Omega-3s and Cardiac Events

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There was another study this week on omega-3 fatty acids. While the study I talked about last Thursday was small with only 21 subjects, this trial contained over 13,000 subjects from 675 hospitals and clinical centers all around the world. In this five-year study, one of the omega-3 fish oil medications was being tested to see if it would reduce cardiac events such as heart attacks, stroke, and death when compared with subjects taking a corn-oil placebo. The study was stopped early when it was clear there were going to be no significant differences in any of the outcomes that were being studied. In other words, the prescription fish oil did not reduce cardiovascular disease events.

While that may seem disappointing, there are some factors that most likely impacted the outcome and a couple that may have but could not be tested.

The Subject Pool

The subjects in this clinical trial had significant risk for CVD; they were required to have established coronary artery disease or significant risk factors to be included in the clinical trial. Those risk factors included being a type 1 or type 2 diabetic, with at least one additional risk factor including chronic smoking, hypertension, hs-CRP higher than two mg/L, moderately increased protein loss, or being older with similar factors as the diabetics.

The Data Not Collected

In reading the study, there were three criteria that came to mind that could have impacted the outcome if the corresponding data had been collected and considered in the statistical analysis. I emailed the relevant author and got the answers.

1. Were data collected on exercise habits of the subjects? No.

2. Were nutritional data collected on the subjects? No.

3. Was the form of omega-3 used, a highly purified carboxylic acid form, assessed as to how the metabolism impacts the omega-3s’ mechanism of action? No.

It seems to me that if the data could be analyzed on exercisers versus sedentary as well as using nutritional factors, even just daily caloric intake, there may have been significant results. As for the form of omega-3s, the CA form is highly absorbed and doesn’t require a fat in the diet to assist with that process. There might have been something else that happens during metabolism that normally assists in the risk reduction. We just don’t know.

The Bottom Line

The authors acknowledge that this subject pool was at high risk for cardiac events. One explanation is that the progression of disease may have already been too advanced and could have impacted the efficacy of the medication. For people with less established CVD, the omega-3s might have been more effective.

Many in the medical field wrote about the failure of omega-3s in medication or supplement form to prove that they have any impact on CVD events or mortality. I think they’re wrong. The one outcome they never test is the quality of life. Granted, it’s difficult to assess but if people can live their lives even 10% better, regardless of CVD events, that seems worth it. Paula and I are still taking our omega-3 supplements; in fact Riley takes one, too, even though he’s only five and we’re not concerned about his heart. Whether you’re worried about your heart or not, omega-3s have many benefits. This study shows no reason why you or I should stop taking them.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2020;324(22):2268-2280. doi:10.1001/jama.2020.22258

Can Omega-3s Reduce Inflammation?

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Omega-3 fatty acids have been in the science news this week. In this Memo, I’ll take a look at a small study that examined the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on specific markers of inflammation in 21 subjects between 50 and 75 who had elevated levels of inflammation. Researchers had subjects follow a particular regimen: take three grams of either DHA or EPA for 10 weeks, cease all omega-3s for 10 weeks, and then take three grams of the other omega-3.

The study showed both omega-3s were effective; they just worked differently, and I can’t explain that without getting technical. It seemed that DHA reduced specific cytokines such as TNF-alpha, IL-6, and IL-10 to a greater degree than did EPA. One of the ways that may have happened was a reduction or replacement of the proinflammatory omega-6 arachidonic acid. The important point is this: however they worked and although they worked in different ways, both DHA and EPA were effective in reducing the inflammatory response in this small study.

Could adding high-DHA fish oil supplements to the diet reduce cytokine production in every case? Specifically, could it potentially have some benefit for the cytokine storm that’s associated with severe cases of COVID-19? We don’t know that yet because that specific research hasn’t been done. But since there are so many other well-documented benefits of omega-3s, make sure you regularly eat fatty fish or take fish oil supplements with DHA and EPA. It’s always a good bet.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:https://doi.org/10.1016/j.atherosclerosis.2020.11.018

Another Year of Wearing Masks?

