The Weight-Gain Pill

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I’m a self-proclaimed channel flipper—I always want to see what else is on when I have the remote. That’s why I did a double take when I saw the beginning of a commercial for weight gain. It wasn’t the typical approach, such as the product contains some formulation of branched chain amino acid, creatine, and other herbs that are supposedly associated with gaining muscle faster. Not this time.

The featured testimonial was a woman who was always “skinny” her entire life. The “before” picture was a very thin woman. Then she begins using this product with an herbal blend and some vitamins in it. She managed to gain 53 pounds! But it went with the product’s Facebook tag line: Curves are in—and we can help!

What was in this magnificent supplement? Vitamin D and zinc and the herbal blend. I’ll give you just one ingredient to give you a clue: dodeca-2E,4E,8Z,10Z-tetraenoic acid isobutylamide. I’ll tell you what I found in the research as well as describe a legitimate weight-gain program for those who might need it in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Why Are You Napping?

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I think people get frustrated with research because, just like I’ve described this week, one study says one thing while another comes to different conclusions. I hope that if you’ve been reading the Memo long enough you won’t be frustrated. In this case, why might studies that seem similar on the surface come up with different results?

First, while the studies seemed to ask the same questions, the studies actually had different objectives. In the Swedish study that showed a reduction in cardiovascular disease (CVD) events for those napping once or twice a week, the subjects were selected because they had not had any cardiac events or diagnosis of CVD. That means that any CVD that took place in the follow-up period was a primary event. In the other two studies, high-risk CVD events were excluded in one but other CVD factors were allowed such as hypertension.

Second, the purpose of the Swedish was designed to look at the development of CVD. The other two studies from Switzerland and the U.K. recruited over 500,000 subjects, but the research questions appeared to be decided after the studies began. There’s nothing wrong with that, but just because you have collected data on many variables, including genetics, doesn’t mean the data collected answer the research questions that were asked.

For example, the premise was that daytime napping causes CVD and hypertension. It seems likely that those conditions could cause fatigue, which would require daytime napping. Even if that were not the case, the subjects appeared to already have problems sleeping, which would impact hormone levels that contribute to CVD such as cortisol levels and many others.

The Bottom Line

These large studies attempted to make sense out of prior research that showed a link between daytime napping and CVD. What I think these studies demonstrate is that the cause of the nap is important. If it’s a planned nap designed to allow digestion or a pause in a long work day, it may not be hazardous to your heart health. However, if a person doesn’t sleep well or has sleep apnea and is fatigued because of that, being forced to nap during the day to recover can indicate a higher risk of developing CVD and hypertension.

Diet, body mass, lack of exercise, and other factors all have a role to play in sleep quality and CVD as well. If you plan your nap, you’re in control. If you’re forced to nap, time to look at your lifestyle and see what you can change.

What are you prepared to do today?

        Dr. Chet

P.S. Just for fun, these are a few of Riley’s more inventive napping positions. Oh, to be that flexible! Maybe the monkey blanket helps.

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

To Nap or Not to Nap

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About 16 years ago, Paula and I spent several weeks (spread out from March to October) helping our son Matthew build his boat-building shop. The daily routine went something like this: start early, break for lunch, take a 30- to 45-minute nap, then work the rest of the day. Matthew and Kerri live near Charleston, SC, where summer temperatures aren’t really conducive to construction work, so napping during the hottest part of the day made a lot of sense, but we also found we got a lot more accomplished every day.

I’ve used that approach off and on ever since. Recently, a couple studies were published that called into question whether naps were a good idea as they might be related to cardiovascular disease (CVD).

The research news caught my attention because the last time I read a research paper about sleep and napping showed that there was no relationship between napping and cardiovascular disease. In fact, the risk over five years of follow-up was a 42% decrease in CVD events when a person took a nap once or twice a week and no risk if a person napped every day (1).

In the most recent research, there was a relationship between napping and hypertension and napping and CVD in two separate studies with thousands of subjects (2, 3). Why? We’ll delve into why there were different results on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Heart. 2019;105:1793–1798.
2. J Am Heart Assoc. 2022;11:e025969. DOI: 10.1161/JAHA.122.025969.
3. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.122.19120.

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Will the Polypill Reduce Second Heart Attacks?

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One of the issues with prevention is having people stick to a plan, even after an event as serious as a heart attack. Lifestyle changes are challenging to stick with, but so is something as simple as taking medications. Remember, this isn’t to prevent a heart attack; it’s to prevent a second one. That’s serious.

The concept of a polypill has been around for close to 15 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. For a long time, that idea never went anywhere, but recently researchers decided to resurrect the concept. This time, the objective was to monitor subjects with recent heart attacks. Would there be a difference in the rate of secondary events between subjects who took the polypill and those who took the same medications as individual pills? The medications used were aspirin, ace-inhibitor, and a statin. After three years of follow-up, the subjects in the polypill experienced significantly fewer secondary events, 9.5% versus 12.7%.

Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually? I’ll tell you the secret to disease prevention on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

What Is Secondary Prevention?

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Secondary prevention encompasses a wide range of health-related conditions. It includes people with risk factors such as high cholesterol and blood pressure, cigarette smoking, elevated HbA1c, atrial fibrillation, and more. It also includes people who may have had a heart attack, stroke, cancer, or were treated and now are trying to prevent a recurrence of another incident. This all falls under the umbrella of secondary prevention.

The problem, as I see it, is that we don’t take the risk factors seriously enough to prevent the occurrence of serious health events. For example, let’s say a person gets a reading of 5.9% in an HbA1c reading. That’s considered pre-diabetic and is definitely on the path to type 2 diabetes. The solution is pretty straightforward: reduce refined carbohydrate intake and total caloric intake if the person has weight to lose. Then start an exercise program and stick to it.

