Let’s Clear the Air

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Among the nutrients that I use every day and recommend to everyone over 50 to delay muscle loss are essential amino acids (EAA), the amino acids that we can’t make ourselves. These are highest in the AAs that are used in muscle growth and repair: leucine, isoleucine, and valine. While the science shows that EAAs are beneficial, they can cause a serious issue: excess gas. As some of you have written to me about, it’s not just ordinary flatulence. Without being too rude, it’s the worst smelling gas one can imagine times 10.

I may have a solution—with the emphasis on may. In doing research for the new edition of Real-Life Detox, I found an article suggesting that the lack of stomach acid, called hypochlorhydria, may be the cause. Even though EAAs are in individual amino acids, they still must have enough stomach acid to chemically modify them for absorption. Fortunately, there appears to be a fix in the form of betaine hydrocholoride or betaine HCl for short.

I’ve used betaine HCl together with a digestive enzyme when I take my EAAs; I also take it when I’m going to eat meat in a meal. Even with a hiatal hernia, I haven’t had a problem with reflux since I’ve been doing it, and it reduced the gas production significantly.

I’ve got more research to do before I’m clear on amounts and timing, but for those of you who’ve had the gas issue with EAAs, help may be on the way. I know your inclination is to try something when it sounds helpful but, in this case, wait. There may be unintended consequences and as I said, this may be a solution—or it may not be. When I know more, so will you.

What are you prepared to do today?

        Dr. Chet

Reference: Integrative Medicine. 2020. 9(1):32-36.

Thank Yourself!

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Whatever your age, whatever your health status, whatever your attempts and misses this year, take a moment and thank yourself by doing something nice for you. A social media post I read made me think about the follow-on effects of caring for yourself.

This woman, a business owner and a mother always in perpetual motion, decided to get a manicure. She just wanted someone to pay attention to her for a little while—not feeling sorry for herself, but everyone else drains her battery. She wanted some time to recharge. So she got a manicure.

And then something unexpected happened: she started to take better care of herself, joined a gym, and exercises regularly. A path to a healthier life with plenty of energy to do all those things she was already doing? Why not try it?

What could you do that would mean the most to you? It may be 30 minutes to read or a new recipe to try. Maybe it’s buying a new tool, paying someone to rake your leaves, or trying a new hobby. The one commodity we can’t exchange or replace is time. Who knows—maybe some time for yourself will lead to better and healthier habits down the road.

Happy Thanksgiving from Paula, me, and the rest of us. We appreciate your support and are thankful for all of you who read what I write. I’ll be back in a week.

What are you prepared to do today?

        Dr. Chet

Bottoms Up!

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As we approach the holiday season, do we have to skip the fruit juice punch or the pumpkin spice lattes? How about eggnog? Let’s take a look at the study on the risks of various drinks, and determine the relevance and the practical risk of what you drink.

Does What You Drink Really Matter?

Here are some of the issues I found with the study.

The data used a food frequency questionnaire as well as additional surveys to collect all the data. I’ve talked enough about the problems with the food frequency questionnaire, and the INTERSTROKE Study didn’t use any better techniques.

In prior papers from the INTERSTROKE study, the researchers identified 10 risk factors that accounted for 90.7% of the Population Attributable Risk (PAR) worldwide for a first-time stroke. The PAR together with the percentage contribution of each factor is as follows:

  • Prior history of hypertension or blood pressure of 140/90 or higher: 47.9%
  • Lack of regular physical activity: 35.8%
  • Apolipoprotein (ApoB) to ApoA1 ratio: 26.8%
  • Diet assessed by the modified Alternative Healthy Eating Index: 23.2%
  • Waist-to-hip ratio: 18.6%
  • Psychosocial factors: 17.4%
  • Current smoking: 12.4%
  • Cardiac causes: 9.1%
  • Alcohol consumption: 5.8%
  • Diabetes mellitus: 3.9%

What a person drinks would be a small contributor to the diet assessment. It’s legitimate, but there are bigger issues in my opinion.

