Happy New Year!

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2,600,000

Think about how much that number represents. If you were to try to count to 2,600,000, at one number per second, 24 hours per day, it would take you over 30 days. If you were to limit yourself to 40 hours per week, it would take you 18 weeks. And you really would have nothing to show for it.

On the other hand, if you walked 10,000 steps per day five days per week, you would also reach 2,600,000. In that case, it would be 2,600,000 steps. If you began the year as a non-exerciser, you would have improved your fitness level. That’s quite an accomplishment.

Or pick a smaller number: 6,500. If you did 25 crunches a day five days a week, you’d have 6,500 crunches and a maybe less fat under your belt this time next year, and more than likely you’d have less lower back pain.

No matter what your health goal or goals are, just a little effort every day can bring you huge results. It really depends on one question that you ask yourself every day:

What am I prepared to do today?

Dr. Chet

 

How to Have a Healthy Brain

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Based on the questions and comments I get, many of you want to know how to protect your brains. Your memories and the ability to make new ones are what make you you. There are many programs and even more books written about the prevention and treatment of Alzheimer’s. In my opinion, they’re premature because we just don’t know enough yet.

That doesn’t mean that there’s nothing we can do to protect our brains and our memories. I recently watched an interview with Lisa Genova, a neuroscientist who wrote the book “Still Alice.” That prompted me to watch her TED talk, which I strongly recommend.

Genova’s suggestions are simple but absolutely based on the current science. Here they are:

  • Get good sleep—that’s critical. When you get into a deep sleep, the brain flushes out those molecules that can destroy neurons.
  • Exercise regularly, especially aerobic exercise for the exact same reason as getting good sleep. Exercise clears the molecules that cause destruction.
  • Eat a diet that reduces inflammation: more vegetables, more fruit, healthier fats, and fewer refined carbohydrates. With a brain-healthy approach, you might just lose a few pounds as well—which also reduces inflammation.
  • Keep your brain engaged in learning new things. In data from the Nun’s Study, autopsies showed some nuns had brains that had shrunken and looked like brains from Alzheimer’s patients, but they had exhibited few symptoms of memory loss associated with the disease because they never stopped learning. That helps you create what Genova calls a cognitive reserve: your brain makes so many extra connections that it can work around the ones that are broken.

That’s it. Eat your veggies. Get some exercise. Get good sleep. Never stop learning. It’s as simple as that. I’ll have a special New Year’s Day Memo for you so after the celebration, check it out.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2lkoXYv

 

2018 Health Goals: Part 2

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Now that you’ve written it down your health goal or goals for 2018, I have a question for you. Were your health goals really what you’d like to change about your health or was it limited by your thought process?

Here’s what I mean. Did you write down your goals or did you start to analyze your goal? You might think I’m talking about the what of the goal. I’m not; I’m talking about the how of your goal. It might go something like this:

“I really want to lose weight and finally get rid of the extra pounds I’ve gained. But to do that, I’ve got to be able to exercise and my knee is so bad, I can’t. Maybe I should see about getting my knee fixed first. But I don’t have any health coverage right now so I can’t afford it. I guess I’ll have to start by losing the weight, but how am I going to do that? There are so many diets, and I don’t know which to choose. Some of them are expensive, and I can’t afford that either. Maybe I’ll check out some programs online that don’t cost very much.”

You go from the goal—what you really want—to something that may be standing in your way that you have to do first. Instead of focusing on your goal, and you very well may have to address some of these issues, you pick something else you have to do first.

Let’s use the exercise obstacle to weight loss. My example picked the most complicated way of dealing with the issue, getting the knee repaired, instead of finding what you can do to exercise right now. You can do upper body exercise, swimming, or pool walking to relieve the pressure on your knee. Where there’s a goal, there’s a way, but you start with the what, not the how.

Now take another look at your health goals. If you allowed your thinking to get in your way, write down what you really want. You’ll figure out the how later, but it shouldn’t affect your goal setting.

