Choosing to Live Longer

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The researchers from the study I reviewed in Tuesday’s Memo had their thoughts on why the U.S. may experience excess deaths compared to other high-income countries. They also suggested that our healthcare system isn’t serving the American people as well as it might. That may be part of the answer. Let me give you my thoughts, before the anti-seed oil gurus and vaccination opponents get started.

Healthcare Systems

Every other country in the comparison had some form of universal healthcare or a combination of public and private healthcare plans—think Medicare with more coverage for an additional purchase. While we’ve all heard stories about hip replacements taking a year to get scheduled, they provide care to everyone without considering payment first. I’m not suggesting I have any answers to the healthcare dilemma, but it’s a part of the problem.

Vaccinations

I decided to look at the vaccination rates during the COVID epidemic because the U.S. mortality rate really skyrocketed during those couple of years, far above what happened in other high-income countries. When compared to other countries’ vaccination rates, we were near the bottom of the list. I know, and hear every day, about many people who are concerned about vaccinations being problematic, but the COVID vaccine may have contributed to the lower mortality rates in other countries.

The Bottom Line

Remember the final reasons that the researchers speculated about—cardiometabolic disease? Heart disease, hypertension, and type 2 diabetes are the top killers in the U.S. along with cancer. We could dramatically reduce mortality and morbidity if we took better care of our bodies. That’s where we fail: we eat too much and we move too little. If we could change those, I’m convinced the death rates would start to tumble.

Eat less. Eat better. Move more. Today.

So, what are you prepared to do today?

        Dr. Chet

Reference: JAMA Health Forum. 2025;6(5):doi:10.1001/jamahealthforum.2025.1118

Too Many Deaths

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Recently I read an interesting study that examined the mortality rates in the United States between 1980 through 2023, including the time before, during, and after the COVID epidemic. Researchers took it one step further: they obtained mortality data from other high-income countries to compare the mortality rates between the countries while accounting for the differences in population size. The countries included Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.

This comparison illustrated that beginning about 1985, the U.S. had more deaths per 100 people than the average of all the other countries. In 2005, the difference increased even more to the point that the U.S. had more deaths per 100 people than every other country in the study. Over the course of the years of observation, that came to an extra 14.5 million Americans who died.

While this was an observational study, it leaves us with the question: why? We certainly spend more on healthcare per capita than any other high-income country, coming in at just over $12,000 per person, while the average of other high-income countries comes in at half that—and yet somehow they’re healthier. The researchers cited drug overdose, shooting deaths, and cardiometabolic disease as the most likely contributing factors. I’ll give you my thoughts on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Health Forum. 2025;6(5):doi:10.1001/jamahealthforum.2025.1118

Magnesium Bonanza: Broccoli-Cauliflower Salad

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Lately I’ve written about magnesium, and I often talk about eating cruciferous vegetables every day. I decided to fall back to one of my favorite recipes from my mother-in-law, Ruth, modify it a little, and give you a recipe for a great salad you can enjoy this holiday weekend. Nutritional information is at the bottom.

Broccoli-Cauliflower Salad

1 pound (about 5 cups, chopped) broccoli
1 pound (about 5 cups, chopped) cauliflower
1 green onion, sliced fine
4 tablespoons sunflower seeds
½ cups mayonnaise
½ cups Miracle Whip salad dressing
¼ cups grated Parmesan cheese
2 tablespoons sugar
¼ cups bacon bits or chopped bacon
¼ teaspoon vinegar (I prefer rice wine vinegar for the milder taste)
¼ teaspoon herb blend Mrs. Dash or a blend you prefer

Cut vegetables into bite-sized pieces, put into a large bowl, and mix together.

Mix together the wet and flavor-building ingredients. Pour over the vegetables and refrigerate overnight. Mix before serving. If you’re like me, I don’t like to wait, so it’s fine to eat it right away as well. You could use light versions of the mayo if that’s what you like, but at only 98 calories from sugar in the whole recipe, I wouldn’t bother with sugar substitute.

You can also adapt it to your taste. Add sliced cherry tomatoes or grapes, shredded carrots, chopped basil, sliced almonds, or maybe pomegranate seeds, or whatever ingredients you like, especially more veggies. And now I wish I’d used some purple broccoli—that would look outstanding! Other recipes add raisins or shredded Cheddar cheese, although those add more calories. The objective is to get your friends and family to eat it, so do whatever it takes to get there.

