Essential Tests: Blood Pressure

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How many times have you had your blood pressure checked in the doctor’s office and it was higher than normal? That’s a common occurrence. It even has a name: White Coat Syndrome. But is your blood pressure really higher only at the doctor’s? Do you check it regularly? If you don’t, you really don’t know. That’s why the second test I think you should also do on a regular basis is your blood pressure. It’s simple and easy and if you keep track, you’ll find a pattern. It’s the pattern that’s important.

Your BP will naturally be higher during exercise or as part of the stress response, but it should come down to normal when the workout or stress is over. However some stressful situations last a long time; you don’t know what your BP is during those times unless you monitor it. Based on the 7th Joint Task Force on BP, for every 20 mm Hg systolic (the top number) or 10 mm Hg diastolic (the bottom number) increase in BP, there’s a doubling of mortality from both ischemic heart disease and stroke (1).

But those are the extreme responses. Even if your BP is 6 mm Hg higher on either, there’s damage occurring inside your arteries. Everyone wants to know how to prevent Alzheimer’s disease by taking a supplement, but that’s not what I’d try first. Exercise and diet can do more to lower your BP than almost anything else, and thus reduce your risk of all diseases associated with HBP including Alzheimer’s.

To monitor your BP, either get a home monitor machine or take it at a pharmacy that has a free monitor. The critical part is that you monitor it regularly on the same device. While that device might have a slight error, taking it repeatedly on the same machine will provide a pattern and that’s the critical part. That way you’ll know when you go to the doctor whether a high reading is just White Coat Syndrome or not. We’ll finish up on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: www.heart.org

 

Essential Tests: Bones and Body Fat

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After Saturday’s Memo, the logical question is: “How do I really know if I’m overfat?” This weeks Memos are going to be about tests. No, you don’t have to study for these tests. I’m talking about medical tests to talk about with your healthcare provider.

At this point, the best way to test for body fatness is using dual-energy X-ray absorptiometry (DEXA). This process uses low-beam radiation and can identify the three main tissues that make up our body: bone mass, lean mass, and fat mass. Yes, DEXA is the same technology that’s used to determine your bone mass to test for osteopenia and osteoporosis. Instead of just doing the wrist and pelvis, the entire body is scanned to determine body composition.

If you want to know your bone health and your body composition, check out the medical services in your area. There’s one hospital that offers DEXA for both purposes in Grand Rapids. If you’re over 40, it’s a great idea to do both tests. The bone scan will most likely be covered by insurance while you may have to pay for the body composition. The cost is about $100 in this area. If you want the most accurate method for bone mass and body composition, check out the DEXA availability in your area.

The goal is to use this information to improve your health. Reducing body fat and increasing bone mass both end up using a similar strategy: Eat less. Eat better. Move more. On Thursday another simple test that’s too often ignored.

What are you prepared to do today?

Dr. Chet-

 

Normal BMI but Still Too Fat

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Last week the health headlines shouted “Study Shows Over 90% of All Americans Are Overfat!” The rate of overweight as assessed by Body Mass Index (BMI) is already 70%; now scientists want to say even more people are too fat? What’s going on? I’ll explain what overfat means first and then tell you about the study behind it.

For the most part, the greater the BMI, the greater the risk for cardiovascular disease, prediabetes, and hypertension. For those of you who aren’t sure of your BMI, check out your BMI in the Health Info section of our website. And if you think you’re just big boned, we show you how to prove it.

But there are people who have a normal BMI under 25.0 but still may be overfat. Considering Waist Circumference in addition to BMI may help but that could still miss some people. How? They may have lost muscle mass; the subtle loss of lean muscle with a gain of fat could lead to overfatness. That increases their risk for the diseases I mentioned earlier.

Here’s the most common example of someone who has a normal BMI but is overfat: a very sedentary elderly person who looks slim, but has very little muscle. As the saying goes “use it or lose it” and they’ve lost it.

A clinician from Arizona has taken it upon himself to redefine the terminology associated with excess body fat. He claims that overfatness gets missed in too many people. The problem he sees is that people who could begin treatment with diet, exercise, and medication if necessary are being missed. He outlined his arguments in a paper published in January 2017 (1), but it was his paper published in July that lead to headlines (2).

