Dr. Art Hister

I have a particular fondness for studies that come to conclusions that agree with stuff I’ve long believed, which is why a study in The Archives of Internal Medicine is now a hot favourite of mine.

You see, I’ve always gained weight very easily and the only way I keep my weight down is by exercising like a madman (easy for me to do because I just try to keep up with my wife) and by being careful about what and especially how much I eat.

But even with that kind of discipline, it’s still hard for me to my weight low enough to be included in that club with BMI’s of 25 or less, which is considered to be the cut-off between those who are overweight and those who are normal weight.

So from my own situation, but also from that of so many others in the same (over-full boat), I’ve long  believed – and I think the data backs me up – that even if I can’t control my weight easily, I can still significantly lower my risks of chronic disease and premature death by following all those other healthy lifestyle practices I am always pushing on you and especially by doing all I can to get fit, which brings me to that study mentioned above in which researchers followed the health of over 5000 Americans from 1999 to 2004.

As you’d expect, more than half these typical Americans was overweight, but here’s the key thing: 51 % of those who were overweight and about 1/3 of those who were obese were nonetheless “metabolically healthy”, that is, their cholesterol levels, their blood sugar levels, their blood pressures, etc were within normal limits.

In other words, although these people were fat, they were still healthy, or as my mom always says whenever I worry about the future, “Don’t be an idiot, Arthur, so far, so good. Relax”.

The other sobering observation from this study is that 23 % of those who were “normal weight” had metabolic readings that put them at higher risk of having a heart attack or stroke or Type 2 diabetes.

My mother’s chicken soup recipe (the way my mom told it to me, which means you will have to come up with your own portions for your own taste) 

 

Ingredients: 

1 kosher chicken, cut up 

1 kosher turkey neck (optional) 

1 pot of water (she says to start with less than water you think you want, and besides, you can always add water) 

Onions (as many as you want to add; my wife, the vegetarian, loves onions cooked in chicken soup, so my mom always adds 4 or 5 extra onions to the soup “just for Phyllis, not for you, Arthur”) 

2 celery stalks (I cut them up, my mom doesn’t) 

1 carrot (my wife also loves cooked carrots, so no surprise, my mom generally adds in several extra carrots) 

1 or 2 cauliflower florets 

Garlic to taste, but whole garlic cloves, not crushed 

Kosher salt to taste (I add lots of this) 

Pepper to taste (I add much more pepper than my mom, but I don’t use whole peppercorns because I hate biting into them when I eat – yes, eat – the soup later) 

Fresh dill (my mom adds a lot of dill because “Phyllis loves it”; she often adds it at the end, but has made it many times with the dill added in early – adds a great smell to the kitchen) 

1 tbsp Ossem Soup Consommé (apparently, this is available in most Jewish stores; I’ve never added this, but then my mom’s soup is better than mine) 

The greens of several green onions, sliced thinly 

 

Directions (again, straight from my mom) 

 

Cook it, Arthur. 

For a long time. 

When it’s finished, add the green onions to serve. 

 

Trust me, folks, if you finally make it right (it took me several trials because I got the proportions all wrong), it’s the best chicken soup you will ever taste, and even better, if you have a cold, and you serve it very hot with lots of added pepper. 

The other great thing is you learn to finally love boiled chicken, which is why you eat this soup, you don’t just slurp it. 

 

A recent report in the New York Times column by John Tierney offers a fabulous real-world experiment to help 0065plain why North Americans are having such a tough time keeping a lid on our weights.

In this small study, a group of people to guess at how many calories there are in a chicken salad and Pepsi from a fast food outlet versus a similar salad and two crackers prominently labelled as trans-fat free, and to no one’s real surprise, I think, people estimated that the salad/crackers meal had a couple of hundred fewer calories in it than the salad/Pepsi combo, although in reality, the salad and crackers actually had 100 more calories in them than the salad/Pepsi combo did.

What this shows, I guess, is two things: 1) people are generally not very good at estimating how much they actually eat during a day, but also 2) in North America, one of the reasons we’re so far off in our calorie estimates, is that we’ve been misled into underestimating our actual intake by labels such as fat-free and trans-fat free, which don’t for a second, of course, mean calorie-free.

