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

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

[1] Myers, J. et al. N Engl J Med 2002;346:793-801

[2] Van Pelt, D.W. et al.JAppl Physiol (1985) 2017;123(5):1150-9

[3] Hwang, C.L. et al. ExpGerontol 2019;116:46-53

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

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 (4^th 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 

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, 4^th 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

[1]Zhu, W. J Sport Health Sci 2020;105-7 doi: 10.1016/j.jshs.2020.01.005

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 (4^th 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

[1] Fang, L. et al. Lancet Respir Med 2020;doi: 10.1016/S2213-2600(20)30116-8

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 4^th 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 4^th 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

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, 4^th 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

[1]Hall, K. et al. Cell Metabolism 2019;30:1-11

[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)

Good bugs for a better mood

Want a better mood – with less help from drugs?  Try increasing the good bugs in your GI tract!  The mechanism for benefit may be the ability of your gut microbes to produce butyrate, a short chain fatty acid with a wide range of metabolic effects, including strengthening the epithelial defense barrier [1], a layer of cells that line the gut to resist invaders like toxins and bad bugs.  In fact, it is increasingly evident that a healthy gut microbiome is also associated with a multitude of other health benefits such as better weight management, less cancer, diabetes, heart disease, and more.  Now that should help improve your mood!    

My recommendation:

There are many non-drug options for treating depression and anxiety, including targeted diet therapy, fitness, weight management, light exposure, and heat therapy; this study adds powerful support for eating more probiotic foods such as plain kefir and yogurt (meaning unsweetened, with milk and active cultures as the only ingredients) as well as foods like salt-cured sauerkraut and kimchi for a healthier gut microbiome and mood.  Although there is a subgroup that does very well on medications, be aware that the lifestyle prescription on pages 23-24 of Good Food, Great Medicine (4^th edition) is arguably more powerful medicine.  For more on how and why to choose probiotic foods, see page 49.    

Miles Hassell MD

[1] Valles-Colomer, M. et al. Nat Microbiol 2019; Feb 4: doi: 10.1038 (Flemish Gut Flora Project)

Joint steroid injection? Think twice…

There are ongoing concerns that steroid injections for painful knee osteoarthritis [1,2] may have the negative effect of accelerating joint breakdown while having no benefit – including for pain control – compared to placebo injections.  This is in addition to data showing that even short-term steroids (as well as other anti-inflammatory medications) have significant potential for harm to overall health.

My recommendation:

This is an area of legitimate debate; however, given both the uncertainty regarding the benefit and the potential harm, I strongly recommend that patients exhaust all other options before having steroid injections.  The alternative is a plan that includes meticulous attention to diet, weight, blood sugar management, appropriate exercise, and topical or oral pain medications.  There are some nutritional supplements that may help, and targeted physical therapy can make an enormous difference.  Occasionally I use lidocaine injections without steroids and see excellent results.

Keep the most important goals in mind: less pain and improved function in the short term, and avoiding further joint breakdown or joint replacement in the long run.  Make sure you have all options in view.  (See my 5/1/2017 blog post on corticosteroids for more information about short-term oral steroids.)

Miles Hassell MD

[1] Zeng, C. et al. Osteoarthritis Cartilage 2019;Jan 29: doi: 10.1016

[2] McClindon, T. et al. JAMA 2017;317:1967-75

High vitamin D supplementation may be harmful, even if blood level of vitamin D is low

Vitamin D deficiency is common, but a review [1] of hundreds of well-done studies suggests that vitamin D supplements are generally not helpful for problems other than bone health and respiratory illness.  Current data suggest that:

• In most circumstances we should not take more than 1,000–2,000 units of vitamin D3 daily
• Blood level of vitamin D should be about 20-40 ng/ml; higher levels are associated with harm

The authors of the review point to evidence indicating that low vitamin D levels are the consequence, not the cause, of ill health.  This is particularly concerning in light of the evidence that high blood levels of vitamin D seem to increase risk of death, falls, and cancer.  