What’s the beneficial nutrients look like? First, all the phytonutrients that come in 1.5 cups of cruciferous vegetables plus some allium nutrients from the green onions. Second, the estimated magnesium level would be about 170 mg per serving. As another bonus, there would be 2,200 mg of potassium per serving, a nutrient we just don’t get enough of in our typical diet.

Compare that with the typical 80/20 burger cooked on a grill: it has no phytonutrients, 25 mg magnesium, and 250 mg potassium. We need that salad! And remember, I never said it had to taste bad. The most important point is to eat what your body needs, and it needs those veggies, even if mayo and bacon are along for the ride.

Remember to check the Health Info section of drchet.com for this and more delicious recipes. I hope you enjoy your salad and have a fun, safe, long weekend.

What are you prepared to do today?

        Dr. Chet

Is Taurine Safe?

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The title said, “Could your energy drink be fueling cancer?”

“Now what?!” was my first thought. Researchers reported in a press release that the amino acid taurine may help cancerous cells make energy to fuel their growth. Because taurine is found in energy drinks and protein supplements, I wanted to check whether this is something to be concerned about or not.

This was a complex study from the perspective of identifying what were the potential stimulators of tumor progression in bone marrow. A taurine carrier was identified. The researchers conducted tests which added taurine to specific types of leukemia cells to determine tumor progression. They concluded that further research was necessary to find something that would block taurine carriers from carrying taurine into tumor calls where they could stimulate the production of energy via glycolysis. That may be correct or not.

The methods section of the paper was over five single-spaced pages long; that doesn’t make it bad, but each unique test has to have a standard error of the method. In other words, how specific and precise does the method measure the variable?

  • Using available leukemia cell lines is a first step to test theories, but we don’t know if that’s how it would work in living human beings.
  • They did testing on rodents, but there were only a few rodents in each group.
  • On top of that, taurine is naturally produced in the body, and they specifically identified tumor sites as one of the locations where taurine is produced. How can that be differentiated from natural production and supplementation?

In my opinion, they were far too aggressive in their conclusions about energy drinks potentially fueling cancer. For now, the most conservative approach is that if you have an aggressive myeloid leukemia, consider reducing taurine intake from all sources, which would also include meats, dairy, and eggs. There’s a lot more research that has to be done before we definitively know how this information impacts the real world.

What are you prepared to do today?

        Dr. Chet

References:
1. https://scitechdaily.com/could-your-energy-drink-be-feeding-cancer-what-scientists-just-discovered/
2. Nature. https://doi.org/10.1038/s41586-025-09018-7

Protect Your Brain—Eat More Magnesium

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In the last Memo, we were left with the researchers’ question: if magnesium intake and BP were not related to a neuroprotective effect, what was? The researchers had some idea based on prior research: inflammation. Let’s take a look at what they found on the follow-up to their original study.

The methodology and subject pool of the study was essentially the same as the other study with the addition of several measures of inflammation, including hs-CRP. Researchers found that as magnesium intake increased, inflammation decreased. Subjects with higher levels of magnesium intake had increased brain volumes including grey matter and white matter, but not white matter lesions. This was an observational study, so cause and effect cannot be determined, but with close to 6,000 subjects, I think we can safely say there’s a definite relationship between magnesium intake and a neuroprotective effect.

How Much Do I Need?

The average intake of magnesium was 360 mg for men and 340 mg for women. A reader recently sent me a post in which a physician recommended that everyone should take 500 mg of magnesium every day. I’m not going to go that far because there’s still too much we don’t know. The biggest issue is we don’t know where the subjects got their magnesium; this study was done in the United Kingdom and they tend to eat more plant-based foods than Americans.

I’ve written to the lead author of the study to see if they plan to publish another study breaking down the contribution from foods and from supplements—I’ll let you know what he says. For now, I’m going to recommend that we increase our consumption of the top five sources of magnesium from foods. Those are:

         1 ounce pumpkin seeds
         3 ounces spinach
         1 ounce almonds
         3 ounces avocado
         1 ounce dark chocolate

If you’re interested in more information on magnesium and its benefits, become an Insider and you can listen to a replay of the last Insider conference call. Remember: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

Reference: European Journal of Nutrition (2024) 63:1807–1818

How Magnesium Affects Your Brain

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If there’s one thing we can usually agree on, it’s that we want to retain as many of our important memories as we can along with the ability to learn new things. That’s why a couple of recent studies on the mineral magnesium caught my attention. Both were published in the past two years by the same research group, but the results of one inspired the second.