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“What do you think? Will we be wearing masks another year?” That’s the question that someone asked me at the health club. I shrugged and said “Maybe. But you know in reality, it isn’t all that bad. My grandson’s kindergarten class wears masks all day, and they seem to manage just fine.” He agreed it wasn’t a problem.

He then went on: “I think it makes you pay more attention. One thing I’ve noticed is that there doesn’t seem to be as much flu this year so far.”

He went on to say, “You know, I clean the machines before I work out and again after I work out. In the past, we were supposed to clean them when we were done, which I did. But I’m just taking the extra step like they ask and clean it before I use it. I bet that makes a difference.” I told him I agree.

I’ve thought about it for a couple of days, but I’m not clairvoyant so I have no idea how much longer we’ll be wearing masks. I don’t think it would be all that bad if we got into the habit of using masks in public, social distancing a little, washing our hands, and cleaning public surfaces before touching them. We would reduce the risk of catching all infectious diseases. The following years’ flu seasons would be easier, and you can’t spread it if you don’t get it.

Just like the guy in the health club said, I think changing our habits would really make a difference. If we did, we just might find that stay-at-home mandates are a thing of the past. How great would that be?

What are you prepared to do today?

        Dr. Chet

Ideas for Long-Hauler Recovery from COVID-19

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There is currently no research on ways to recover faster if you have chronic symptoms after your initial COVID-19 infection. When this occurs, the best thing we can do is to use what we know to help restore the body as long as it does no harm. That’s the approach I used when putting this together.

Understand these recommendations are hypothetical, but they’re based on what we currently know. Much of it depends on the types of symptoms that you may have; deep muscle pain is not the same as a chronic cough or the loss of smell.

  • Try to get some exercise, preferably outdoors. Even brief stretching exercises, including deep breathing, are better than nothing. As you gain back strength and lung capacity, you can increase the amount and types of exercise, but it’s important to get blood flowing to the extent that you can.
  • Increase your intake of vegetables and fruits and decrease your intake of refined carbohydrates and saturated fats, especially from deep fried foods. Give your body the best nutrition that you can afford—it doesn’t have to be all organic. Raw fruits and vegetables are better because of the phytonutrients and the potential for beneficial bacteria.
  • Take these supplements that may help, depending on your symptoms. Use vitamin D for immune support; probiotics for the microbiome and immune support; high-DHA fish oil for any neurological issues including the loss of smell and taste; coenzyme Q10 for muscle fatigue and soreness; and a multivitamin-multimineral that contains plant concentrates. I know that there are a whole lot more antioxidants and herbs that you may hear about, but all of these have known functions they can benefit the organs involved.

That’s it. It sounds like the recommendations I always give: Eat less. Eat better. Move more. Well, there’s a reason for that; they really help you get healthy. The supplements target those body systems and organs to help their recovery as well.

One more thing: because the mental aspect of being a long-hauler is so tough, make an extra effort to do the things that make you happy but don’t take too much energy: video chat with your favorite people, wear your favorite or most comfortable clothes, listen to your favorite music, or get some sunshine even if it’s just putting on a coat and sitting outside for a few minutes. If prayer and meditation help you, be sure you make time for those.

Until the science and research catches up with the long-haul COVID-19 symptoms, this is the best approach I can recommend. This plan may work or it may not. But one thing is for sure: you’ll be getting better nutrition as a result.

What are you prepared to do today?

        Dr. Chet

The COVID-19 Long-Haulers

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I’ve spent most of my time on COVID-19 talking about how to prevent getting the infection, but I haven’t talked about what happens if you get the infection and recover from it. I hope you have a mild case, and in a week or two, you’re back in business. Your body has built up antibodies, so research shows you should be in good shape at least for a while.

However, some people are experiencing symptoms long after they’ve recovered from the initial infection. They call themselves long-haulers. The path of the disease is unpredictable; people feel better and think they’re on the mend and then get walloped by the symptoms again. The top five symptoms are fatigue, shortness of breath, joint pain, chest pain, and cough. For some people, the after-effects of having COVID-19 are actually worse than the initial infection. Fatigue and shortness of breath seemed to occur in over half the people who’ve had confirmed COVID-19 infections, and they last for several months.

