How Exercise Improves Sleep

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To become the best version of yourself, it takes more than just eating better and moving more. One factor that gets overlooked is sleep.

Sleep patterns change over a lifetime; in addition, isolation during the COVID pandemic can also impact sleep patterns. Moderate to strenuous exercise has long been known to have a positive impact on sleep, but what about people who can’t exercise at a high level? Using a technology called actigraphy, researchers in Hong Kong attempted to find out whether mild exercise can help people with insomnia.

Actigraphy is a noninvasive technique that measures physical activity levels of a subject by means of a wristwatch-like motion-sensing device that can be worn for prolonged periods of time. Researchers recruited 320 participants with a mean age of 67 with most subjects being female. There were 110 in the control group, 105 subjects in the conventional exercise group, and 105 subjects in the tai chi group. Subjects in both exercise groups exercised for one hour, three days per week. The conventional exercise was a combination of brisk walking and weight training for 12 weeks, while the tai chi group attended a 12-week Yang-style, 24-form tai chi training program.

When compared to controls, both the exercise and tai chi groups showed improved sleep efficiency, reductions of wake time after falling asleep, and reduced number of awakenings. The actigraphy and sleep diary reports were consistent; there were no differences between exercise groups in benefits.

There’s good reason to believe that if mild to moderate exercise works for people with insomnia, it will work for anyone who wants more and better sleep. Seems like a good deal to me: invest three hours a week to help your entire body and get better sleep as a plus.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021;4(2):e2037199.

Vitamin C, Zinc, and COVID-19: Ask the Right Questions

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As we left off Tuesday’s memo, I suggested that both the researchers in the study that was halted as well as the physicians who used dietary supplements as part of their treatment were wrong in their conclusions. At this point we don’t know for certain whether vitamin C and/or zinc can help with COVID-19.

Let’s define which questions we’re asking. Are we trying to prevent people from catching COVID-19? Are we trying to help them recover from a COVID-19 infection? Are we trying to prevent hospitalization? Are we trying to prevent death? Those are all different questions.

The Videos

Let’s stick with helping people recover once they’ve been infected with COVID-19. At this point, we don’t have solid data as to how long the patients were infected before they sought treatment, how many days it took them to fully recover, or if they recovered without any further treatment of any type. We also get no data on the people who needed further treatment in the hospital.

It’s not reasonable to suggest that every patient seen in these physicians’ videos all recover and no one ever gets worse, but that’s never discussed.

The Research

As for the researchers, they didn’t ask two very valuable questions: what were the subjects’ vitamin C and zinc levels before the treatment began? Without that measure, they couldn’t know whether they needed supplements; maybe their levels were as high as needed, and they didn’t need any more.

Second, how did they administer the vitamin C? If they were familiar with the research, they’d know vitamin C is more effective when given intravenously. The subjects could have been given vitamin C on an outpatient basis to begin, and then used supplements for the rest.

The Bottom Line

Neither group really provides us with much information about vitamin C and zinc to help people recover from COVID-19. When it comes to the use of dietary supplements and COVID-19, there’s a difference between preventing a person from catching the infection at all, reducing the number of days that they’re infected with the virus, and reducing the risk of having the infection progressing to hospitalization and potentially death.

Where does that leave us? Now more than ever, we should support our immune system. Vitamins D, C, and the mineral zinc can help us do that, and at the first hint of illness I’d recommend the Immune Boost supplements. I’d also like to recommend getting tested for C and zinc as we do for D, but it’s not practical at present.

Most multivitamin-multiminerals can provide a baseline to get you started. Don’t forget food has nutrients as well, so a healthy diet may help you stay COVID free.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021; doi:10.1001/jamanetworkopen.2021.0369

Vitamin C, Zinc, and COVID-19

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Last week, a study was published in JAMA Online that did a randomized controlled trial using vitamin C and zinc to treat people diagnosed with COVID-19. Several longtime readers asked me to review videos posted by physicians and other healthcare professionals who’ve used vitamin C and zinc to treat COVID-19 infections. I did and I’ll comment on Saturday, but let’s look at the science.

Researchers from a well-respected healthcare organization, the Cleveland Clinic, requested volunteers from multiple locations in Ohio and Florida for a study. The purpose was to see if vitamin C (8000 mg), or zinc (50 mg), or vitamin C plus zinc would reduce symptoms associated with diagnosed COVID-19 when compared to a group taking no dietary supplements. The objective was to see if symptoms in the groups taking the supplements could be reduced by 50% within five days or less when compared with controls. They used symptom scales such as fever, cough, and shortness of breath, among others.

