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Tag: insulin resistance

  • Should You Take Statins?  | NutritionFacts.org

    How can you calculate your own personal heart disease risk to help you determine if you should start on a cholesterol-lowering statin drug?

    The muscle-related side effects from cholesterol-lowering statins “are often severe enough for patients to stop taking the drug. Of course, these side effects could be coincidental or psychosomatic and have nothing to do with the drug,” given that many clinical trials show such side effects are rare. “It is also possible that previous clinical trials”—funded by the drug companies themselves—“under-recorded the side effects of statins.” The bottom line is that there’s an urgent need to establish the true incidence of statin side effects.

    “What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?” That’s the title of a journal article that reports that, even in trials funded by Big Pharma, “only a small minority of symptoms reported on statins are genuinely due to the statins,” and those taking statins are significantly more likely to develop type 2 diabetes than those randomized to placebo sugar pills. Why? We’re still not exactly sure, but statins may have the double-whammy effect of impairing insulin secretion from the pancreas while also diminishing insulin’s effectiveness by increasing insulin resistance.

    Even short-term use of statins may “approximately double the odds of developing diabetes and diabetic complications.” As shown below and at 1:49 in my video Who Should Take Statins?, fewer people develop diabetes and diabetic complications off statins over a period of about five years than those who do develop diabetes while on statins. “Of more concern, this increased risk persisted for at least 5 years after statin use stopped.”

    “In view of the overwhelming benefit of statins in the reduction of cardiovascular events,” the number one killer of men and women, any increase in risk of diabetes, our seventh leading cause of death, would be outweighed by any cardiovascular benefits, right? That’s a false dichotomy. We don’t have to choose between heart disease and diabetes. We can treat the cause of both with the same diet and lifestyle changes. The diet that can not only stop heart disease, but also reverse it, is the same one that can reverse type 2 diabetes. But what if, for whatever reason, you refuse to change your diet and lifestyle? In that case, what are the risks and benefits of starting statins? Don’t expect to get the full scoop from your doctor, as most seemed clueless about statins’ causal link with diabetes, so only a small fraction even bring it up with their patients.

    “Overall, in patients for whom statin treatment is recommended by current guidelines, the benefits greatly outweigh the risks.” But that’s for you to decide. Before we quantify exactly what the risks and benefits are, what exactly are the recommendations of current guidelines?

    How should you decide if a statin is right for you? “If you have a history of heart disease or stroke, taking a statin medication is recommended, without considering your cholesterol levels.” Period. Full stop. No discussion needed. “If you do not yet have any known cardiovascular disease,” then the decision should be based on calculating your own personal risk. If you know your cholesterol and blood pressure numbers, it’s easy to do that online with the American College of Cardiology risk estimator or the Framingham risk profiler.

    My favorite is the American College of Cardiology’s estimator because it gives you your current ten-year risk and also your lifetime risk. So, for a person with a 5.8 percent risk of having a heart attack or stroke within the next decade, if they don’t clean up their act, that lifetime risk jumps to 46 percent, nearly a flip of the coin. If they improved their cholesterol and blood pressure, though, they could reduce that risk by more than tenfold, down to 3.9 percent, as shown below and at 4:11 in my video.

    Since the statin decision is based on your ten-year risk, what do you do with that number? As you can see here and at 4:48 in my video, under the current guidelines, if your ten-year risk is under 5 percent, then, unless there are extenuating circumstances, you should just stick to diet, exercise, and smoking cessation to bring down your numbers. In contrast, if your ten-year risk hits 20 percent, then the recommendation is to add a statin drug on top of making lifestyle modifications. Unless there are risk-enhancing factors, the tendency is to stick with lifestyle changes if risk is less than 7.5 percent and to move towards adding drugs if above 7.5 percent.

    Risk-enhancing factors that your doctor should take into account when helping you make the decision include a bad family history, really high LDL cholesterol, metabolic syndrome, chronic kidney or inflammatory conditions, or persistently high triglycerides, C-reactive protein, or LP(a). You can see the whole list here and at 4:54 in my video.

