Is Cold Pasta Healthier?

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Our grandson Riley has loved pasta since he started eating solid food (that’s him digging into his pasta at two; if his ear looks orange, it’s because his imaginary cell phone rang during dinner), and he often eats it cold. I mean refrigerator cold; he’ll eat it warm if we go out to a restaurant, but he prefers it cold. I don’t mean macaroni salad—I mean cold pasta, preferably with Riley sauce. The Riley sauce is my recipe created for him with a base of a marinara sauce; I grind up onions, garlic, mushrooms, carrots, zucchini, and beef with the grinding attachment for Paula’s KitchenAid mixer and add them to the base along with some additional spices. Then I slow cook it for a couple of hours. He eats that with a spoon (cold, of course) and doesn’t realize all the veggies he’s getting.

But it’s really the cold pasta that may be healthier for him. Why?  Doesn’t pasta increase blood sugar rapidly? Sure, if it’s hot. But when pasta is put in the refrigerator for a day or more, a process called retrogradation happens. As the pasta loses water, the remaining molecules lose their original structure and form a new structure. Those turn some of pasta’s sugar molecules into a resistant starch that passes through the body without being digested in the same way. When eaten cold like Riley does, that starch resists digestion until it gets down to the probiotics. There it can be turned into short-chain fatty acids instead of sugar molecules. Those fatty acids are much better for us for a variety of reasons.

As you celebrate the last summer holiday this weekend, keep in mind that pasta might be a dish best served cold. Have a fun Labor Day weekend, and please be safe if you’re traveling anywhere this weekend.

What are you prepared to do today?

        Dr. Chet

Lithium: It’s The Amount That Matters

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I received a question from a long-time reader the other day. They asked, “What is the difference between lithium orotate and the lithium in batteries?” The short answer is simply that they are the same metal. Given the history of lithium batteries and their tendency to overheat and sometimes explode, I’ll go into a little more detail.

Lithium is the lightest metal on the Periodic Table. It is a soft, lustrous metal and, while it is found in quantity in mines, it is everywhere. As an element, it can be toxic. What makes it less so is that it can naturally bind to so many other elements. Depending on what it binds to, that can determine whether it’s safe to use.

Lithium orotate is an organic salt and far supersedes the efficacy of other organic salts and inorganic salts such as lithium carbonate. In batteries, the value of lithium is its ability to freely give up ions that can result in the production of energy, but there’s about 38.4 mcg of elemental lithium contained in 1 mg of lithium orotate. That’s at least 1,000 times less than found in a single AA lithium battery and without the toxic solvents necessary to make the battery work.

Another reader asked about the highest sources of lithium in the food supply. That’s something I would have included, but it all depends on the water supply and whether the soil has lithium in it. For now, there is no way to provide a list. Eat them all!

I hope that clarifies things. On Friday: why the way Riley eats pasta might just be best for gut health.

What are you prepared to do today?

        Dr. Chet

Lithium: A Hopeful Discovery

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You may recognize lithium as a treatment for some mental health issues such as bipolar disorder. That would require a pharmacological dose of 600–1,800 mg of lithium per day; levels that high can create severe side effects. But prior research showed that people who were treated with lithium had lower rates or delayed onset of cognitive impairment. The next step in the study was what form of lithium and what amount could help reverse the cognitive impairment and potentially be used to prevent mild cognitive impairment and Alzheimer’s disease.

Forms of Lithium

Researchers examined a variety of organic and inorganic salts to find the form which prevented or reduced the sequestration of lithium in amyloid plaque. Lithium carbonate, the inorganic salt form most used in pharmacological doses, did not prevent the pathology in low-dose supplemental form. An organic form called lithium orotate was successful in amounts consistent with dietary intake. Over a period of weeks, the mice drinking lithium orotate in their water reversed the cognitive impairment and other negative effects.

What’s Next?

The first thing you may be thinking is, “I gotta get me some of that!” Slow down. Remember, these were tested in mice—there are no human trials yet. While there are tests for assessing lithium levels, they’re generally reserved for patients with mental disorders. With such a small range found within the blood, testing requires medical interpretation, and we don’t really know what that level may be in someone with mild cognitive impairment.