He and his co-authors examined the BMIs of people in countries all over the world. Using prior studies that estimated the number of normal-weight people who are overfat, ranging from 9.7% to 20%, he then applied that to the normal-weight populations (as assessed by BMI) in the top 30 developed countries in the world. That’s how they derived the headlines of over 90% overfat—not just in the U.S. but also New Zealand, Iceland, and Greece as well. To be fair, this applied only to males. Don’t rest on your laurels, ladies. All the same countries were greater than 80% for females.

 

The Problems

There are three with his approach in my opinion. First, adding another definition to replace BMI doesn’t really help people or their physicians as he implies. Confirming a person with normal BMI is overfat would require a more advanced exam or assessment of body fat. I’m not sure that’s practical.

Second, I looked at his work from every direction and couldn’t get the numbers to work. If 70% of Americans are overweight or obese and you add 20% of the remaining 30%, it adds up to 76% not 90%. Even if the numbers worked, the statistic would apply to a physician’s total number of patients. There would be no way to identify who is overfat without additional testing.

Third, there’s another group that needs to be addressed, and that would be those who are overweight according to their BMI but are metabolically healthy. In fact, that’s a significant problem today. Even after losing over 30 pounds, my BMI is still in the overweight category. By every test of metabolic fitness—blood pressure, cholesterol, HbA1c, or insulin—I’m at no additional risk of heart disease, yet I’m still classified as “at risk” due to my BMI. I think that’s a greater issue and will be more so as healthcare gets debated. Is your BMI over 25? You’ll pay more, even if your test results are stellar.

 

The Bottom Line

I agree with the concept that the author put forth: there are people with normal BMIs that are overfat, and they’re at greater risk for CVD and metabolic diseases. But new definitions aren’t necessary. What is necessary is identifying who is at risk. That will only occur when doctor and patient meet face to face. When was your last doctor’s appointment?

What are you prepared to do today?

Dr. Chet

 

References:
1. Front. Public Health 4:279. doi: 10.3389/fpubh.2016.00279.
2. Front. Public Health 5:190. doi: 10.3389/fpubh.2017.00190.

 

Chelation Therapy: Too Soon to Judge

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The results of the study on chelation therapy in subjects with diabetes showed a reduction in cardiovascular incidents during the follow-up time. No single event dominated, ranging from heart attack to stroke to death, but overall there were fewer incidents. Subjects who did not have diabetes did not experience a benefit in v incidents during the same follow-up time.

That led the researchers to speculate why. They couldn’t come up with any specific reason other than the chelation must involve a mechanism that was not yet identified. They carefully suggested that while the results were positive, this study could only suggest that larger clinical trials were necessary and the findings do not constitute enough evidence to be recommended as a treatment.


Should You Do It?

Here a few more things to consider:

  • The cost: each session costs $90 to $150 and there should be at least 30-40 of them. Add office visits and the total price could be around $5,000; none of it is covered by insurance.
  • All the subjects continued to use their typical medications for diabetes, cholesterol, and blood pressure. This was not replacing traditional treatments, it was in addition to the treatments.
  • The investment of time was significant at three-plus hours once a week or on whatever schedule the patient and doctor agree upon.


The Bottom Line

This study demonstrated a small cardiovascular benefit to the patients, reducing the risk of a cardiovascular event from 35% to 25%. In my opinion, the results are too small to justify the cost of money or time.

I know people who swear by chelation therapy, and I’m happy it worked for them, but there’s too much we don’t know. Nobody tracks what is actually changed in the body during chelation. Where do the heavy metals go? What if someone doesn’t process metals the same way to eliminate them? At this point, there are more questions than answers.

Here’s an idea. Spend the money on more vegetables and fruit for your diet. Invest the three hours per week in additional exercise. Both of those things will give you a better return on your investment than chelation therapy.

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2014;7:15-24

 

Update on Chelation Therapy

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One of the questions asked during Tuesday’s Conference Call was about chelation therapy for helping with memory. I didn’t find any research to support that outcome, but a couple of studies have been published on chelation therapy with cardiovascular disease (CVD). One paper was from the Trial to Assess Chelation Therapy or TACT study.

Chelation therapy is used to eliminate heavy metals with the goal of reducing the metals that can be toxic to the body. While it’s been used for decades, the research hasn’t demonstrated a clear benefit.

For the TACT trial, researchers recruited over 1,700 subjects. In this paper, they used a sub-group of subjects from the original study who had diagnosed diabetes and had a heart attack more than six months before the study began. Half the diabetic subjects received chelation with EDTA (ethylene diamine tetraacetic acid) as well as some vitamins and minerals. The other half were infused with just saline solution. All subjects were given low doses of vitamins and minerals.