In fact, it’s often quite the opposite, with many fat-free foods actually being loaded with extra calories in order to make them more palatable, because as any cook knows, nothing can make average food taste better than sugar, salt, and fat.

The secret to weighing less, I’m afraid, is not to fool yourself by eating a ton of stuff that’s labelled fat-free or trans-fat-free but simply to eat less and move more.

Sorry, I’m just the messenger.

I’ve always had a “weight problem”, by which I mean that I gain weight very, very easily and the only way I can keep my weight down is by exercising a lot (which admittedly, is not hard for me to do since all I have to do is try to keep up with my wife, a notorious exercise maniac), as well as by being very careful about what and especially about how much I eat.

But one of the key things I’ve learned from that lifelong battle with weight control is how hard it is for most of us to keep our weights under that magic formula of a BMI of 25 or less, and because I also have a terrific respect for Mother Nature, who is clearly one smart gal, and who clearly, I think, wants us to stick around a long time, I’ve long argued that excess weight doesn’t matter nearly as much as a risk factor for your health as does your overall activity level.

In other words, if you want to reduce your risk of dying prematurely or getting sick early in life, you should not, I think, focus on your weight as a risk factor nearly as much as you should focus on how much exercise you do.

All of which brings us to a study just published in the Archives of Internal Medicine that followed the health of over 5000 American adults as part of the (US) National Health and Nutritional Surveys between the years 1999 and 2004, and as you’d expect, more than half these typical Americans were overweight.

But here’s the interesting thing: 51 % of those who were overweight and about a third of those who were obese were nonetheless also “metabolically healthy”, that is, their cholesterol levels, their blood sugar levels, their blood pressure readings and other markers of metabolic health were within normal limits.

In other words, these people were fat, yes, and some were very fat (obese) but they were still healthy, and the word “still” is crucial here because we really have no idea how long they maintain these healthy metabolic readings, although as my mom always says, “So far, so good”.

But here’s the other sobering observation from this study: about ¼ (23 %) of those who were at so-called “normal weight” (their BMI was under 25, in other words) had metabolic readings that put them at higher risk of having a heart attack or stroke or developing Type 2 diabetes.

Bottom line: weight does matter in terms of your cardiovascular risk profile, but not nearly as much, I suggest, as at least two other risk factors, namely smoking and exercise.

In some of the last few items on my Global TV blog site, I’ve told you about depressing news for kids and for middle-aged adults that came from studies presented at the recently-concluded annual meeting of the American Heart Association in New Orleans, so not to leave you feeling left out if you’re older than that, there was a also some depressing heart news for seniors, too, the most noteworthy of which was a study about the costs to the heart from not getting enough sleep.

Now, if you’re not there yet, you may think that every senior gets enough sleep because, it always seems to younger folks, seniors are forever dozing off: at the park, at the dinner table, on the couch, even in line.

But the reason some seniors do that – and certainly this is not true for all seniors, some of whom are way more with it and aware than people half their age – is that they are actually not getting enough good quality sleep at night, which according to a study from Japan, might also jeopardize their healthy by significantly raising their risk of heart attacks if they also have high blood pressure, a condition that afflicts a great many seniors.

In this study, which was also published coincidentally in the Archives of Internal Medicine, researchers  followed 1200 Japanese seniors with high blood pressure, and found that those seniors who got less than 7 ½ hours sleep a night had over twice the risk of suffering a heart attack of stroke compared to seniors who got enough sleep, an effect that was particularly pronounced in those seniors whose high blood pressure did not dip during the night, which is what blood pressure is supposed to do while you’re asleep.

Hormone replacement therapy (HRT) for menopause is actually a huge misnomer because no one – no one – has ever shown that you need to replace hormones at menopause as we age, either in women or in “andropause” in men. 

In other words, why call it therapy when that kind of use of hormones has never been shown to be therapeutic? 

In fact, all that’s ever been shown is that hormone levels – nearly all hormone levels - do indeed drop with age, precipitously in women at the time of menopause, somewhat more slowly and gradually in men over the years, but it certainly doesn’t follow that keeping those hormone levels as high as they once were offers any benefit to anyone. 