Did you know that within three days of beginning a walking or exercise bike program, your body will begin to utilize insulin better? That’s how quickly your body reduces insulin resistance and starts the path back to a lower HbA1c and thus reducing the risk of type 2 diabetes.

Aging with a vengeance is all about prevention—primary prevention to prevent serious diseases and conditions from occurring in the first place and secondary prevention to deal with them if they do occur. Aging is a risk factor in and of itself but not because of a calendar; it’s the changes that naturally occur as we age. What we do to resist or delay those changes is at least partly in our hands. That’s why I said aging with a vengeance begins in your 30s and maybe even younger.

It all begins with six simple words: Eat less. Eat better. Move more. I’ll continue to comb the research to find strategies to deal with other issues. Next week, I’ll review a research study that reveals the secret to getting results.

What are you prepared to do today?

        Dr. Chet

What Is Primary Prevention?

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The key to aging with a vengeance is prevention. One of the obvious goals is to prevent problems such as stroke or heart attack in healthy people and in people who have risk factors for disease. Today’s Memo will deal with primary prevention.

Primary prevention focuses on helping apparently healthy people prevent the onset of disease. Eating a healthy diet that focuses on plant-based sources of food would be an obvious preventive measure; so would a regular exercise program. Supplementation to fill in any gaps in the diet would also fit here.

But there are more steps that we don’t typically consider. Yearly physicals are important as we pass 30; I cringe every time people in their 60s say they’ve never had a physical. Something as simple as examining the skin for misshapen moles or measuring blood pressure regularly can be critical, because early treatment can prevent a disease such as skin cancer or hypertension that can cause life-threatening issues. Then add keeping your vaccinations up to date and flossing your teeth daily, and you’ve got a great start on primary prevention. I’ll elaborate in a new Straight Talk on Health available to Members and Insiders on Saturday. Then in Saturday’s Memo, I’ll talk about secondary prevention.

Tomorrow night at 9 ET is the Insiders Conference Call. The focus is on answering Insiders’ questions. I’m also going to address some of the latest research on artificial sweeteners to see whether they’re hazardous to our health or not. Become an Insider by 8 p.m. tomorrow and you can take part in the call.

What are you prepared to do today?

        Dr. Chet

The Spice of Progress

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Last week was about consistency, and this week is about variety, the spice of progress. I recently ran into an orthopedist I know whose first words to me were, “What’s wrong with your ankle?” followed by, “How come you’re not walking properly? You’re not toeing off.” He did an assessment later that day.

The ankle was the result of not walking heel to toe. The walking issue was more complicated. He tested my hip strength a couple of different ways, and I failed miserably. Lying on my side, I couldn’t raise my leg against any type of resistance.

He showed me the exercises to use to gain back that strength, and I’m embarrassed to admit they’re some I stopped doing once I got back the range of motion in my knee. I’ve been focused on getting back my quad and hamstring strength. While that’s fine, I ignored the postural and stabilizing muscles of the lower back and especially the hip. I immediately added those back into my routine. The result was increased soreness as you would expect when you’ve started training again. The change in my normal walking gait was immediate, and I adapted within a week.

Then I got a call from an ex-student.

A Variety of Squats

This was not just any ex-student: Paul still holds the World Powerlifting Organization Record for the Squat at over 1,100 pounds. He mentioned in passing that not everyone is the same when it comes to training. To train more of his gluteal muscles, he squats with his legs four feet apart instead of the typical shoulders-width apart. I’ve tried that kind of squat, and it does activate more of the gluteal muscles.

In addition to foot position, there are squats holding a weight on your shoulders, in front on your chest, with a kettle bell held between your legs, or with a dumbbell in front of you. You can also sit down, almost, and stand back up.

What’s my point? There are two, actually. You can increase the strength of a joint by adding a variety of exercises that stress the joint at different angles. Second, it helps to have an exercise professional guide you through the process so that you’re doing them properly. It’s worth the price of a 30-minute session to add variety. In eating, that would include the cost of taking a healthy cooking class.

The Bottom Line

No matter your age, being consistent is essential to building a foundation. To take your health and fitness to a higher level, consider spicing up your workouts—not necessarily more strenuous exercises, because something low stress such as walking or yoga can make a difference. It takes time and the rewards may not result in documentaries filmed about you, but you have no idea your capacity until you try.

Paula and I are going to take off Labor Day week, so I’ll see you after that.

What are you prepared to do today?

        Dr. Chet

What We Can Learn From “NYC Point Gods”

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We’re watching a little more basketball these days because it’s Riley’s favorite sport. That’s how I discovered a documentary about the glory years of point guards in the 1980s and ’90s in New York City. It may still be a thing, but back then it was special.

One part of the documentary focused on one thing: The Handle. That’s the ability to dribble and create magic with a basketball, and magic it was. But for me that wasn’t the real point. The results were outstanding, but the price was the time it took to get the Handle: years. Dribbling with one hand while bringing home a bag of groceries in the other. As one guard said, some eggs were broken. Dribbling before dawn down the middle of the street. Given the conditions in NYC at the time, it was probably the only smooth surface and was well lit.

What does that have to do with health? Just this—what are you investing in your body to make it better? Are you going to prehab before joint surgery and really working at it? Are you putting in more effort to get back the range of motion after joint surgery?

What about eating better? What have you done to improve your meals? Those herbs we take as supplements can be effective when used in cooking as well.

If you want specific results, you have to invest the time and effort. Everyone can be average, and that’s fine because it helps our health and quality of life. But as we all age with a vengeance, who wants to be average? Average aging means impaired in some way the older we get. What if it could be better? More on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.sho.com/titles/3506971/nyc-point-gods

What Not to Do When You Want to Lose Weight

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How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.