What Would You Invest in a Healthier Diet?

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Would you eat more vegetables and fruit if your health insurance paid for it? How about an overall healthier diet that also included whole grains, nuts and seeds, fish, and healthy oils? Would you eat healthier if it didn’t cost you more?

Researchers from Tufts and Harvard examined the potential cost and benefits of subsidizing 30% of the costs of both approaches in Medicare and Medicaid programs. This was a computer simulation using data from NHANES on dietary intake and the relationship to cardiovascular disease and type 2 diabetes. They used the CVD events and mortality data and the current costs of treatment. Then they created models, one with increasing vegetable and fruit intake and another increasing all the aforementioned food, to find out if a healthier diet would affect disease events, deaths, and costs associated with the treatments.

Their estimates found that over a lifetime, the vegetable and fruits model would prevent 1.93 million CVD events and 350,000 CVD deaths while saving $40 billion in healthcare costs. The healthy food model would prevent 3.28 million CVD cases and 620,000 CVD deaths, prevent 120,000 diabetes cases, and save $100 billion in healthcare costs.

However, the net cost of the first model—subsidies minus healthcare savings—would be $84 billion while the second would cost $111 billon. It would improve the quality of life, but at a price. It’s easy to get lost in big numbers so let’s bring it down to the individual. After deducting healthcare savings, it would cost $110 per person per year for the fruit and vegetable subsidy and $185 per person per year for the healthy foods model. Does that seem like a reasonable investment for a healthier life for everyone?

The unknowns are whether physicians would actually write the prescriptions for foods; they’re not known for their nutrition knowledge and have a tendency to look for a pharmaceutical solution. But I think that’s minor; the real unknown is whether people will actually buy healthier foods and eat them.

We’ll find out: $25 million has been set aside in the 2018 Farm Bill to run pilot programs. It will be years before we know the results, but it’s a start to see if the theoretical will meet the actual.


The Bottom Line

Using food to improve health and quality of life makes sense. Whether having insurance companies or government pay 30% for healthier foods will work, I’m not convinced. I get the reduction of CVD events and deaths that could potentially be saved and the reduction in healthcare costs, but I question the $100 billion price tag without a public health education program to go along with it. Maybe a better approach would be to invest in the public health education program to teach people and physicians how they can use food to be healthier.

But now you know how a healthier diet could affect your life. What are you prepared to do today?

        Dr. Chet

Reference: PLoS Med 16(3): e1002761. https://doi.org/10.1371/journal.pmed.1002761.

Too Fat to Get Sick?

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Once in a while, a health news story makes you do a double-take and say, “Did I just read what I thought I read?”

The legislature in West Virginia passed a bill to delay the implementation of water safety guidelines from the Environmental Protection Agency for two years. They’re allowing delays in the restriction of 60 pollutants, including some known carcinogens, dumped into streams and rivers by chemical manufacturers. How did this happen? A lobbying group for the chemical manufacturers lobbied the legislature to delay the implementation so that more state-specific data could be gathered. Sounds reasonable, doesn’t it?

No. The lobbying group’s justification for the delay is that West Virginians are fatter and thus can handle more pollutants. They also drink less water and eat less fish as well; therefore additional amounts of pollutants are just fine in drinking water.

I understand that we’re now in an era of turning back EPA regulations, and maybe some are even justified. But a legislature that accepts this BS argument by a group representing chemical companies doesn’t seem to have the health of their populace in mind. The facts are that many pollutants are stored in fat, so being heavy may make people more vulnerable, not less.

Too fat to get sick? Unbelievable. Maybe it’s time to see what’s happening to the water in your area.

What are you prepared to do today?

        Dr. Chet

What Do Tests Tell Us?

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Based on last week’s push-up challenge, many of you have emailed me to let me know how you did. No matter how many or how few push-ups you did, it’s a start that can help you increase your muscular strength and stamina. All you have to do is to continue to do them as part of your exercise plan.

You may have seen an article in the Washington Post that examined another test associated with increased mortality. The idea is that you’re supposed to start by standing and then lower yourself to a sitting position on the floor with your legs crossed; then rise again. You start with 10 points and deduct one point every time you have to use your hands, arms, or sides of your legs while getting up or down. The fewer the points, the higher your risk of dying sooner.