 

My recommendation:
Get vitamin D through natural sources rather than supplements.  A blood level of 20–40 ng/ml is a reasonable target, but I only recommend supplementing with 1,000–2,000 IU of vitamin D3 daily if you are not able to get enough vitamin D from natural sources like oil-rich fish (salmon, tuna, sardines, etc.) and non-burning sunlight on as many square inches of bare skin as is socially acceptable.  Mushrooms which have been exposed to ultraviolet light for a few hours may emerge as another useful vitamin D supplement.  Despite decades of research it is still not known if taking vitamin D supplements will provide the same benefits, or if people who naturally have higher blood levels of vitamin D are healthy for some other reason.  For more detail and some useful general resources on nutritional supplements, see page 89 of Good Food, Great Medicine, 3^rd edition – and then check out Salmon Cakes (page 227), Tuna and White Bean Salad (page 232), and Sardine Pâté (page 152) for a few of our favorite ways to improve vitamin D levels! 

Miles Hassell MD

 
[1] Autier, P. et al. Lancet Diabetes Endocrinol 2017;5:986-1004

Drinking coffee is healthy everywhere – except in California?

The California court system has ruled that coffee retailers must warn consumers about small amounts of acrylamide (a naturally-occurring substance widely present throughout the food supply) in roasted coffee beans.  Like many compounds found in everyday foods, it has been shown to cause cancer when given (1) to animals at high doses, and (2) in isolation, conditions not present with humans drinking coffee.   An analogous argument would lead to a ban on apples, because apples contain cyanide (they really do!).  The fact is that people who drink coffee appear to be significantly healthier than those who do not, with less risk of heart disease, atrial fibrillation, diabetes, dementia, depression, respiratory illness, and all-cause death.   

My recommendation:

1. Continue drinking coffee but skip added sweeteners and commercial milk substitutes.  (For details on the health benefits of coffee see pages 36-37 of Good Food, Great Medicine – 3^rd edition.)
2. Be wary of recommendations using reductionist arguments that don’t stand up to scientific evidence or critical thinking.  We need be able to counter irrational judgments with thoughtful reasoning – our health depends on it.
3. Eat an apple with your coffee – it helps keep the doctor away!

Miles Hassell MD

Let’s stay healthy, strong, and independent as we age by making good food and activity choices today

A 2017 British study looking at the impact of a good diet on our physical performance confirms again that eating more vegetables, whole fruit, and whole grains -- and less processed foods like white bread, added sugar, and processed meat -- not only improves overall current health, but also dramatically improves our physical and mental strength, balance, agility, and vigor as we get older.  This naturally leads to fewer broken bones and greater independence.

My recommendation:

The food choices mentioned in the study fit the pattern of a whole food Mediterranean diet, which has consistently been shown to be beneficial for healthy aging – a high consumption of vegetables and whole fruit, whole grains, beans, good fats like extra-virgin olive oil, eggs, unprocessed meat, and moderate alcohol.   Whole food sources of protein, vitamin D, and antioxidants have been associated with improved muscle mass, strength, and physical performance in older age.  The benefits?  Less frailty and more independence, with a healthier brain and joints at every age.  For more information and sources on graceful aging, see pages 15-16 in Good Food, Great Medicine, 3^rd edition.       

Miles Hassell MD

 
[1] Robinson,S. et al. J Gerontol A Biol Sci Med Sci 2017;00:1-6

Want to reduce weight or diabetes risk? Chew slowly!

This is science speaking, even though it sounds a bit like something our mothers might say!  A study of 1,083 Japanese men and women comparing fast, normal, and slow eaters was presented at the American Heart Association’s Scientific Sessions in 2017. [1] The study found that fast eaters had:

• 5 times more new-onset metabolic syndrome than slow eaters
• increased waist circumference and overall weight
• higher blood glucose levels
• lower levels of good HDL cholesterol

Also, the fast eaters in the study reported eating dinner 2 hours before sleeping and snacking after dinner, both high-risk habits for weight gain.  Previous studies have confirmed these findings, so this isn’t new news.  When we spend more time chewing our food, we feel satisfied sooner – the stomach takes about 20 minutes to get a message to the brain that we’re full. 