Saturday I’ll focus on one goal that concerns many of us: keeping our brains as healthy and functional as we can for as long as we can.

What are you prepared to do today?

Dr. Chet

 

2018 Health Goals: Part 1

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It’s that time of year to set goals for 2018. There are many areas of your life for which to set goals, but let’s focus on your health goals. I want you take some time and write down your health goals for 2018. There are three areas that most people want to change: their body weight and shape, their fitness level, and their pain levels. Of course, there’s always smoking and if you smoke, that should be number 1.

Take some time when you read this and write down your health goals, whatever they are. I’ll be sending another Memo later today but don’t read it until you write down your health goals for 2018.

What are you prepared to do today? Prepare to write down your goals.

Dr. Chet

 

Santa, Rudolph, and Merry Christmas!

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The final question about Santa Claus has to do with his girth. How can he deliver gifts all over the world in one night while being so heavy? Here’s something that we all need to understand: just because people are overweight, that doesn’t mean they can’t be fit.

Fat and fit? You better believe it. The problem is that we have so few heavy people who move into a high fitness category. But if they do, they can be fit according to a classic definition of fitness: the amount of oxygen used per kilogram of body weight per minute. Santa most likely qualifies; he must work out hard in the off season.

Would it be better to be leaner? Probably but remember, he’s a fictional character. I think we need to worry more about ourselves. But that’s a Memo for another time.

Rudolph’s Red Nose

I got a great question related to this week’s Christmas theme: why is Rudolph’s nose red? I couldn’t pretend to figure out that one, but wouldn’t you know it, someone else did. You can read about it in this news release from Johns Hopkins faculty and staff (1). They also diagnose the Grinch’s heart and explain how Scrooge could travel through time. The writing isn’t excessively scientific, so it might be something you could share with the older kids in your life who’ve grown skeptical about the magic of Christmas.

The Bottom Line

We hope you had fun with this week’s Memos. Health news can be overwhelming. As you prepare for this holiday, safe travels, and enjoy the time with family and friends. I’ll resume the Memos next Thursday with some ideas for your 2018 health goals.

From Paula and I, Merry Christmas, happy Kwanza, happy Dhanu Sankranti, we hope your Hanukkah was happy, a belated Happy Mawlid al-Nabi, and Happy Holidays to everyone! If we missed your holiday, let us know and we’ll be sure to include it next year. What’s important is that we all enjoy our holiday festivities and our family and friends, and we get to eat our special holiday foods.

What are you prepared to do today?

Dr. Chet

 

Reference: http://releases.jhu.edu/2017/12/04/johns-hopkins-scientists-explain-rudolph-grinch-scrooge/

 

Why Does Santa Have Dimples?

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Let’s continue with our light-hearted look at science and health by answering a major question about the Christmas icon Santa Claus: What causes his dimples? Wait a minute, wait a minute. Dimples? Yes, it’s right there in the poem, “A Visit from St. Nicholas”:

His eyes—how they twinkled! his dimples, how merry!

Sometimes they’re hidden by his moustache and beard, of course. But what causes dimples?

The primary cause is actually genetic and comes from a difference in the zygomaticus major muscle, the muscle that attaches to the corner of the mouth and pulls up and back when contracted, i.e., when you smile. Some people have a double smile muscle, and others have a Y-shaped muscle; with two points of attachment on the upper portion, the extra attachment causes the dimple.

Dimples become more pronounced when you smile. There’s also another reason dimples become deeper—you carry more fat in your face. Santa’s pretty chubby, so it’s no surprise he has dimples.

One more on Saturday.

What are you prepared to do today?

Dr. Chet

 

Why Do Santa’s Eyes Twinkle?

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Whenever you see Santa Claus, he always seems to have a twinkle in his eye. You might notice that in people as well; Paula did and asked me to find out how that happens. Whether you’re Christian, Jewish, Muslim, Hindu, or anything else, if you live in the U.S., you’ve probably heard lots of Christmas lore, so let’s find out why Santa’s eyes twinkle.