Finally, looking at the actual risk of stroke in the U.S. and Canada, it’s 0.9% if you’re 18–44 years old, it’s 3.8% at 45–64 yrs, and it’s 7.8% if you’re over 65. That’s the risk without modifying any risk factors in the PAR. What a person drinks would be a very small contributor to that risk. I think working on BP and exercise first makes a lot more sense.

The Bottom Line

Does what you drink matter? Unless you overconsume alcohol, probably not. Could you help yourself out? Yes. Drink seven or more cups of water per day—that’s just 60 ounces—and enjoy a cup or two of any type of tea per day; if you like iced tea, try Paula’s recipe on our website. And if all you’ve ever had is black tea, you need to branch out and try some more exotic varieties. Both water and tea lowered the odds ratio of a first stroke.

Other than that, try to strike a balance with what you drink. Spend more time getting your BP under control, and one of the ways to do that is to exercise. This is as good a time as any to begin. I know you can do it.

What are you prepared to do today?

        Dr. Chet

References:
1. International Journal of Stroke 2024, Vol. 19(9) 1053–1063.
2. Journal of Stroke 2024;26(3):391-402.
3. Lancet 2016 Aug 20;388(10046):761-75.
4. MMWR. May 23, 2024. 73(20);449–455.

What Am I Supposed to Drink?

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Why would someone ask that question? It was in response to a health news report on a couple of studies that suggested that if you drink too much fruit juice, any soda at all, or five or more cups of coffee, you’ll have an increased risk of a first stroke. Let’s take a look at the studies to see if we should change any of our drinking habits.

Based on the methodology, cases of first stroke were recruited from 142 centers in 32 countries between March 2007 and July 2015; at the same time, they recruited matched controls who did not have a stroke. They ended up with 13,462 subjects with stroke and 13,488 controls that did not have strokes. The mean age was close to 62 +/- 13 years. Besides biometric data including neural imaging, the researchers used a variety of surveys including food frequency questionnaires to determine all fluid intake.

After accounting for 15 potential factors that might skew the data, researchers calculated the odds ratios for water, soda, fruit juice, coffee, and tea intake. Teas of all types reduced the odds ratio for stroke, as did drinking seven or more cups of water per day. Any soda, fruit juice, or five or more cups of coffee per day raised the odds ratio, almost doubling the risk of a first stroke.

Should we be concerned? Let’s take a closer look at what this study really means on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. International Journal of Stroke 2024, Vol. 19(9) 1053–1063.
2. Journal of Stroke 2024;26(3):391-402.

BRI: It Just Doesn’t Matter

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Continuing our look at the BRI, the mathematician demonstrated that BRI is associated with body fat distribution. It makes sense; the waist measurement would provide an indication of fat around the waist. The next question is: would the BRI be a better predictor for cardiometabolic disorders than BMI?

BRI and Mortality

A group of researchers decided to use open-source data from the National Health and Nutrition Examination Survey database to examine the relationship between BRI and all-cause mortality. They coincided with the years that physical assessments were done including height and waist circumference; body weight was collected but not used in this instance. The time period began in 1999 and continued every two years through 2018.

There were two observations that were significant. First, in every demographic group, regardless of age, gender, or race/ethnicity, the BRI has increased during every examination period. As a country, the U.S. has gotten fatter. That matches every other measure such as body weight or BMI as well.

The second observation was that the hazard ratio (HR) increased as the BRI dropped below normal, then normalized when the normal BRI was reached, and the HR rose again as the BRI increased. Simply stated, there was an increased risk of mortality when people were too lean or too fat.

You may be wondering why I don’t give you a formula to do calculations for yourself. It’s very complicated and there are BRI calculators available on the website below. The main reason is that it just doesn’t matter—the BRI is no better at predicting mortality than the BMI. The researchers had the body weight data they needed to compare the BRI with the BMI directly. They just didn’t do it. However, looking at the mathematicians’ validation study, the categories of adiposity associated with BMI matches up quite well with the BRI and thus with body fatness. There’s no need for any more precision than is achieved with BMI.