My recommendation:

Chewing our food slowly is definitely a good idea for both weight management and overall health.  It’s also a good idea not to drink your calories, and there are at least two reasons for this:

1. Chewing is an important first stage of the digestion process, so it also benefits gut health
2. Concentrated liquid calories like smoothies and juice can be a weight and blood sugar trap, even when made from whole foods

Eating a whole food Mediterranean-style diet with plenty of vegetables, fruit, beans, nuts, whole grains, and unprocessed meat naturally requires more chewing.  On the other hand, the more foods are processed, the smaller their particle size, and the faster we can eat them.  To read about other reasons to avoid processed food and liquid calories, see pages 9 and 74-75 in Good Food, Great Medicine, 3^rd edition. 

Miles Hassell MD

[1] Yamaji, T. et al. November 2017 American Heart Association Scientific Conferences Poster Presentation M2043 Session:  LB.APS.07

Low-tech choices beat high-tech treatments for keeping our tickers ticking: study shows coronary artery stent no better than placebo for stable angina

A 2018 randomized controlled trial [1] compared placing a coronary artery stent to open up a severely clogged artery to a placebo procedure for stable angina, and found that the stent procedure made no difference to the outcomes and was potentially harmful.  (Angina is typically chest pain or other symptoms due to clogged arteries in the heart.)  In contrast, randomized controlled trials [2] have shown the Mediterranean diet reduced cardiac events by up to 70% and deaths by 56% in patients with heart disease; in similar head-to-head trials, [3] exercise has been better than stents for patients with heart disease.

My recommendation:

Medications, coronary artery stents, and surgery all have an important role to play in treating heart disease, and have contributed to a dramatic reduction in heart disease risk over the last 30 years. However, remember that our food and activity choices are likely even more important than the high-tech approaches for both preventing and treating heart disease.  For information and references on using a whole food Mediterranean diet, weight management, and exercise to help keep our tickers ticking and trouble-free, see pages 59-92 in Good Food, Great Medicine, 3^rd edition.

Miles Hassell MD

 

[1] Al-Lamee, R. et al. Lancet 2018;391:31-40

[2] Lorgeril, M. et al. Circulation 1999;99:779-85
[3] Hambrecht, R. et al. Circulation 2004;109:1371-8

Get up and move! You’ll live longer and feel better

Are chairs the new cigarettes?  It looks like it.  A 2017 study links sedentary behavior to increased death from any cause, regardless of our exercise habits or time in the gym.  The longer we sit, the higher the risk – and it rises by over 50% if you sit more than 12 hours a day. [1]  Whoa! 

My recommendation:

If our job requires us to spend most of our working hours sitting in front of a screen, we simply need to remind ourselves to

• Stand up and (if possible) walk around every hour or so
• Make use of the stairs (if any) where we work
• Think about having “walking meetings” rather than sitting around a table

At home, carve out 30 minutes of screen time each day to do something active (hmm. . . about the length of our favorite show?) – perhaps several short bursts of low-tech high-intensity activities like skipping rope or climbing stairs, which may even be more effective.   In any case, get a little short of breath and sweaty every day.  For suggestions on how to make exercise work for you, and some impressive evidence for the health benefits of staying active at any age, see pages 50–55 in Good Food, Great Medicine, 3^rd edition.

Miles Hassell MD

[1] Diaz, K.M. et al. Ann Intern Med 2017;167:465-75

Got heartburn? Long-term use of proton pump inhibitors appears to raise risk of stomach cancer – explore alternatives!

Heartburn and gastro-esophageal reflux disease (GERD) describe a common group of symptoms that lead to more serious problems.  One of the most common treatment approaches is to suppress the stomach acid with drugs, typically proton pump inhibitors (PPIs) such as omeprazole and many others.  While these drugs do not stop the abnormal sloshing of stomach fluids into the esophagus where they don’t belong, they can certainly reduce the discomfort and help prevent some of the complications of GERD. However, there is increasing evidence that PPIs can have serious side effects, as well.  A 2017 study published in the journal Gut followed 63,000 patients over an average of 7.6 years, and found that chronic use of PPIs significantly increased stomach cancer risk, and the risk increased the longer patients were on the medications. [1]
 
My recommendation:
For patients with heartburn, I try to prescribe acid reducing drugs for as brief a time as possible, and take time to discuss the many evidence-based alternatives for treating GERD without medication, including vigorous lifestyle changes.  80-90% of GERD sufferers who overweight are able to eliminate or reduce their reflux drugs just by losing 10% of their body weight. [2]  To create a personalized action plan see pages 59-92 in Good Food, Great Medicine (3^rd edition).  For additional GERD-fighting suggestions see our January 2017 newsletter.
 

