deceive; I think many people are simply unaware of how much they eat, especially when they graze or sample food as they eat, pick at the kids’ leftovers, or eat little snacks at work.

Diet Change and Heart Disease

The Women’s Health Initiative is one of the largest studies done on examining the role of diet and heart disease in women. Results published in 2006 demonstrated that after a number of years on a low-fat diet, there were no differences in the rates of different forms of heart disease. What struck me at the time was that the goal was to reduce fat intake to 20% of total caloric intake, but using a form of dietary recall, the experimental subjects were able to lower their percentage fat intake from 35% down to 28%. That’s still much higher than the goal of 20%. If we were to estimate an average error in food intake based on dietary recall, it could very well be that these subjects actually had well over 30% fat intake due to under-reporting.

Why is that a big deal? Two reasons. First, they were not on a diet that was designed to reduce fat intake enough to impact cardiovascular disease. Second, in a review just published in 2021, a scientist is calling for the repudiation of the results of that study claiming that a low-fat diet does not work to reduce heart disease (or type 2 diabetes either). Based on the results of that WHI trial, we don’t know that for sure because of the potential for under-reporting food intake including fat, as well as the inability of the subjects to meet the goal of 20% fat in the diet. One error begets more errors. In this case, it’s being used to suggest that low-fat diets are not the way to reduce heart disease, and I’m just not ready to make that leap.

Nutrient Studies

There are a number of studies that have used FFQ as the method of assessing food intake in individual nutrient trials. Aside from the “How many portions of beef did you eat per week over the past year” type of questions, the total number of questions ranges from 138 to 164 on most FFQs. The degree with which people will report that accurately is suspect to begin with. Add to that the potential under-reporting of food intake when you’re trying to assess iron, calcium, folic acid, and other nutrients in the diet can provide significant errors in determining how much nutrients people are getting. As the saying goes: garbage in, garbage out.

One more thing. The FFQ were validated by three-day diet histories, which are also prone to significant error.

The Bottom Line

Research that examines dietary intake may be prone to errors. It doesn’t make it worthless; it just means we have to interpret the results carefully. This is especially true when determining whether any specific diet can help reduce disease or prove whether a nutrient is beneficial or not.

What we can do is speak in global terms. Eat better. Eat less. Move more. Do that first and worry about the details later. Even with the potential errors in assessing food intake, there’s no question about that.

So here’s what I challenge you to do: for the next month, make a strong effort to eat better than you do right now. I think if you take this first step, you’ll feel the difference.

What are you prepared to do today?

        Dr. Chet

References:
1. Front. Endocrinol. 2019. 10:850. doi: 10.3389/fendo.2019.00850
2. JAMA. 2006;295:655-666.
3. Open Heart 2021;8:e001680. doi:10.1136/openhrt-2021-001680