Before this becomes a supplement you want to take, a couple of good human trials should be done to determine the proper dosage and any potential side effects. Tremors and nausea are routine side effects when lithium is used to treat mental conditions, but at normal food and water intake levels—1 to 3 mg per day—there should be none. There are many lithium orotate products in the marketplace that range from 1 to 5 mg, but let’s not get ahead of the science.

The Bottom Line

I think there are still questions to be answered before we all start supplementing with lithium orotate. While there is no RDA for lithium, there is a provisional target of 1 mg per day from diet. However, because the amount of lithium in water and food can be so variable, taking 1 to 5 mg per day of lithium orotate seems like a reasonable thing to do if you are over 50 years and are starting to experience memory issues beyond the normal where-are-my-keys problems.

It will take a while before we have the results of human trials. It would also help if you eat better, drink water, and get some exercise; those also help reduce the development of amyloid plaque. When I know more, so will you.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. https://doi.org/10.1038/s41586-025-09335-x

Lithium and Brain Health

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The health field has been buzzing about a study that was recently published related to Alzheimer’s disease markers and the mineral lithium, a soft, silvery-white alkali metal. Got lithium? You can use it in batteries, nuclear reactions, and many other industries; it’s also used in medications to stabilize mood.

Researchers decided to find out the relationship between markers for Alzheimer’s such as types of amyloid structures in the brain. There have been associations with reduced lithium intake and mild cognitive impairment in prior studies, so researchers decided to examine how mice on a reduced-lithium diet would respond. They measured several other minerals as well, but the only one associated with an increase in amyloid structures was lithium. It seems that when there’s not enough lithium in the diet, the brain cannot function as normal and sequesters the lithium in the amyloid bodies; brain function decreases further as lithium levels drop, including cognitive impairment.

The normal amount of lithium found in the diet suggests we get 0.6 to 3 mg per day, mostly from water and food. That amount is able to sustain the 7 mg typically found in an adult human. The next question would be how much it would take to reverse cognitive impairment. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. https://doi.org/10.1038/s41586-025-09335-x

When It Comes to Carbs, Quality Matters

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You probably guessed right after reading Tuesday’s Memo that there are benefits from the quality of carbohydrates a person eats on a low-carb diet. In fact, one might say that because the carb intake is very low, every decision matters. Before getting into the results, let’s use the definition to identify the carbohydrate quality used in the study.

Good Carbs, Bad Carbs

High-quality carbohydrate diets are characterized by higher intakes of whole grains, non-starchy vegetables, whole fruits, nuts, and legumes, with correspondingly higher dietary fiber.

Lower quality carbohydrate diets are characterized by higher intakes of refined grains, sugar-sweetened beverages, baked desserts, and other sweet snacks.

The Results

While there were numerous statistical applications used, when comparing the lowest quintile of high-quality carbohydrates with the highest, as the percentage of high-quality carbohydrates increased, the markers of inflammation decreased.

When comparing the lowest quintile of low-quality carbohydrates with the highest quintile, the markers of inflammation increased as the percentage intake increased.

Understand that the high-quality carb eaters ate low-quality carbs as well, just not as much as the low-quality carb eaters. That means you don’t have to eat only one way. I’ve been developing a carb theory, one that goes along with the 80/20 rule: if you can eat well 80% of the time, you can loosen up 20% of the time, at least when it comes to carbohydrate quality.

The Bottom Line

This was not the be-all, end-all study; they used food frequency questionnaires, and I’ve talked ad nauseum about why I think they’re not much better than no info at all. But it was a practical approach to establishing that eating better most of the time can have benefits and may even reduce the risk of disease. We’ll see if there are future papers that track morbidity and mortality in the same group of subjects. Until then, eat less, eat better, and move more.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479

Lower Carb Diet: Does Quality Count?

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The Framingham Study began in 1948 and focused on monitoring nutrition and cardiovascular disease among other conditions. The purpose was to monitor the dietary and health habits as well as the health outcomes of a large group of people over time. Much of what we know about diet and cardiovascular disease comes from the longitudinal data collected; that study continues today with a focus on the children whose parents were part of the original study. Study participants have regularly scheduled physicals and blood work as well as dietary intake assessed by a food frequency questionnaire.

The researchers wanted to study the effect of high-quality carbohydrate intake versus low-quality carbohydrate intake on markers of inflammation in those people following a lower carbohydrate diet. These were not hard-core ketogenic diet followers; the average carbohydrate intake was about 41% instead of the typical 50% to 60%. Subjects had similar intakes of percentage of protein and fat intake. They were compared by the quality of the carbohydrates that they ate.

