Can You Be Obese and Healthy?

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The research question that was most interesting to me as a graduate student was this: could you be overweight, even obese, and still be healthy? That question still interests me today, and for good reason: 70% of the U.S. population is overweight or obese, and we’ve just passed 40% of the entire population falling into the obese category. And it’s not just the U.S.; we’ve exported our poor fitness and diet habits around the world.

Research done decades ago from by Cooper Institute, most often under the direction of Steven Blair, demonstrated that you could be fat and fit. Their research showed that people who were obese, meaning they had a BMI greater than or equal to 30.0, were no more at risk for death from cardiovascular disease or all-cause mortality if they were in the high fitness category.

That’s not the same question as this: could you be metabolically healthy and at no more risk for death from cardiovascular disease or all-cause mortality than someone with a normal BMI (18.5-24.9 kg/m2)? Researchers from Germany decided to examine that question. They used data collected from the National Health and Nutrition Education Survey III, which included over 12,000 subjects, and the U.K. Biobank, which contained over 374,000 subjects. Then they examined the statistical relationship between many different variables such as triglycerides, total cholesterol, hemoglobin A1C, C-reactive protein, systolic blood pressure, and on and on. Once they had a series of statistical relationships between obesity and mortality, then they sought to derive as simple an algorithm as they could to develop a profile of someone who would be metabolically healthy and obese. I’ll tell you more about that in Saturday’s memo.

Meanwhile, have you examined that map that was part of the CDC atrial fibrillation primer? Here’s what I saw: I’ll call it the I-75 Corridor of A-fib. Starting in Flint, MI, if you follow the pattern of the deepest red, it follows I-75 through Detroit to Toledo, OH, then Cincinnati, OH, and all the way down through Georgia to Florida. That’s the I-75 Corridor of A-Fib. What does it mean? Nothing, as far as I know; it doesn’t correspond to race or income or temperature. It’s an observation, nothing more, but maybe some epidemiologist or statistician somewhere will look into in more deeply.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Net Open. doi:10.1001/jamanetworkopen.2021.8505

Omega-3s and A-Fib: More Analysis Required

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I hope that you took the time to review the paper on atrial fibrillation as well as the research letter on omega-3s and atrial fibrillation. If you haven’t, especially the primer on A-fib, please do it. It’s a serious condition that requires attention if you have it; in most cases, fixing it is surprisingly simple.

The research letter included five studies. I decided to look at each of those research papers individually to see how each trial was conducted, especially on the populations used in those experiments. Here’s what I found.

The Subjects

The subjects in the studies had several characteristics in common. First, they were, on average, in their mid 60s and older. Second, they had already had a myocardial infarction (heart attack) or were at high risk for cardiovascular disease due to factors such as obesity, hypertension, elevated triglycerides, and others. Third, most were taking multiple medications.

They definitely were not healthy and free of disease. The potential for a cardiac event increases if you’ve already had a cardiac event. On top of that, in the trials that used prescription fish oils, the attempt was to lower triglycerides in those patients who were taking a maximal dose of statins. There may be some interaction that hasn’t been identified yet between very high doses of omega-3s, equal to or greater than four grams, and statin medications or other pharmaceuticals the patients were taking to control blood pressure, heart rate, etc.

In short, this does not apply to everyone. In fact, in the concluding statement of the research letter, the researchers state that physicians should be cautious when prescribing high-dose omega-3s in patients with high triglycerides and an increased risk of cardiovascular disease.

Additional Analyses

As I alluded to in the prior paragraphs, I think the analysis should include factors such as exercise, diet, and especially prescription medications. It may be that the number of subjects might not be able to be broken down by statin intake, beta blocker intake, or ace inhibitors, but I think that it should at least be examined to see if there’s any trend.

Also, the data could be separated into those people who’ve had a heart attack and those that haven’t, even though they may have significant risk factors for cardiovascular disease. After a heart attack, there may be morphological changes such as damage to nerve conduction or the buildup of scar tissue that could impact how omega-3s impact the heart itself.

Are all of these possible? I would think it would be with over 150,000 subjects from all the studies included in the meta-analysis.

Two More Things

I still have not found a single nutritionist involved in any of this research. When you look at prior studies that seemed to benefit heart rhythms, it’s DHA omega-3, not EPA, which is the factor related to better heart rhythms.

Take a look at the map that’s in the primer on atrial fibrillation. It applies to those on Medicare who are 65 and older, but there’s an amazing and obvious trend. I’m even going to give it a name; I’ll tell you that next Tuesday. The only clue that I’ll give you is to think maps and what they’re typically used for.