There appears to be two reasons. First, it conveys some form of emotion. The eyes release tears that are spread over the eyeball, just enough to make them seem slightly misted. As the light hits someone’s eyes, they appear to twinkle or sparkle.

The second reason also has to do with light. The effect seems to be greater when someone’s eyes are dilated, as from walking from a dark room into the light. Combined with the emotional misting, it really makes someone’s eyes twinkle.

Understanding why it happens doesn’t make it less meaningful—those twinkling eyes are really glad to see you, just like Santa who seems glad to see everyone. We’ll explore the science behind Santa’s dimples on Thursday.

Happy Hanukkah, a belated Happy Mawlid al-Nabi, happy Dhanu Sankranti, Merry Christmas, and Happy Holidays to everyone!

What are you prepared to do today?

Dr. Chet

Why Do Statins Fight with Grapefruit?

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One of the most complicated medication-food interactions is grapefruit and statins, the popular cholesterol-lowering drug. The goal of this Memo is to make sense of the research to date by answering a couple of questions.

Before I begin, let me briefly explain how a statin works. One of the many enzymes required to produce cholesterol in the body is called HMG CoA reductase. In fact, it’s the rate-limiting enzyme; it controls how much cholesterol is made. Interfere with the enzyme, and you can block the production of cholesterol. That’s what most types of statins do; they block HMG CoA reductase, thus limiting the amount of cholesterol made. If your cholesterol is too high, it goes down.

How Does Grapefruit Juice Interact with Statins?

While this is some complicated biochemistry, let’s see if I can explain it simply. There’s a series of naturally occurring enzymes produced in the small intestine called CYP 450 3A4 that modifies the statin before it’s released into the bloodstream; it controls the amount and the form of the statin that gets into your body. Grapefruit juice contains phytonutrients that interfere with the CYP 450 3A4 action, letting more of the statin get into the bloodstream more quickly. Rather than fighting, it was more of a case of helping too much.

Is that good or is it bad? The research never really specifies. The logical expectation is that it would lower cholesterol too much or because it’s not in the correct form, maybe not enough. I couldn’t find an answer to that question. The original research on grapefruit juice began in the late 1980s and seemed to end about 2004. Since then, the recommendation is if you take a statin, no grapefruit juice.

What Is the Real Concern with the Interaction?

This question perplexed me for years, but I finally found an answer: with too much of the statin available due to the interference of the phytonutrients with the CYP 450 3A4, the overabundance could lead to an increased risk of rhabdomyolysis, a breakdown of muscle tissue. Muscle pain is a frequent side effect of taking statins, so the concern makes sense. The problem is that it was never really tested in any research I could find.

On top of that, the primary studies on grapefruit juice and statins used double-strength grapefruit juice in high amounts and a high dose of statins in healthy subjects. Yes, they found that the statin levels increased. But no other measures were checked such as impact on cholesterol production or markers of muscle damage. That was the state of research for the past decade.

What If You Wanted to Boost Your Statin?

In a recently published review paper, researchers theorized on the impact of grapefruit juice on cholesterol levels and the risk of cardiovascular disease. They found that if a statin such as simvastatin was taken at the same time as grapefruit juice, it increased the absorption 260% but if taken 12 hours apart, absorption was up only 90%. With atorvastatin, the increase was 80% no matter when the grapefruit juice was taken.

Calculating the effect on benefits and hazards, when simvastatin or lovastatin are taken at the same time as grapefruit juice, the estimated reduction in LDL cholesterol is 48%, and therefore, the decrease in heart disease is 70%. If the juice is taken 12 hours before these statins, the reductions are, respectively, 43% and 66%. For atorvastatin, the reduction in LDL cholesterol is 42% and in reducing the risk of CVD by 66% (1). Without the grapefruit juice, the reduction in LDL cholesterol is 37% with a decrease in risk of CVD of 61%.