After all, as I have argued for years, even though we’ve never discovered what they are, it seems to me that you still have to believe that there must be very, very good reasons that God in her wisdom has determined that certain hormone levels drop with age, and furthermore, that it will take lots and lots and lots more insight on the part of us rather less-than-insightful humans before we know what to do with those changes in hormonal status. 

Anyway, the point here is that over the last decade, we’ve learned (over many dead and injured bodies) that using HRT inappropriately increases the risks of many potential complications including especially higher risks of strokes, heart attacks, and some cancers in older women taking hormones, and just as important, several studies have also indicated that there is no overall improvement in quality of life with the use of hormones by women, which you would think would have nearly completely halted the use of HRT. 

Well, it hasn’t, in large part because there is really nothing better out there for treating severe symptoms (particularly hot flushing) that accompany menopause in some women, and that continued use of hormone therapy has in turn led many experts to now argue that HRT is really not as bad as has been claimed if it’s used only in young women. 

So if you’re a menopausal woman taking hormones, please note that a just-released study published in the Archives of Internal Medicine concludes that the use of all variants of HRT in women at all ages is associated with an increased risk of strokes, although the risk is directly related to how long a woman uses HRT and to the dose she uses. 

Bottom line: don’t use HRT unless you have to, and if you have to, use the simplest formulation at the lowest dose for the least amount of time you can get away with. 

As if you needed this, here’s yet another confusing report about how much sunlight is really good for you.

A recent study from Europe claims that getting too much sunlight early in adult life raises the eventual risks of developing age-related macular degeneration or AMD, the most common cause of severe vision loss in the elderly.

In fact, for some seniors, this risk of AMD attributed to sunlight was triple that of a control group, although the good news in this study is that this risk of AMD was particularly elevated in those seniors with the lowest blood levels of anti-oxidants (particularly vitamin C levels and vitamin E levels), of if you prefer to look at it from the healthier perspective, if you eat a healthy diet with lots of anti-oxidants, you’re much less likely to develop AMD even if you get too much sunlight.

Avery much-hyped recent study published simultaneously in the New England Journal of Medicine enrolled over 17000 people with “normal” cholesterol levels but with elevated levels of CRP, a protein that some people insist is a major marker for a higher risk of heart attacks and strokes.

Half the participants were given rosuvastatin or Crestor, one of the several statin drugs on the market, and half placebo.

The study was meant to run for 5 years but was terminated after 19 months because according to the evaluators, the results were so convincing: Crestor lowered the risks of every single “cardiovascular events” including heart attacks, strokes, and death from heart problems, by a pretty impressive 44 %, lowered CRP levels by 37 %, and reduced the already-low LDL levels by a whopping 50 %.

So the conclusion that most people drew is that

1) even people at presumably low risk of heart attack benefit from taking a statin drug, and

2) CRP should be measured in a great many more people.

But, here’s another way to look at the numbers: based on the 400 cardiovascular events seen in the entire study, statisticians conclude that you need to treat 95 patients with a statin drug for 2 years to prevent one such event.

In other words, if you’re wondering what to do, it’s sobering to learn, I think, that based on these numbers, the vast majority of people with “normal” LDL levels and raised CRP levels who are put on a statin will not benefit from taking it.

On the other hand, there is the cost of treatment, which according to another study, would prevent 30,000 cardiovascular events a year in the US but would cost $ 9 billion a year for this one treatment alone.

And that doesn’t take into account, of course, some of the other major costs that would accrue:

a higher risk of Type 2 diabetes (the statin group had somewhat higher insulin levels),

screening everyone who might have elevated CRP levels,

all the lost time from work to get prescriptions renewed

all the new drug interactions from 4 million more drug-takers

the side effects and complications, and

the potential cost of people not taking as good care of themselves since they would feel they were doing enough by taking drugs for their condition.

For me, this study raises as many questions as it answers, and the most important unsettled matter is this: what do you as an individual do with this kind of data.

Frankly, no one knows, but you can bet lots of people have strong opinions.