The Bottom Line

While interesting, the Research Letter on the update of omega-3s in relation to atrial fibrillation leaves more questions than answers. So far, it applies only to people over 65 with high triglycerides and other risk factors for cardiovascular disease. If you already take omega-3 fatty acids, there’s probably no reason to stop, but it’s a discussion you should have with your physician.

It’s also obvious that if you do have high triglycerides, you can work on changing that by changing your diet first. Reducing refined carbohydrates is the key; eating more vegetables helps as well.

It always comes back to this: eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal – CVD Pharm. 2021 doi:10.1093/ehjcvp/pvab008
2. Curr Atheroscler Rep. 2020. https://doi.org/10.1007/s11883-020-00865-5
3. Atrial Fibrillation Primer. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

Research Update on Omega-3s and A-Fib

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A recent research letter to The European Heart Journal caught my attention. This was a continuing meta-analysis of data linking the use of omega-3 fatty acids to atrial fibrillation. The result of the original analysis in 2020 and the additional studies that were examined in the current meta-analysis led to the conclusion that there’s an increased risk of atrial fibrillation for those who take omega-3 fatty acids. That seemed surprising to me because prior research suggests that there’s a reduced risk of fibrillation in those that use omega-3 fatty acids.

To quote Vince Lombardi, “What the heck is going on around here!”

The concern by the research group seems to be focused on the current recommendations for high-dose prescription fish oil for elevated triglycerides. The problem is that the original meta-analysis that included 14 studies did not just use prescription fish oil; it used fish oil from dietary supplements as well. While the current update seemed to focus on the prescription omega-3s, it also used margarines enhanced with vegetarian-sourced omega-3s.

What are we supposed to do? Dig deeper. Do the results apply to everyone? No. Are there other potential problems with these studies? Yes, and I’ll cover those on Saturday. Until then, if you want a primer on atrial fibrillation, read the link in Reference 3; pay close attention to the map. You can also read the Research Letter by checking out reference 1; it’s open access.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal – CVD Pharm. 2021 doi:10.1093/ehjcvp/pvab008
2. Curr Atheroscler Rep. 2020. https://doi.org/10.1007/s11883-020-00865-5
3. Atrial Fibrillation Primer. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

Aging with a Vengeance and Your Proteome

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This year’s Super Bowl Webinar focused on aging with a vengeance—becoming the best version of yourself, no matter your age. The study we just reviewed on the proteome suggests that the people were healthier who were biochemically younger than their actual age. Here are the actions I believe can help at the three critical phases of aging that were identified in proteome study. As I find out more, I’ll be more specific.

31 to 37

If you have weight to lose, now is the time to lose it. Take it from me and my decades of experience with weight loss programs: it becomes more difficult the older you get. Find a way to eat that will maintain a reduced body weight and stick with it.

Reduce your protein intake. That may seem a little odd, but this is a time to focus on vegetables, fruit, whole grains, and quality oils.

Focus on your cardiovascular system by doing aerobic exercise on a regular basis. Use interval training to make the most of your time, and when you’re fit enough, you can add high-intensity interval training (HIIT) to your routine.

57 to 63

The kind of 80- to 85-year-old you’re going to be is dependent on what you do now. If you haven’t achieved a normal body weight, that’s a high priority just as it was in the prior age group. I know how difficult this is because it’s eluded me throughout my life; I lost a lot of weight and kept it off for years, but I’d still like to weigh less.

Increase protein intake to 1–1.5 grams per kilogram body weight per day.

Supplement your diet with essential amino acids. While the amounts are still not absolutely clear from the research, 10–20 grams per day is a good goal.

If you’re not already doing so, add weight training to your exercise routine. Start with using your own body weight, then add exercise tubes or light weights, and then use machines or free weights. Now is the time to retain or even increase your muscle mass.

75 and Older

If you haven’t achieved a normal body weight, there’s still time. My wonderful mother-in-law lost a significant amount of weight at this age, and she was an overweight diabetic in a wheelchair.

Increase protein intake to 1.5–2 grams per kilogram body weight per day. It’s difficult because appetite decreases and protein makes us feel full. It will help reduce the muscle loss that’s happening.

Supplement your diet with essential amino acids; the amounts are still between 10–20 grams per day.

Add weight training to your exercise routine. It will help you to retain or even increase your muscle mass. Stay within any orthopedic or other limitations, and get some help if you need to, but do it. Your primary caregiver will probably be glad to refer you to a physical therapist who can get you started safely.

The Bottom Line

For all that’s been written about healthy aging, we still don’t know very much. Healthy aging begins the day we are born, but we realize that only when it dawns on us that we’re aging. No matter your age, no matter your current state of health, it can be better. You can learn more in the replay of this year’s Super Bowl Webinar, but it will be available for only a little while longer.