Miles Hassell MD

 

[1] Cheung, K.S. et al. Gut 2017;doi:10.1136

[2] De Bortoli, N. et al. Dis Esophagus 2016;29:197-204

Tackling myth of “metabolically healthy obesity:” excess waistline is risky even if blood pressure and cholesterol are OK

“Metabolically healthy obesity” is a common medical classification of people with obesity (BMI>30) who have a normal metabolic profile, such as normal blood pressure (BP) and cholesterol levels. Some schools of thought suggest that these individuals are therefore not at significant risk; however, in a 2017 study following 3.5 million participants for an average of 5.4 years, researchers found that individuals with obesity and no metabolic abnormalities had a 49% increased risk of coronary heart disease and 96% more heart failure than their normal-weight counterparts.

My recommendation:

Anyone with an excess waistline needs to lose weight, and it can be very motivating to consider the impact weight loss has on future independence and quality of life. When faced with the myriad of weight loss options available, we should always choose the option with the best evidence for improving overall long-term health rather than focusing only on short-term weight loss.  The most sustainable and evidence-based weight-loss program to date is a whole food Mediterranean diet, portion control, and a daily habit of physical activity.  Start now!  For a wealth of practical strategies to help incorporate these choices into your own life and transform your health trajectory, see pages 60-61 and 69-92 in Good Food, GreatMedicine (3^rd edition) or see our free weight loss handout at goodfoodgreatmedicine.com.
 

Miles Hassell MD

[1] Caleyachetty, R. et al. J Am Coll Cardiol 2017;70:1429-37

 

Reducing attention-deficit/hyperactivity disorder (ADHD) with – the Mediterranean diet!

In a 2017 study of children and adolescents with ADHD compared to matched controls, adhering to a Mediterranean diet pattern was associated with almost one-third of the risk of developing ADHD.  The study noted that a “higher frequency of skipping breakfast and eating at fast-food restaurants” were associated with a higher prevalence of ADHD diagnosis.   

My recommendation:

Whether for ADHD, depression, or dementia, it looks like the Mediterranean diet is the choice to make to reduce your risk.  This is a particularly important consideration for parents: the food habits we model and teach our children have a profound impact on their long-term health – including mental health.

Apply evidence-based non-drug approaches first – regardless of other concurrent treatments.  Here are my top three strategies for minimizing risk of ADHD:

1. Eat a whole food Mediterranean diet low in refined carbohydrates (like sugar, white flour, sweet drinks – including ALL fruit juice) and high in healthy fats (like extra-virgin olive oil, avocados, oil-rich fish).  Eat breakfast and skip the fast food!
2. Structure your day and keep to your schedule as much as possible; including 30–60 minutes of vigorous activity, preferably outdoors (brisk walking or energetic yard work), and adequate sleep.
3. Reduce screen time: use the computer for work and the smart phone for phoning – and minimize screen-based entertainment.  

Miles Hassell MD

[1] Ríos-Hernández, A. et al. Pediatrics 2017;139:doi:10.1542

Even short term use of sleeping pills more than double risk of hip fracture. Pursue alternatives!

Medications such as benzodiazepines (like lorazepam, alprazolam, etc.) and non-benzodiazepines (like ambien, zolpidem, etc.) have many potential harmful side effects, one of which is hip fracture.  A recent systematic review and meta-analysis of 18 high-quality studies showed that short term use (less than 14 days) of these medications was associated with an increased risk of hip fracture 2–3 times normal. [1] These findings are significant in view of the short and long term disability, loss of independence, and much higher risk of dying associated with hip fractures.

My recommendation:

Sleep problems are generally fixable, and the goal should be both improved sleep with better long-term health.  For some suggestions for better sleep see pages 56–57 of Good Food, Great Medicine, 3^rd edition.  If your insomnia doesn’t improve, schedule a consultation with a health professional.  Finding a drug-free solution to a good night’s sleep is worth the effort! 

Miles Hassell MD

[1]Donnelly, K. et al. PLoS One 2017 Apr 27;12(4):e0174730