    If you’re still uncertain, guidelines suggest you consider getting a coronary artery calcium (CAC) score, but even though the radiation exposure from that test is relatively low these days, the U.S. Preventive Services Task Force has explicitly concluded that the current evidence is insufficient to conclude that the benefits outweigh the harms.

    Michael Greger M.D. FACLM

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  • The Pros of Early Time-Restricted Eating  | NutritionFacts.org

    The Pros of Early Time-Restricted Eating  | NutritionFacts.org

    Calories eaten in the morning count less than calories eaten in the evening, and they’re healthier, too.
     
    Time-restricted feeding, where you limit the same amount of eating to a narrow evening window, has benefits compared to eating in the evening and earlier in the day, but it also has adverse effects because you’re eating so much, so late, as you can see below and at 0:12 my video The Benefits of Early Time-Restricted Eating

    The best of both worlds was demonstrated in 2018 when researchers put time-restricted feeding into a narrow window earlier in the day. As you can see below and at 0:28 in my video, individuals who were randomized to eat the same food, but only during an 8:00 a.m. to 3:00 p.m. eating window, experienced a drop in blood pressure, oxidative stress, and insulin resistance, even when all of the study subjects were maintained at the same weight. Same food, same weight, but with different results. The drops in blood pressure were extraordinary, from 123/82 down to 112/72 in five weeks, and that is comparable to the effectiveness of potent blood-pressure drugs.


    The longest study to date on time-restricted feeding only lasted for 16 weeks. It was a pilot study without a control group that involved only eight people, but the results are still worth noting. Overweight individuals, who, like most of us, had been eating for more than 14 hours a day, were instructed to stick to a consistent 10- to 12-hour feeding window of their own choosing, as you can see below and at 1:17 in my video. On average, they were able to successfully reduce their daily eating duration by about four and a half hours and had lost seven pounds within 16 weeks. 

    They also reported feeling more energetic and sleeping better, as seen in the graph below and at 1:32 in my video. This may help explain why “all participants voluntarily expressed an interest in continuing unsupervised with the 10-11 hr time-restricted eating regimen after the conclusion of the 16-week supervised intervention.” You don’t often see that after weight-loss studies. 

    Even more remarkably, eight months later and even one year post-study, they had retained their improved energy and sleep (see in the graph below and 1:55 in my video), as well as retained their weight loss (see in the graph below and 1:58 in my video)—all from one of the simplest of interventions: sticking to a consistent 10- to 12-hour feeding window of their own choosing. 
    How did it work? Even though the study “participants were not overtly asked to change nutrition quality or quantity,” they appeared to unintentionally eat hundreds of fewer calories a day. With self-selected time frames for eating, you wouldn’t necessarily think to expect circadian benefits, but because they had been asked to keep the eating window consistent throughout the week, “metabolic jet lag could be minimized.” The thinking is that because people tend to start their days later on weekends, they disrupt their own circadian rhythm. And, indeed, it is as if they had flown a few time zones west on Friday evening, then flew back east on Monday morning, as you can see in the graph below and at 2:40 in my video. So, some of the metabolic advantages may have been due to maintaining a more regular eating schedule. 


    Early or mid-day time-restricted feeding may have other benefits as well. Prolonged nightly fasting with reduced evening food intake has been associated with lower levels of inflammation and has also been linked to better blood sugar control, both of which might be expected to lower the risk of diseases, such as breast cancer. So, data were collected on thousands of breast cancer survivors to see if nightly fasting duration made a difference. Those who couldn’t go more than 13 hours every night without eating had a 36 percent higher risk of cancer recurrence. These findings have led to the suggestion that efforts to “avoid eating after 8 pm and fast for 13 h or more overnight may be a beneficial consideration for those patients looking to decrease cancer risk and recurrence,” though we would need a randomized controlled trial to know for sure. 
     
    Early time-restricted feeding may even play a role in the health of perhaps the longest-living population in the world, the Seventh-day Adventist Blue Zone in California. As you can see in the graph below and at 3:55 in my video, slim, vegetarian, nut-eating, exercising, non-smoking Adventists live about a decade longer than the general population. 