The subjects were followed for over six years to see if there were any changes in inflammatory markers, because inflammation is related to an increased risk of many diseases and conditions including cardiovascular disease. Was it beneficial to eat better carbs? I’ll let you know on Saturday along with comments about the significance of this study.

Tomorrow night is the Insiders conference call. If you want to participate and get your questions answered, become an Insider by 8 p.m. ET tomorrow night; I’ll include you in the call or you can listen to the replay.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479

Walking for Fitness

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The message from Tuesday’s Memo was that walking over 4,000 steps per day can bring health benefits from several diseases and conditions, and the benefits increase the more steps you take—up to about 12,000 steps, the highest that were recorded in the studies. What I didn’t say was that those were not all workout steps. Some people certainly included their exercise steps within those steps taken when they wore tracking devices, but most totals just reflected a person’s normal activity.

What if you could boost the benefits you get? We know that fitness levels decrease the risk of cardiovascular disease at every age. What if you turned up the intensity of the steps you already take? Research shows fitter people live longer in every age group—even those in their 80s and 90s—so it makes sense to challenge yourself and increase your fitness level.

Three Ways to Boost Fitness While Walking

1. Walk faster. You can be precise and count seconds or steps, or you can pick spots where you have the room and just walk faster. How fast? It depends on your fitness level and orthopedic issues, but a goal could be 5% of your steps in a day. If you averaged 4,000 steps per day, that would be 200 steps broken into 10 segments of 20 steps. You could increase that over time to 10% of your daily steps.

2. Walk up hills. Use the same idea as with walking faster. In my neighborhood, I’m usually going up a hill or down one. I do about 150 steps up a hill as fast as I can and then saunter back to the bottom of the hill. Again, use the same concept as you would with walking faster: time or percentage of total steps.

3. Use the stairs. Every step is a step, but a step bearing your weight is even better. Every floor will have between 10-15 steps between floors. You can even do this in your home. Same logic regarding time or percentage of total steps.

Should You Take a Companion?

Years ago, Paula’s cousin decided to improve his fitness, so he’d go out for a walk every evening. He’s not a scary guy but he lives in a nice neighborhood, and several times he was questioned by police patrolling the area. So he got a dog to take with him on his evening walks—and he was never questioned again.

The Bottom Line

Walking is a great form of exercise, and we’ve seen the benefits from the research on mortality and morbidity, but examining the walking speed in those studies shows that most steps taken by most people were between two and three mph. That’s pretty slow. We also know that being fitter increases benefits regardless of age. If you get your doctor’s permission to exercise more strenuously, adding some type of higher intensity challenges one or two times a week can increase your fitness level without spending any more time than you currently are.

What are you prepared to do today?

        Dr. Chet

References:
1. Lancet Public Health 2025; 10: e668–81
2. JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.
3. JACC. 2022. Fitness and Mortality. https://doi.org/10.1016/j.jacc.2022.05.031

Research Update on Walking

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Questioning prevailing thought and dogma are always a good idea in my opinion. Last week’s look at eggs put the issue of dietary cholesterol and LDL-cholesterol in perspective.

This week we’re going to look at the concept of 10,000 steps per day as the number required to get health benefits. This first came up in 2019 when a research group looked for a relationship between walking and all-cause mortality in an elderly group of subjects. There was, and they found that about 7,500 steps per day were needed to see a benefit. (The 10,000 steps as initially promoted was actually a marketing ploy, as I wrote about back then.)

This time, researchers wanted to expand the examining all-cause mortality to include the following:

  • Cardiovascular disease incidence
  • Cardiovascular disease mortality
  • Cancer incidence
  • Cancer mortality
  • Type 2 diabetes symptoms
  • Dementia
  • Depressive symptoms
  • Falls

They used meta-analyses to combine the results from over 60 studies and presented the results in hazard ratios. Every cause of mortality and morbidity decreased once they reached 4,000 steps per day. The benefits continued with additional steps; they slowed down at over 7,000 steps per day but continued to improve.

There were interesting differences between morbidity and mortality. While walking lowered the hazard ratio of cardiovascular disease mortality by 47% or more, it only reduced the hazard ratio of getting cardiovascular disease by 25%. Taken to an extreme, you might still have a heart attack, but you won’t die from it. There were similar results for cancer; the incidence was reduced by only 5%, but mortality was reduced by 34%.