I’m a dead man if that’s the case. I couldn’t get down because my knee couldn’t handle the stress, hands or no hands; Paula has two bad knees, so she’s out of luck, too. If you can’t get down, you can’t get up.

Maybe you couldn’t do any full push-ups. Are you toast as well?

Understand what the tests mean. If you have strength, you’ll have better balance. If you’re flexible, that helps with core strength and also balance. Stamina indicates you have aerobic fitness. These all speak to your quality of life as well as your cardiovascular fitness, and those are associated with living longer. The simple tests provide a snapshot of where you stand in relation to other people 50 and older. If these tests don’t play to your strengths, there are other tests to assess your strength, flexibility, and balance; don’t give up until you’ve tried those.

Want to live longer? Make fitness a part of your everyday life. Maybe you’ll live longer, maybe not, but you’ll have a better quality of life in however days you live.

What are you prepared to do today?

        Dr. Chet

Drop and Give Me 41

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The study on firefighters, push-ups, and CVD was interesting—not only for the relationship between push-ups and CVD, but also for the other relationships between the number of push-ups and other variables. Here’s a summary:

As the number of push-ups increased:

  • Body mass index decreased
  • Systolic and diastolic blood pressure decreased
  • Blood sugar decreased
  • Total cholesterol, LDL-cholesterol, and triglycerides decreased
  • HDL-cholesterol increased

One more thing: age decreased as well. In other words, the men in the study who could do more push-ups were younger. Was that the real reason—they were younger so naturally they could do more push-ups? They accounted for age in the statistical analysis, so it doesn’t appear to be so.

Does this study show cause and effect? No, because it’s observational. What it shows is that the lifestyle of the subject is important in the development of CVD. The subjects who had the greatest reduced risk had the highest aerobic and strength fitness, which may be reflective of an overall healthy lifestyle. Because push-ups require no equipment, progress can be easily tracked in a physician’s office. That was the actual point of the study: a simple test that could be predictive of CVD among other factors.

Here’s my challenge to you. After you see how many you do as a baseline, work at doing push-ups every day until you can hit 41. If you can’t do one, start with knee push-ups, push-ups from an exercise ball or chair, or wall push-ups (stand more than an arm’s length from the wall). As you can get to 41 one way, move to the next more difficult type.

When you get to 41, send me an email saying you did it and I’ll send you a coupon code good for 30% off the Optimal Performance Program; Member and Insider discounts apply. I’ll take you at your word, no selfies and no videos. After all, the only person you would be cheating is yourself and your risk of heart disease. I know age doesn’t matter; one of my readers in his 80s can already do this challenge. All it takes is a little sweat equity. Check with your doctor and get started.

What are you prepared to do today?

        Dr. Chet

Reference: doi:10.1001/jamanetworkopen.2018.8341.

Push-Ups and CVD

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On Tuesday, I asked you to see how many push-ups you can do before you can’t do any more (if you’re fit enough with no real orthopedic issues). How did you do? I have torn biceps in both arms, but I managed to eke out 21. But you may be wondering why I asked you to do push-ups.

A study published in JAMA Online periodically tested a group of 1,500 firefighters between 21 and 66 in 2000 to 2007. They were given several tests including maximal exercise capacity, height, weight, blood pressure, blood glucose, and the number of push-ups they could do. They were tracked for 10 years.

Researchers divided the results into quintiles based on the number of push-ups. They found that as the number of push-ups increased, the rate of CVD decreased. While not all comparisons were statistically different, there was a definite pattern of benefit.

That wasn’t the only data that proved to be interesting in the study. I’ll finish it on Saturday, along with a challenge.

What are you prepared to do today?

        Dr. Chet

Reference: doi:10.1001/jamanetworkopen.2018.8341.

Once a Year, No Matter What!

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I was in the gym locker room recently when I heard a guy ask a question: “Can I use any locker or are they assigned?” I turned to see if he was talking to me, but another guy told him there were no assigned lockers and to use whatever is open. That’s when the locker seeker said, “I couldn’t remember because I’m here only once a year.”

