Tag Archive for: cardiovascular disease

Body Fat: Location Matters

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Last week, I mentioned in passing that a hippopotamus has less body fat than most humans. Since then, I’ve wondered exactly how little body fat they had. By several estimations, it’s around 5%—about the same as elite soccer players. That’s not enough fat to cause the hippo health problems as we see in humans; they have a thick skin and a bad disposition to boot. What they also have is a lot of muscle.

I was reminded about the differences between visceral and subcutaneous fat. Subcutaneous fat is found underneath the skin and seems to be more a storage facility for fat. Visceral fat is the worst type because it’s packed in and around our organs like the liver, kidneys, and intestines. It’s also metabolically active and not in a good way. It causes the release of inflammatory hormones which contribute to all sorts of diseases such as cardiovascular disease, type 2 diabetes, and cancer. But is it hazardous for every person who is obese, even morbidly obese? I’ll let you know on Saturday.

Tomorrow is the Insider Conference Call. Without realizing it, I picked a day where many readers have another important teleconference that they want to attend. The Guest Pass is still a great option because you can watch the replay at your leisure, and if you send your questions before the meeting begins at 9 p.m. Eastern Time, I’ll answer them as well. It’s an opportunity to double your education investment that can help your business and your health. I hope you’ll join me.

What are you prepared to do today?

        Dr. Chet

Clock-Changing Solutions

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We’ve become so obsessed with sleep, even our watches can track the amount of quality sleep we get, so we can expect something unusual tonight. We go to bed at our usual time and for most of us in the U.S., we wake up one hour earlier than planned because the clocks have changed. As someone who adapts to sleep changes well, I empathize with those who don’t. Here are a couple of solutions I’ve found, one societal and one personal.

Don’t Change the Clocks

Researchers from Stanford undertook a very complicated theoretical study. By using county solar light patterns, time policy, and health data with circadian models, they calculated the relationship of those variable conditions and diseases. Let’s just say this would be impossible without the number crunching ability of today’s computers.

What they found was that a shift to Standard Time year-round would decrease the occurrence of stroke and obesity. A permanent shift to Daylight Savings Time would also decrease the occurrence of stroke and obesity as well, although not to the same extent. It should be noted that the impact was dependent on both latitude and longitude of people within the time zone.

How big of an impact? With Standard Time it could potentially reduce the risk of obesity by 0.78% and the risk of stroke by 0.09%. Not a big deal? Based on the current population, that could mean a reduction of the cases of obesity by 2.6 million cases and 300,000 cases of stroke per year in the U.S. While this is an emotional as well as political land mine for many proponents and opponents of time changes, this is one variable that deserves consideration.

Naps

Getting some additional sleep, even as little as a 20-minute nap, can be beneficial. Researchers in Greece found that people who took a nap in the afternoon had a lower rate of death from cardiovascular disease (CVD). How much lower? 37%!

This was confirmed by a study published last month suggesting that naps under 30 minutes reduced CVD outcomes—however, naps longer than 60 minutes increased the risk of CVD events. Speculation was that long naps interfered with nighttime sleep patterns.

The Bottom Line

We all look for an easy way to reduce our risk of heart attacks. Sometimes, the simplest solution is the correct one, and you can’t get much simpler than sleep. It can be challenging to fit in a nap during the day, but if you can do it, it may help you to be more effective in what you’re doing and lower your risk of cardiovascular disease and possibly other diseases as well. As for a permanent switch to Standard Time for more early sunlight? That will be open for debate, so we have to do what we can control.

What are you prepared to do today?

        Dr. Chet

References:
1. https://doi.org/10.1073/pnas.2508293122
2. Arch Intern Med. 2007 Feb 12;167(3):296-301. doi: 10.1001/archinte.167.3.296
3. Pub Health Rev. 2026. doi: 10.3389/phrs.2026.1609013.

Warning: Spring Ahead

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This coming weekend, the clocks are moved ahead one hour in most states here in the U.S. This seems to impact some people more than others; our bodies are more sensitive to the effects of changing sleep patterns than we think. I first wrote about this 10 years ago, and I wanted to check to see if anything has changed.

In a 2008 study, Swedish researchers found that when the clocks are turned ahead one hour in the spring, the number of heart attacks increase on the following Monday and stay elevated above the mean for the rest of that week. This was confirmed in a 2020 study that examined the same question in a larger population of Swedish and U.S. citizens.

What about the opposite situation? In the fall after the clocks are turned back, the number of heart attacks goes below the mean for the following week. One hour—that’s all we’re talking about, and it has a profound effect for about 1% of the population. Does one percent sound like no big deal? That’s over 3.3 million people who could be impacted over the next couple of weeks.

Is there a solution to this? I’ll let you know on Saturday. In the meantime, perhaps going to bed a few minutes earlier every night until then may help.

What are you prepared to do today?

        Dr. Chet

References:
1. NEJM. 2008. Oct 30;359: 1966-1968.
2 Arch Intern Med. 2007 Feb 12;167(3):296-301.
3. https://doi.org/10.1371/journal.pcbi.1007927

Brain Boon, Not Brainrot

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Maybe you’ve been hearing about brainrot; if you have a kid in the house, the odds go way up. My point in mentioning this is to suggest that peanuts don’t contribute to brainrot, but may be a brain boon as I talked about on Tuesday. The question was why?