Researchers used data from the UK Biobank Study to examine the relationship between magnesium intake, blood pressure, and specific brain volumes. Just over 6,000 male and female subjects ages 40–73 completed the 16-month study. Brain volumes were assessed by MRI and included grey matter and white matter lesions. Dietary intake was assessed at least five times over the course of the study via the Oxford WebQ food frequency questionnaire.

The results demonstrated that high magnesium intake was associated with increased grey matter and lower volume of white matter lesions; there was no relationship between blood pressure and magnesium intake. What is also interesting was that brain volumes were stationary if magnesium intake remained stable, but if magnesium levels were low and rose, there was an increase in grey matter. It’s unclear if reducing magnesium intake would decrease grey matter.

The question is why? Prior research showed that low magnesium intake is related to increased blood pressure, but that wasn’t the case in this study. What caused the positive outcomes? We’ll look at the second study on Saturday.

The Insider conference call is tomorrow night. We’ll expand on the magnesium studies, including what supplement forms may be better than others. I’ll also be answering questions from Insiders. Become an Insider before 8 p.m. tomorrow night and you can join the discussion.

What are you prepared to do today?

        Dr. Chet

Reference: European Journal of Nutrition (2023) 62:2039–2051

I’m Alive V2.56

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When I woke up this morning, I knew I had another year to do what I do but with more urgency. If you want to know the story, read last year’s Memo to understand. Why more urgency? Simple: I’m not any younger and while I try to age with a vengeance, the clock keeps ticking and I’ve got a lot to do. Let’s get to it.

My foray into the primary or secondary cause of death stems from a variety of sources: my once-favorite statistician, a comic, self-proclaimed gurus, and many healthcare professionals who should know better. I’m going to try to set things straight with a few examples.

The Cold

Q. Someone has a really bad cold, but a light bulb has gone out and he must get on a ladder to change it. While up on top, he sneezes, falls off the ladder, hits his head, and dies. What is the cause of death?

A. Was it the cold? The light bulb? The ladder? None of those—he died from a fall. Without those first three factors, there would have been no fall, and he’d still be miserably dealing with cold symptoms.

The Car Accident

Q. Let’s say someone is a type 2 diabetic. She is obese, has high blood pressure, and has been diagnosed with cardiovascular disease. She has a car accident; she is severely injured, loses a lot of blood, and while on the way to the hospital, she has a myocardial infarction and dies in the ambulance. What is the cause of death?

A. The loss of blood due to injuries in the car accident. The CVD may be a contributing factor, but with no accident and no blood loss, she won’t die on that day.

The Respiratory Infection

Q. Let’s keep the same person for this scenario only in this case, she catches a respiratory viral infection like the flu or respiratory syncytial virus (RSV), which has been in the news lately. She gets severe symptoms including congestion that require hospitalization. She continues to get worse, has a heart attack, and dies. What is the cause of death?

A. The cause of death is the viral infection. The obesity, the hypertension, the diabetes, and the CVD could have been contributing factors, but again, no infection and she’s still alive. You may be surprised that 6,000–10,000 people per year with CVD die due to RSV this way each year.

More
The rantings of the people I mentioned earlier shouting, “They died of their lifestyle, not of an infection!” is simply wrong. The presence of the pre-existing conditions might kill them in the next 5, 10, or 30 years, but they’d been living with those conditions for some time, and there’s no reason to think they would have died on that particular day—no infection, no death at that time. It was the infection that caused their death.

The Bottom Line

We live in a world where social media and purported health gurus overshadow science, and sometimes, common sense. There are plenty of gray areas in the interpretation of health information. Yes, we should all do better to improve every facet of our health, but we should not change the interpretation of causes of death to fit a specific narrative. That can harm us all because it may raise doubt about preventive steps we can take. In the end, it’s your body and your choice. Choose wisely.

What are you prepared to do today?

