What Is ACE?

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Angiotensin-converting enzyme—ACE—is the enzyme that converts angiotensin I into angiotensin II (ANG2). You’re probably thinking, “Well, that clears it up!” Here’s the problem: under the right conditions, ANG2 causes vasoconstriction and sodium and water retention, and the result can be hypertension because the overwhelmed kidneys can’t get rid of sodium or fluids.

However, it gets more complicated. There are two ANG2 receptors, A1 and A2, but A1 creates the problems related to blood pressure. It also contributes to pulmonary hypertension and pulmonary fibrosis under the right conditions. The problem is that we don’t know exactly what those conditions are.

What we are finding out is this: the lung contains A1 and A2 receptors, and it just so happens that the COVID-19 virus can use those receptors to allow the virus entry into cells. Once there, the viruses can multiply and may contribute to the extreme immune response of the lower lungs.

For people who are being treated for hypertension and are taking an ACE inhibitor, it would seem prudent to take your medication on schedule. If you take a medication whose name ends in “pril”—that’s your ACE inhibitor. We don’t know for sure that it will help and there’s a lot of research to go, but we will find out. Until then take your BP medications and do all those other things you’re supposed to do to lower BP.

What about the rest of us? Is there something we can do? Maybe and I’ll cover that on Saturday.

Reminder: my audio High Blood Pressure: Getting It Down is half price this week, CD or MP3. Learn more about what you can do to control your blood pressure.

What are you prepared to do today?

        Dr. Chet

References:
1. DOI: 10.1101/2020.02.24.20027268.
2. doi: https://doi.org/10.1101/2020.01.26.919985.

High Blood Pressure and COVID-19

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If you have hypertension, commonly called high blood pressure, and you’re taking a medication called an ACE inhibitor (angiotensin-converting enzyme inhibitor), make sure you take it regularly. It may—and I repeat, may—provide some protection against the COVID-19 virus. I’ll spend the rest of the week explaining why, but I want you to have that information first because you have no idea what you’ll be exposed to between now and Saturday.

What prompted this urgency? I read a Research Letter in JAMA Network that reported the comorbidities of people who died in 21 hospitals in Wuhan, China, between January 21 and 30, 2020; comorbidities are the simultaneous presence of two chronic diseases or conditions. The first indicator of morbidity (death) was age and try as we may, we can’t change that. The top modifiable morbidity was hypertension; half the people who died had high blood pressure. The second was diabetes.

Near the end of the short paper, the authors noted that hypertension is not a typical risk factor for sepsis, the uncontrolled immune-system response seen in the most serious cases of COVID-19. They commented that prior research had demonstrated that ACE receptors were discovered in the lungs; perhaps ACE inhibitors could be used as a potential treatment for the COVID-19 infection. More research is needed. I’ll examine this issue the rest of the week.

Insiders, remember there’s a Conference Call tomorrow night. I’ll explain this research and address some of the outlandish claims being made by so-called experts about cures for COVID-19 as well. If you’re not an Insider, go to the Store at drchet.com to check out how you can become one now.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. doi:10.1001/jamanetworkopen.2020.5619

Not So Smartphones

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Many variables that were included in the smartphone study weren’t reported, and there’s a good reason for that: they were non-significant. I don’t mean not statistically significant—I mean not significant in the real world either. In fact, I don’t think I’ve ever seen a study with so many variables that were non-significant.

The one that surprised me the most was that simple tracking of blood pressure or the use of the artificial intelligence (AI) application did not change the percentage of people who took their BP medications regularly. Neither approach shifted the scale one little bit. I would have expected that at least some people would have started taking their meds regularly, but they didn’t in either group. In next Tuesday’s Memo, I’m going to give you a good reason to take your meds based on a recent COVID-19 study.

Many of the variables were from questionnaires, and as I often remind you, self-reporting is always suspect. But it raised a few questions about the reported results.

Questions

The first question I had was related to the statistical analysis they ran. Instead of looking for differences within groups, they ran comparisons only between groups. I’m not saying that any differences were profound, but it did appear that there were some that were interesting.

For example, the control group demonstrated no differences in servings of processed meats per week, but the app group decreased servings by about one-half portion. The servings of sugar-sweetened beverages decreased by about a half-portion per week as well, while there were no changes in the control group. That would seem to be a benefit and if a statistical analysis were run, it might have been statistically significant—take a win wherever you can get it. You shouldn’t overstate the findings, but it does support the idea that reminders about a healthier diet might be effective.

I don’t understand why the researchers used an application that was being beta-tested for use in the study. If the number of subjects was limited, and AI requires a lot more data points to really “learn” enough to decide what the subjects need to know and how best to present it to them, it seems the study was destined to fail before it began. If they had called it a pilot study to gain insight to propose a major clinical trial, that would be more logical because that’s what pilot studies are for: to decide whether larger studies are warranted. They came to the same conclusion, but focused on what they didn’t show instead of what they did.