The simple things I’ve talked about in this Memo are a beginning. When I know more, so will you. Inevitably, it comes back to a single question:

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0673-2

Proteome: Predicting Your Age

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Have you ever taken a test or questionnaire that predicts your health age? What they’re really predicting is your longevity based on lifestyle factors and where your health stands today. What if you could be more precise in actually calculating your health age? That’s what researchers did based on the results of the proteome study I talked about last week.

The researchers identified 373 proteins that could be used to predict someone’s age within about three years. They used proteome data from other studies to test the predictive capability. When the test predicted people were younger than they actually were, those people did better on cognitive and physical tests. That means the proteome was revealing a pattern of proteins associated with someone who was younger.

Don’t run out to get this test; it isn’t available—yet. Scientists are working to narrow the proteins included in the age-predictive equation; there’s a lot of work to be done before it can have any clinical significance.

Does that mean there’s nothing we can do now, test or no test? I think we have some options, and I’ll tell you about that Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0673-2

The Proteome: A Cross-Sectional Study

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Every study begins with a question. A single question often leads to more questions, which leads to questions about whether the outcome can be measured, and on and on. In this case, the question was related to changes in the blood proteome over a lifetime: Is the proteome stable? Is it a series of continuous reduction or expression in some key proteins, or are there identifiable changes that occur at different points in a lifetime?

The best way to know that is to obtain serial blood draws from a group of individuals every year (or two years or five years) to track changes in the blood proteome, the entire collection of proteins in our blood cells. We live too long to make that practical. The next best thing is to select a large group of people of all ages, get blood samples from each along with other demographic and lifestyle measures, and compare the differences over the entire age-span. That’s a cross-sectional study.

Here’s what a large group of researchers choose to do. They recruited 4,263 people from 18 to 95 years old. Getting blood samples and other data from the subjects, they measured 2,925 blood proteins. Stop and think about that: they looked at over 12 million data points. The technology to measure each protein is incredible in and of itself; now add to that the sheer volume of number crunching that it takes to analyze that much data. Without high-speed supercomputers, it wouldn’t be possible in a reasonable amount of time.

The researchers found that over the years 1,329 proteins varied at different ages of the subjects; the ages where there was more variability than at other times were about 35, 60, and 78 years old. What does that mean? The first step in finding out would be to identify all the proteins and find out what they do. If some form of lifestyle change could impact aging, that would be necessary to know.

But that isn’t all they did with the data: scientists love predictive algorithms. We’ll take a look at what they discovered on Tuesday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0673-2

What Is the Proteome?

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In the week we took off, I spent my time researching a couple of fascinating studies. We all have different ideas of what’s fun, don’t we? For me, getting to research topics in depth is a refreshing opportunity to learn something new. I’m going to share part of what I learned in the next several memos and it’s all about the proteome.

Obvious question: what is the proteome? A proteome is the complete set of proteins expressed by an organism—same idea as the microbiome, but with proteins instead of microbes. That includes obvious proteins such as muscle, hormones such as insulin, or many of the thousands of enzymes and other proteins the body makes. Those proteins may be produced only during specific circumstances and in response to events within and outside the body. The proteins can be systemic or they can occur in individual tissues and cells.

More than what, why is the proteome important? Research has demonstrated that there’s variability in the proteome at specific times during life. The idea is to identify which proteins change and which ones are associated with a healthier life. That’s the first step and I’ll cover a study that did just that on Saturday.

Tomorrow is the monthly Insider conference call. Check out the membership and if you become an Insider before 8 p.m. Wednesday, you can take part.

What are you prepared to do today?

        Dr. Chet

Reference: Aging Cell. 2018;17:e12799. https://doi.org/10.1111/acel.12799

Statistics and Lies

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The past year has been full of opinions about the COVID-19 virus, the treatments that people claim work, and even the number of deaths from the virus. I mean, people were full of it. And still are.

The story I heard most often from a variety of people was that people died from other causes, but physicians were told to put COVID on the death certificate by hospitals—all part of a conspiracy theory to make this innocuous virus seem dangerous. Except it wasn’t an innocuous virus. It was and is dangerous, and the preliminary mortality statistics show that: 345,000 people died from the virus in 2020.

The other lie was that there were no reported deaths from heart disease because everyone who died from heart disease was assigned COVID as the cause of death. That’s a lie; 691,000 people were reported to have died from heart disease. “They would have died from heart disease anyway,” I read again and again. I don’t disagree, but the question is when? Without the added factor of COVID, they might not have died for decades.

