Tuesday, June 9, 2020

Serve others, live longer!

Are you interested in life extension strategy that doesn’t involve drugs, diet, or exercise?  Look no further than volunteering!  There is a large amount of observational data to suggest that those who volunteer live longer lives than those who don’t, lowering their mortality risk by approximately 20%. [1]

While this has been a relatively consistent finding in medical literature, it’s based on observational studies, which means that critics point out the many different variables and features of those that volunteer that may account for this difference.

 I would respond to this in two ways:

  1. The critics may be partially correct.  However, if those who volunteer have features that confer longer life outside of the act of volunteering itself, we should be trying to get some of those features.  “Success leaves tracks” as the saying goes, and spending time with those who will likely live longer may rub some beneficial traits off on us!
  2. The second response would be that there seems to be data that indicates that volunteering in and of itself DOES independently increase our life span.  A 2017 study followed 300,000 married people, and compared partners who volunteered with their spouse who did not, with the thought that following a married partner might account for some of the confounding variables (socioeconomic status for example).  At the end of three years, those who volunteered lowered their mortality risk by 22% (women) and 23% (men) compared to non-volunteers.  Their spouses who did not volunteer had no improvement in mortality.  The study concluded “This study provides further evidence that the lower mortality associated with volunteering is unlikely to be due to health selection or to residual confounding arising from unmeasured selection effects within households. It therefore increases the plausibility of a direct causal effect.” [2]

My recommendation:

Volunteer a few times per month (more if able) to help those in need or for a cause you believe in.  You will be helping make the world a better place, and you may just live longer because of it.  “Everyone can be great, because anybody can serve” – Martin Luther King Jr.

Traditional avenues for volunteering may be limited for the moment, but there are plenty of D-I-Y workarounds: bring a meal to a friend, do yard work for someone who needs help, offer to take a neighbor’s dog for a walk, go shopping for someone who isn’t able to, send a cheery note or make a phone call to someone who lives alone…the possibilities are limitless!

David Ellis MD

[1] Jenkinson C.E. et al. BMC Public Health 2013;13:773

[2] O'Reilly D. et al. Int J Epidemiol 2017;46(4):1295‐1302

Tuesday, June 2, 2020

Less hot, less sweaty: In defense of longer, slower exercise

Even though Dr. Hassell, my practice partner, frequently encourages the “breathless and sweaty” elements in exercise, a longer-duration, slower-pace approach to exercise also has proven benefit and may be right up your alley.  The important thing is that you make the time for it: as a medicine, other than perhaps optimal diet and sleep, exercise is without equal – especially when there’s a consistent pattern of activity.  It is also a profoundly important predictive factor: low peak exercise capacity has been shown to be a stronger predictor of increased risk of death than other traditional risk factors including hypertension, smoking, diabetes, and obesity [1]. 

Most people understand exercise as a stress that you willingly (or unwillingly) place on your body in order to gain a positive response.  Many patients are concerned that if they aren’t feeling tired, hot, and sweaty, they simply aren’t working hard enough for such a response to be beneficial.  While intensity is an important component of exercise (and there are specific benefits to be obtained from intense exercise that cannot be replicated elsewhere), exercise with longer duration and less intensity has significant value and should not be discounted.  Specifically, continued movement for >45 minutes at a pace that consistently elevates your heart rate but leaves you able to talk comfortably in complete sentences has been shown to improve rates of angiogenesis (new blood vessel formation) [2], equivalent improvements in VO2 max (the gold standard measurement for aerobic capacity) [3], and perhaps most applicably, higher rates of enjoyment [4] than more intense interval efforts.

My recommendation:
Exercise every day, but don’t let perfection be the enemy of progress.  If you aren’t ready to consistently get out of breath and sweaty in your pursuit of health, and would otherwise forego exercise due to lack of perceived value, rest assured that longer duration, lower intensity exercise is still a massive boon to your health and should be pursued with vigor!

