Primary vs. Secondary Meds

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One of the key questions for the FDA advisory panel to consider was whether the prescription fish oil was a primary preventer of cardiovascular disease or a secondary preventer. What’s the difference? Primary prevention of CVD would impact the disease and stop events before they occurred in the subjects taking the fish-oil medication. Secondary prevention would prevent additional CVD events from happening in those with established CVD.

If you were a type 2 diabetic with an additional risk for CVD such as obesity or being a smoker, taking the prescription fish oil with a statin would prevent a heart attack or stroke from happening; that’s primary prevention. Based on the Reduction of Cardiovascular Events with Icosa-pent Ethyl–Intervention Trial (REDUCE-IT) that didn’t happen, but it did prove to be a secondary preventer of additional cardiac events in those subjects in the study with established disease.

The question is whether the FDA will approve the prescription fish oil as a primary prevention or a secondary prevention pharmaceutical. The advisory panel seemed split on that count. The assumption by some was that there was disease present even though the event had yet to occur. Others said “prove it” by doing an actual clinical trial to examine that question. We’ll find out how the FDA decides later this year. As I mentioned yesterday, the financial implications are huge.

There are still some things to consider with the clinical trial, and I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: N Engl J Med 2019;380:11-22. DOI: 10.1056/NEJMoa1812792.

Prescription Fish Oil Update

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“This Fish-Oil Heart Drug Could Be Big, Could Be Huge.” That was the headline in a well-known financial report after a Food and Drug Administration panel unanimously voted in favor of an expanded use for the prescription fish-oil drug. I mentioned this was a possibility when I first talked about Vascepa in October. The FDA is expected to make a final decision by the end of the year.

What is the expanded use? The medication could be prescribed to those who have established heart disease or type 2 diabetes with another CVD risk factor and are already taking statin medications to lower cholesterol. The advisory panel approved the use because research showed that when combined with statins, it could reduce CVD endpoints such as death, heart attacks, and strokes by an additional 4.8% when compared to a placebo over a 4.9 year follow-up period, 17.2% versus 22%.

One more thing. The medication could be prescribed to those with triglycerides as low as 150 mg/dl. That would include millions more potential users in the U.S. and Canada alone. You can see why the headline was in the financial news; the potential profit for investors could be huge. A lot is riding on what the FDA decides. I’ll explain that on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Bloomberg Online. Max Nisen. Posted 11-15-2019.

Can Cilantro Help with Seizures?

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Paula and I dislike cilantro; it tastes like soap to us. According to research, that’s a genetic trait. However, cilantro appears to have some very interesting qualities relating to seizures and neurological disorders. Here’s the study.

A research group examined the components of the herb Coriandrum sativum. This herb, commonly known as cilantro, has been used as an anticonvulsant in natural medicine. Their objective was to isolate components that could act as an anticonvulsant. This was not easy research. How do you know what to look for? There are minerals that transmit signals, and there are gates and channels that have to open and close for signals to move throughout the brain and nervous system.

The good news is they found one. They’re called neuronal voltage-gated potassium channel subfamily Q or KCNQ for short. If those channels are not working properly, it causes a dysfunction that can cause severe epileptic encephalopathies. Those types of seizures are resistant to modern anticonvulsants. Researchers found a component called long-chain fatty aldehyde (E)-2-dodecenal that’s able to activate a variety of KCNQ channels, thus preventing seizures.

There is a lot of research that still needs to happen, but this study shows that it’s theoretically possible for the chemical in cilantro to help. The results must be confirmed in animals and humans, but that shouldn’t stop anybody from eating cilantro now. Even though the specific component can’t be quantified in every cilantro leaf we might eat, it may still be beneficial. If someone suffers from seizures, especially if they’re resistant to medication, regular use of cilantro in meals may help.

Mushrooms, berries, and cilantro—although we don’t have all the details, food can assist medicine and may play a more important role in the future. We just have to make sure we eat better, each and every day.

What are you prepared to do today?

        Dr. Chet

Reference: The FASEB Journal, https://doi.org/10.1096/fj.201900485R.

Remember the Berries!

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Did you ever forget where you put something? Do you ever have trouble remembering the right word when you’re trying to explain something? Did those events ever make you worry about your memory? Based on the questions I get, many of you are concerned. The second study examined what foods may help your memory.

Researchers tested a group of over 200 subjects using a variety of short-term memory and cognitive tests. They then gave the subjects in the experimental group a blend of polyphenols from grapes and blueberries in capsule form with a total of 258 mg of concentrates daily; the control subjects got a placebo.