Subjects were infused once per week for 30 weeks and then biweekly and bimonthly until 40 sessions were completed. Each chelation session lasted three hours. With the investment of time, did the chelation therapy result in fewer cardiovascular events over the next five years? We’ll see on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1161/CIRCOUTCOMES.113.000663

 

Let’s Go!

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Riley, my pretend grandson, is learning to talk; he’s taking his time about it, but he’s got a few things down pat. Paula says he’s the only child she’s ever known who used verbs before he used nouns, and his favorite verb is go.

Whenever he hears anything that sounds like “shoes,” he perks up and asks, “Shoes?” If I tell him, “Go get your shoes,” he’s off like a rocket to find them. Then he brings them to me and wants me to put them on him. As soon as I do, he runs to the front door and starts saying, “Let’s go!”

RileysWalk2I’ll admit there are times I’m not crazy about going out in 85-degree muggy weather, but I can’t look into those big blue eyes and say no. So off we go! I’m teaching him boundaries because he wants to go everywhere and get there fast; he’d barely learned to walk when he started running. He’s learning stop and if he doesn’t, he has to hold my hand. But it’s a joy to see a toddler, or anyone really, who wants to move so much.

Whether you’re a parent or a grandparent, getting kids to move early in life is important. But you have to be able to keep up with them, and that means you have to be fit as well. Do you really want to say Daddy or Grandma is too tired? Of course that will happen sometimes, but it should be rare. By the way, going with them counts as exercise for you, too.

That means you have to take care of you first. If you do, when you hear, “Let’s go!” you’ll be ready to go.

What are you prepared to do today?

Dr. Chet

 

Maybe They Won’t Notice

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Last Friday, we had a small tornado touch down in our area. The wind and lightning were so bad, they woke me up at 3 a.m. I looked out the deck window and the rain was horizontal from the North. My front door window, covered by five feet of roof, was getting pummeled by rain. That has never happened.

In the morning, I checked to see the damage. The plants that are normally spilling over the front of the large containers were blown up over the plants standing in the back like an apron over Grandma’s head. The wind blew so hard, the lounge folded over—and it’s cast aluminum! I walked the yard and everything seemed to be fine. Nothing blown over. There were uprooted trees in the neighborhood that Paula and I noticed as she took me to the airport. We escaped. Or so we thought.

We never looked up in the back yard. Ever see the commercial where an older sibling takes the hair-trimming shears and cuts a path down the center of his little brother’s head? That’s what our locust tree looks like; a big branch in the center broke. How we didn’t notice that for three days is beyond me.

What’s the relation to our health? We don’t check our bodies enough. Where did that freckle come from? But it isn’t a freckle. I’m really out of shape! Except that shortness of breath isn’t really happening because you’re out of shape.

We’ve got to pay attention to our bodies, folks. They’re speaking to us all the time. Stop ignoring what they tell you and get things checked out; better to deal with it earlier rather than when it’s a serious problem. You don’t need a tornado to hit your life.

What are you prepared to do today?

Dr. Chet

 

Should You Get the Shingles Vaccination?

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I think everyone over 60 should get the shingles vaccination, and the older you are, the more important it is. You’re going to get a lot of opinions on this one, so here’s how I arrived at this recommendation.

Remember, one out of three or 33% of those over 60 will get shingles. The shingles vaccine is effective only 51% of the time. If the vaccine is effective half the time, that lowers your chances by half so your odds are only about 17% that you’ll get shingles. But that isn’t the reason I would recommend it.

The reason is because of the postherpetic neuralgia (PHN) that some people develop. Shingles is bad but PHN is worse; I’ve heard excruciating stories from people, mostly due to the region that was affected. You cannot predict where it will occur and the rash and pain is debilitating. Here’s the important point: the shingles vaccination will lower the risk of getting PHN by 67%. That lowers the risk of getting PHN to less than 10%. Those are odds I like.

It’s not known what increases your risk of shingles. The best predictor is family history: if your parents or siblings have had shingles, the probability is greater that you’ll get it. And that makes the vaccination an even better bet.

I have no family history of shingles, but I got the shingles vaccine about a year ago. I’m neither an advocate for nor against vaccinations. I look at the science and determine the odds; I don’t always get the flu vaccine. In this case, because I intend to live a long time and the odds of getting shingles increases with age, I decided it was the right decision. Yes, it’s an expensive vaccination, but check your coverage; Paula just discovered she can get it for about half price through her prescription plan and with her sensitive redhead skin, she’s not taking any chances.