    Their greater life expectancy has been ascribed to these healthy lifestyle behaviors, but there’s one lesser-known component that may also be playing a role. Historically, eating two large meals a day, breakfast and lunch, with a prolonged overnight fast, was a part of Adventist teachings. Today, only about one in ten Adventists surveyed were eating just two meals a day. However, most of them, more than 60 percent of them, reported that breakfast or lunch was their largest meal of the day, as you can see below and at 4:26 in my video. Though this has yet to be studied concerning longevity, frontloading one’s calories earlier in the day with a prolonged nightly fast has been associated with significant weight loss over time. This led the researchers to conclude: “Eating breakfast and lunch 5–6 h apart and making the overnight fast last 18–19 h may be a useful practical strategy” for weight control. The weight may be worth the wait. 


    For more on fasting, click here
     
    My big takeaway from all of the intermittent fasting research I looked at is, whenever possible, eat earlier in the day. At the very least, avoid late-night eating whenever you can. Eating breakfast like a king and lunch like a prince, with or without an early dinner for a pauper, would probably be best. 
     
    For more on fasting, fasting for disease reversal, and fasting and cancer, check the related videos below.  

    Michael Greger M.D. FACLM

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  • Eating Fast Is Bad for You—Right?

    Eating Fast Is Bad for You—Right?

    For as long as I have been feeding myself—which, for the record, is several decades now—I have been feeding myself fast. I bite big, in rapid succession; my chews are hasty and few. In the time it takes others to get through a third of their meal, mine is already gone. You could reasonably call my approach to eating pneumatic, reminiscent of a suction-feeding fish or a Roomba run amok.

    Where my vacuuming mouth goes, advice to constrain it follows. Internet writers have declared slowness akin to slimness; self-described “foodies” lament that there’s “nothing worse” than watching a guest inhale a painstakingly prepared meal. There are even children’s songs that warn against the perils of eating too fast. My family and friends—most of whom have long since learned to avoid “splitting” entrees with me—often comment on my speed. “Slow down,” one of my aunts fretted at a recent meal. “Don’t you know that eating fast is bad for you?”

    I do, or at least I have heard. Over the decades, a multitude of studies have found that people who eat faster are more likely to consume more calories and carry more weight; they’re also more likely to have high blood pressure and diabetes. “The data are very robust,” says Kathleen Melanson of the University of Rhode Island; the evidence holds up when researchers look across geographies, genders, and age. The findings have even prompted researchers to conduct eating-speed interventions, and design devices—vibrating forks and wearable tech—that they hope will slow diners down.

    But the widespread mantra of go slower probably isn’t as definitive or universal as it at first seems. Fast eaters like me aren’t necessarily doomed to metabolic misfortune; many of us can probably safely and happily keep hoovering our meals. Most studies examining eating speed rely on population-level observations taken at single points in time, rather than extended clinical trials that track people assigned to eat fast or slow; they can speak to associations between pace and certain aspects of health, but not to cause and effect. And not all of them actually agree on whether protracted eating boosts satisfaction or leads people to eat less. Even among experts, “there is no consensus about the benefits of eating slow,” says Tany E. Garcidueñas-Fimbres, a nutrition researcher at Universitat Rovira i Virgili, in Spain, who has studied eating rates.

    The idea that eating too fast could raise certain health risks absolutely does make sense. The key, experts told me, is the potential mismatch between the rate at which we consume nutrients and the rate at which we perceive and process them. Our brain doesn’t register fullness until it’s received a series of cues from the digestive tract: chewing in the mouth, swallowing down the throat; distension in the stomach, transit into the small intestine. Flood the gastrointestinal tract with a ton of food at once, and those signals might struggle to keep pace—making it easier to wolf down more food than the gut is asking for. Fast eating may also inundate the blood with sugar, risking insulin resistance—a common precursor to diabetes, says Michio Shimabukuro, a metabolism researcher at Fukushima Medical University, in Japan.

    The big asterisk here is that a lot of these ideas are still theoretical, says Janine Higgins, a pediatric endocrinologist at the University of Colorado Anschutz Medical Campus, who’s studied eating pace. Research that merely demonstrates an association between fast eating and higher food intake cannot prove which observation led to the other, if there’s a causal link at all. Some other factor—stress, an underlying medical condition, even diet composition—could be driving both. “The good science is just completely lacking,” says Susan Roberts, a nutrition researcher at Tufts University.

