Happy Fat Tuesday!

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Today is Mardi Gras—in case anyone doesn’t know, Fat Tuesday is the literal meaning of the French term. It’s the final celebration before the period of Lent that culminates in Easter Sunday. Many Christians use this time to give up something they enjoy as a sacrifice. The idea is to reflect and focus on our spiritual self; no matter your beliefs, giving up something you enjoy to focus on your inner self is a good idea. This week, I’m going to talk about giving up three typical categories of food and drink: sugar, salt, and alcohol. What benefits could you gain in the 40 or so days of abstinence from these foods? What may be a healthier substitute?

Let’s start with sugar, and by that I mean cake, cookies, donuts, sweet rolls, pies, ice cream, and candy. These are the ultimate in refined carbohydrates. If you were to abstain from these foods for 40 days, several things could happen. First, your insulin levels would probably drop because you wouldn’t have high levels of sugar hitting your bloodstream. If you’re prediabetic, you might see your triglyceride and HbA1c levels decline. If you had a fatty liver, it would most likely begin to clear up.

What could you substitute that would be healthier? Berries, fresh or frozen, any type, and you could even put a tablespoon of whipped cream on them. The antioxidants and phytonutrients would be better than the refined sugar; fruit sugar is processed differently, so it would not affect your blood sugar. Second choice would be citrus, and third would be apples.

If you’re considering giving up something for the next 40 days or so, make sure it’s something you really enjoy and eat regularly. Paula has a friend from Montana whose father, years ago before every food was available year round, gave up watermelon every Lent. It has to be meaningful.

What are you prepared to do today?

 

Dr. Chet

 

How New and Expectant Mothers Can Be Healthier

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Complicated issues require complex solutions and the rise in maternal mortality rate (MMR) is complicated. Public healthcare policy and access to quality pre- and post-natal care is not directly in our hands; legislative public heath policies take time and not everyone agrees on what should be done. But a mother’s health is in her hands to some degree. What can she do to put the odds in her favor to have a healthy baby and protect her body for the long term?

Lose weight if necessary. Obesity carries with it an increased risk of high blood pressure and prediabetes. Even a 10% loss in weight may help her body withstand the stresses that pregnancy and childbirth bring. Obviously losing weight while pregnant is a delicate dance; it’s crucial to emphasize complete nutrition while minimizing calories.

Improve her fitness level. When you look at the physiological causes of MMR, close to 50% could be attributed to cardiovascular or metabolic issues such as prediabetes and hypertension. The more fit a woman is before she becomes pregnant, the lower the risk of those conditions.

Address issues during pregnancy such as gestational diabetes and preeclampsia seriously. They can impact a woman after she gives birth and contribute to increased bleeding, dangerously high blood pressure, and other cardiovascular issues. She should follow her physician’s recommendations for lifestyle and medications to address the issues.

Finally, a woman should know as much as she can about what to expect after childbirth. Not just taking care of the baby, but how to take care of her body, and the warning signs that something may not be right. When in doubt, check it out; better an unnecessary phone call than an unnecessary health crisis.

Let’s be practical. The MMR is rising but the risk is still very low at about 21 out 100,000 births in the U.S. If a woman does all she can to take care of herself before and after she gives birth, not only will it reduce the risk of MMR, it will result in healthier babies and mothers as well. That alone is worth the effort.

What are you prepared to do today?

Dr. Chet

 

References:
1. Obstetrics & Gynecology: August 2017;130(2):366–373.
2. http://bit.ly/2BZ1pOx

 

Why Is the MMR Rising?

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Based on the trends of the past 15 years, the maternal mortality rate (MMR) is increasing. There doesn’t seem to be any single cause that can be identified as “the” reason. Having looked at the research, I think there are three categories that contribute to the increase in MMR.

  • Access to prenatal and postnatal healthcare is inconsistent. In short, we don’t seem to spend enough time teaching mothers how to have a healthy baby, and then we don’t follow the mom’s health as well as we should to make sure she stays healthy. No single reason stood out, but the factors that stood out are the closing of rural hospitals, race and ethnicity, and limited access to healthcare coverage.
  • Women are waiting to have children later in life. While that’s a personal decision and can be related to the economy of the 21st century, every year older raises the risk of complications.
  • Women who wait to have children have a higher rate of obesity; along with that come a higher rate of prediabetes, hypertension, and an increased risk of cardiovascular disease.

Those seem to be the contributing factors to the increase in MMR. The question is what can be done about it? I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. Beckers Hospital Review. December 2016.
2. America’s Health Rankings. 2016.
3. Obstetrics & Gynecology: August 2017;130(2):366–373.

 

The Rising Maternal Mortality Rate in the U.S.

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Paula recommended I read an article on maternal mortality rate (MMR). I had heard of the infant mortality rate but the MMR was new to me, so I dug into the details. This week, we’re going to take a look at the MMR, why it’s a cause for concern in the U.S., and what can be done about it.