I thought maybe he uses this gym only when he visits this area. Then I realized he meant he gets to the gym only once a year, probably making light of his infrequent visits. The problem is that seems to be what most Americans do: buy gym memberships and never use them.

That’s why a study just published this past week is important. Researchers examined a number of physical variables in a group of firefighters and tracked them for ten years; the goal was to look at factors related to cardiovascular disease. I’ll talk about that study this week.

In the meantime, if you’re fit enough with no real orthopedic issues, see how many push-ups you can do before you can’t do any more.

What are you prepared to do today?

        Dr. Chet

Dealing with Keto Breath and Other Odors

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Quick question: what side effect do you typically assign to eating asparagus? I bet you took less than a second to come up an answer: a different odor to your urine, sometimes quite pungent. Asparagus is a cruciferous vegetable with phytonutrients that produce the effect.

On Tuesday and Thursday, we looked at digestive problems with going keto; today we’ll look at odor issues.

Ketosis, the result of metabolizing fat into ketones for use as a fuel, also has a specific odor associated with it: your breath can smell like nail polish remover. The ketones may have complicated names such as acetoacetate, beta-hydroxybutyrate, and acetone, but they do one thing: they cause an odor in your mouth and as you breathe out. Our bodies always make those odors, but because we’re forcing the body to produce more ketones, the odor is more noticeable as ketone remnants exit the body via breath and urine.

In this case, there’s no real solution. If you want to use fat as a fuel almost exclusively, you learn to live with the smell. Just make sure to drink plenty of water, because water is important to get rid of these chemicals and protect the kidneys. Drinking water and brushing more frequently may help compensate for keto breath.

Health news has recently become full of eye-catching headlines about something termed “keto crotch.” While it can affect men, it seems to especially impact women by changing the odor of the vagina and vaginal discharges. It seems obvious that it’s the result of the diet, although there’s no research that I could find that has examined it. Gynecologists speculate that it’s the change in the vaginal pH that can contribute to increased odors. If that’s true, it would radically change the vaginal microbiome and that could change the odor. At this point, we don’t know.

One thing that may help is taking probiotics that contain Lactobacilli strains; some research has demonstrated benefits for bacterial vaginosis. Whether probiotics will help with the odor associated with the keto diet or not is unknown, but it’s possible. A prebiotic would also be needed to feed the probiotic because on a keto diet, there’s no fruit with its special sugar to feed the bacteria.

The Bottom Line

Going keto has side effects. Some people may not get any of them. Genetics, the microbiome, and other factors no doubt will have an impact on the extent of the side-effects. I’ve tried to cover the obvious ones this week but there are others, from depression to fatigue.

Which brings me to a question I’m often asked: what do I think about the ketogenic diet? I think it’s a good tool to use fat as a fuel for a limited time, and together with the right exercise program, it can be effective in helping people lose body fat; that’s why it’s part of the Fat-Burning Plan in the Optimal Performance Program.

I assess diets this way: what has to be added to make it healthy? Veganism requires most people get vitamin B12 from somewhere other than meat. The keto diet lacks vitamins, minerals, fiber, and probiotics typically found in vegetables. Both diets lack essential nutrients. If you decide to go keto, it’s important to add these supplements to your diet: a multivitamin-multimineral, probiotics, prebiotics, and fiber.

Because of the side effects, I just don’t think going keto is sustainable. Use it as a tool, as a means to an end for a specific goal. The goal is to stay healthy by learning to always do these three things: Eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

Keto: Clearing the Air and Your Colon

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The next keto diet issues are still related to the digestive system: excessive gas and constipation. Let’s address the issue of gas first so that maybe the next time you bend over, you won’t have to worry about challenging the strength of your anal sphincter muscles.

The protein content of the revised keto diet may be lower than prior versions, but the body still has to break it down. If you don’t make enough digestive enzymes to breakdown the protein, it produces gas as it ferments in the microbiome. A lot of it. The simplest thing to do may be take a digestive enzyme that contains proteases to breakdown proteins before every meal. Taking a probiotic may also be a good idea, but we don’t know the specific strains of bacteria that will work on protein.