David Ellis MD

[4] Foster, C. et al. J Sports Sci Med 2015;14(4):747–55

Wednesday, March 25, 2020

COVID-19 strategy: Build immunity in your kitchen!

It’s easy to feel helpless while we wait for an effective treatment for COVID-19 or any other infection, but look at it this way: better health through home cooking has never been more convenient!  The kitchen is the best place to work on strengthening the immune system, and it just so happens that most of us have some extra time right now.  We also all have some adjustments we can make to our food and activity choices to boost our immunity and lower our risk factors, and preparing our own meals from scratch is one of the most powerful single adjustments we can make.  Choose from a wide range of whole foods, culture a healthy intestinal tract (“gut microbiome”), avoid refined carbohydrates and sweet drinks, get daily exercise, and schedule 7-9 hours of sleep at night: these steps all help our immune systems beat back bad bugs.  You’ll find a prescription for improving immunity and reducing inflammation on pages 22-23 of Good Food, Great Medicine (4th edition).  By the way, type 2 diabetes and high blood pressure are both associated with weakened immunity, and the steps to boost immunity are the same ones you would take to reverse these two conditions: simply treating them with medications does little to improve immunity. For a 14-step plan to reverse type 2 diabetes and high blood pressure, turn to the Risk Reduction Action Plan on pages 90-110. The best time to start is now!

My recommendation:
We’ve talked about what to do, so now let’s talk about putting it into action.  Grab your copy of Good Food, Great Medicine and turn to the section called Practical Eating (pages 111-150): it’s full of tips on shopping for ingredients and equipment, menu planning, meal suggestions, and cooking.

Miles Hassell MD 

Tuesday, March 24, 2020

COVID-19 strategy: Fitness is hygiene for your immune system

Some patients have told me that they can’t work out because their gym is closed.  Pre-COVID-19, this can’t-work-out syndrome was blamed on other factors (time, weather, bad knees, and so on) but it simply represents a fundamental misunderstanding of exercise.

The fact is, exercise is another form of hygiene; a self-care activity to improve immunity, reduce inflammation, help prevent unnecessary disease, and improve our quality of life.  We brush our teeth twice a day, so we can take two minutes to exercise twice a day!  Like any important act of hygiene, exercise can be done in any scenario.  Don’t get me wrong – gyms are great: lots of extra equipment, often a fun atmosphere, and good social interaction.  However, what about when the gym is closed? 

My recommendation:
Do whatever it takes to be able to exercise under any circumstance.  Love lifting weights?  Buy some – or use something you already have, like a couple of milk jugs filled with water.  Can’t live without the rowing machine at the gym?  Get one and put it in your living room – or achieve the same results with simple resistance bands.  Favor minimalism?  Get a jump rope, medicine ball, and pull-up bar, throw in some jumping jacks, go for a brisk walk outside. . . there are virtually endless home work-out options if we just get creative.  (For more ideas, see Let’s Move More! on pages 70-74 in Good Food, Great Medicine, 4th edition.)  Exercise is too important to be neglected at a time like this.  It’s another form of hygiene: let’s treat it like one!

David Ellis MD

Thursday, March 19, 2020

COVID-19: Another reason to reverse your diabetes and high blood pressure

As the COVID-19 pandemic continues to unfold, people tend to focus on their acute risk factors, behaviors, and interactions to avoid exposure.  This make good sense from an individual and public health perspective, but we need to be equally aggressive in pursuing habits and lifestyle changes that will improve not only our overall immunity and strengthen our natural defenses against COVID-19, but also improve our quality of life and longevity.  This approach is especially needed for those with type 1 and type 2 diabetes and high blood pressure.

Many view diabetes as an independent disease of the endocrine system that only encompasses blood sugar and vascular concerns; however, the immune system implications are profound.  Unfortunately, this may be particularly true in the case of coronavirus susceptibility.  In a recent article in Lancet Respiratory Medicine, [1] the authors hypothesized that a specific enzyme elevated in people with diabetes or high blood pressure, as well as those on ACE inhibitor blood pressure drugs, may increase their susceptibility to coronavirus.  Here is the relevant quote for those interested in the technical details:

“Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.  The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs)… These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19.”