The MMR is the number of women who die in the first year after childbirth. The problem is that there has been a rise in the U.S. MMR over the past 30 years from 7.2 women per 100,000 births to just over 26 per 100,000 births in 2015 (1). The MMR in the U.S. is moving in the wrong direction; other modern societies, such as Japan, the U.K., Finland, and Italy, have lowered their rates to fewer than five per 100,000 women. In Canada, deaths rose from six per 100,000 births in 1990 to 11 in 2013.

To use one of my favorite Vince Lombardi quotes, “What the hell is going on around here?” Why is this happening in the U.S.? The reasons are complicated, and that’s what I’ll talk about on Thursday. If you’d like to read the article that began this search for answers, check out the second reference.

What are you prepared to do today?

Dr. Chet

 

References:
1. Lancet 2016; 388: 1775–812.
2. http://n.pr/2EjqtvV

 

My Verdict on D3 vs. D2: A Draw

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The medical community and the health gurus agree, and the research appears to agree with them: vitamin D3 is better than vitamin D2. A no-brainer, it would appear.

No. My call at this point: it’s a draw. Here’s why.

The Current Research

The research on vitamin D and absorption is a mess. There’s little to no consistency. You saw the number and attributes of subjects, quantity of the supplemental forms of vitamin D, and the length of the studies. The bulk of the studies use therapeutic doses, 50,000 IU and up, to see how the forms of D are absorbed to treat serious deficiencies of vitamin D in people. Vitamin D2 has been used for treatment for decades that way and still is today.

It’s true, that vitamin D3 does increase blood levels of vitamin D more and it seems to last longer than D2. So what? This is not a medication, it’s a nutrient. Why would anyone stop taking it? What the research proves is that levels of both forms of D decline after a person stops taking the supplement. I could have predicted that without doing a single study.

The study that came closest to reality that D3 is better than D2 was the study on hip fractures—at least that lasted three months. The studies that last longer give higher doses, up to 500,000 IU in a dose, and see what happens over a year. Why? What will that tell you? No one takes supplements like that.

The Ideal Study

If I could construct a study, I would track a large group of people divided into a placebo group, a group taking vitamin D3 only, a group taking vitamin D2 only, and a group given half the dose each of D3 and D2. It would also use off-the-shelf dietary supplements; when researchers have specific products formulated that are not for sale, the resulting info is worthless to us as consumers. The dose should be reasonable such as 2,000 or 5,000 IU. Subjects should be followed for at least a year. Several variables should be checked regularly.

The Bottom Line

Based on my assessment of the current research, vitamin D3 is better absorbed and converted to active vitamin D than D2, but there’s no evidence that D2 is not effective or that it’s harmful—it’s been used nearly 100 years! In my opinion, it may require a third more D2 to equal D3 to get equivalent effectiveness. Other than that, if you want the vitamin D you take to be effective, the only thing you need to do is take it consistently.

The Super Bowl Webinar is tomorrow. Time to start getting rid of the body fat you’ve been wanting to lose.

What are you prepared to do today?

Dr. Chet

 

The Research on Vitamin D3 vs. D2

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One area that the medical field and the health gurus agree: vitamin D3 is better absorbed and utilized than vitamin D2. Four studies are constantly referenced when the best type of vitamin D is discussed (1-4); here’s a quick look at those studies.

Study 1: 4,000 IU vitamin D3 and D2 supplementation was given to 55 and 17 subjects respectively; the study lasted 14 days.

Study 2: 50,000 IU of each form of vitamin D was given to two groups of 10 men once; the men were followed for the next 28 days to monitor changes in vitamin D levels.

Study 3: 95 inpatients with hip fractures were randomly assigned to receive 1,000 IU of vitamin D3 or vitamin D2; the subjects were tracked for three months.

Study 4: 32 elderly women, split into groups of eight subjects, were given 300,000 IU of vitamin D3 or D2 orally or via muscular injection; they were monitored for the next 60 days.

The results from each study concluded that vitamin D3 was better than vitamin D2 at raising serum vitamin D levels. Is this the final conclusion that can be reached? Could there be questions that weren’t answered in these or any studies so far? I’ll let you know on Saturday.

If you really want to understand the ketogenic diet, join the Super Bowl Webinar in just three days. You’ll learn how it works and how it can work for you.

What are you prepared to do today?

Dr. Chet

 

References:
1. Am J Clin Nutr. 1998 Oct;68(4):854-8.
2. J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91.
3. Bone. 2009 Nov;45(5):870-5.
4. J Clin Endocrinol Metab. 2008. 93:3015-3020.