The Bottom Line

It’s really the clinical use that seems to bother everyone, but with rare exceptions, the BMI gives an indication of body fatness. If physicians or other health care professionals cannot see the patient before them and realize they are too lean or too muscular to fit the typical interpretation of BMI, the fault lies with them, not the tool they are using.   

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408
4. https://bri-calculator.com/#calculator

Body Roundness Index

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The Body Mass Index (BMI) has been used to provide an indication of whether someone is under weight, normal weight, overweight, or obese and the degree to which they are obese. There’s no measure of percentage of body fatness implied, but physicians and other medical professionals have used it for that purpose for a couple of decades. Why? It can be used to assess the potential risk of developing cardiovascular disease, pre-diabetes, and other metabolic conditions.

I happened upon a commentary in JAMA on the Body Roundness Index or BRI for short. It was published in response to a recent study published in a JAMA Network Open by researchers who examined the relationship between BRI and mortality.

Let’s start with this: what is the BRI? The BRI was developed by a mathematician. The reason was interesting; the developer told the commentator that the BMI is based on a “cylindrical” model but when she looked in the mirror, she felt she was more egg shaped. What she did, as a mathematician, was develop a model based on an “ellipse.” Why? She gave a couple of reasons.

The first reason is that BMI can misclassify individuals because it fails to distinguish between individual amounts of fat-free mass (FFM) and fat mass (FM). BMI also does not provide information about the distribution of body fat—specifically, visceral fat versus subcutaneous fat. She developed a mathematical model, to assess body fatness which would indicate where the fat is distributed. With some very complicated math, she developed the BRI. It uses only two measurements: height and waist circumference. The benefit of using the BRI is that it may be a better predictor of body fat than the BMI. Is it? We’ll check out the research study that began this examination of BRI on Saturday, because as Shaq famously said about getting in shape, “Round is a shape.”

The Insider Conference Call is tomorrow night. If you become an Insider by 8 p.m., you can participate in the call to get your questions answered.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408

Expand Your Food World

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Paula and I watch a lot of cooking shows; most are competitions and the styles of cooking vary from diner food to high-end restaurants. The one thing that is prevalent is that you see a lot of foods and cooking techniques from other continents and cultures. This weekend, I’m going to challenge you to try different spices, different vegetables and fruits, and different techniques.

The spice blend that we’ve discovered is fish sauce. It seems like it would be used only in cooking seafood, but it gives a great umami (meat-like flavor) to every sauce, casserole, and soup. The only caution would be that it’s made from shrimp or other seafood marinated in salt for up to two years, so if someone is allergic to seafood, don’t use it. Also, try a little first because you can add more, but you can’t take it out.

A vegetable would be ube or purple yams. It’s one of the foods that is the staple of the Blue Zone areas in southeast Asia. It’s easier to find than it used to be, and you can use it like regular potatoes. One of the fruits Paula and I tried was prickly pear, but I don’t have the patience for it because it’s full of seeds. On top of that, the flavor is subtle so while it’s full of nutrients, it doesn’t have an intense flavor or texture.

One technique to try is to spatchcock a chicken or turkey, also called butterflying. The technique involves cutting out the neck and back with shears and pressing the bird flat; press hard enough to break the breastbone and the bird lies flat. It’s easier to get seasoning on the bird meat under the skin, cooking time is reduced, the skin will be crisp, and it will have the moistest breast meat you’ve ever eaten. Just be sure to check the temperature in the breast to make sure it reaches 160° and it should get to 165° or higher while it rests.

Food is one of life’s great pleasures as well as the source of nutrients we all need. It’s a shame to be bored with food, so I’m challenging you to shake it up a little. The objective this weekend is to eat a food, use a spice or blend, or technique you’ve never tried before. Then let me know how it went.