The researchers stopped the study early due to futility: there were no differences in any of the experimental groups compared to the controls after reaching 40% of the subjects they intended to recruit. Frontline physicians say supplements work against COVID; this research trial says they don’t. Who’s correct? I think they’re both wrong, and I’ll tell you why on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021; doi:10.1001/jamanetworkopen.2021.0369

Less Can Be More If…

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Let’s dig into the results of the National Health Interview Survey analysis to see if less really can be more: does mortality decrease even with fewer than 30 minutes per day most days of the week as long as part of the workouts was vigorous? We’re not examining other potential health benefits of exercise such as the risk of type 2 diabetes, weight loss, or gaining strength—just risk of death.

I examined the Hazard Ratios for the number of minutes spent in vigorous physical exercise per week and the total minutes of exercise per week. For those who exercised 1 to 149 minutes per week (less than the national recommendations), if 1 to 74 minutes of the total were spent in vigorous exercise, there was a 29% decrease in all-cause mortality. For CVD, there was a 20% decrease in mortality and a 24% decrease in mortality from cancer. There were additional benefits when a greater number of minutes were spent in vigorous activity, especially from CVD. Clearly, less can be more.

But…

A person must be fit enough to be able to do vigorous exercise. The survey defined vigorous exercise as hard enough to raise the heartrate and breathing rate and to increase sweating. The older you are, the less you may be able to sustain that type of effort, whether due to a lack of fitness or pre-existing CVD or orthopedic issues; the same holds true for someone who is overweight or obese. If you’re in any of those categories, you must get your physician’s approval before doing intense exercise.

You don’t have to wait, though; work up to it over a period of months with the guidance of a professional exercise specialist. Just as with any goal, you approach it in a stepwise manner. If you can walk for exercise, it may be something as simple as walking fast for 15 seconds every 3 minutes. Progress from there, increasing the fast walking by 15 seconds every week or every few days. If your body isn’t ready yet, it will let you know.

If you can get 20 to 30 minutes most days with over half of those minutes being vigorous, you may reap the benefit of lower risk of death, according to the data. Just proceed with caution and remember, this doesn’t include time working on strength, endurance, or flexibility.

What are you prepared to do today?

        Dr. Chet

References: JAMA Int Med. doi:10.1001/jamainternmed.2020.6331

Is Intense Exercise Better?

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The national recommendation for exercise is 30 to 60 minutes most days of the week. That works out to 150 to 300 minutes per week or 2.5 to 5 hours. At one point or another, I think many people have asked “What’s the least amount of exercise that I can do and still get benefits?” It’s not a simple question because it depends on the benefits you want to get. Top of the list is probably decreasing the risk of dying. It’s time to consider that question as we try to become the best version of ourselves. A recently published study may help.

Researchers analyzed the survey results from over 400,000 subjects in the National Health Interview Survey. This survey is given every year to 35,000 randomly-selected people in the U.S. Researchers focused on questions related to physical activity. They wanted to know whether people exercised, how long they exercised, and how intense the exercise was. They also asked how much time was spent in vigorous exercise within the total time people exercised.

I could have predicted the results: as the percentage of time spent in vigorous exercise increased, all-cause mortality and mortality from CVD and cancer decreased. This held true for all age groups as well as for all BMI groups. Even if you’re obese, you can still reduce your risk if part of your workout is dedicated to vigorous exercise. The question remains: how intense and how long do you have to exercise to get the life-saving benefits? I’ll finish this on Saturday.

The Insider Conference Call is tomorrow night. I’ll go into more details on this study as well as review a video making the rounds about the safety of the COVID vaccinations. If you’re not an Insider, this may be the right time to join.

What are you prepared to do today?

        Dr. Chet

References: JAMA Int Med. doi:10.1001/jamainternmed.2020.6331

Why I Hate Cilantro

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The All of Us genetic testing results I told you about Tuesday included four more genes; by examining the results, these genes explain a lot about my personal tastes. These are not world-changing genetic analyses such as risk for cardiovascular disease or celiac disease, but they’re nevertheless interesting. Here’s what else I found out about myself from the results.

