Why Nutrition Is a Process

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A celebrity doctor who specializes in cancer treatment said something that caught my attention, and it goes to this question: why are some people cured by specific treatments while others don’t respond at all? In his opinion, it’s because the cancer creates a new system in the body that competes with the other systems.

The new system may be different in each body once the cancer is established, which could mean that everyone really requires an individual approach. A systems approach would be necessary only if the cancer gets too established; early diagnosis can use treatments that work in most people. Late diagnosis means the cancer has established a system with strengths and weaknesses that are unknown. But the systems approach isn’t limited to cancer.

What’s a Systems Approach?

A systems approach is simply this: we attempt to reach a goal by looking at the interactive nature and interdependence of all the factors in an entity.

Here’s an analogy: you flip the switch for the light in your kitchen, but the light doesn’t go on. What could be wrong? The light won’t work if:

  • Your bulb is burned out
  • Your circuit breaker needs to be reset
  • An electrical outlet somewhere has a tripped GFCI
  • Your switch has gone bad
  • A wire is loose in your light fixture
  • The power is out to your whole house

Turning on a light is easy—my grandson Riley is very good at it and he’s not even three. But if it’s not working, you have to look at each element of the system to find the problem and get the kitchen light back on.

How Vitamin D is Part of Your Bone Health System

While osteoporosis or weight gain doesn’t create a new system like cancer does, there are numerous steps in both processes. On top of that, if we’ve been on the path to bone loss or weight gain, there may be changes in normal metabolism that have to be overcome.

Let me explain using vitamin D for bone health. Whether we make vitamin D in our skin, get it from food, or take it in supplement form, it has to be processed by the liver to become the active form to promote bone growth. If there’s a defect in getting the raw vitamin D from food or a supplement into the bloodstream and on to the liver, not enough vitamin D would be made into the active form. Or there may be a defect in the processing of the raw vitamin D once it gets to the liver. Or there may a defect in the receptor for the active vitamin D on the target tissue. I could go on and on about where issues could occur, but I hope you get the point. Right now, we have no idea where the issue might be for the use of vitamin D in an individual just as we don’t know where the weak point of a cancer system might be and thus where we should attack.

Do we quit? No. We simply use a systems approach—we look at every step necessary to reach our goal and what we can do at each step. We begin with taking vitamin D for a specific period of time. We then get re-tested, most likely a bone density scan. If there’s growth, great. If there’s not, then we either add more D or add calcium or switch to a different form of calcium. Then retest. If that doesn’t work we can add vitamin C or glucosamine, both critical to the manufacture of connective tissue. There are other factors such as smoking and exercise that also impact bone growth. We systematically add new variables or add more of some that we’re already doing. Might this take a long time? Yes. Would we have to pay attention? Yes. But is it a natural approach to complicated conditions? Again, yes. No matter what the condition, if you’re going to try to deal with it nutritionally, that’s the approach you’ll have to take. You have to find what works for you.

The Bottom Line on Vitamin D

The systems approach goes a long way to explain why some people benefitted from vitamin D and calcium to prevent fractures and others did not. The only fact the meta-analysis study proves is that vitamin D and calcium supplementation don’t work for everyone. The key is to move on to the next approach; it may be different supplements or it may even be a medication. More options must be tried until a solution is found for each individual.

Over time, I’m going to continue to explore this concept of a systems approach to nutrition. I have no idea where it will lead, but it’s worth spending more time thinking and researching it.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.

 

You Actually Have to Take the Supplements

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The authors of the study on calcium and vitamin D supplementation as they relate to fractures were all orthopedic surgeons, as stated in the paper. They had no known training in nutrition. Maybe not statistics either.

When you perform a meta-analysis, each research study included is given a weight in the form of a percentage, which indicates how much it contributed to the outcome. Not all studies should contribute equally; that helps to eliminate the bias of a tremendous benefit in a very small study versus a large study with no benefit. They didn’t seem to read something in three studies that contributed close to 90% of the analysis (2-4): the authors of those papers said that the reduction in fractures did occur, or at least bone was restored, when the subjects took over 80% of the doses of calcium and vitamin D they were supposed to take. The problem: average compliance was around 50%.

What these surgeons could have done was tease out the data on those subjects who were compliant and analyzed that data. What they might have had were results that demonstrated that in order to get a benefit, subjects had to take the supplements regularly. That would have been meaningful. Instead, inexperience or ignorance left us with headlines but little else.

Still, there are some questions that were raised in my mind and I’ll cover them on Saturday. But one thing won’t change: if you’re going to take supplements of any kind, you’ve got to actually take them if you want a benefit.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.
2. Lancet. 2005;365(9471): 1621-1628.
3. Arch Intern Med. 2006;166(8):869-875.
4. Am J Med. 2006;119(9):777-785.

 

Are Vitamin D and Calcium Still Worth Taking?

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Maybe you recently read a headline that went something like this: “Vitamin D and Calcium Do Not Prevent Fractures.” Many headlines were much worse. Over this past weekend I read the research paper published in JAMA. Is it real? Should you not bother taking your calcium and vitamin D to protect your bones? No—keep taking them. But it does give me an opportunity to talk about some of the issues surrounding these types of papers as well as the complexity of nutrition for our health. That’s our topic this week.