        Dr. Chet

References:
1. https://doi.org/10.1111/imj.13377
2. Biomedicines 2023. 11:71

Finding the Cause of Death

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Last week, I left you with a question about a hypothetical situation: What if my grandmother’s bedsores had become infected to the degree that it spread throughout her body; she still had congestive heart failure but didn’t have pulmonary effusion at that time. What would be the primary cause of death?

With so many health experts and influencers that get a lot of attention in social media, causes of death appear to be misunderstood. Let’s cover it as simply as I can, based on the definitions from the CDC, WHO, and other agencies around the world.

  • The primary cause of death is the situation or condition that started the chain of events resulting in death.
  • The secondary cause(s) of death are any conditions that may have contributed to the death.

In the case of the hypothetical situation, the cause of death was the systemic infection from the bedsores. The congestive heart failure was a secondary cause of death. We can’t know for certain, but the infection probably took away the ability to fight back due to the weakened condition of the cardiovascular system.

I’ll give some examples of misinformation in Saturday’s Memo—which is May 10. Long time readers will understand the significance of that day.

What are you prepared to do today?

        Dr. Chet

Why My Grandmother Died

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You may be wondering why the TAP-IT study created that stop-in-my-tracks moment. In the mid-1980s, my grandmother Frances was 80 years old and was always my biggest fan. She had congestive heart failure, so doctors tried the needle procedure, which drained close to 20 lbs. of fluid from around her lungs; you can imagine the pressure that caused on her heart. But congestive heart failure is an unforgiving disease—at least it was back then. Without a real treatment other than thoracentesis, there’s no cure.

Months later, the pulmonary effusion happened again, but she refused treatment because the procedure had hurt too much the first time. She died a couple of weeks later. The study prompted my realization that a medication like a diuretic might have prevented a rather difficult death with multiple bedsores.

The fact that there was never a randomized controlled trial to compare the two approaches until 45 years later just absolutely astounds me. At least now there are treatment options for people with the same condition without the same type of complications.

Just to be clear: there was no coming back from advanced congestive heart failure as my grandmother had. Using either procedure would not have cured her—it would have eventually killed her anyway. But the difference was really in her quality of life. She may have lived longer and certainly less painfully using the diuretic, which as I said was available even back then. But there was no research to support it.

What Was the Cause of Death?

There appears to be a lot of misinformation today about cause of death. I’m going to use my grandmother as an example. I mentioned that she had severe pulmonary effusion due to the congestive heart failure. But she also had bedsores. If they had gone septic, resulting in a whole-body infection, what would have been the official cause of death? That’s what we’ll explore next week. Please share your thoughts.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

TAP-IT to Stop It

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Have you ever had a moment where you were reading something, listening to an audio, or watching a video where you just had a moment of realization and absolutely stopped in your tracks? The reason is that you got hit with a discovery of some fact that you didn’t know. More than that, you realized what it meant. That’s what happened to me while listening to a podcast from a cardiologist about pulmonary effusion and how to treat it.  Let’s start there.

Pulmonary effusion (PE) is the buildup of fluids in the connective tissue surrounding the lungs and the chest cavity.  If enough fluid builds, it’s going to push on the lungs and ultimately push on the heart and make it very hard to breathe. To restore function, the fluid has to be removed. This happens to people who have congestive heart failure.

The TAP-IT study, formally called Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial, was recently published in a leading heart journal. The researchers selected subjects who were 80+ years of age with less than a 25% ejection fraction. This population was chosen because they are the ones most likely to suffer from pleural effusion. They compared subjects who took diuretics to alleviate the fluid with subjects who got thoracentesis. The goal was to determine if there were any differences in outcomes as assessed by the number of days lived after beginning treatment.

The results? There were no differences in outcomes between the two groups. That’s amazing! Both reduced the pleural effusion, but there were differences in patient comfort and quality of life. As you might imagine, sticking a 2- to 5-inch needle through the rib space and into the pleural cavity to drain the fluid is going to be uncomfortable if not downright painful. There were also 20 out of 80 pneumothoraxes with the needle approach, while there were no complications noted in the group that took the medication.

The realization? This was the first randomized controlled trial that compared thoracentesis with diuretics, even though diuretics have been available for 75 years and thoracentesis for 175 years! Why did that matter to me? I’ll tell you on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161