    Scientists don’t even have universal definitions of what “slow” or “fast” eating is, or how to measure it. Studies over the years have used total meal time, chew speed, and other metrics—but all have their drawbacks. Articles sometimes point to a cutoff of 20 minutes per meal, claiming that’s how long the body takes to feel full. But Matthew Hayes, a nutritional neuroscientist at the University of Pennsylvania, criticized that as an oversimplification: Satisfaction signals start trickling into the brain almost immediately when we eat, and fullness thresholds vary among people and circumstances. Studies that ask volunteers to rate their own speeds have issues too: People often compare themselves with friends and family, who won’t represent the population at large. Eating rate can also fluctuate over a lifetime or even a day, depending on hunger, stress, time constraints, the pace of present company, even the tempo of background music.

    In an evolutionary sense, all of us humans eat absurdly fast. We eat “orders of magnitude quicker” than our primate relatives, just over one hour a day compared with their almost 12, says Adam van Casteren, a feeding ecologist at the University of Manchester, in England. That’s thanks largely to how we treat our food: Fire, tools such as knives, and, more recently, chemical processing have softened nature’s raw ingredients, liberating us from “the prison of mastication,” as van Casteren puts it. Modern Western diets have taken that pattern to an extreme. They’re chock-full of ultra-processed foods, so soft and sugar- and fat-laden that they can be gulped down with nary a chew—which could be one of the factors that drive faster eating and chronic metabolic ills.

    In plenty of circumstances, slowing down will come with perks, not least because it could curb the risk of choking or excess gas. It could also temper blood-sugar spikes in people with diets heavy in processed foods—which whiz through the digestive tract, Roberts told me, though the healthier move would probably be eating fewer of those foods to begin with. And some studies focused on people with high BMI, including Melanson’s, have shown that eating slower can aid weight loss. But, she cautioned, those results won’t necessarily apply to everyone.

    The main impact of leisurely eating may not even be about chewing rates or bite size per se, but about helping people eat more mindfully. “A lot of us are distracted when we eat,” says Fatima Cody Stanford, an obesity-medicine physician at Massachusetts General Hospital. “And so we are missing our hunger and satiety cues.” In countries such as the United States, people also have to wrestle with the immense pressure “to be done with lunch really fast,” Herman Pontzer, an anthropologist at Duke University, told me. Couple that with the fast foods we tend to reach for, and maybe it’s no shock that people don’t feel satisfied as they scarf down their meals.

    The point here isn’t to demonize slow eating; in the grand scheme of things, it seems a pretty healthful thing to do. At the same time, that doesn’t mean that “eat slow” should be a blanket command. For people already eating a lot of high-fiber foods—which the body naturally processes ploddingly—Roberts doesn’t think sluggish chewing has much to add. The extolling of slow eating is, at best, “a half truth,” Hayes told me, that’s become easy to exploit.

    I do feel self-conscious when I’m the first person at the table to finish by a mile, and I don’t enjoy the stares and the comments about my “big appetite.” Certain super-slow eaters might get teased for making others wait, but they’re generally not getting chastised for ruining their health. When I asked experts if it was harmful to eat too slowly, several of them told me they’d never even considered it—and that the answer was probably no.

    Still, for the most part, I’m happy to be the Usain Bolt of chewing. My hot foods stay hot, and my cold foods stay cold. I’ve intermittently tried slow eating over the years, deploying some of the usual tricks: smaller utensils, tinier bites, crunchier foods. I even, once, tried to count my chews. The biggest difference I felt, though, wasn’t fullness or more satisfaction; I just kind of hated the way that my mushy food lingered in my mouth.

    Maybe if I’d stuck with slow eating, I would have lost some gassiness, choking risk, or weight—but also, I think, some joy. There’s something to speed-eating that can be plain old fun, akin to the rush of zooming down an empty highway in a red sports car. If I have just an hour-ish (or, knowing me, less) of eating each day, I’d prefer to relish every brisk, indecorous bite.

    Katherine J. Wu

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