Blue Zones: Where Are You Going?

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Why do you get up in the morning? If you’re a parent with small children, it’s obvious. If you work outside the home, easy to understand. But what happens when you decide to retire, or even retire early? If you want to live well to 100, what are you going to do for the next 30+ years? One of my questions to people who say they want to retire is “to do what”—be first in line for a supermarket’s free sample day?

Purpose

People who live well to 100 in Blue Zones have some sort of purpose. It’s more than just a positive attitude, although that appears to help. For some, it’s an opportunity to socialize: to meet someone for a walk and talk, or to get together with old friends to get coffee with their senior discount at the fast-food joint and tell stories.

For others, it’s volunteer activities, the desire to serve others: food banks, delivering meals, teaching, and so on.

Having faith in something greater than this world is important to many centenarians. That also provides purpose to many.

They still work. One gentleman gets up, gets on his horse, and moves cattle from one pasture to another.

The purpose can be as different as there are people, but everyone seems to have a good reason to get up in the morning.

Stress

One thing that they seem to learn is how to deal with stress. It may be playing games in a group, group exercise such as tai chi or yoga, or even preparing meals from scratch. Stress never goes away; it may be that with age comes the experience that stress is usually temporary, and often you’ve seen worse. Finding ways to deal with it is important.

The Bottom Line

Secrets of the Blue Zones doesn’t provide answers; it provides directions. Communities are laid out differently in modern countries than in most Blue Zone cities and towns. We want space; we value independence. But what price do we pay in our longevity by taking away access to friends, families, churches, and community centers? Having a purpose is not just a goal sheet with a to-do list; it’s the need to serve others in some meaningful way. More next Tuesday.

What are you prepared to do today?

        Dr. Chet

Lessons from the Blue Zones

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Living to 100: Secrets of the Blue Zones is a Netflix documentary that examines the lifestyles of people in several regions of the world that have a high proportion of people who live to 100. It’s a review of the observations of Dan Buettner, who has spent the better part of 30 years finding and examining cultures that have a larger than normal number of residents who live to 100. He’s written several books, films, and articles on the topics over those years. In this series, he goes back to look at those cultures again.

In the next several Memos, I’m going to give you my thoughts on each of the four areas he describes in his summary. I came away with a new perspective on a couple of areas including exercise and nutrition. In reality, they might contribute to longevity the least. While I think that each area is important, I’ll start with what I see as the weakness of his approach.

We know a lot about how people in these cultures ate and moved. We also see the social interactions they develop and their outlook on life. But they were already in their 80s, 90s, and 100s; we don’t know anything about people who were in their 70s when he began his observations 30 years ago and where they are today. Could someone adapt these lifestyles in their 50s, 60s, even 70s and live well into their 80s, 90s, or 100s? It sounds reasonable, but unless there are studies ongoing that will be published in the future, we don’t know that for sure. We can only look at the present.

I’ve decided the answer would be yes which is why I’m developing aging with a vengeance. The goal isn’t to live to 100; it’s to live well to 100 years or whatever your goal is. We’ll begin with outlook on life on Saturday. What’s yours? We’ll find out how important that can be.

What are you prepared to do today?

        Dr. Chet

Reference: Living to 100: Secrets of the Blue Zone. Dan Buettner. 2023. Netflix.

The Cause of Obesity

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On Tuesday, I said that I couldn’t get past the word disease in the statement from CDC Head of Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” While we can agree that there may be a genetic or medication contribution to obesity, there is only one real cause.

The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that has a known cause, and a distinctive group of symptoms, signs, or anatomical change. There’s no question that obesity has anatomical changes that result in symptoms.

But understand the numbers of obesity. Not everyone is massively oversized; the average height for a man in the U.S. is 5’9” and over 202 pounds to be considered obese, while for the average height of a women is 5’4” and over 173 pounds. There are many people who can hide that weight well. My point is that it’s not the largest individuals who are tipping the scales in the increase in obesity; it’s all of us above normal weight contributing our share.

The disorder part of the definition is one that is clear.

The Cause of Obesity

The cause of obesity is the systematic overconsumption of calories, usually taking years, if not decades, to manifest itself.

The Evidence for the Cause

There are two examples I’ll cite, both related to World War II. The first was the Minnesota Starvation Experiment. Male conscientious objectors had to lose 25% of their body weight in six months. They were normal weight when the study began, and their caloric intake was adjusted weekly to maintain the required weight loss. The result was a linear loss of 25% of their weight in six months.