This isn’t to suggest that you should stop taking ACE inhibitors: these medications have benefits that are carefully considered by your doctor and sometimes necessary depending on your disease process.  It DOES, however, remind us of the fact that diabetes, and probably high blood pressure, are major risk factors for impaired immunity, and every effort should be taken to vigorously pursue lifestyle measures to reverse type II diabetes and high blood pressure. 

This is a challenging time for our nation and our local communities.  We need to be in a position to help care for our most vulnerable, and that starts with taking good care of ourselves.  As always, Dr. Hassell and I are available (largely via telehealth right now) to advise you in these efforts and answer any questions you may have.

My recommendation:
For a comprehensive plan to reverse type 2 diabetes and high blood pressure, the Risk Reduction Action Plan on pages 90-108 of Good Food, Great Medicine (4th edition) is a good place to start.  You can also download the following evidence-based lifestyle handouts at goodfoodgreatmedicine.com/resources/resources.htm

  1. An Evidence-based Guide to Successful Waist Loss and Preventing or Reversing Insulin Resistance and Type 2 Diabetes
  2. Control High Blood Pressure
  3. Cold and Flu
  4. Concerned about Coronavirus?  

David Ellis MD

Wednesday, March 4, 2020

Are you concerned about the Coronavirus (Covid-19)?

If you are, it’s not surprising, considering the relentless play-by-play news coverage.  It is too early to know what level of concern is justified, but the next couple of weeks will probably tell us.  Flu viruses typically wane rapidly in March, so normal seasonal factors could throttle this outbreak before it gets a foothold here in North America.  In the meantime, there are simple steps we can all take to build up our immunity, not just to protect us from a flu virus, but also from most other preventable disease.  These steps will even reduce your risk of premature cancers, heart disease and stroke, type 2 diabetes and pre-diabetes, dementia, and depression.

Our recommendation:
As well as the usual flu-fighting precautions (hand washing, coughing protocol, and so forth), these nine steps will help develop and maintain a robust and fighting-fit immune system.

1. Eat at home!  Prepare your own food from scratch where possible.  Processed foods are associated with worse health outcomes, while homemade whole foods are associated with better immunity.  Include vegetables or whole fruit, protein, and healthy fat with every meal and snack.  (See Good Food, Great Medicine 4th edition for ideas: pages 134–150.)

2. Minimize sugars, sweet drinks, fruit juice, and refined grains. These high starch/high carbohydrate foods contribute to abnormal sugar metabolism, including type 2 diabetes and prediabetes.  Type 2 diabetes, in turn, is associated with depressed immunity and vulnerability to severe complications from influenza and a host of other maladies.

3. Eat high-quality protein.  Your immune system runs on protein, so make sure you include beans, whole grains, fish (especially oil rich fish such as salmon, herring, sardines and tuna), poultry, eggs, cultured dairy (yogurt, kefir and cheese), and unprocessed meat (beef, lamb, and pork).

4. Culture a healthy microbiome, a diverse range of good bugs in your intestines (gut).  Your microbiome is dependent on eating a wide range of whole foods to "feed" your gut, of which whole grains may be the most important.  Eat cultured foods such as plain yogurt and kefir, and traditional fermented foods like fresh sauerkraut -- but remember that most whole foods are also loaded with probiotics.  Apple cider vinegar (1–2 tablespoons per day in salad dressing or in a glass of water or sparkling water) also helps the microbiome.  We recommend that you do not take probiotic supplements: they can actually have a harmful effect by narrowing the diversity of the gut bugs.

