Common-Sense Health: Where Is Your Wallet?

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Keeping things balanced is important, and I try to do that in the Memos I write. Usually I tackle issues that are serious with significant health implications, but life is to be enjoyed so this week, we’ll lighten up before a holiday by talking about a guy’s wallet. And this is also about balance.

When Paula and I had dinner with friends this weekend, the husband talked about the physical therapy for back pain he’s been doing. The exercises have worked, but he chided me: “You didn’t tell me my wallet could affect my back.” Oops. He’s correct.

If you have a wallet in your back pocket and you sit most of the day, the force of the chair on the wallet can compress the sciatic nerve, and voila, you may have pain shooting down your lower back and the back of your leg. A recent paper talked about three men with lower back pain that was due to their wallet.

The simplest solution is to reduce the size of your wallet or just carry what you actually need on a clip in your front pocket or in your jacket: a picture ID, a credit card, your Costco card, and some cash. What more do you need? Membership cards? I have an app on my phone that shows my gym membership so I don’t need to carry that card.

If you have lower back pain, I would recommend you get a referral to a physical therapist to find out how you should deal with it; there may be different muscle groups involved depending on your specific anatomy. But if you’re sitting on a fat wallet that throws off your balance, changing that could make a difference.

How could your pillow affect your hip? I’ll let you know on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Curr Rheumatol Rev. 2017 Mar 9. doi: 10.2174/1573397113666170310100851.

 

The Bottom Line on Essential Amino Acids

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Essential amino acids are becoming more prevalent in the sport nutrition supplement offerings. Yet there are still questions that remain, and we don’t have a total picture of who will benefit from EAA use. Let’s take a look.

Questions

Even with this new research, there’s so much we still don’t know about EAAs.

  • Is there a special proportion of EAAs that works best? In other words, should the amount of leucine or isoleucine or tryptophan be higher than other EAAs? What’s the best proportion?
  • What’s the best source? Milk, which contains whey and casein? Soy? Rice? Pea? Or a form of meat such as chicken, fish, or beef?
  • Do the EAAs compete for absorption? Does eating a complete protein such as the protein in beef or chicken inhibit the absorption of the EAAs in the protein? After all, just eating more meat could potentially be the best solution, but maybe it’s not as efficient as getting the EAAs in a stand-alone product.
  • How much muscle will athletes build in how long a time? Will it be 1% or 5% better than just eating more protein or will it be the same?
  • Should the EAAs be taken alone or as part of a protein shake?
  • When is the best time to take the EAAs in relation to a workout? Or does it really not matter? What about other nutrients taken at the same time such as carbohydrates or fats? Will they positively or negatively impact the EAAs?

There are some partial answers in the research but nowhere near enough to say “This is how you do it for the best benefit.” That’s not to say that there are no opinions, but it’s based more on limited research or personal experience than anything else.

The Bottom Line

Based on all of the available information, here is the bottom line on EAAs.

  • Everyone needs more EAAs in their diet, especially those of us over 50. (We all need to do more resistance exercise, but that’s a different Memo.) It’s more than just losing muscles mass as we age; it’s also about being able to make all the hormones we need for optimal health.
  • Eat about one gram protein per pound of body weight up to about 150 grams per day. If someone is overweight or oversized, trial and error is the only way to set an upper limit. But it’s critical for athletes and older people to hit that mark. Chicken seems to be the best profile for EAAs next to milk protein, but there’s more research needed.
  • If you get your EAAs from powders, whey protein isolate seems to have the best profile based on the content of branch-chained amino acids, but soy protein has a good profile as well. There doesn’t seem to be a perfect source yet.
  • If you want to take a separate EAA product that has no other amino acids, that’s fine. It will probably be best to take it before you work out or lift weights, but there’s good reason to take it after working out as well. About 15 to 30 minutes later, take your complete protein, whether from powders or food.