Even though they weren’t randomized controlled trials, I think that’s phenomenal. But could you juice the results even more? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Lancet Public Health 2025; 10: e668–81
2. JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.

Eggs: A Practical Solution

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Based on Tuesday’s Memo, do we have a “hard-boiled” answer to the question of whether the dietary cholesterol in egg yolks positively impacts LDL-cholesterol levels? Or total cholesterol levels? We can’t “eggsactly” get a complete answer from this study, and here’s why. (Okay, no more puns or “yolking” around.)

Study Issues

  • The LDL-cholesterol levels in the EGG phase (high cholesterol, low sat fat, two eggs per day) were 104 mg/dl. That was lower than the 108 mg/dl in the EGG-Free phase (low cholesterol, high sat fat, no eggs) and lower than the 109 mg/dl in the control group that ate the typical diet, but with only one egg per week. The standard deviation with the groups was over 20 mg/dl, which means that 66.7% of the subjects in any group could be 20 mg higher or 20 mg lower; that 104 result could actually be 84–124.
  • While an argument could be made that the standard deviations were similar, there’s also the potential measurement error. That is currently 12%, so as all measures were about 100 mg/dl, each individual measurement could be within a range of 88–112 mg/dl.

These two issues alone raise doubt whether the EGG diet clearly reduced LDL-cholesterol.

There are also a couple of dietary factors:

  • When placed on the reduced fat diet while eating two eggs per day, the fiber intake increased by eight grams per day, while the grams of protein decreased by 20–30 grams per day. Fiber can lower cholesterol.
  • Less protein would be available to be made into sugar and fat.

One comment pointed to the statement “funded by the Egg Council” to suggest that’s why the data skewed the way it did, but the last thing we want to do is discourage that kind of research. If private companies and associations do not fund research, it won’t get done; there’s no reason to believe that the NIH will fund basic science research going forward.

A Practical Approach

As I’ve maintained recently, whether talking about seed oils, maltodextrin, or eggs in this case, it’s all about the amount consumed. What the study did show is that excess saturated fat may be, and probably always has been, the cause of abnormal cholesterol levels in people without the genetic tendency toward high cholesterol. The lesson for us is to try to get saturated fat intake to less than 10% of your total caloric intake. One more thing—increase the intake of vegetables to decrease the percentage of saturated fat as well.

If you follow these two suggestions, there should be no problem with eating eggs every day if you want. Just be careful of fat bombs such as sausage and bacon that can add fat you don’t need.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2025. 122 :83–91. DOI: 10.1016/j.ajcnut.2025.05.001

To Egg or Not to Egg?

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That’s today’s question. This Memo was driven by another provocative headline from a university press release: “Groundbreaking study finds eggs don’t harm heart health” published in SciTech Daily. I think most informed healthcare professionals have known for a while that there’s little to no relationship between cardiovascular disease and dietary cholesterol from eggs and other animal sources—at least for most people.

Researchers in Australia decided to investigate how much dietary cholesterol from eggs, saturated fat, and a low-fat diet would impact a variety of blood lipid levels. While they measured at least 50 variables related to cardiovascular disease, they focused on LDL cholesterol. They recruited 61 healthy people, 48 of whom completed the 15-week study. In a random order, each subject spent five weeks on one of the following diets (note the amount of cholesterol and saturated fat in each diet):

  • The control diet had high cholesterol and high saturated fat; it mimicked the typical Australian diet, which is similar to the typical American diet. They were limited to one egg per week.
  • The EGG diet had high cholesterol but low saturated fat, plus two eggs per day.
  • The EGG-Free diet had low cholesterol and high saturated fat with no eggs.

What did they find when they compared how people did on each diet? Those on the EGG diet averaged 6 mg/dl lower LDL-cholesterol than either the EGG-free diet or the control diet. The EGG-free diet that was high in saturated fat resulted in the highest LDL cholesterol. Even with no additional eggs, the control diet still had higher LDL than the EGG diet. 

Does this give the egg a free pass when it comes to blood lipids? Can the lead author really state, “We’ve delivered hard-boiled evidence in defense of the humble egg”? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2025. 122 :83–91. DOI: 10.1016/j.ajcnut.2025.05.001