Paula and I, and actually the entire family here at home, probably had the virus. This happened way back in January and early February, before we were really aware the virus existed. Paula had other complicating factors and still has unexplained fatigue. What can we do about it? There’s no research to guide us, but I’ll give it my best effort in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.health.harvard.edu/blog/the-tragedy-of-the-post-COVID-long-haulers-2020101521173
2. JAMA. doi:10.1001/jama.2020.12603.

Why We Need Hope

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I hope you all had a good Thanksgiving and were as safe as possible. The COVID-19 seven-day average continues to stay over 150,000 cases per day. We’ll find out in a couple weeks how we did during the Thanksgiving holiday related to masking and social distancing. It’s difficult to be without family and friends, especially over the holidays, but the one thing we can take solace in is that this is temporary; the better we all follow the rules, the sooner we can all be together again.

It reminds me of an interview a well-known business advisor had with a prisoner of war in Viet Nam years after the war ended. He asked who did better in captivity—people who were optimistic about rescue or those who decided they would simply endure? The answer surprised him: the optimists did far worse than other POWs. The optimists would say, “We’ll be out by Christmas for sure!” Then Christmas would come and go, so they would pick the next significant event and say the same thing. The events would pass, one after another, and soon, the optimists lost all hope.

Don’t do that. One thing we have is hope. The current treatments for those who get COVID are better than six months ago, and they will be better tomorrow as we learn more about the disease. Vaccinations will start soon and while the distribution will take time, there’s hope for those who are most at risk. If we do all we can with the things we can control, there will be an end to this. We don’t know exactly when that will be, but it will happen. Until then we grind it out, we endure. We’re tougher than we think we are. Let’s prove it.

What are you prepared to do today?

        Dr. Chet

Another Path to Trained Innate Immunity

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There is one more action that may give a person a way to enhance trained innate immunity short of catching COVID-19 itself, and that’s to catch a cold. Specifically, a coronavirus cold. I read a great article in the New Scientist that I’ll summarize for you. I urge those of you who want to know more to read the paper listed below.

There are four fairly common coronavirus colds we all get at some time: OC43, HKU1, 229E, and NL63. In a study cited by the article in the New Scientist, researchers collected data from medical records of just under 16,000 patients. Of those, 875 had a documented case of coronavirus colds verified by a test; the rest of the subjects did not. Those who had a confirmed case of one of the types of coronavirus colds had milder cases of COVID-19, fewer required intensive care, and fewer had to be put on mechanical ventilation. The mortality rate was 4.8% in those who had a prior cold and 17.7% without a verified cold test.

The upside is that it seems to provide some trained immunity against COVID-19. The downside is that the immunity seems to wane over the years. I think this research is important because it shows one more way to train the immune system. It may not be practical in the real world, but if you happened to catch a simple cold in the past six months, you may have some innate immunity—if you happened to catch the correct form of the cold virus. For the rest of us, the flu shot is still the best course of action in training our immune system.

What are you prepared to do today?

        Dr. Chet

References:
1. The New Scientist. https://bit.ly/35yxbDY
2. J Clin Invest. 2020. https://doi.org/10.1172/JCI143380.

How to Train Your Immune System

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Here’s where we stand: healthcare workers in the Netherlands who got last year’s flu vaccine had fewer cases of COVID-19 than their unvaccinated counterparts. In addition, white blood cells treated with the flu vaccine, with or without the tuberculosis vaccine, demonstrated enhanced immune responses when exposed to the COVID-19 virus.

Where does this lead? It’s a quality known as trained innate immunity: exposure to one vaccine, such as the flu vaccine, will train the immune system to respond to another virus such as COVID-19. However one test-tube study does not prove it will work in the real world. Let’s look at some additional research.

The Flu Vaccine and COVID-19

Several retrospective studies have looked at the flu vaccine and COVID-19. In two studies from Italy, people over 65 who got the flu vaccination had a lower mortality rate from COVID-19. There are several more observational studies, but these studies don’t prove cause and effect.

