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

How Isometrics Help Lower Your BP

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If you have a home blood pressure monitor, try a little experiment on yourself. Set up your monitor and cuff and sit quietly in a chair. After five minutes or so, take a deep breath, exhale, and hit the Start button on the monitor while breathing normally as your BP is taken. Record the results. Make sure the cuff deflates completely and continue sitting for another five minutes.

Then repeat the deep breath, exhale, and hit the Start button. This time, I want you to contract the muscle in the opposite arm as much as you can and hold the contraction until the BP is done, breathing normally the entire time. Do you notice a difference in the BP without and with contracting your opposite arm? Unless you lift heavy weights on a regular basis, you probably did.

When you contract the opposite arm, you’re restricting blood flow to that arm, thereby increasing the resistance. When you relax, there should be an increase in blood flow to that tissue. When you do isometric exercises regularly, that’s what happens in every muscle group involved.

How Isometrics Can Lower BP

Let’s return to the study. The researchers did a secondary analysis to see if they could find the exercise that lowered BP the most. The wall sit or wall chair worked best to lower systolic blood pressure, while running lowered diastolic blood pressure the most.

What’s the wall sit? It’s depicted in the photo above. The idea is to stand a foot or so from the wall, lean back until your back contacts the wall, and slide down to a sitting position for five to ten seconds, then slide back up. Repeat ten times several times per day; the key is to never hold your breath while you do it. The quadriceps and the gastrocnemius are a substantial amount of muscle. Restricting blood flow with isometrics will increase the resistance on the heart and blood vessels. The benefit is that you will get a training effect on both that lowers BP.

What’s actually going on with the nervous, cardiovascular, and muscular system isn’t quite clear, but knowing why won’t help you do them. If you don’t have orthopedic issues (and you don’t hold your breath while performing the isometrics), no matter what muscle groups you use, you may help lower your BP. I think the wall sit works the best due to total muscle mass involved, but every muscle group will help.

The Bottom Line

Will isometrics make you super fit? No. Super strong? No. There are also limitations as to the angles where strength will increase due to specificity of training. But there seems to be an emphasis on improving health with short episodes of exercise. Isometrics fit that niche quite well and as the study demonstrated, quite effectively as related to BP. We’re not done yet because two other studies have focused on activities that involve movement. We’ll talk about those next week. In the meantime, have a great Labor Day holiday.

What are you prepared to do today?

        Dr. Chet

Reference: British J Sp Med Online July 2023. doi: 10.1136/bjsports-2022-106503

Isometric Exercise Lowers Blood Pressure

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This summer has seen several studies about exercise, so we’ll just continue with the flow from last week. The first study caught me by surprise: isometric exercise lowers blood pressure. When you do isometric exercises, you increase tension in a muscle without moving the joint, such as holding your leg still while you clench your thigh muscles; if you’ve got a wall, a chair, and a floor, you’ve got all you need. We don’t think of isometric, also called static exercise, as being effective in changing the dynamic flow of blood in the cardiovascular system. Let’s take a look at the study.

Researchers conducted a literature search of all published studies that examined the impact of any type of exercise on systolic blood pressure (SBP) and diastolic blood pressure (DBP.) They conducted a pairwise and network meta-analysis to see which exercise helped BP the most. The most important finding was that every form of exercise significantly reduced SBP and DBP when performed for two weeks and longer: aerobic exercise, dynamic resistance (weight) training, combined training, high-intensity interval training (HIIT), and isometric exercise.

When they compared the efficacy of the different forms, isometric exercise lowered SBP the most, followed, in order, by combined training, weight training, aerobic training, and HIIT.

To me, isometrics are somewhat easy to perform because it removes obstacles such as orthopedic issues or equipment. But why would it reduce blood pressure more than other modes of exercise? We’ll check that out on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: British J Sp Med Online July 2023. doi: 10.1136/bjsports-2022-106503

The Key to Building Muscle

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The mega meta-analysis I talked about on Tuesday found that every combination of resistance, sets, reps, and number of days per week resulted in increased strength and increased muscle size compared to people who did nothing, but there were some combinations that provided the best results.

Finding the Best Approach to Building Muscle

Without question, lifting multiple sets with heavy weights improved strength the most. Even just one day per week showed an improvement in strength, but the most consistent results were found with at least two weight training sessions per week. What was surprising was that two sessions per week of multiple sets with light weights also saw a significant improvement in strength.

When it came to muscle hypertrophy, or more simply put, muscle size, lifting light weights for multiple sets twice per week saw the same improvement as lifting heavy weights multiple sets twice per week. That seems a little odd but may be supported by another recently published study.

In a pilot study with 22 subjects, half the group was put on a low-resistance, high-repetition weight training program while the other half was put on a more traditional heavy weight training program with fewer repetitions. The low-weight, high-repetition group performed sets of 20 to 24 repetitions, while the heavy-resistance group did the more traditional eight to 12 repetitions per set. The results showed similar benefits. There was an increase in muscle strength and muscle size in both approaches. Also the mean age of the subjects was 59 years. That eliminates the “younger people are stronger to begin with” factor.

Volitional Exertion
The pilot study reveals the key: in both approaches, the subjects were trained to push themselves to voluntary or what’s termed in the business as “volitional exertion.” It doesn’t mean barely able to lift the weight without assistance—it means that it would be a challenge to do one more repetition. It wasn’t the weight; it was the effort.

The Bottom Line

Since I talked about the 3/7 weight training program in the last Super Bowl webinar, I’ve favored that approach the most in my recommendations. It would be the low-resistance, high-repetition, two days per week approach. It seems better for beginners because even a two-pound resistance will produce results as long as they go to volitional exertion.

The author of the Washington Post article got it wrong when she said it would be easy to add muscle; it still requires consistency and effort. But it’s easier because it can be done in the comfort of your own home. Now, if we can just get everyone to do that—but that’s a challenge for another day.

What are you prepared to do today?

        Dr. Chet

References:
1. Br J Sports Med 2023;0:1–12. doi:10.1136/bjsports-2023-106807
2. Experimental Gerontology https://doi.org/10.1016/j.exger.2023.112219

Finding the Best Weight Training Program

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This year’s Super Bowl webinar on Aging with a Vengeance focused on muscle mass: hanging on to it or building it up if you’ve lost it, and how to make it happen. The fitness columnist for the Washington Post recently wrote an article on weight training that caught my attention, and I decided to take a closer look at the research behind her commentary about how easy weight training could be. There was one point that was glossed over. Let’s take a look at a recently published study that was the basis for her commentary.

Researchers decided to do what could best be described as a mega meta-analysis reviewing thousands of studies on weight training to see which type of program worked best to build strength and to increase muscle size. There were three main focal points: identify the best resistance (light, medium, or heavy weights), the best combination of sets and reps, and the number of days in a week necessary to accomplish the goals of size or strength. They found 192 studies that fit the profile for inclusion in the review. The results of their analysis were depicted in the graphs that are the graphic for this memo. Amazing.

The thickness of the lines indicates the number of studies that examined a specific type of weight training program; that gives us an indication of where the focus of research on weight training has been. In the results section, every combination of resistance, sets and reps, and days per week demonstrated some benefit. Then the researchers tried to tease out whether the use of light or heavy weight was better. I’ll talk about that on Saturday and also give you the key to determining the best weight training program.

What are you prepared to do today?

        Dr. Chet

Reference: Br J Sports Med 2023;0:1–12. doi:10.1136/bjsports-2023-106807