After six months, they retested all the subjects. They did not find an overall effect. But when they examined those who began with the poorest memory and learning ability, those subjects gained the most benefit. The researchers estimated that some subjects gained the equivalent of 14 years in memory ability.

Where do you buy this blend? It’s not available in this exact blend that I could find. However, a half cup of red grapes has 100 mg of polyphenols while blueberries have about 400 mg of polyphenols. The amounts will vary by the variety of grape, but that’s something you can start doing today to improve your memory. While we don’t know if other berries will have the same impact, any berry has polyphenols. Even if they don’t help with memory, they’ll certainly have other health benefits.

We’ll wrap this up on Saturday. There’s still time to take the survey to help me decide where I’m going in 2020.

What are you prepared to do today?

        Dr. Chet

Reference: The Journals of Gerontology: https://doi.org/10.1093/gerona/gly166.

News on Food as Medicine

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As a conventional medical journal and one of the leading medical journals in the world, The Journal of the American Medical Association doesn’t often publish reviews of the impact of food on health. However, a recent edition of the Journal included a summary of three such studies, and that’s the topic for this week.

The first study examined whether mushrooms, which are full of vitamins, minerals, and phytonutrients, decrease the risk of cardiovascular disease (CVD) or type 2 diabetes (T2D). The researchers re-analyzed the data from the Nurses’ Health Study and the Health Professionals Follow-up Study. When they compared more than five servings of mushrooms per day with less than one serving per day, they found no differences in the rate of symptoms or markers associated with CVD or T2D. One interesting note was that if mushrooms were substituted for meat, there was a decreased risk of T2D.

This is one of the first studies to acknowledge the problems with nutrition data in these types of studies. The data on mushrooms were only collected at the beginning of the studies; that doesn’t allow for comparisons over time. Further, the questionnaire didn’t allow for data on a variety of types of mushrooms. The best observation at this point is that we don’t know whether mushrooms or specific types of mushrooms are beneficial for reducing the risk of disease until more research is done.

We do know they’re good for you, so enjoy your mushrooms; sautéed mushrooms are a great addition to many dishes. Here’s another way to enjoy mushrooms: Creamy Mushroom Soup from the Health Info page at drchet.com. Check out the other recipes while you’re there.

We’ll look at another study on Thursday.

What are you prepared to do today?

        Dr. Chet

P.S. Don’t forget to complete the survey on Dr. Chet’s Traveling Health Show. I could be coming to a city near you in 2020! Click the link below to go to the survey.

Survey

Reference: AJCN https://doi.org/10.1093/ajcn/nqz057.

Where Would You Like to Go to a Seminar?

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As I plan my travel for 2020, I’d like your feedback on which cities I should visit. I’m thinking North America, but if you’re convinced I should go elsewhere, let me know. Here’s a link to a very short survey—only six questions.

                        Survey

What are you prepared to do today? I hope you’re in the mood for a few questions.

        Dr. Chet

It Gets Worse Before It Gets Better

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In last month’s Memos, I talked about many different aspects of exercise including flexibility, strengthening, and the various types of fitness and stamina. There’s one more thing you need to know. But first, a story.

Paula has been having an issue with her ankle and foot. She got it checked out with her podiatrist, and it’s a problem with the tendons in her foot including the Achilles tendon. Yesterday we went to see our favorite physical therapist; he did a thorough examination of her foot, ankle, knee, and hips. He recommended some stretching and strengthening exercises as well as some non-impact aerobic exercise. He then said something important: everything may seem worse before it gets better.

I’m going to tell you the same thing as you attempt to work on your body to help you really live instead of merely being alive: you may feel worse before the work you invest begins to pay off and you start to feel better. That’s one reason I ask you to see your doctor before you begin, who’s familiar with your orthopedic issues as well as any conditions that can be impacted by exercise. That’s why you always check first.

If you can get professional help to help you get started, that’s even better—someone to help you choose the right exercises to fit your particular body and limitations. Get a referral to a good physical therapist or find a certified personal trainer with experience helping people who are less fit; you definitely don’t need one of the no-pain-no-gain goons. It doesn’t need to be a long-term relationship, just advice to help you get a good, safe start. And you can probably work out a routine to do at home if joining a gym isn’t your style, but a short-term membership may be helpful in determining which exercises and types of equipment are best for you. For example, don’t buy an exercise bike without trying different types.

For a while, you’ll probably feel worse, especially if it’s been years since you’ve worked on some of these muscles and joints. You may want to refer to the pain scale on drchet.com. Take it slow and let discomfort be your guide. If you overdo it and you’re in pain, back off, ice or heat and rest, and then get going again with a little more caution. After all, you want to live all your days. The work you put in will generate some satisfaction before you may feel the benefits. Better to take longer to get there than stop altogether. The good news is that once you get over that hump, and it may take many months, you’ll feel better than ever.