The Bottom Line

The use of smartphones, tablets, and laptops together with applications designed to monitor health are growing in use. Paula recently had a consultation with a specialist and her first telemed physical. I think there’s a place for these types of electronic services, especially during this unusual time. But no matter how many subjects are used to train AI, I think it will always stop short of what they hope applications will do, because there’s no app that will get people to do what they don’t want to do. No logic. No mini-goal setting. No reasoning.

I always thought that education was the key. It isn’t. Even with my education, I have trouble doing the things that I know I should do for my health. The willingness to change has to come from within. Until people have that, no program, person, or application will help them achieve their health goals. It’s wrapped up in the third word in my tagline: what are YOU prepared to do today? It is and always be your choice.

Because we’ve talked about blood pressure all week and more is coming next week, this seems like an obvious time to offer you my High Blood Pressure download at half price; only a few CDs are left, also half price, and when they’re gone, they’re gone. Members and Insiders who log in first will get their discounts as well.

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/39OmUCc.
2. JAMA Open. doi:10.1001/jamanetworkopen.2020.0255.

Limitations of the Smartphone BP App

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In the examination of a smartphone application to help lower blood pressure, the results were a little surprising. Take a look at the graphic representation above of the study, including the results. More and more journals are going to that type of graphic summary. They’re great summaries, but they don’t always tell the entire story.

A quick review on blood pressure: systolic is the upper number and indicates the pressure when your heart is beating; diastolic is the lower number and indicates the pressure when your heart is resting. The ideal BP range is 110/70 to 120/80.

In this case, as you could see on the graphic, there was a difference of only 3 mmHg in systolic BP between those using the AI-generated coaching application and those who didn’t use that app. One of the discussion points was that the number of subjects was not great enough to be able to discern the significance of less than a 5 mmHg difference in BP. Achieving statistical significance is pretty much irrelevant in the real world if the difference between the approaches was so small. Yes, in a population of 50 million, a 1 mmHg drop in systolic BP may save some lives, but who do you really want tracking your BP: an artificial presence or your physician?

What really caught my attention was that both approaches worked. The overall decrease in the AI group was 8.3 mmHg versus 6.8 mmHg in the control group. There were decreases in diastolic BP as well. Whether it was the automated BP reporting alone or not, it appeared that just paying attention got results. But that’s not all I got out of the study. I’ll let you know more on Saturday. By the way, how you coming along with your new habit?

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/39OmUCc.
2. JAMA Open. doi:10.1001/jamanetworkopen.2020.0255.

Get Health Support via Your Smartphone

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Paula has an appointment with her primary care doctor this morning, and she’ll be right here on the sofa when it happens. Telemedicine is now a part of everyday life, but your phone can be an asset to your health even beyond speaking to your doctor.

For example, hypertension is still a significant problem in the U.S., and it’s directly related to heart disease, stroke, and kidney disease. The typical treatments are medications, diet, and exercise. The problem is that too many people don’t follow through consistently enough to help themselves. Before I go any further, here’s a hypothetical: Imagine an application for your smartphone that would record your blood pressure and help you with diet and exercise recommendations and tracking; would that help you and others lower mild hypertension?

That’s what a group of physicians and public health officials in the Chicago area wondered. In the Smart Hypertension Control Study, they scanned more than 2,700 electronic medical records to find just over 300 people with mild hypertension to take part in a study comparing two different approaches to managing hypertension. Both the experimental group and the control groups used home blood pressure monitoring (HBPM) that could be reported automatically after it was taken with a Bluetooth connection to a smartphone. The experimental group used a smartphone app—a hypertension personal control program (HPCP).

The application used artificial intelligence to provide reminders and feedback along with diet and exercise information. The primary outcome was a difference in BP between the groups; I’ll tell you more about the results on Thursday. Until then, pick one single habit, such as taking your temperature or washing your hands, and through Saturday see how regularly you do that.

Hypertension is bad any time, but with a virus that seems to kill people with preexisting conditions, this is a great time to improve your habits.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Open.doi:10.1001/jamanetworkopen.2020.0255.

Observations and Questions About the Step Study

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Most research papers such as the step study I began to review on Thursday have a main point, sometimes a couple points, and that’s all we take from it. But there some interesting things that may not get headlines but are still worth mentioning. Let’s take a look at some other results from the steps and mortality study.

Observations

Whatever you might believe about exercise was proven true by this study—not the positive outcomes such as the decrease in overall mortality, as well as CVD and cancer mortality, but questions that paint a picture of who exercises. For every category, from education to smoking to alcohol consumption, what we would expect was confirmed. But we also learned that people are high steppers who we would not expect to be.