The study was a meta-analysis of studies that examined the relationship between the risk of fractures in elderly populations and supplementation with calcium, vitamin D, and both supplements together. After a rigorous database search, 33 randomized controlled trials were included in the meta-analysis. Some studies lasted several months, and some lasted several years. The amounts of calcium and vitamin D in the supplements varied in every study. After analysis, the researchers determined that neither calcium nor vitamin D nor the combination of both reduced the rate of fractures when compared to placebo. That led to their conclusions.

This was a mess as you probably guessed with differing quantities and lengths of the trials. What bothered me most was that if they really understood nutrition as well as the results of the studies they included, they could have done something special. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.

 

What’s New on DrChet.com

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With a new year just beginning, it’s time to update you on what’s happening in the next month or so.

New: The Bottom Line on Alzheimer’s Disease

Your brain makes you who you are. We may fear cancer or diabetes but we dread the thought of losing our ability to think. In this Bottom Line, I examine programs that claim they can treat and perhaps reverse cognitive decline and Alzheimer’s disease. Are they right? I’ll give you the state of the research today and what you can do now to protect your brain no matter how young or how old you are. It’s available in both PDF and MP3—choose the format you prefer and get the most up-to-date information for only $1.99, free for Insiders.

Insider Conference Call

The next Insider conference call is Thursday, January 18 at 10 p.m. ET. This is a good time to decide to become an Insider; the conference calls give you the most recent information as well as preferred access to me. There are other benefits as well, but start the New Year with a commitment to be more informed about your health. Check it out here.

Are You Eating Better?

If you’re going to eat healthier, go the extra step and eat the foods that will help your body detox itself. Get all the details in Real-Life Detox, available as either a spiral-bound book or as an e-book, either in ePub format or Mobi, so you can keep a copy on your phone as well as read it on your new Kindle or your laptop.

One More Thing

I’m working on the Annual Super Bowl Webinar and this one is going to be special: it’s all about losing body fat. I’ve taken the ultimate fat-burning program from the old Optimal Performance DVD and made it appropriate for anyone, no matter your current fitness level—no athleticism required. The Super Bowl Webinar will be at noon ET on February 4. You really don’t want to miss this one so put it on your calendar today, and I’ll let you know when you can register.

What are you prepared to do today?

Dr. Chet

 

Excuses for Avoiding the Gym

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The New Year is upon us and with that, a commitment by many to exercise regularly. No matter where you live, that may involve joining a gym, but all gyms are not created equal. What you need, besides a convenient location and reasonable price, is a facility that provides you with the equipment you need to accomplish your goals and short-circuits your excuses.

“I don’t know what to do.”
I’m going to challenge conventional thinking in how you solve that problem: once you have clearance from your physician to exercise, ask for a referral to a physical therapist. He or she will work with you to determine the best exercises for your body and your history, especially the more years you have in your body. Broken bones, sprains, strains, injuries, gaining weight, losing weight—we all have a physical history. If you have a problem with the mechanics of your body or reinjure yourself, that will impact your ability to exercise, so begin with a physical therapist if possible.

Paula and I both have done that. Once we worked with our physical therapist to find what exercises to do on which machines or weights or tubes, we selected a gym which had the resistance and aerobic equipment most suited to our needs. I still do the exercises I was shown and I’ve been running for close to a year with no time off for injuries. That’s the longest I haven’t been forced to take time off.

You may even find out you don’t need a gym; walking or running plus exercises you can do at home may be all you need. Your physical therapist will get you headed in the right direction. The downside: if you’re exercising at home you can do it anytime, and that may lead to eternal procrastination. If you’re letting exercise slide day after day, maybe you need a more formal workout setting.

“I just don’t feel comfortable there.”
Think about how your social needs may affect your adherence to your workout plan as well. Paula reads while she bikes and I listen to podcasts on the treadmill so a big gym works for us, but you may need a more social environment with friends to keep you honest and engaged.

“It’s too far.”
Another factor is location. When Paula worked out on the way home from her job, she found that the farther the gym was from work, the less likely she was to get there; it was too easy to run errands on the way and never quite make it to the gym.

“I got hurt and I’m too sore, so I can’t exercise.”
Besides getting input from your physical therapist, here’s the most important advice I can give you: start slow. If you begin by doing too much, you’ll be sore or injured and you’ll be out. Your objective is to keep going—it’s a marathon, not a sprint—so an easy start is your best plan.

It turned out that Planet Fitness works for Paula and me: plenty of resistance equipment and all the aerobic machines we could want at a very reasonable price. I also must add that there are more really overweight people working out at the Planet than anywhere I’ve ever been, which I love to see.

For you, it may be someplace different; maybe you’ll do better with swimming and workout classes at the Y. The important point is to select your gym by what you need and you might find it becomes a lifetime habit.

What are you prepared to do today?

Dr. Chet

 

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/