It’s your body. Only you can decide what’s right for you. For more information, check out the link below.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2sNdd1r

 

What Causes Shingles?

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“What’s your opinion on getting the shingles vaccination? It’s expensive and my insurance doesn’t cover it. Is it worth it?”

A little background first. Shingles is a viral infection. One million people will get shingles this year, and one out of three people 60 and older will get shingles in their lifetime. It’s caused by the same virus that causes chicken pox; if you’ve had chicken pox, you’ve still got the virus lying dormant in your body. It hides in your nerve cells until for some unknown reason, it begins to multiply and cause the pain and blisters of shingles.

The virus manifests itself with burning and pain, even before a rash breaks out. Generally speaking, it lasts two to three weeks and goes away by itself. While it’s inconvenient, it’s not life threatening; itching and burning can be treated. However, what is much more serious is when shingles turns into postherpetic neuralgia. The pain and inflammation can last for weeks, even months, and sometimes years. It can be debilitating. We don’t know what makes some cases serious while others clear up on their own.

That brings us back to the vaccination—and I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: https://www.cdc.gov/vaccines/vpd/shingles/public/index.html

 

Why I’ll Keep Using Coconut Oil

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The research that the authors of the American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease, specifically on coconut oil, seems to be in conflict. The authors suggested coconut oil is bad for us, but the research studies they used didn’t really seem to confirm that conclusion. What gives?

The criteria that the Advisory’s panel used were limited in scope. There’s no evidence that the regular use of coconut oil contributes to CVD, even in cultures that regularly use coconut oil. They used a part-equals-whole logic. As they reported, there were significant increases in LDL-cholesterol when subjects increased coconut oil in their diet in the studies they cited. Because a high LDL-cholesterol level contributes to CVD, therefore coconut oil must contribute to CVD. That’s why the Panel does not recommend its use.

I understand what they said. The data they used supported their conclusion. However, they used a very narrow use of the data on coconut oil to support their recommendation.

They are correct when they state that coconut oil is high in saturated fat; in fact, it has the highest percentage of saturated fat of all fats and oils including lard and butter. But it also has a very high percentage of short- and medium-chain saturated fatty acids as opposed to longer chain fatty acids. The advantage is that short- and medium-chain fatty acids can by-pass the liver and be used directly to produce energy in most organs of the body, which makes coconut oil an option for getting energy quickly.

Let’s examine the statement that LDL cholesterol increased when subjects were taking coconut oil (1). In one study, LDL rose from 166 to 171 mg/dl in men and 155 to 156 in women (2). In another study, LDL rose from 118 to 128 mg/dl in a study of men and women (3). These were studies that lasted six weeks and five weeks respectively. There’s no evidence it would continue to rise had the subjects continued to use coconut oil. An increase of 3–6% in LDL-cholesterol wasn’t translated into a risk for CVD. Statistically significant? Yes. Meaningful in the real world? No.

The panel did not recommend coconut oil because it has saturated fat and has no other health benefits, but that point is debatable. Research on other benefits of coconut oil is really just beginning. Too many health gurus are overstating the benefits, especially when it comes to Alzheimer’s disease, and that creates the hype and most likely, the reason the Panel singled out coconut oil to examine more closely.

 

The Bottom Line

The Panel suggested we keep fat intake to no more than 30% of dietary intake; of that, only 10% should be saturated fat. They recommend that we substitute poly-unsaturated and mono-unsaturated fats and oils for saturated fat. That’s not really controversial and it’s a good idea.

What they did not say was that we couldn’t use coconut oil as one of our sources of saturated fat. If we eat 2,000 calories per day, that would mean up to 200 calories per day can come from saturated fat; that’s about two tablespoons per day, and that seems to be a reasonable source of saturated fat consistent with their recommendation.

Here’s the real bottom line: if you’re going to use a sat fat as a source of immediate energy, coconut oil is a healthier choice than lard or butter. And that’s why I use coconut oil; I don’t use a lot, but it works for me and makes sense to me as a scientist.

My recommendations never change. Eat less. Eat better. Move more. And in my opinion, using coconut oil is eating better.

What are you prepared to do today?

Dr. Chet

 

Reference:
1. Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510
2. J Lipid Res. 1995;36:1787–1795.
3. Am J Clin Nutr. 2011;94:1451–1457