For example, would we expect obese subjects to be in the fewer than 4,000 steps per day category or in the greater than 12,000 steps per day category? You would be right if you thought most were in the more sedentary category; 36.7% of those with a normal BMI were in the highest step category. But it doesn’t mean that there were no obese subjects in the greater than 12,000 steps per day category; in fact, 24.8% of those with BMI greater than 30 were in the highest step category.

Why? That’s what we really need to find out. What makes them different? Why are they doing what we don’t expect, or did they just do that well when they wore the accelerometer? If we want to change behavior, that’s what we need to find out.

This was an observational study, so it cannot prove cause and effect, but it gives us insight into the type of studies that will be able to determine cause and effect, such as randomized controlled trials. They can be better designed by building on this study.

Questions

Because we’re in a “Stay Home and Stay Safe” environment, there were some logical questions about stepping and coronavirus infections but I couldn’t find a single answer. When I searched for “fitness and coronavirus,” I found the term fitness meant fitness of the virus, not humans.

I used different search combinations and finally decided to try exercise and coronavirus. There were a number of papers that were written in the last couple of months about the safety of exercise during the pandemic as well as exercise to relieve stress for first responders, but those are still not exactly what I wanted. I wanted to see if steps or exercise would reduce the rate of catching coronavirus, any coronavirus.

I didn’t find that, but I discovered an interview with exercise immunologist Dr. Jeffrey Woods. Rather than summarize it for you, I’m giving you a link to this article for you to read. While it’s difficult to prove improved resistance to coronaviruses, Dr. Woods’s creative research has come close. As long as most of us have the time, I suggest that you read it.

The Bottom Line

Research studies such as the one I’ve reviewed this week tell us a lot about what we know and what we still need to find out. There are too many questions left on the table that never get answered related to diet, nutrition, and exercise. Do you really get all the nutrients you need if you eat a perfect diet? No one knows because no one has ever tested it. Let’s hope we get some answers related to diet, fitness, and supplementation as it relates to the prevention and possible treatment of the coronavirus when this challenge is all over, but I’ll go out on a limb and say you’ll never be worse off by being in better shape. Now that many of us have more time, let’s work on that.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382.
2. Journal of Sport and Health Science 9 (2020) 105-107.

Step It Out!

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By the looks of it, “Stay Home and Stay Safe” will extend through the beginning of May and perhaps longer. As we adapt to our new normal, here is a little incentive to make exercise a regular part of your life from now on.

Researchers analyzed data from the 2003–2005 National Health and Nutrition Education Survey (NHANES). During that version of this recurring study, they collected seven-day accelerometer data from over 4,850 adults 40 years and older representative of the population of the U.S. They tracked the group of subjects through 2015 to look at all-cause mortality and steps per day.

If you look at the graph, you can see that deaths per 1,000 decreased as the number of steps per day increased. The mortality rate was half the amount at 8,000 steps per day than at 4,000 steps per day. While it continued to decrease slightly, the optimal amount of steps seemed to be between 8,000 and 10,000 steps per day. One surprising outcome was that intensity didn’t seem to matter; just volume.

All-cause means just that: all causes. That’s a real motivating factor to work on stepping it out every day. But it raised a question: could steps per day reduce the risk of getting upper respiratory infections? I won’t make you wait until Saturday. The answer is that no research has answered that question yet. But there was a lot more to this study, and I’ll cover that on Saturday.

Reminder: this week you can save 19% on two items at drchet.com. Use the coupon code virus.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382.

Adjusting to Your New Normal

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Today is the end of the month; it’s also the end of the first quarter of the year. I would guess that due to COVID-19, you may have to set new and perhaps different goals. I know I am; my seminar schedule has blown up completely—for now. The challenge is that we really don’t know how to set business or work goals because we don’t know what the new normal will be, but we’ll adapt.

However this is the perfect time to decide what you want your new normal health to be like.

What changes do you want to make? Lose weight? That’s on nearly everyone’s list, but there are many other potential health goals, such as to get more flexible, gain muscle, increase stamina, increase strength, lower blood sugar and HbA1c, do 50 consecutive push-ups, lower blood pressure, and more such as building the best immune system you can. We may have to “Stay Home and Stay Safe” and we may have to work from home, but we get the one thing we all want more of: time. Time to cook better. Time to stretch. Time to learn more about how to be healthy. Time to exercise, because that’s one thing we’re allowed to do outdoors. As you set those goals, set your health goals for the new normal for you.

Let me suggest one area to start: prepare yourself mentally. This is going to be a long, drawn-out process, and it’s not going to be over soon. There may be repeated periods of “Stay Home and Stay Safe” coming. You have to be ready for that.

The normal you know today is gone. It will take time to develop a new normal. It will be different than this one, and it won’t be the final one, but there will be a new normal until a real treatment is found that works quickly and prevents outbreaks and a vaccine is developed. Let’s get there together.