As research continues, I’ll update the recommendations as we get more answers. For now, make sure you get enough protein for health and growth based on what we know today.

What are you prepared to do today?

Dr. Chet

 

Essential Amino Acids for Older Adults

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One of the issues we all face as we get older is the loss of muscle mass; the technical term is sarcopenia. While some of the loss can be attributed to declining hormone levels as well as the decline in physical activity, we tend to eat less protein as we get older. Less protein intake means less muscle and other protein synthesis.

Researchers in Japan wanted to see if increases in muscle mass were related to protein intake, specifically EAAs. Instead of jumping right into supplementing with EAAs, they recruited 10 older men with a mean age of 69 and gathered nutritional information using a three-day dietary record. They put the men on a progressive weight training program, lifting three days per week for 12 weeks.

All men gained muscle mass, about one pound of muscle per leg. In analyzing the diet, the average protein intake was 99 grams of protein per day with 37 grams from EAAs. What they found was that those men with higher EAA intake, especially leucine, had a greater increase in muscle mass. It was even better if they had the EAAs with their breakfast.

This was a small preliminary study that examined current food intake with no intervention other than exercise. It may indicate that in order to be efficient at adding muscle mass, EAAs are important in older adults. What does this mean for you if you’re in that age group or an athlete wanting to add muscle mass? I’ll let you know on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: J Nutr Sci vitaminol (Tokyo). 2017;63(6):379-388. doi: 10.3177/jnsv.63.379.

 

Essential Amino Acids: The Basics

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I’ve been getting many questions about essential amino acids lately. What are they? Why do I need them? Are they only for athletes? What can they do for me? In addition, I came across an interesting study that supports the use of EAAs in a specific population.

The EAAs include the amino acids phenylalanine, threonine, tryptophan, methionine, lysine, histidine, leucine, isoleucine, and valine. They’re essential because we can’t make them, but we can make other amino acids from these EAAs. In addition, three of the EAAs are designated as branch chain amino acids (BCAAs): leucine, isoleucine, and valine; they’re known as protein-building amino acids and important for building muscle.

Think of the EAAs as the rate-limiting amino acids. If we don’t have enough of them, we can’t make the other amino acids and thus, every protein made in the body can be affected. We often think only in terms of muscle, but the lack of EAAs could affect the manufacture of insulin, human growth hormone, leptin, and adiponectin to name just a few.

BCAAs have been marketed to athletes who are training to make muscle for years. Recently, EAAs have entered the arena because of their ability to make proteins that support muscle building. But that’s not the only group that may benefit as a recent study demonstrated. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Prepare to Compete

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Let me be clear: I think that the single most important thing that you can do to be healthy is to exercise regularly. Whether walking, swimming, or one of the hundreds of other types of exercise, talking with your physician about it may be all that’s required for you to get started.

Moving from exercise that helps your health to competing in fitness events requires more—that’s independent of your body weight lest you think I’m talking only about the very heavy people that competed in the triathlon. Here’s what I recommend.

First, you should have a stress test that assesses how your heart and blood vessels perform under maximal conditions. That applies to men over 40 and women over 50, for sure. But I also think if you have been overweight for over five years, you should have the test regardless of age. The maximal exercise test is not foolproof, but it’s the best available predictor of heart problems. This isn’t just me being a worrier; I’m sad to report that one participant died of a heart attack last Sunday. Getting checked out before you start is the best way to protect yourself.

Second, you should have a complete lipid profile, HbA1c, and a blood insulin test as a minimum. As I suggested in Thursday’s memo, you need to know whether you’re a prediabetic or even an undiagnosed type 2 diabetic. The best option for you would be to exercise, but when you push yourself hard for long periods of time, it’s going to affect your blood sugar levels as it would affect a diabetic’s, not someone who has a normal carbohydrate metabolism; for instance, you could pass out if your blood sugar gets too low, and if you’re out alone on a run, that’s a problem. You can deal with it, but you have to know if it’s an issue.