This one is extreme but applies nevertheless. No one walked out of concentration camps overweight after being liberated—no one. They were systematically starved until they no longer had the energy to work.

In both cases, there was not a change in structure or function; the people were simply starved. The result was weight loss. There’s no change in structure or function when we systematically overeat. However, once we’re overweight and obese, there are changes in the structure and function of our bodies that must be dealt with. But it still comes down to this: a calorie is a calorie. No matter what genetics we have or what medications we take or how little we move, we won’t get fat if we don’t overeat.

The Bottom Line

We are obese because we consistently eat too many calories. We can reduce our weight if we systematically eat less. Yes, there are challenges to overcome because of those structure and function changes caused by chronically overeating. You just have to find the way to reduce your caloric input that works for you. Eat less. Eat better. Move more.

I frequently am asked which calorie-counting app is best, and I don’t have an answer. Do you? Have you found one that’s easy to use? Drop me an email and let me know which app you like and why. I’ll give them a try and let you all know which ones perform best.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Fatter Than Ever

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It seems ironic that the last Memo was titled “Make Every Bite Count” while the CDC was in the process of releasing the latest obesity statistics. This shouldn’t be any newsflash, but as a country we’re fatter than ever. In 2021, 19 states exceeded 35% obesity among the residents; in 2022, it jumped up to 22 states. Three states exceeded 40% of residents were considered obese: Louisiana, Oklahoma, and West Virginia.

Which age group is the fattest? Those between 45–54 years with 39.9% obese. The leanest? Young adults at 20.5%. This link to the maps shows where your state scored; it’s not a pretty picture.

This is a statement by Karen Hacker, the head of the CDC’s Center for Chronic Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” I can’t get past the word “disease” and I’ll explain why on Saturday.

In the meantime, if you have access to Netflix, I urge you to watch the short series “Live to 100: Secrets of the Blue Zones.” It has slightly changed my opinion on how to age with a vengeance; I’m going to give you my thoughts on it beginning next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Make Every Bite Count

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You’re eating vegetables, fruit, whole grains, dairy, proteins foods, and oils, and you’re staying within calorie limits for a healthy BMI. Does this sound abnormal to you? Sure, we can quibble about the need for dairy or the percentage of carbohydrates, but the Dietary Guidelines for Americans (DGA) are reasonable, and they’re almost exactly the same as when they were first written almost 50 years ago.

Is there a recommendation to “make sure you eat every cookie, candy, pie, and pasta in mass quantities every day” anywhere to be found? No. Is this a responsible approach to get the nutrients you need? Yes. The guidelines also recommend foods that are specific to cultures and ethnic groups and a variety of cooking styles.

Compare that with the keto recommendations of severely restricting carbohydrates, or veganism restricting animal products of any types, or the paleo diet restricting every grain for some unverifiable theory about what people ate in the Paleolithic era. Which sounds stranger to you now?

DGA Limitations

The DGA also includes these recommendations:

  • Added sugars: Less than 5% of calories per day starting at age 2. Avoid foods and beverages with added sugars for those under 2.
  • Saturated fat: Less than 10% of calories per day starting at age 2.
  • Sodium: Less than 2,300 milligrams per day, and even less for children younger than 14.
  • Alcoholic beverages: Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to two drinks or less in a day for men and one drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more.

The Bottom Line

Is there a lot to criticize about the DGA? Not really. Most people who do are actually criticizing the Western-style diet and the food selections people make when eating that way. Nowhere does it say that we should eat ultra-processed foods to fulfill the carbohydrate recommendations. As I’ve said, I like Cheetos and peanut butter cookies about as much as the next person, but those are not something to eat on a regular basis. As the occasional snack in small amounts, sure. But as a regular part of the diet? No. The guidelines can recommend, but they can’t control manufacturers to the extent that they produce only foods that fit within the DGA. That choice on how to follow the guidelines is laid upon your shoulders for you and your family.

Now that you know what the guidelines actually say, maybe you can make better decisions about what you want to put into your body and in what quantity. Remember the tag line of the DGA? Make every bite count. Your body, your choice.

What are you prepared to do today?

        Dr. Chet

Reference: Dietary Guidelines for Americans, 2020-2025 Executive Summary

What Are the Dietary Guidelines for Americans?

