Essential Amino Acids for Older Adults

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One of the issues we all face as we get older is the loss of muscle mass; the technical term is sarcopenia. While some of the loss can be attributed to declining hormone levels as well as the decline in physical activity, we tend to eat less protein as we get older. Less protein intake means less muscle and other protein synthesis.

Researchers in Japan wanted to see if increases in muscle mass were related to protein intake, specifically EAAs. Instead of jumping right into supplementing with EAAs, they recruited 10 older men with a mean age of 69 and gathered nutritional information using a three-day dietary record. They put the men on a progressive weight training program, lifting three days per week for 12 weeks.

All men gained muscle mass, about one pound of muscle per leg. In analyzing the diet, the average protein intake was 99 grams of protein per day with 37 grams from EAAs. What they found was that those men with higher EAA intake, especially leucine, had a greater increase in muscle mass. It was even better if they had the EAAs with their breakfast.

This was a small preliminary study that examined current food intake with no intervention other than exercise. It may indicate that in order to be efficient at adding muscle mass, EAAs are important in older adults. What does this mean for you if you’re in that age group or an athlete wanting to add muscle mass? I’ll let you know on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: J Nutr Sci vitaminol (Tokyo). 2017;63(6):379-388. doi: 10.3177/jnsv.63.379.

 

Essential Amino Acids: The Basics

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I’ve been getting many questions about essential amino acids lately. What are they? Why do I need them? Are they only for athletes? What can they do for me? In addition, I came across an interesting study that supports the use of EAAs in a specific population.

The EAAs include the amino acids phenylalanine, threonine, tryptophan, methionine, lysine, histidine, leucine, isoleucine, and valine. They’re essential because we can’t make them, but we can make other amino acids from these EAAs. In addition, three of the EAAs are designated as branch chain amino acids (BCAAs): leucine, isoleucine, and valine; they’re known as protein-building amino acids and important for building muscle.

Think of the EAAs as the rate-limiting amino acids. If we don’t have enough of them, we can’t make the other amino acids and thus, every protein made in the body can be affected. We often think only in terms of muscle, but the lack of EAAs could affect the manufacture of insulin, human growth hormone, leptin, and adiponectin to name just a few.

BCAAs have been marketed to athletes who are training to make muscle for years. Recently, EAAs have entered the arena because of their ability to make proteins that support muscle building. But that’s not the only group that may benefit as a recent study demonstrated. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Prepare to Compete

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Let me be clear: I think that the single most important thing that you can do to be healthy is to exercise regularly. Whether walking, swimming, or one of the hundreds of other types of exercise, talking with your physician about it may be all that’s required for you to get started.

Moving from exercise that helps your health to competing in fitness events requires more—that’s independent of your body weight lest you think I’m talking only about the very heavy people that competed in the triathlon. Here’s what I recommend.

First, you should have a stress test that assesses how your heart and blood vessels perform under maximal conditions. That applies to men over 40 and women over 50, for sure. But I also think if you have been overweight for over five years, you should have the test regardless of age. The maximal exercise test is not foolproof, but it’s the best available predictor of heart problems. This isn’t just me being a worrier; I’m sad to report that one participant died of a heart attack last Sunday. Getting checked out before you start is the best way to protect yourself.

Second, you should have a complete lipid profile, HbA1c, and a blood insulin test as a minimum. As I suggested in Thursday’s memo, you need to know whether you’re a prediabetic or even an undiagnosed type 2 diabetic. The best option for you would be to exercise, but when you push yourself hard for long periods of time, it’s going to affect your blood sugar levels as it would affect a diabetic’s, not someone who has a normal carbohydrate metabolism; for instance, you could pass out if your blood sugar gets too low, and if you’re out alone on a run, that’s a problem. You can deal with it, but you have to know if it’s an issue.

Third, you should get an orthopedic analysis. By that I mean that your joints should be evaluated for range of motion, tendon and ligament stability, and gait. Swimming affects the shoulders, bicycling the lower back, and running the hips, knees, and feet. Any abnormality will be exacerbated; for example, the forces you create when you run is five times your body weight. Do the math—that’s a lot of stress on your knees and feet.

Once you get the all clear, get after it. Start conservatively but if you have the urge to compete to see what you’re capable of, do it. I think if you want a challenge, whether to walk or run a 5K, swim a mile, or bike 50 miles, or combine them into a single event such as the triathlon, you should do it. Just make sure you get your body checked out before you do.

Final Observation

While I believe exercise is important no matter the level at which you do it, exercise won’t help you lose a lot of weight. Surprised? Remember the size of the people I mentioned that competed in the triathlon—not just overweight but obese? If they had put in the training, and I know some of the competitors and know that they did, you’d have thought they would have lost a significant amount of weight. They didn’t.

Burning calories helps with weight loss, but as a well-known expert once said “Americans can’t out run their appetites.” If you could exercise six or eight hours a day, you could probably lose weight without changing your diet, but I doubt you have that kind of time. You can use exercise as a tool to help you lose weight, and exercise pays major benefits in fitness, strength, and stamina. But you will not lose weight unless you also eat less and eat better.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Heavy and Healthy?