Bitter

Remember, there are five tastes: bitter, salty, sour, sweet, and umami. Evidently not everyone tastes foods the same way; I didn’t know that there are at least 25 different types of bitter receptors. I have a gene that allows me to taste flavors that are considered bitter. There are at least 550 foods identified as bitter; some I naturally like such as coffee. We can adapt to tastes regardless of our genes, so you may develop an appreciation of bitter foods if you don’t like them now.

Earwax

I have a normal gene that allows me to produce wet earwax as opposed to dry, flaky earwax. In the analysis I received, there’s a long explanation about earwax and what it does. One function of earwax is to keep the ear drum dry when water enters the ear canal; it made me wonder if that’s why some people are more prone to “swimmer’s ear” than others.

Lactose Intolerance

There’s a gene that, depending on its location on your DNA, will allow you to produce more lactase, the enzyme that breaks down the milk sugar lactose. If the gene is in a different position, you may lose your ability to produce enough lactase, and thus you become lactose intolerant. Mine is evidently in a good position because I digest dairy products just fine.

Cilantro

I have the “I hate cilantro” gene. Actually, that’s an overstatement. If you have the gene mutation, you have a slight chance of disliking it, somewhere between 3% and 21%. To me (and Paula), it strongly tastes like soap instead of the refreshing citrus flavor most people experience.

Those were the genetic results I’ve gotten so far—nothing earth shattering but interesting nonetheless. It explains a lot, including that in spite of your genes, you can overcome some of your genetic tendencies and learn to love cilantro.

Consider joining the All of Us Research Program. You’ll be contributing a lot and you just might learn some interesting things about your genes as well. Check it out at https://www.joinallofus.org//#.

What are you prepared to do today?

        Dr. Chet

All of Us: Genetic Results

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Almost two years ago, I wrote about the All of Us Research Program. Their goal was to get 1,000,000 partners who would be subjects in the largest study ever done within the U.S. I decided to participate fully and that means answering questionnaires as well as giving blood samples and other basic health information. I’ve gotten some results but this past week, I finally got some of the analysis of my DNA and genetics.

Paula likes to call me a pure-bred: all of my ancestors were Polish (with the exception of one maternal great-grandfather), while her ancestors came from all over Europe. While I was curious what the ancestry portion of the DNA test would reveal, there wasn’t much doubt. The All of Us program goes through great pains to explain why some people might want to know their ancestry while others might not. I would describe it as fairly rigorous just to make sure that you really, really wanted to know the outcome.

My DNA confirmed that there was a 79% chance that I was from Eastern Europe, specifically Poland or the Ukraine. The rest of the probability was northern or western European. No great surprises there. They also tested for four other genes, and I’ll talk about those on Saturday.

They’re still looking for participants. I would urge you to go to https://allofus.nih.gov/ and be part of something greater than yourself. You might also find out why you love cilantro or think it tastes like soap.

Super Bowl Webinar Replay

If you missed out on the webinar, you can still watch it in its entirety by purchasing the replay. It was the kick-off event for longer term focus on helping you become the best version of yourself. Aging with a Vengeance is just the beginning; you’ll see more as the year goes on.

What are you prepared to do today?

        Dr. Chet

Fighting the Mutants Among Us

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Unless you’ve been avoiding all information about COVID-19, you know that there are now variants or mutations of the original virus. The first mutation was identified in the United Kingdom; soon after, another was identified in South Africa, and finally, another in Brazil. Will there be more? Undoubtedly. Is it a big deal? Maybe.

If a variant doesn’t respond to current treatments or one of the current vaccines, that’s a problem. If we’ve had the virus and it doesn’t respond to the antibodies we’ve developed, we have to start over again. We don’t know if those problems will show up; at this point, we just don’t have enough data.

But there’s one thing that we can do. We can try to avoid catching the COVID-19 virus in the first place, no matter which variant we get. While we may get a mild form of the original or variant viruses, the longer the virus stays in our body, the more it replicates. And every time it replicates, it gets a chance to try something new: to mutate. With an increase in replication comes an increase in the odds of another successful mutation. The virus can learn how our bodies attack it and, simply by wildly reproducing itself, increase the odds a variant will survive. We spew the variant virus without knowing it, and voila, another mutant gets a chance to spread.

We are each part of the first line of defense: if we deny the virus a host, we remove its chance to replicate and mutate.

You personally could be the one person who stops the next deadlier mutation by not giving it a place to do its dirty work. That’s why we need to deny the virus a chance to get inside our noses and mouths; even if you’ve been fully vaccinated, do everything you can to keep the virus out of your body. Double up on masks, social distance, wash your hands—you know the drill. Apply the Swiss Cheese COVID Protection approach. In this case, we’re trying not to catch it, not to give it a chance to replicate and mutate, and not to spread it.