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“Make every bite count.” You might think that phrase came from one of the many nutritional gurus on the Internet or in the thousands of books written about the best way to eat. Fact is, that’s the tagline from the USDA Dietary Guidelines for Americans 2020-2025 (DGA). Do you know what’s contained in those guidelines? We often see criticism of the DGA by those gurus, but they seem to be obsessed only with the supposed high carbohydrate levels and how bad that is for us. I thought we should review the guidelines so we understand the facts.

The most important change I see is an emphasis on nutrition in a baby’s first year and then at various life stages. The main focus, whatever the age group, is to focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. Two concepts there that we shouldn’t miss: food first and don’t overeat for your health and activity pattern. A healthy dietary pattern consists of the same nutrient composition in the foods and beverages across all food groups, in recommended amounts, and within calorie limits.

Here are the core elements that make up a healthy dietary pattern:

■  Vegetables of all types: dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables

■  Fruits, especially whole fruit

■  Grains, at least half of which are whole grain

■  Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives

■  Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products

■  Oils, including vegetable oils and oils in food, such as seafood and nuts That’s it. Sounds reasonable to me—how about you? I’ll talk about what is unreasonable and the most important recommendation of the DGA on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Dietary Guidelines for Americans, 2020-2025 Executive Summary

Protein in the 21st Century

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The results of the study seemed to be definitive: animal sources of protein yield more absorption of essential amino acids (EAAs). The reason the researchers undertook the study was that the Dietary Guidelines for Americans 2020-2025 (DGA) uses the term “ounce equivalencies” when describing protein sources. From the DGA: one ounce equivalent equals one ounce of meat, one whole egg, a quarter cup of beans, or a half ounce of nuts. The researchers question whether those sources are actually nutritionally about the same. As you can probably guess, they’re not.

Defining Equivalency

The researchers demonstrated that on an equal weight basis, those categories of foods are not equivalent on the net absorption of EAAs. When looking at the EAA breakdown of each food on the USDA Food Central Database, they are not equivalent at the same weight in EAAs or in any category. The calories are not the same per serving, the fat content is all over the place, and animal sources of food contain no fiber.

I think that both the USDA and the research group would be better served by using the word standardized, but that’s not really enough, either: it must be standardized to a specific nutrient or category. If one were to standardize to EAAs, then pork, beef, chicken, lamb, and every other animal would make the list, but plant-based products would not unless the serving size were different. Both beans and almonds have EAAs, but the portion sizes would be different and so would the calories and other nutrients.

A Better Idea

We don’t live at the turn of the last century or the 1930s; we have the technology today to use protein powders and EAAs in powder form as an addition to the foods we eat. There’s no reason we can’t add more protein as our protein needs change with our age without adding the fat and cholesterol that come with animal protein. Whether you prefer animal-based protein such as whey or plant-based protein such as soy, rice, hemp, or pea protein, you can increase the amount you get every day based on your needs. The amounts you need may vary, but 25 grams of protein is a good place to begin.

To avoid any discrepancy in the EAA content between plant and animal sources, use a product that specifically contains EAAs. They’re individual amino acids that do not have to be broken down as proteins do, and they’re absorbed faster. In this case, an additional 10 grams per day is a good place to begin.

The Bottom Line

I think the focus on protein is good at any age because we’re still a carb-centric society. If everyone would just follow the DGA instead of the modern adaptation we’ve concocted over the years, everyone would end up healthier. But we do love our Cheetos and chocolate truffles, so the teaching continues. Just remember: Make every bite count!

What are you prepared to do today?

        Dr. Chet

References:
1. Nutrients, 2023. https://doi.org/10.3390/nu15132870
2. https://www.dietaryguidelines.gov/

Best Protein Sources: Animals or Plants?

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Protein quality is integral to our health at any age and even more as the years go by. We think of protein as it relates to muscle, but there are many other uses for protein in our body: bones, skin, hair, and the hemoglobin in your blood—virtually every body part or tissue. Then there is the proteome; we make at least 10,000 different proteins to help the body do what it does. Insulin is just one example of such a protein. Your ability to make proteins is dependent on making sure you have enough protein intake on a regular basis.

Today there is more emphasis on obtaining nutrients such as protein from plant-based sources. The question is this: do we get the same amount of essential amino acids (EAA) from both animal and plant-based sources of protein? Researchers decided to compare the absorption of essential amino acids from four sources of protein, two animal and two plant-based.

Researchers recruited subjects from two different age groups: 22–39 and 55–75. The subjects ate the same exact caloric and macronutrient meal on four different occasions with one of the following added: two ounces of cooked pork, scrambled eggs, canned black beans (rinsed), or raw almonds. Then the EAA content of their blood was tested for the next five hours.