There are problems doing clinical trials, ethical considerations being one of them; for example, if getting the flu vaccine proves to have a beneficial effect, it puts the people in the study who did not get the flu vaccination at risk. There’s also the possibility that it might have been other factors that were actually beneficial, such as lifestyle. It’s all very complicated.

Other Vaccines and COVID-19

Several studies have reported an enhanced immune response against COVID -19 after certain vaccinations. The polio- and measles-containing vaccines have been identified as stimulating the immune system and providing protection against covid-19. The bacillus Calmette-Guérin (BCG) vaccine against tuberculosis could protect against COVID-19 as well. Both have been investigated as potentially being immune-stimulating against severe upper respiratory infections. In countries where BCG is given on a regular basis, the rates of COVID-19 have remained lower than in countries that no longer use it because tuberculosis has been eradicated for the most part.

The Bottom Line

These are observational studies; there’s a lot of research to be done to find out how vaccinations for one virus can provide benefits against a completely unrelated virus. Trained immunity means immune cells are reprogrammed in some way. The “how” is important because what we may find out is that there’s another way to do it, or research may find other factors such as vitamin D status that complement the vaccinations to enhance trained immunity.

One lesson this foray into trained innate immunity has taught me is that our immune system gets weaker as we get older and must constantly be “trained.” It’s not just diet, exercise, and supplements that help our innate immunity; it seems that exposure to other viruses in the form of vaccines may help protect us against severe cases of COVID-19 and possibly other viruses as well. Right now the simplest way to do that is to get the current flu vaccination. We may not evade catching COVID-19, but having a better-trained immune system may help us avoid the most severe symptoms and possibly even death.

I got my flu vaccination and so did Paula. Talk with your physician and see if it’s right for you. Your body. Your choice. But I hope you’ll do whatever you can to put the odds in your favor.

What are you prepared to do today?

        Dr. Chet

References:
1. medRxiv preprint doi: https://doi.org/10.1101/2020.10.14.20212498
2. Nat Rev Immunol. 2020 June; 20(6): 375–388.

How Vaccines Can Affect COVID-19

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In vitro studies, more commonly called test-tube studies, are used when you want to see if there’s a relationship between cells and microorganisms. In the case of the researchers in the Netherlands, blood cells, vaccines, and the COVID-19 virus were used. While the laboratory techniques were complex, here’s what they found.

The researchers isolated peripheral blood mononuclear cells from the Buffy coat layer of cells. The Buffy contains primarily white blood cells after centrifugation. The researchers then exposed the white blood cells to the flu vaccine commonly used in the Netherlands for 24-hours. Half the samples were also exposed to the bacille Calmette-Guérin vaccine, typically used for tuberculosis. After a week, the samples were exposed to the COVID-19 virus. The objective was to see if immune system markers were increased after exposure to the virus.

The flu vaccine increased the immune capability of the white blood cells. The addition of the BCG vaccine increased the capability of the immune response. The cells were better able to make cytokines faster. If it happened in humans, the cytokines would be able to respond faster thus reducing the ability of the COVID-19 virus to replicate.

What does this all mean? I’ll finish this on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: medRxiv preprint doi: https://doi.org/10.1101/2020.10.14.20212498

The Flu Shot and COVID-19

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This week, I’m going to review a series of studies that outline a strategy that includes getting the current flu vaccination. The first study is an observational study. In my opinion, it’s the way research should begin: look for relationships between factors first, and then conduct experimental trials.

Researchers in the Netherlands used the medical records database of a large hospital to find out the answers to a couple of questions. First, of over 10,000 healthcare workers who worked there, they wanted to find out how many got the flu vaccination during the 2019–2020 flu season last fall. Then they examined how many employees got the COVID-19 infection since the pandemic began. They learned that of those who were not vaccinated, 2.23% got the COVID-19 virus; of those who got the flu vaccination, 1.33% got COVID-19. That works out to a 39% reduction in the risk of catching COVID-19 for people working in a healthcare setting if they get vaccinated for the flu.

As we know, there’s not a cause-and-effect relationship in these types of studies. But it does indicate that it’s a place to look—which is exactly what they did in the next phase of the research paper. More on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: medRxiv preprint doi: https://doi.org/10.1101/2020.10.14.20212498