Be a hero: don’t give the virus a chance to invade and mutate.

The Bottom Line

I know if we had our druthers, we wouldn’t bother with masks and so on, but the overwhelming feeling I get is that we just want this to be over. Let’s all work to that end by doing what we have to do to stop the virus in its tracks.

The title of tomorrow’s Super Bowl Webinar is Aging with a Vengeance. Dealing with viruses and other health challenges is a part of that.

What are you prepared to do today?

        Dr. Chet

Double-Up for Safety

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This is Super Bowl week so let’s lead with a football analogy in the fight against the COVID-19 virus. “The best offense is a great defense” has been used as a way to deal with teams who have a great offense: if you stop them from keeping the ball, they can’t do much scoring. That appears to be a good strategy used to keep from getting COVID-19, especially as new strains appear.

The CDC does not recommend wearing two masks because there’s no science to support it, and I haven’t found a single study on double-masking. But it does make sense from this perspective: if wearing one mask is 50% effective, which it appears to be, wearing two may increase it to 75% effective. Remember the Swiss Cheese COVID Protection approach to reducing infection? No single approach works perfectly but put all of them together, and they can significantly reduce the risk of catching the virus.

I’ll take it one step further. Wear two masks when you’re going to be in one place for a long time. I double-mask when I work out: a cloth mask over a surgical mask. With restaurants opening in more states, it’s probably a good idea there as well. With shopping, if you’re standing talking with someone, yes. If you’re picking up and buying something like restaurant takeout, maybe yes and maybe no because you still may have to wait in line. Remember: respect, not fear.

Super Bowl Webinar

My 11th Annual Super Bowl Webinar is Sunday at 3 p.m. ET; Aging with a Vengeance is the theme. I’m going to provide attendees strategies on four aspects of aging and specific ideas on how to address each issue, all in about an hour. Join me Sunday afternoon, but if you can’t, I’ll have a replay available for viewing later. Sign up today. Members and Insiders: remember to sign in to drchet.com first to get your discount.

What are you prepared to do today?

        Dr. Chet

How to Be Stone Free

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I do my best to avoid social media. Occasionally, I make a comment and it confirms I was correct to have hands off in the first place. There was a discussion on the benefits of a lifestyle-only approach to health, completely avoiding conventional medicine. I remarked that some things, such as the bladder stones I just had removed, couldn’t be fixed with lifestyle alone and that it was good to have medical options available. That led to being lectured on how diet could fix anything. Hmmm. I, too, have Google. And I also have a PhD in health education and nutrition, but okay and buh-bye. I can’t deal with that level of ignorance.

After my urologist told me he had removed stones over an inch in diameter, my little stone didn’t seem so bad. I asked him, “What was the treatment before catheters and surgery were invented?” What happened was that people died. They couldn’t urinate, developed infections when they couldn’t eliminate their urine, and died.

Every time you think things were better back then, before conventional medicine was developed, think again. That doesn’t mean our healthcare system couldn’t be better, but it sure beats death.

Preventing Stones

There are several steps we can take to reduce the risk of forming any type of stone.

  • Drink plenty of fluids. Aim for one-half your body weight in ounces of fluids per day. Every fluid counts, even caffeinated drinks such as coffee and tea, plus the ice that melts in your iced tea or soft drink.
  • Reduce your sodium intake. That’s one of my specific issues because I love salty foods. Sodium can help cause stones from calcium, so lowering your intake is important.
  • Reduce protein intake from animal sources. Excess protein contributes to an increase in acidity, which can also help create an environment that makes stones.
  • Increase vegetable and fruit intake. They contribute to making the body more alkaline, which reduces stone formation.
  • Increase your citric acid intake. The easiest way to do that is to drink lemonade, limeade, and eat more citrus fruits. Just remember to pay attention to the sugar in the lemonade.

The Bottom Line

The biggest risk factor for getting a stone is having had a stone. To reduce the risk, we have to change our lifestyle. We don’t have to be perfect; we just have to be better than we are today. If you’ve experienced the pain and discomfort of any type of stone, these changes are a whole lot easier to live with in my opinion.

And for the record, diet can’t fix everything. It can help, so do all you can, but if you need medical care, the smart move is to call your doctor’s office.

What are you prepared to do today?

        Dr. Chet