5. Exercise! The contribution of exercise to immunity and overall health is poorly appreciated. Need antioxidants?  Exercise!  Need anti-inflammatories? Exercise! Want to cut your risk of influenza? Exercise! Want to reverse your type 2 diabetes or type 2 diabetes? Exercise!  Many exercise recommendations exist: include something two or three times a day, even if only for 5–10 minutes each time, upper and lower body, and get a bit short of breath and sweaty. Skip rope, climb stairs, go for a brisk walk, toss a medicine ball, use a rowing machine. . . find something that works for you.

6. Sleep is an essential nutrient our bodies can’t store, and is restorative to every aspect of our immune systems.  Schedule 7 – 9 hours nightly, especially if you’re concerned about getting sick.

7. Heat, as in regular deep hot baths (for 15–30 minutes daily) or saunas (5–10 minutes a few times per week) seem to improve cardiovascular risk, mood, blood sugar, and help with weight management.  The important factor may be the transient increase in core body temperature activating the immune system.

8. Sunlight seems to boost the immune system, too.  (Admittedly, here in Portland it is not a dependable source for much of the year; for other sources see our handout Calcium, Vitamin D, and Osteoporosis.)  We recommend a few minutes (5-15) of direct, non-burning midday sunlight on sunny days, with as many square inches of skin exposed as possible, without sunscreen.  This helps produce vitamin D and probably many other metabolic benefits.

9. Finally, consider cutting back on screen time: it not only makes it harder to do the previous 8 steps, but it also exposes us to an unhealthy level of news about the Coronavirus!  

What if you do get the flu, or symptoms that you suspect could be the coronavirus? 
It would probably be wise to contact your physician, especially if you are in a high risk group due to your health history, known exposure, or recent travel to a high-risk area.  Meanwhile, read our Cold, Flu, and Sinusitis handout for treatment tips, useful information about natural remedies and pharmaceutical options – and even recipes! 

More resources 
For more immune-boosting ideas and recipes read Good Food, Great Medicine 4th edition, especially the prescription on pages 22–23.  For more information about the flu, a couple of online resources are: uptodate.com/patients and cdc.gov.

Miles Hassell MD

Wednesday, May 22, 2019

Live longer, avoid cancer, and lose weight: research shows that making your own food may be your most important decision

Living longer and feeling better is often a matter of which food we eat when we’re hungry – and it looks like we’d be all be better off if we stop choosing commercially-processed food.  This includes those convenient ready-to-eat protein bars, heat-and-eat meals, and food from restaurants or grocery store delis.  Multiple studies show commercially processed food to be associated with increased weight gain [1], a shorter life [2], and more cancer [3].  In one of the most recent studies [1], participants were randomized to either a diet of unprocessed food or a diet of highly-processed food: both diets were matched for calories, sugar, fat, fiber, and other major nutrients.  Those eating the highly processed foods gained weight over the period of the study, while those eating unprocessed foods lost weight; although they were offered the same amount of food, they apparently simply ate less.  There appears to be many reasons why processed foods cause more harm (see pages 59–61 of Good Food, Great Medicine, 4th edition), including chemical alterations during processing, additives, calorie density, and less appetite suppression.  The fact that those eating less processed foods were also more likely to be at lower risk of common diseases is a bonus worth considering!
My recommendation:
For optimal health, one of the best decisions we can make for ourselves and our family is to prepare our food from scratch as much as possible.  It takes some extra time, but the rewards are unbeatable.  Get together with family and friends and make home cooking a part of your life.  Bring a lunch to work.  Keep snacks simple and homemade, and put together a repertoire of easy dinners.  Teach children how to help in the kitchen when they’re young and cook when they’re older.  There are lots of meal planning ideas, recipes, and snack suggestions in Good Food, Great Medicine, pages 134–146.  Call our office at 503.291.1777 to sign up for a disease reversal class or schedule an appointment for a one-on-one medical consultation (goodfoodgreatmedicine.com).

Miles Hassell MD

[2]Schnabel, L. et al. JAMA Intern Med 2018; doi:10.1001 (NutriNet-Santé Study)
[3]Fiolet, T. et al. BMJ 2018;360:k322 (NutriNet-Santé Study)