Nutrients May Hold the Key

Peanuts, as well as other nuts, are high in the amino acid l-arginine. Nitric oxide (NO) increases dilation in blood vessels which help blood flow everywhere but especially to the heart and the brain. We usually associate nitrates from vegetables with that process, but there’s another pathway which uses arginine to increase NO levels as well. That could explain the increases in blood flow to the areas of the brain. The increase in NO could also partially explain the reduction in systolic blood pressure.

In addition, the fiber in peanuts, the antioxidant properties found in the peanut skin phytonutrients, and replacing saturated fats with unsaturated fats may also have an impact on blood flow. The peanut skins contain resveratrol, a phytonutrient that has shown promise in reducing cardiovascular disease in general.

Carbohydrate intake increased while fat decreased during the eating-peanuts phase of the study. One of the key findings was that the unsaturated fats in the nuts replaced some of the saturated fats in the diet. Overall, the peanuts were beneficial.

Limitations with Hope

This was a small study with essentially healthy older adults; how that might work for people with disease must still be tested. The cost of the methodology using special MRI analytics limited how many subjects would be realistic to study, but there were at least some benefits in every category they tested. This shows that modifying the diet in just one area may be a step toward improving your health. There’s no reason not to try eating peanuts (unsalted or lightly salted is preferable) to see how it impacts us personally.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.clnu.2025.10.020

Melatonin: Stay the Course

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As we continue to examine the results that appeared to suggest that the chronic use of melatonin in people diagnosed with insomnia could result in an increased risk of a diagnosis of heart failure, heart failure hospitalizations, and death from all causes, let’s put the unreviewed abstract in perspective. One correction from Tuesday. The researchers did not track the subjects for five years; the gathered data from the past five years. That’s an important difference

The simplest way to is to convert the percentage of risk into real percentages. The study reported that the risk of developing heart failure was over 90%. That’s true, but it’s based on the percentage of insomniacs that didn’t use melatonin at 2.7% versus 4.6% in those that did use melatonin. The same logic was used for hospitalizations (19.0% vs. 6.6%), and mortality (7.8% vs. 4.3%). It still seems like a significant risk, but there’s one more number that’s important: the total number of subjects in the study.

Insomnia: The Numbers

In the United States, the average number of adults that are diagnosed with insomnia is 12%. With 268 million adults in the U.S., that means that 32.2 million people have chronic insomnia. The percentage diagnosed is about the same in all high-income countries around the world. The researchers used a database that claims to have 150 million de-identified electronic medical records in its database, so how did the number of subjects get to only 120,000? It should have been at least 15 million.

Yes, the subjects were matched for a variety of criteria including age, gender, medications, and other factors but still, that’s an awful lot of lost subjects. Even without the diagnosis of insomnia, other diagnoses such as depression and other mental health diagnoses result in insomnia. They can also predispose people to heart failure as well. Those subjects would also have been lost.

The most significant information that was not collected was any data on over-the-counter melatonin use. To their credit, they do cite that as an issue, but there are no data as to how much melatonin was actually used by the subjects who took melatonin. There’s no record of melatonin use by people in the non-melatonin group if they didn’t report it as a supplement they use to their physician. There are more questions, but that’s enough to call the results into question.

The Bottom Line

Perhaps after the peer-review process, the data collection will be more clear. But as for right now, the best thing that could be said is that they distributed a great press release that caused a lot of concern. But as for actual research evidence? There’s no reason to modify melatonin use at this point. However, it’s always a good idea for you to report any supplements you’re taking to your healthcare provider.

What are you prepared to do today?

        Dr. Chet

Reference: American Heart Association Scientific Sessions 2025, Abstract MP2306

Melatonin: CVD Risk?

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Medical conferences are always a great source of controversy; studies are presented that haven’t been peer reviewed but have great press releases to advertise them. The American Heart Association met last week, and the Scientific Sessions didn’t disappoint. The abstract that caught my attention was based on an analysis of a large database of subjects from a variety of countries that demonstrated that melatonin used to treat insomnia could lead to an increased risk of cardiovascular disease (CVD) and hospitalization.

Researchers chose subjects who were diagnosed with insomnia and took melatonin for at least a year based on their medical charts. They were matched with control subjects on a variety of characteristics including age, height, weight, and many more variables, who were also diagnosed insomniacs but did not report melatonin use. They were tracked for five years.

The abstract stated that there was a 90% greater risk of CVD diagnosis in the melatonin group. Further, there was a 350% increased risk of being hospitalized in the melatonin group and a 100% increased risk of dying from all causes as well.

Is it time to throw out the melatonin? I’ll give you some perspective on this study on Saturday.

Tomorrow night is the Insider conference call and, wow, there is a lot to talk about! If you become an Insider by 8 p.m. tomorrow night, you can join in on the call. Protein intake. Creatine. Bike paths and medical costs. And even more.

What are you prepared to do today?

        Dr. Chet

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.