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The major observation I had as I volunteered at the Grand Rapids Triathlon was that the body weight distribution of the people participating in the triathlon mimicked the population of the U.S. We’re a fat nation; 70% of the population is overweight and half of those are obese. Those percentages also seemed to apply to the participants in the race.

In addition to being a regular Grand Rapids event, the Grand Rapids Triathlon was also the National Championship for the Clydesdale and Athena athletes. In order to qualify for the Clydesdale division, men must weigh over 220 pounds; for women to qualify for the Athena division, they must weigh over 165 pounds. Based on my observations, a majority of the participants would have qualified for that category, whether that was their intention or not.

There were men well over 300 pounds and women over 250 pounds that participated in the triathlon. Talking with several other volunteers, I said that unless they had a signed release from their physician, I would hesitate to let them participate. They countered that as long as people put in their time training, they were fit enough to compete. Good point, but that logic doesn’t really hold up. The primary concern everyone thinks of is cardiovascular disease and that makes sense. But if someone is overweight, the real concern is undiagnosed type 2 diabetes and orthopedic stress.

While I applaud their effort and would never want to prevent anyone from exercising, I would hope that they would have had a thorough medical exam before they took their first step. We can’t assume because they had trained for the race they were actually healthy enough to compete in the race. I’ll cover what those tests should be and a surprise conclusion that you don’t want to miss on Saturday.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: The People

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The Grand Rapids Triathlon was held this past weekend, and I volunteered to work at an aid station. The station happened to be at the transition area where everything is happening; I couldn’t have picked a better spot. People lined up to head to the river for the swim, coming back from the swim to get on their bike, then parking their bike and finishing up with the run portion of the triathlon. It was fascinating to watch as they finished one portion of the event and had to change modes to do the other.

There were three different triathlons going on at the same time, made possible by advancements in chip timing. The computer knows where everyone is all the time. Here are the events and distance for each:

Sprint: 600 meter swim, 20K Bike, 5K Run
Olympic: 1500 meter swim, 40K Bike, 10K Run
Half-Ironman: 1.2 mile swim, 56 Mile Bike, 13.1 Mile Run

People of all ages and sizes competed. I think that’s the operative word: compete. Even though it was most likely a personal goal to see whether they could finish or not, trying to finish in a specific time, or maybe even trying to win their age-group, the willingness to complete and put forth such a tremendous effort is something to be admired.

But should everyone have been out there swimming, biking, and running? I’ll talk about that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Yes, Supplements Matter

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The study that was published in the Journal of American Academy of Cardiology created several issues that go beyond the headlines of supplements being of no benefit. Let’s first take a look at the published results of the study.

The researchers found that most supplements such as multivitamins, vitamin D, calcium, and vitamin C do not have a significant effect on cardiovascular disease or overall mortality. On the other hand, folic acid had a significant beneficial effect on reducing stroke and overall CVD, and B-complex, a vitamin with a variety of B vitamins in it, also helped reduce the incidence of stroke. However, the study showed antioxidants had a negative effect on all cause mortality as did niacin. Whether beneficial or not, the results, while statistically significant, were not clinically significant.

The researchers stated that they expected beneficial effects on the reduction of cardiovascular disease and overall mortality. The fact that they did not find those benefits resulted in the headlines that supplements don’t matter.

Here are just three of the issues with the study. They included studies with different nutrients as well as studies that didn’t have the same amount of nutrients. The RCTs included in the analysis did not have the exact same amounts of any given nutrient in the supplement; three of the studies on antioxidants and cancer mortality had different amounts of beta-carotene and vitamin E. Another way of putting it was they not only were comparing apples to oranges, but they also compared three oranges to a dozen apples.

Another issue was adherence to the study rules. The subjects did not necessarily take all the supplements they were given, and compliance varied between the studies. Positive or negative effects could be determined by whether subjects took all of their supplements or took them only when they remembered or felt like taking them. The adherence to supplement use varied by study.

Here’s one more issue. Every RCT used supplements as a potential treatment for a disease—in this case, diseases related to the heart and the death rate from heart disease or other diseases. It’s the treatment model used by physicians: the pill, whether pharmaceutical or supplement, must reduce the incidence of or cure the disease. While desirable, that’s not what nutrition is all about.

The Bottom Line

While we would like to see research results that prove that we can live longer or better by taking supplements, that isn’t really the point in my opinion. We take supplements to fill the gaps in our diet. As the researchers point out, if everyone ate more plant-based foods, we could meet the minimal amounts of nutrients our bodies needs. That hasn’t happened in the 30 years I’ve looking at this issue, and I don’t see it changing any time soon.

Taking vitamin and mineral supplements serves as nutritional insurance to support your body’s processes and to make sure you don’t open the door for deficiency diseases; supplements are more like shotguns than rifles. Supplements do matter and I’m going to continue to take mine every day.