Third, you should get an orthopedic analysis. By that I mean that your joints should be evaluated for range of motion, tendon and ligament stability, and gait. Swimming affects the shoulders, bicycling the lower back, and running the hips, knees, and feet. Any abnormality will be exacerbated; for example, the forces you create when you run is five times your body weight. Do the math—that’s a lot of stress on your knees and feet.

Once you get the all clear, get after it. Start conservatively but if you have the urge to compete to see what you’re capable of, do it. I think if you want a challenge, whether to walk or run a 5K, swim a mile, or bike 50 miles, or combine them into a single event such as the triathlon, you should do it. Just make sure you get your body checked out before you do.

Final Observation

While I believe exercise is important no matter the level at which you do it, exercise won’t help you lose a lot of weight. Surprised? Remember the size of the people I mentioned that competed in the triathlon—not just overweight but obese? If they had put in the training, and I know some of the competitors and know that they did, you’d have thought they would have lost a significant amount of weight. They didn’t.

Burning calories helps with weight loss, but as a well-known expert once said “Americans can’t out run their appetites.” If you could exercise six or eight hours a day, you could probably lose weight without changing your diet, but I doubt you have that kind of time. You can use exercise as a tool to help you lose weight, and exercise pays major benefits in fitness, strength, and stamina. But you will not lose weight unless you also eat less and eat better.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Heavy and Healthy?

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The major observation I had as I volunteered at the Grand Rapids Triathlon was that the body weight distribution of the people participating in the triathlon mimicked the population of the U.S. We’re a fat nation; 70% of the population is overweight and half of those are obese. Those percentages also seemed to apply to the participants in the race.

In addition to being a regular Grand Rapids event, the Grand Rapids Triathlon was also the National Championship for the Clydesdale and Athena athletes. In order to qualify for the Clydesdale division, men must weigh over 220 pounds; for women to qualify for the Athena division, they must weigh over 165 pounds. Based on my observations, a majority of the participants would have qualified for that category, whether that was their intention or not.

There were men well over 300 pounds and women over 250 pounds that participated in the triathlon. Talking with several other volunteers, I said that unless they had a signed release from their physician, I would hesitate to let them participate. They countered that as long as people put in their time training, they were fit enough to compete. Good point, but that logic doesn’t really hold up. The primary concern everyone thinks of is cardiovascular disease and that makes sense. But if someone is overweight, the real concern is undiagnosed type 2 diabetes and orthopedic stress.

While I applaud their effort and would never want to prevent anyone from exercising, I would hope that they would have had a thorough medical exam before they took their first step. We can’t assume because they had trained for the race they were actually healthy enough to compete in the race. I’ll cover what those tests should be and a surprise conclusion that you don’t want to miss on Saturday.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: The People

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The Grand Rapids Triathlon was held this past weekend, and I volunteered to work at an aid station. The station happened to be at the transition area where everything is happening; I couldn’t have picked a better spot. People lined up to head to the river for the swim, coming back from the swim to get on their bike, then parking their bike and finishing up with the run portion of the triathlon. It was fascinating to watch as they finished one portion of the event and had to change modes to do the other.

There were three different triathlons going on at the same time, made possible by advancements in chip timing. The computer knows where everyone is all the time. Here are the events and distance for each:

Sprint: 600 meter swim, 20K Bike, 5K Run
Olympic: 1500 meter swim, 40K Bike, 10K Run
Half-Ironman: 1.2 mile swim, 56 Mile Bike, 13.1 Mile Run

People of all ages and sizes competed. I think that’s the operative word: compete. Even though it was most likely a personal goal to see whether they could finish or not, trying to finish in a specific time, or maybe even trying to win their age-group, the willingness to complete and put forth such a tremendous effort is something to be admired.