What are you prepared to do today?

        Dr. Chet

On the Road Again

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It’s time to hit the road again. It’s been too long since I’ve done my own seminars, so I’m planning 2020 Health and Nutrition seminars. My goal is to go to a dozen or so cities throughout the U.S. and Canada next year.

It’s not that I love to travel—it’s that I love to teach. It’s great doing large events with thousands of people, but I like teaching smaller groups because I can cover more material.

Where am I going? That’s up to you. I want to plan as far in advance as I can. For sure I’ll do one in Grand Rapids and another in the Charleston, SC, area where our kids live. After that, I have some ideas but I want you to help me decide.

So here’s the deal: if you think your city would be a good location, let me know; include your best guess about how many people you think might attend.

I’ll soon be sending out a survey with questions about locations, dates, days of the week, and times of day. One thing is certain: I’ll need some help in each area to select a reasonably priced and easy-to-access venue. The seminars are open to everyone. If you’re interested in your personal health, you will benefit. If you’re interested in benefitting your business, it will help you as well.

Look for that survey from me and respond as soon as you can. Call, text, or email me. I’m going on the road again, and you can help decide whether it’s in a city near you.

What are you prepared to do today?

        Dr. Chet

Final Thoughts on Living Every Day

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There are dozens of topics that I could still cover about making sure you live your life every day you’re alive: supplements you could take, a healthy microbiome, protecting your vision, and on and on. But if you don’t get to the part where you eat less, eat better, and move more, the rest doesn’t really mean much. On top of that, there are no definitive answers yet on some of the things we worry about. So I’m going to finish with two things I think are important based on what I’ve read about living every day.

What’s Your Purpose?

You need to have purpose in your life, regardless of age. You should be able to articulate why you get up every morning. If you can state that, it will make it a whole lot easier to do the things you know you have to do to live that purpose. You have to take care of yourself to uphold that purpose.

Laugh and Have Some Fun

Life is to be enjoyed. Yes, we live in stressful times and our lives may be a mess, but we have to be able to laugh and enjoy life. That’s why I had Paula put a picture of Riley, our little fire chief, in this Memo; I’d wager you smiled when you saw it. You can get a lot more release of healthy hormones from smiling and laughter than you can from worry and frowning. Even if it’s just for a few minutes, find the joy in life and take the time to relish it.

The Bottom Line

I hope you’ve enjoyed this month-long look at living your best life. The important thing is to find those areas that you don’t do as well and work on making better habits. That’s the key to living every day you’re alive. Live every day to the best you can in your current circumstances with the goal of making each day just little bit better than yesterday.

What are you prepared to do today?

        Dr. Chet

New Research Yields One More Factor

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The last recommendation for you in living every day you’re alive involves keeping the body working its best through regular maintenance. That means seeing your healthcare professionals on schedule. Here are some examples of what that can mean.

Researchers recently published a paper on the impact of a narrow band of ultraviolet light on the microbiome. If people were deficient in vitamin D, their microbiome was not as healthy as those who had normal vitamin D levels. The UV light did not improve the microbiome of those who had normal vitamin D levels, only those who did not. That’s why you need to get your bloodwork done regularly, including getting your vitamin D levels checked. Whether by sun or supplement, vitamin D is critical to your microbiome and many other aspects of your health.

A couple of years ago my glasses were broken and I needed a new prescription, so I finally had my eyes examined. It had been at least five years since my last exam. Turns out I have glaucoma; by using a couple of drops a day, I haven’t lost any vision. But if I hadn’t had my eyes checked, who knows what could have happened?

One more. It seemed like I kept getting shorter and shorter every time I had a checkup, so I had a bone density test done. Turns out I have osteopenia. Long-time runners like me aren’t supposed to get that, but there it is. I changed my supplements and I’ll get checked again this year.

I’ve often talked about the importance of protecting your dental health. Yes, teeth can be replaced, but it’s really expensive as Paula and I know from experience. While a dental checkup may seem like lot of money, it’s worth it to protect not only your teeth, but many other aspects of your health such as heart and digestive health.

Today’s lesson is get your body checked on a regular basis. We don’t ignore our hearts (for the most part) but the ability to see, to hear, to have strong bones, even to chew food is dependent on taking care of those specialty organs on a regular basis.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Microbiol., 24 October 2019 | https://doi.org/10.3389/fmicb.2019.02410.