No time to cook? Try a food from another region of the world you haven’t eaten before—West African, Caribbean, and South Asian all have intriguing spices and flavors that may be unfamiliar. They may be a miss, but if you find something you like, you’ve completed the challenge: expanding your food world, even if it’s only a new dessert.

What are you prepared to do today?

        Dr. Chet

A Little Help from My Friends

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Do you realize that it’s been six months since I introduced a new product? Have I had ideas? Yes—in fact, so many of them, I get stymied at where to begin. Because you are my readers, and therefore potential customers, what would you like from me?

Let me help you get started. I want to do a second edition of the Real-Life Detox book. There are some topics I want to remove and have ideas how to replace them. What would you like to see? Intermittent fasting for detoxing? More recipes? How to detox every week? Would you like it digital only or would some of you like a hard copy?

How about aging with a vengeance? Would you like to see more related information related to that topic? And believe me, there’s a lot more.

How about a revisit to conditions like bone health, digestive health, and on and on?

How about format? Written? More audio? Video? Live presentations? How about beginning the traveling seminar tour I was beginning when covid hit?

Take some time, get your favorite beverage, and tell me what you’d like to read, see, or hear. Then let me know.

What are you prepared to do today?

        Dr. Chet

The Point of Youth Sports

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Malcolm Gladwell, the author of The Tipping Point among many others, published Revenge of the Tipping Point, a look back at what he got right and what may not have turned out to be correct. As I was listening to a new podcast interview, he made a comment on youth sports that stuck with me:

Travel to a game should never take longer than the game itself.

Sport should be fun, not work. Playing on a travel team may seem exciting, but it’s a huge commitment by the entire family, both in time and money. Gladwell’s point was that the quest may not be worth the return. It doesn’t mean that there’s no benefit, but in context, playing to enhance an application for college seven years away is a long shot.

Riley runs like the wind and he can dribble both a soccer and basketball well. But unless he develops a keen interest in the games, playing local makes the most sense. The reason? He’s having fun, staying active, and making friends. I want to see athletics remain a life-long activity rather than watch him burn out chasing the spotlight. To that extent, I agree with Malcolm. If you have a little Tiger Woods or Serena Williams at home, you may decide differently, but the reason you know their names is that their level of talent is extremely rare. Most kids just want to have fun with their friends, and that may be the best lesson they can learn about sports.

What are you prepared to do today?

        Dr. Chet

P.S. If you have a young athlete at home, make sure you’re feeding them the right stuff at the right times; get Dr. Chet on Youth Sports in either MP3 or CD.

Should I Use Folate or Folic Acid?

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In the past few years, there has been a trend toward using folate, the natural form of vitamin B9, versus using folic acid, the synthetic form. Many times I’ve answered the question “Which form is better? I’ve heard…” I said on Tuesday that the study on folic acid, blood lead levels, and autism had a lesson. That lesson is this:

Folic acid from enriched foods or supplements is equivalent to folate from foods or supplements.

The body efficiently converts folic acid to folate, and from that point, there’s no difference in the benefits to the mothers or their babies. Even in women who have the MTHFR mutations, folic acid is still beneficial.

This won’t close the door on people who insist that folate is the better choice, but we know their assertions aren’t based on research. Every study on the impact of folate/folic acid on pregnant women and their offspring used folic acid. That’s the form that was put into grain-based foods beginning in 1998 with the objective of reducing birth defects; the reduction in birth defects has been estimated at 70%. Further research has demonstrated benefits to the children of mothers who supplemented with folic acid, such as reductions in allergies, asthma, and ADHD.

The Bottom Line

The results from the study on the benefits to the offspring of women who may have been unintentionally exposed to lead is that folic acid intake is directly related to prevention of harms to their babies. It also illustrated that megadosing is not required. The lesson is that folic acid, whether added to grain products or in supplements, is an effective form of B9 to accomplish that goal.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479