This paper uses published data from many studies to perform these calculations. It doesn’t change the message in their conclusions. The benefits from the additional reduction in cholesterol may be worth the slight risk of rhabdomyolysis, but that doesn’t mean you’ll find any change in the grapefruit juice recommendation any time soon. But at least you now know the issues and why grapefruit is not the demon it’s been made out to be.

The Bottom Line

It’s important to understand that the drug, the statin, is the abnormal thing here, not the fruit. It doesn’t seem to make any sense to modify properties of a healthy diet just to be able to take a medication. But we live in the real world. Until the pharmaceutical industry can find a way to make medications that can help us and work with a healthy diet, be prudent. If you take a statin, talk with your cardiologist about finding a way to fit citrus in your diet. You may have to limit the amount or limit the times of day you eat or drink grapefruit, but as long as the net effect is getting your lipid levels in the desirable range, there has to be a way, especially since most statins should be taken at bedtime. The research is far from clear, so it’s a case by case basis.

What are you prepared to do today?

Dr. Chet

 

Reference: http://dx.doi.org/10.1016/j.amjmed.2015.07.036.

 

Interaction Between Food and Blood Thinners

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Blood thinners are the second most common medication that can interact with food and supplements. Blood thinners such as warfarin are used to prevent blood clots in people with atrial fibrillation, artificial heart valves, and deep vein thrombosis.

When a blood thinner is prescribed, people are given a list of foods and supplements to avoid. Top of the list is vitamin K and foods that contain vitamin K such as green leafy vegetables. Herbs such as garlic and ginkgo, supplements that contain vitamin E, coenzyme Q10, and omega-3 fatty acids are also discouraged because they may make the blood thinner. The goal is to optimize the international normalized ratio (INR), a measure of clotting ability. It isn’t that those types of patients have blood that coagulates more than normal; the theory is that keeping vitamin K from interfering with the blood thinner will reduce the probability of clots.

The problem: the recommendations are not supported by definitive research; it’s more a matter of playing it safe based on the theory of what the nutrients will do rather than actually based on science. In a recent review article, the authors concluded: “Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with vitamin K antagonists. It would be, perhaps, more relevant to maintain stable dietary habits, avoiding wide changes in the intake of vitamin K.” I absolutely agree.

What do you do? First, decide what diet you want to eat and supplements you want to take and stick to it. Second, work with your physician to adjust the blood thinner to get the dosage just right to keep your INR within range. Third, if you can’t get it normalized, there may be other factors as yet unknown that are affecting clotting. You’ll have to stick to the common recommendations, science-based or not.

Last chance to become an Insider and listen to tonight’s free conference call and get your health questions answered. You can learn more and join at this link.

What are you prepared to do today?

Dr. Chet

 

Reference: Medicine (Baltimore). 2016 Mar;95(10):e2895.

 

Food-Medication Interactions

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One of the questions I got after Saturday’s Memo was about how to take thyroid medication to maximize effectiveness. It was of those smack-your -forehead moments—how could I forget that? This week’s Memos will cover food interactions with the three most common medications. Your physician and pharmacist should handle the medication-to-medication interactions; I’ll stick to food, including supplements. Let’s begin with synthetic or natural thyroid medications.

In order to maximize absorption of thyroid medication, take it on an empty stomach, preferably in the morning. Wait about an hour before eating.

If you take a multimineral with calcium and iron or a stand-alone calcium supplement, wait at least four hours before you take it. The range of medication loss is 25% to 35% when taken with calcium. But even more important is to be consistent in when you take your medications, when you eat, and when you take your supplements.

Next I’ll cover blood thinners.

The next Insider Conference Call is Thursday might. If you want to attend as well as listen to prior Conference Calls, sign-up as an Insider before then.

What are you prepared to do today?

Dr. Chet