There are so many issues with this research paper—much too long for this Memo—that I recorded a Straight Talk on Health about them. If you’re a Member or Insider, you can listen to Research Update on Supplements any time. If you’re not, now is a good time to join.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Update on Prostate Cancer Treatment

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The treatment of prostate cancer has been changing over the past few years. For most men with prostate cancer, wait and see has become the norm. It all depends on age, the location, and the aggressiveness of the cancer. The more aggressive types of cancer, located close to the outer capsule of the prostate, typically required radiation treatment. The question has been the best time to begin that treatment. A recent study provided some insight.

Researchers selected 1,566 consecutive men who had a prostatectomy in various medical centers. Based on a scoring system that ranked the severity, location, and other factors, they either received immediate radiation therapy or they were monitored until the cancer returned and then given salvation radiation therapy. The immediate-radiation patients experienced reduced biochemical recurrence (as assessed by PSA), they had lower rates of the cancer spreading, and the death rate was lower when compared with salvation therapy. In this case, the more aggressive treatment for men with aggressive prostate cancer produced better outcomes.

The Prostate Health webinar will be available for a few more weeks. If you’re concerned about the health of your prostate or what to do for benign prostatic hypertrophy or prostate cancer, you absolutely have to watch this webinar. If you want to know what questions to ask your physician, this webinar is a must see. Order it today.

What are you prepared to do today?

Dr. Chet

 

References: JAMA Oncol. 2018;4(5):e175230. doi:10.1001/jamaoncol.2017.5230.

 

Life Expectancy Is More Than Living Longer

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What’s more important to you: living longer or living better with the years you have? Think about it as you read this Memo and I’ll come back to that later.

The Upside of the Study

There were three important lifestyle variables that clearly stood out (1). The more exercise you get, the better off you are. Of those who got perfect 5s, they averaged over an hour per day of exercise. Second, the lower the BMI, the better; researchers didn’t track who might have lost weight over the years to get in the lowest BMI category, but it’s clear that carrying fewer pounds helps.

Finally, the Alternate Healthy Eating Index (AHEI) is a score of the quality of the diet, not the quantity. The highest quintile was below 60 out of 100 possible points. That means you don’t have to eat perfectly; just eat your vegetables and fruit and fewer refined carbohydrates and sugars, and you’ll see benefits.

The Downside of the Study

The subjects were overwhelmingly white and they were nurses and doctors for the most part. Whether that translates to other races and professions, we just don’t know.

The biggest issue for me is the Food Frequency Questionnaire used in the original studies as well as the AHEI scores. Trying to remember what you’ve eaten in so many categories over a year never made sense to me; there’s just too much potential for error. There were also differences in AHEI scores between the Nurses Study (all women) and the Health Professionals Follow-Up Study (all men). The men had an AHEI of 59 while the women in the nurses study had an AHEI of 37.5 in the groups assigned a 5. That makes no sense to me. I know the FFQ were slightly different, but the way the data are extracted to arrive at the AHEI score should have accounted for that. Are men so much better with the quality of their diet? Not buying it.

Supplements

Here’s something I found interesting. The use of a baby aspirin went up as the overall scores went up. In contrast, multivitamin use went up as the overall scores went down. To me, that means that healthcare professionals in all professions know that taking a baby aspirin is good for you. It also means that the poorer the diet, the more people try to compensate with supplements. The goal should be to complement a good diet with a multi, not try to make up for a poor one.

Amount of Time Living with Disease

I asked you a question at the beginning of this memo: what’s more important to you: living longer or living better? Right now, the average number of years spent living with some form of disease is almost 12 years (2). Not every condition is as debilitating as others, but would you rather live longer no matter what your health is or would you rather live well right up to the day you check out? Only you can answer that one. The study didn’t examine quality of life so we don’t know how the subjects did.

Here’s my guess: I would wager that the more healthy lifestyle variables you can add to your life, the longer and better you will live. Eat less. Eat better. Move more. It all starts with those six words.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.
2. https://ourworldindata.org/life-expectancy.

 

How Much Does a Healthier Life Increase Life Expectancy?

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This week is about life expectancy and the results of a recent study on how to possibly extend it. Looking at lifestyle’s impact on mortality, here are the criteria researchers applied (1).

  • Smoking: never smoked
  • BMI: 18.5–24.9
  • Exercise: at least 30 minutes daily of moderate to vigorous physical activity which included brisk walking
  • Healthy diet: high diet quality score (upper 40%) of the Alternate Healthy Eating Index
  • Moderate daily alcohol intake: one drink or less for women, two or less for men

Individuals were given one point for each factor if they complied, 0 if they did not, so every person had a score between 0 and 5. The researchers then calculated predicted life expectancy for each score.

Here’s what they determined. Comparing those who had perfect 5s on their lifestyle score with those who had 0, women who were 50 years old were projected to live an average of 43 more years while men were projected to live another 37 years. For the subjects who scored 0 on the lifestyle score, the women were projected to live another 29 years while the men had another 25.5 years. That’s an additional 14 and 12 years respectively.

This was not all in or all out; the higher the lifestyle score, the longer someone was projected to live. I think it’s important to know that you don’t have to do it all at once. No matter what your current age, one significant change may help you live longer.

On Saturday I’ll wrap up this look at lifestyle and life expectancy.

What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1161/CIRCULATIONAHA.117.032047.