The EAA absorption in descending order was pork, eggs, black beans, and almonds; the subjects’ bodies absorbed at least twice as much EAA from animal sources than plant-based sources. There was no difference in EAA absorption between age groups. A few questions remain, and I’ll answer those on Saturday.

Tomorrow night’s Insider conference call will include more about EAAs and a self-experiment on ultra-processed foods. You can also get your questions answered if you become an Insider before 8 p.m. Eastern tomorrow night. I hope to see you then.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients, 2023. https://doi.org/10.3390/nu15132870

How VILPA Can Reduce Cancer Risk

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We’re going to switch from mortality to morbidity: in this case, the objective is to reduce the risk of getting one of thirteen types of cancer. This was interesting for all kinds of reasons, but mostly because researchers specifically looked at subjects who claimed they didn’t exercise regularly. The data were part of a sub-study of subjects that included wrist accelerometry data. The participants reported no leisure time exercise and one or fewer recreational walks per week; they used a seven-day trial of wearing the accelerometer before the study to be sure.

The purpose of the study was to test the relationship of unplanned vigorous activity to the diagnosis of cancers, especially those associated with the lack of physical activity such as breast and colon cancer. The researchers wanted to determine the dose of vigorous activity required to reduce the risk by 50% compared to maximal risk. They termed the activity Vigorous Intermittent Lifestyle Physical Activity or VILPA for short.

What would count as VILPA? Walking up several flights of stairs, running to catch a bus, or fast walking through an airport to catch a flight. Even roughhousing with the kids might qualify.

Study Results

There were 22,398 participants with a mean age of 62. Over the six-plus years of follow-up, there were 2,356 new cancer events with 1,084 diagnosed physical-activity-related cancers.

They analyzed the data to find out how much VILPA per day was beneficial. One-minute bouts and two-minute bouts revealed the same dose-response curve. The more one- to two-minute bouts of VILPA, totaling at least 4.5 minutes per day, the lower the risk of developing cancer, especially a physical-activity-related cancer.

Less May Be More

We’ve looked at the amount of weight training that helps reduce blood pressure, the minimal number of steps needed to reduce mortality from CVD, and now, how to reduce the risk of some cancers by intense burst of exercise. There seems to be no doubt that some exercise, even in one-minute intervals, can be beneficial.

The Bottom Line

Nowhere in these research papers did they suggest that this was the way to train athletes—they all wanted to find the minimum to show how it could be beneficial. Even if you have little time to exercise, you can probably fit in a few one- or two-minute sessions; you could wait until it’s put into an organized program, or you could just do it right now. As long as your doctor says you can exercise, take the clothes off the exercise bike, jump on, and pedal as fast as you can for a minute. Do that a few times a day. There’s your VILPA workout.

If your only goal is to reduce the risk of disease, this is the way to begin. Based on the most recent research, you might find you like the way you feel and begin to do a little more. Who knows? But you must begin somewhere, and it all depends on one question:

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2023.1830

How Many Steps Do We Need?

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Last week, we talked about how to lower blood pressure using a form of weight training called isometrics. As I made clear, you won’t look like a body builder, but it can help your cardiovascular health. This week, we’ll look at two recent studies to clarify how much aerobic exercise we need to reduce the risk of all-cause and cardiovascular disease mortality.

The typical recommendation for aerobic exercise is 10,000 steps per day. That was based more on marketing than on science, but it has stood as the standard for years—until recently. Several studies have shown the actual amount may be between 4,000 and 7,000 steps per day.

In a recently published study, researchers included data from 17 studies and over 225,000 subjects. They tracked the subjects for just over seven years to find out all-cause mortality and cardiovascular disease mortality. One more thing: all the data were collected electronically as opposed to relying on some sort of mechanical device that underestimates or overestimates steps per day.

After using meta-analysis, the researchers used 3,900 steps per day as a baseline for the median risk of mortality. For every 500 additional steps per day, the mortality risk decreased 7% and for every thousand additional steps per day it decreased 15%. As the number of steps increased, the cardiovascular and all-cause mortality risk decreased until about 12,000 steps where it leveled off.

Going with our theme of doing just enough to reduce our mortality rate, it would seem that 4,000 steps per day, whether as part of your regular day or in addition to your everyday activity, gives a baseline of protection. But do you really have to invest that much time? We’ll check that out on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Eur J Prev Card (2023) 00, 1–11 https://doi.org/10.1093/eurjpc/zwad2292