Back to the idea of time to learn more about how to be healthy; as you’re listening to podcasts, add a Dr. Chet MP3 or CD to your playlist. Or now that you have more time to cook, get the Real-Life Detox book or e-book to give your body a better chance to be healthy. This week we’re offering a special discount: use the code virus to get 19% off any two items. That’s 19% in addition to the Member and Insider discounts.

What are you prepared to do today?

        Dr. Chet

Sorry, but Some Health Writers are Scammers

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The typical research paper may have findings that are controversial, but researchers are using the techniques of their profession. I may disagree with their conclusions for a variety of reasons, but at least it’s contained. Following the threads this author created was a challenge but fruitful, especially the first one.

The readers of her columns were told to hop on over to the FDA website to see how easy it is to get beneficial statements on the label. I read the entire set of guidelines, and here’s the bottom line: it’s most definitely not easy to get a label claim approved.

She asked the industry rep to give her the name of a scientist who is not in the supplement industry who believed the health claims on supplement labels were meaningful. The rep couldn’t think of anyone.

She made a big deal over that one: no independent scientist supports the claims on labels. “Just think about what that means,” she added. It means that the supplement industry rep isn’t acquainted with scientists outside of her area of expertise. Why would she be? It’s not her area. But if you’ve been a science writer for over 22 years, you would certainly know plenty of scientists. Why didn’t she contact them for their opinion?

The writer then talked about a conversation with an executive for a well-known nutrition watch-dog group. He talked about the gold standard for removing a product from the marketplace: ephedra was banned back in 2003 because people who took the weight loss product had died.

Actually, it took the death of a professional football player to get everyone interested in ephedra, which is more like medicine than a supplement. People died, but in most of those 55 cases, it was the abuse of the herb that caused the issue, not the recommended use. I wasn’t an ephedra fan because weight loss is calories in, calories out; you would expect that messing with metabolism to cause issues, especially when overusing an herb.

Then it was a wandering rehash of other studies on increased risks of cancer. It was her responsibility to do the reading before she wrote the article. Was she being one-sided in what she wrote? I think a better way to say it was that she didn’t complete her background research.

There was some talk, silly in my opinion, with a religion professor about the psychology of why people take supplements. And then she completed her comments by saying that people who take dietary supplements are wasting money on products that will never help them.

The Bottom Line

All in all, it was a poorly researched article about the benefit, or lack thereof, of dietary supplements. What was clearly apparent was that her lack of nutrition education meant she really didn’t know what questions to ask. Based on what she said, she never really read the FDA Guidelines for supplement manufacturers. If she had, she could have picked a product with a wild claim, and I can think of several, checked the background research, and then evaluated it according to the law to determine whether it complied or not, rather than simply saying it was easy.

Health writers, and in fact, any writer who writes about science, needs to be a critical thinker, not one that criticizes without thinking. In this case, she failed to do her job. The big problem with that is most people don’t have the science background to know whether what she said is trustworthy and many people will be misinformed, perhaps to the detriment of their health.

What about her claim that people are wasting money on supplements? We all know from our own experience, as well as from science, that supplements can make a difference in our health. As I’ve always said, no amount of supplements will make up for an unhealthy lifestyle, but using specific supplements are an important part of staying healthy.

What are you prepared to do today?

        Dr. Chet

Reference: FDA Link: https://bit.ly/2QLDRa2

Investigating Supplements

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Let’s turn to what the author I wrote about on Tuesday said and examine it in detail. She interviewed a variety of experts; I checked them out and they were most definitely legit, especially those who worked in the research arms of the NIH. She asked them a simple question that went something like “Which supplements have well-established benefits?” The scientist who works in the complementary and natural approaches research arm said the list was short: ginger for digestive issues, peppermint for the same, melatonin for sleep, and fish oil for cardiovascular disease all have established benefits. The clinical trials that weren’t as beneficial were for turmeric, St. John’s wort, ginkgo biloba, and echinacea. (That doesn’t mean they won’t work for you; we’re all different.)

Then she talked with an expert in vitamins and minerals who recommended folic acid for neural tube defects, vitamin B12 for vegans and the elderly, the combination of nutrients that seems to help with an eye condition and finally, that multivitamins have some benefit.

She then asked the same question of a senior representative of a dietary supplement industry group. The person replied with much the same list of supplements and benefits.

In effect, the government agencies and the industry group agreed about benefits from some supplements. The next logical question in the writer’s mind was “What about all those supplements that neither group addressed? What about those supplements that fill the shelves of pharmacies, health food stores, and on the Internet? The type that say ‘good for energy,’ ‘may help your immune system,’ and so on.”

The author suggested that a curious person should just bop on over to the FDA website to see how easy it is for companies to get these statements on the product labels. So I did. I’ll let you know what I found out and finish this on Saturday.

What are you prepared to do today?

        Dr. Chet