 

Vitamin D3 vs. Vitamin D2

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Many of you have questions about the different forms of vitamin D available in supplement form: vitamin D3, known as cholecalciferol, and vitamin D2, called ergocalciferol. Although they’re slightly structurally different, both have been used for years to help with vitamin D deficiency.

Vitamin D is necessary for bone health, of course, but research has found D to be related to other conditions such as depression, multiple sclerosis, and more. Vitamin D is a vitamin we can make ourselves when exposed to the correct ultraviolet radiation, but we shun the sun these days for a variety of reasons; both D2 and D3 are available in foods such as fish and dairy. Today getting a vitamin D blood test is commonplace; if it’s low, vitamin D will be prescribed by your physician, and of course you can buy vitamin D as a supplement.

Why the controversy about the form D3 or D2? Many Internet gurus and medical blogs from major health organizations claim that D3 is the only supplement you should use; D2 is not as good because it’s not as well absorbed and it can cost more.

What does the research say? What form should you take? We’ll find out this week as I review the research on both forms of vitamin D.

Remember, the Super Bowl Webinar is this Sunday. You don’t want to miss this one! All you have to lose is some fat.

What are you prepared to do today?

Dr. Chet

 

Do Fit People Live Longer?

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Will being fit help you live longer? Does the improvement to the respiratory, cardiovascular, and muscular systems result in an increase in longevity? Researchers in Austria did a thorough review of the science of fitness to find out.

They approached it in the same manner I would: review the systems involved and how aging affected them. Then find out how each system responds to exercise training. Finally, look at the diseases related to aging to see if fitness made a difference.

It would be great to say that they concluded that fitness impacts how long we will live, but at this point, there’s no conclusive evidence that it does. But what being fit can do is give you more life in each day. The systems’ response to exercise may not stop the Grim Reaper, but at least he will have to chase you to catch you.

The researchers focused on those systems directly related to fitness, but there are so many more benefits to your hormonal system, nervous system, digestive system, and more. You may not live a single second longer, but I believe you will live better every second you have—less time in the nursing home or hospital, and more time out doing what you want. And that’s definitely worth the time and the effort.

The countdown to the Super Bowl Webinar is at eight days. Whether you’re already very fit, restricted in the intensity you can exercise, or haven’t worked out in years, I’ll teach you how to lose more fat than any other program. Sign up today.

What are you prepared to do today?

Dr. Chet

 

Reference: Front Biosci. 2018. Mar 1;23:1505-1516.

 

How Long Does Fitness Last?

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Does exercise when you’re young have any impact when you’re older? That’s the question researchers sought to answer in a very unique study. They recruited men who competed in running events in the 1968 Olympics and evaluated fitness variables to see how they had changed since then. The subjects were tested in 1993 and retested in 2013. Did their fitness and cardiovascular measures decline at the same rate as their age would predict?

Maximal heart rate is calculated by subtracting your age from 220. There are formulas that make it a little more precise, but the shortcut is close enough for most purposes. At every retest, the runners measured max heart rate was significantly higher than predicted. The maximal amount of oxygen they used was also higher than would be expected for their age.

What does this mean? The fitness you attain when you’re younger can impact your fitness when you’re older. This study shows that there are some measures related to the cardiovascular system that can be sustained. You may never have trained like an Olympian, but even if you start later, the fitness you gain may yield benefits years later. Improving your fitness now will still pay dividends twenty or thirty years ahead when you may have more physical restrictions than you have now.

That raises another question: will being fit help you live longer? We’ll tackle that on Saturday.

If you want the best way to combine a change in your diet with an exercise program to maximize fat loss, no matter what your current fitness level may be, make sure you sign up for the Super Bowl Webinar.

What are you prepared to do today?

Dr. Chet

 

Reference: Med Sci Sports Exerc. 2018 Jan;50(1):73-78.

 

How Chromium Conflicts with Levothyroxine

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In the recent series of Memos on thyroid issues, I explained what you need to know about levothyroxine, the medication prescribed for an underactive thyroid gland. New research highlights a key factor in ensuring its effectiveness.

Researchers examined a dietary supplement to see what impact it would have on absorption of levothyroxine. They found that chromium picolinate reduced the absorption of the drug in subjects who took a high level of levothyroxine.

If chromium picolinate, typically used in weight loss supplements, interferes with high levels of the drug, it could impact lower doses even more; less would be available to be absorbed. If not as much of the drug is absorbed, it will not be as effective.

If you’re trying to lose weight, the last thing you want to do is lower your metabolic rate, so what should you do if you take both levothyroxine and chromium? The researchers recommended that people taking the medication be warned to take it at a different time from the supplement; four hours is the time frame. Take your levothyroxine as soon as you get up—that’s when you should be taking it anyway—and begin the supplement with lunch and throughout the rest of the day, depending on how much you take.

What are you prepared to do today?

Dr. Chet

 

Reference: Thyroid. 2007 Aug;17(8):763-5.