Do we have too many people with pre-existing conditions such as heart disease, hypertension, smoking, and type 2 diabetes? Absolutely. But solving that problem requires long-term solutions. Again, without COVID, there would have been many fewer deaths.

The Bottom Line

As I’ve said from the beginning of this pandemic, there’s no reason to fear the virus. You should respect it and do the things that reduce the risk of catching it, especially now with the serious mutations that are evolving. There’s talk of infrastructure legislation coming at some point. To me, we all need to evaluate our personal infrastructure, make a plan, and get our own bodies in order. That’s the way to deal with this pandemic and the next one.

Health is a choice. Choose wisely today and every day.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. doi:10.1001/jama.2021.5469.

2020 Mortality Statistics

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The statistics on the causes of death in the U.S. always take a year or more to collect because every state and the District of Columbia forwards the death certificates with the cause of death to the National Center for Health Statistics Vital Statistics System for review and compilation. You can see why it would take a year. However, with the ongoing pandemic, it’s critical to get a provisional count of the number of deaths and the causes. You can read the JAMA Letter yourself at the link below.

The total number of deaths rose to 3,358,814, an increase of just over 500,000 people. The leading cause of death remains heart disease which rose by 31,000 deaths to 690,882. Cancer deaths decreased slightly, but cancer was still the cause of 599,000 deaths. The next cause of death was attributed to COVID-19 coming in at just over 345,000.

Were there any real surprises? Not for me. It does raise some questions, and I’ll address those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. doi:10.1001/jama.2021.5469

New Research on Vitamin D and COVID-19

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The research confirming the benefit of adequate levels of higher vitamin D (25-hydroxyvitamin D) blood levels keeps growing. In this Memo, I’m going to cover two of the most recent studies, both observational studies; the researchers were able to obtain vitamin D levels from medical records after subjects were admitted with COVID-19 infections.

Study One: Vitamin D and COVID-19

The first study was conducted at two medical centers in the Boston and New York City areas. Participants were hospitalized adults with confirmed cases of COVID-19 between February 1 and May 15, 2020; 144 patients, median age of 66, were included in the final analysis. Overall mortality for all subjects was 18%. However, in subjects with vitamin D levels greater than 30 ng/ML, the mortality rate was 9.2% versus 25.3% in those with vitamin D levels below 30 ng/ ML. The researchers concluded that patients with COVID-19 who had levels greater than 30 ng/ML had lower mortality rates and did not require mechanical ventilation to the same degree as those who did not have adequate vitamin D levels.

Study Two: Vitamin D and COVID-19

In the second study, researchers did a chart review of all COVID-19 patients over 18 who were hospitalized in a Boston Medical Center. All patients were positive for COVID-19 and had a vitamin D test in the prior year; 287 patients were included in the analysis. Of those, 14% of all patients died during the hospitalization; 100 out of the 287 had vitamin D levels greater than 30 ng/ML.

Focusing on those patients over 65, they found that patients with normal levels of vitamin D had a 67% decreased odds of dying, 78% decrease risk of acute respiratory distress, and 74% decrease in severe sepsis or septic shock. There was a similar relationship, even if subjects were obese as assessed by BMI greater than 30.0 kg/m2.

The Bottom Line

These two studies add to the body of work that suggest that adequate levels of serum vitamin D are essential for reducing symptoms and mortality for COVID-19, especially in those greater than 65 years of age. It does not mean that it’s time to start mega-dosing on even more vitamin D than you may be taking.

What it means is that you should get a vitamin D test to find out where you stand. We have no idea whether any of these people took vitamin D, and if they did, we don’t know how much they took. If you really want to age with a vengeance, then approach things in a stepwise manner. You don’t start on a solution before you know if you have a problem. So get a vitamin D test scheduled and then you can make an informed decision about whether you’re taking an adequate amount of vitamin D or you may need to up it a bit.

If you’re thinking, “Nah, COVID is almost gone,” think again. Yes, many of us are now fully vaccinated, but the new variants are so lethal that we can’t ignore them, and too many people seem to have “Superspreader” as their goal. Keep your defenses up, because you don’t want to be one of the very last people to die of COVID-19. Let’s finish this race strong—and then have a cook-out.

It’s time for spring break so Paula and I will be taking some time off. We’ll be back with the next Memo on April 13. Have a safe and healthy spring break and any holiday you may celebrate. What are you prepared to do today?

        Dr. Chet

References:
1. Mayo Clin Proc. 2021. doi: 10.1016/j.mayocp.2021.01.001.
2. Endocr Pract. 2021. doi: 10.1016/j.eprac.2021.02.013.