On the other hand, probiotics in general may help ease the constipation that can occur while on the ketogenic diet. The problem is this: the colon doesn’t have enough to do—waste products from foods are simply not there. Fats don’t have anything left after digestion; almost all protein sources don’t have much residue either. But your digestive system still has to repair and rebuild the digestive system on a regular basis. In addition to the probiotics, soluble fiber may again be the solution for the same reason as with diarrhea: it adds bulk to the stool.

I’ll wrap this up on Saturday with the topic that seems to still be making headlines: the odors associated with going keto.

What are you prepared to do today?

        Dr. Chet

The Downsides of Going Keto

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News stories about the side-effects of the still-popular ketogenic diet are showing up more frequently, so let’s review those this week and look at what you can do to address the issues while still attempting to stay in ketosis.

The first side effect is generally diarrhea. With the newer version of the ketogenic diets, the emphasis is on fats and oils, which make up the majority of calories, with protein second, and carbs last. Two things seem to contribute to diarrhea. The first is the use of fats containing high amounts of medium-chain triglycerides (MCT) such as extra-virgin coconut oil and other oil products made with added MCT. The reasons are unknown; it’s most likely related to changes in the microbiome due to the radical change in diet, but it may be that it’s a question of volume of MCT. Oils such as olive oil don’t seem to cause the problem. The solution to this problem may be experimenting with different oils to find the ones that work better for each individual.

The other reason the keto diet can cause diarrhea is a lack of fiber. The keto eating plan has no significant source of fiber in a diet without grains, beans and legumes, and vegetables; a couple cups of lettuce aren’t going to help very much. Soluble dietary fiber supplements may help, whether psyllium, inulin, or other fiber sources. Begin slowly by adding 5 grams a day mixed with water and slowly increase it to 15 or 20 grams spread out over the day. It can add bulk to the stool and stop what has been described as explosive diarrhea.

More on Thursday. Tomorrow is the Insider Conference call. There’s time for you to join before tomorrow’s call at 9 p.m. Eastern Time. What are you prepared to do today?

        Dr. Chet

Protein and Longevity: The Unproven Relationship

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I think the best way to assess whether the study I’ve been examining this week on protein and longevity is meaningful or not is to examine the interview with the primary author Christopher Proud, PhD. I’m going to give a series of his statements and whether the research addressed the question.

“Science has shown for some time that eating too much, in particular protein, reduces lifespan; and now we know why.”

This statement isn’t exactly true. While there does seem to be a relationship between calorie restriction and longevity in fruit flies and some species of mice, it hasn’t been proven in humans. There’s evidence in longitudinal studies on relationships between animal protein intake and some diseases, but it’s not accepted that high protein intake leads to an early grave. More likely, there are genetic and environmental factors to consider, but to suggest that eating less overall increases longevity for humans is not correct at this time.

“Eating high-fiber carbohydrate, such as those found in fruit, vegetables, and unprocessed grains and seeds, will produce the healthiest benefits. This is similar to the traditional Mediterranean diet which has well-established links to longevity. We already knew that lower food intake extends lifespan.”

Same as before—it’s an overstatement. There are some studies that show a decreased rate of diseases using the Mediterranean diet, but that doesn’t mean it will result in people living longer. It may mean they live better for the time they’re alive.

“Our team demonstrated that increased [protein] nutrient levels speed up protein synthesis within cells. The faster this process occurs, the more errors are made.”

Based on the way I understand the methods, they did impact protein synthesis by knocking out the eEF2K enzyme. As of this writing, I haven’t heard back from Dr. Proud, so I have yet to find how they overfed the cells, flies, or worms to effect that change.


The Bottom Line

I don’t think that the research done in this series of studies proves that high protein intake decreases longevity. As excited as the corresponding author was during the interview, it wasn’t as clear as he made it out to be. The research didn’t do anything to help set a target goal for human protein intake. How is it supposed to help without practical applications?

What is important is that we need to seek balance in our nutritional intake. It may be true that too much protein will impact the correct production of proteins, which would have long-term effects, and it’s hard to go wrong eating more fruits and vegetables. But longevity isn’t tied to a single nutrient or a single habit. We need to strike a balance. Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References: Cell Biology 2019. https://doi.org/10.1016/j.cub.2019.01.029.