But should everyone have been out there swimming, biking, and running? I’ll talk about that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Yes, Supplements Matter

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The study that was published in the Journal of American Academy of Cardiology created several issues that go beyond the headlines of supplements being of no benefit. Let’s first take a look at the published results of the study.

The researchers found that most supplements such as multivitamins, vitamin D, calcium, and vitamin C do not have a significant effect on cardiovascular disease or overall mortality. On the other hand, folic acid had a significant beneficial effect on reducing stroke and overall CVD, and B-complex, a vitamin with a variety of B vitamins in it, also helped reduce the incidence of stroke. However, the study showed antioxidants had a negative effect on all cause mortality as did niacin. Whether beneficial or not, the results, while statistically significant, were not clinically significant.

The researchers stated that they expected beneficial effects on the reduction of cardiovascular disease and overall mortality. The fact that they did not find those benefits resulted in the headlines that supplements don’t matter.

Here are just three of the issues with the study. They included studies with different nutrients as well as studies that didn’t have the same amount of nutrients. The RCTs included in the analysis did not have the exact same amounts of any given nutrient in the supplement; three of the studies on antioxidants and cancer mortality had different amounts of beta-carotene and vitamin E. Another way of putting it was they not only were comparing apples to oranges, but they also compared three oranges to a dozen apples.

Another issue was adherence to the study rules. The subjects did not necessarily take all the supplements they were given, and compliance varied between the studies. Positive or negative effects could be determined by whether subjects took all of their supplements or took them only when they remembered or felt like taking them. The adherence to supplement use varied by study.

Here’s one more issue. Every RCT used supplements as a potential treatment for a disease—in this case, diseases related to the heart and the death rate from heart disease or other diseases. It’s the treatment model used by physicians: the pill, whether pharmaceutical or supplement, must reduce the incidence of or cure the disease. While desirable, that’s not what nutrition is all about.

The Bottom Line

While we would like to see research results that prove that we can live longer or better by taking supplements, that isn’t really the point in my opinion. We take supplements to fill the gaps in our diet. As the researchers point out, if everyone ate more plant-based foods, we could meet the minimal amounts of nutrients our bodies needs. That hasn’t happened in the 30 years I’ve looking at this issue, and I don’t see it changing any time soon.

Taking vitamin and mineral supplements serves as nutritional insurance to support your body’s processes and to make sure you don’t open the door for deficiency diseases; supplements are more like shotguns than rifles. Supplements do matter and I’m going to continue to take mine every day.

There are so many issues with this research paper—much too long for this Memo—that I recorded a Straight Talk on Health about them. If you’re a Member or Insider, you can listen to Research Update on Supplements any time. If you’re not, now is a good time to join.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Update on Prostate Cancer Treatment

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The treatment of prostate cancer has been changing over the past few years. For most men with prostate cancer, wait and see has become the norm. It all depends on age, the location, and the aggressiveness of the cancer. The more aggressive types of cancer, located close to the outer capsule of the prostate, typically required radiation treatment. The question has been the best time to begin that treatment. A recent study provided some insight.

Researchers selected 1,566 consecutive men who had a prostatectomy in various medical centers. Based on a scoring system that ranked the severity, location, and other factors, they either received immediate radiation therapy or they were monitored until the cancer returned and then given salvation radiation therapy. The immediate-radiation patients experienced reduced biochemical recurrence (as assessed by PSA), they had lower rates of the cancer spreading, and the death rate was lower when compared with salvation therapy. In this case, the more aggressive treatment for men with aggressive prostate cancer produced better outcomes.

The Prostate Health webinar will be available for a few more weeks. If you’re concerned about the health of your prostate or what to do for benign prostatic hypertrophy or prostate cancer, you absolutely have to watch this webinar. If you want to know what questions to ask your physician, this webinar is a must see. Order it today.

What are you prepared to do today?

Dr. Chet

 

References: JAMA Oncol. 2018;4(5):e175230. doi:10.1001/jamaoncol.2017.5230.