Are you on a path to ideal aging?

   What is really cool about this recent study from Akbaraly et al is not what they found but what they were looking for and how they defined those things (the constructs).
Here is the citation:

Akbaraly, T., Sabia, S., Hagger-Johnson, G., Tabak, A. G., Shipley, M. J., Jokela, M.,  Kivimaki, M. (2013). Does Overall Diet in Midlife Predict Future Aging Phenotypes? A Cohort Study. The American Journal of Medicine, 126(5), 411-419.e413.

And you can see the study summary abstract by clicking here  

   My goal today is to explain the variables they used and the assumptions behind them such that you might consider your lifestyle in the same context.

   The researchers wanted to see if a persons diet pattern and score on the Alternative Healthy Eating Index (AHEI) in mid life - 30 to 60 years old, impacted how they aged, beginning at age 60.  First of all, seeing a study that used the AHEI made me happy and the index should sound familiar to you.  See past posts and a good explanation of the system that scores your diet's quality here.

   Akbaraly et al studied more than 5000 adults.  At one time during the 16 years of study, they asked the participants to complete a food frequency questionnaire (FFQ).  They used a statistical program to assign people to one of two dietary patterns based on their FFQ.  They also  gave them a score on the AHEI.  The two dietary patterns were "Healthy Foods" and "Western Type".  You might already guess that the Healthy Foods group also scored best on the AHEI. 

   The Healthy Foods group consumed more fruits and vegetables, whole grains, and fish while the Western Type group consumed more fried foods, processed food and red meat, plus pies, sweetened desserts, chocolates, refined grains, high-fat dairy products, and condiments (like that crazy fattening mayonnaise!).  

   You can consider the diet patterns the predictors.  What do they predict?  The type of aging one might experience.

   The researchers created 5 categories of aging.and assigned people to one of them at the end of the study (2007-2009). The first is IDEAL aging, next is where a person has nonfatal heart and circulation diseases, then fatal heart and circulation disease (i.e., the person died from heart attack or stroke before 2007), the fourth type is death from another cause, and the fifth is referred to as usual or natural aging - these people have the usual chronic diseases (e.g., heart disease, diabetes, cancer) that are NOT really normal as in many cases they could have been prevented.

   The Healthy Foods diet was associated with better health and functioning in older age.  A high score on the AHEI reduced the chances of dying too soon.  A premature death is one that  occurs before age 75 in most high income countries.  (BTW -In this study they concentrated on the diet and 'made like' everyone weighed the same and exercised the same).

   But don't you most want to know what it means to have aged Ideally?  I will tell you - as I am well on my way of doing just that thing :)  - knock on wood please.

At the end of the study, the ideal agers:

1)  were alive, and

2)  did not have any chronic diseases (e.g., diabetes (or blood sugar levels requiring medicine), cancer, coronary (heart) disease, or stroke risk/history, or 

3) mental health problems (determined by responses to  questions on a trusted survey)

4) had good thinking and memory skills (they were tested for this - including word recall and basic math), and

5) normal blood sugar levels (for ones age and sex), and

6) good lung function (for age and sex), tested with the forced expiratory volume (FeV1) Remember that?  See this post.

and 

7) had normal or above normal walking speed for age and sex

   There are things that happen to us when we get older that we have no control over - like our hair turns grey or gets thinner, we get some wrinkles and age spots (more if we don't take care of our skin), but disease in old age is NOT inevitable - you can reduce your chances of some of the 'usual' diseases of aging by eating well and exercising - NOW.

   Remember too, it's only a healthy lifestyle if you engage in it everyday - and it only helps you as long as you do it (minor and infrequent indulgences allowed :))

Quantifying the healthiness of YOUR diet

   This past June, I used several blog posts to talk about how researchers measure the healthiness of a meal pattern.  I discussed the Healthy Eating Index which is associated with the Dietary Guidelines for Americans, the Alternative HEI which was created by nutrition scientists at Harvard, and the diet component of a cardiovascular health measure from the American Heart Association.
   In one post, I offered the criteria below which is from the AHEI.  I bring this back to your attention today because I found a legitimate website that offers a 'test' on the healthiness of YOUR meal pattern (or diet).  I took the quiz and I liked it because it seemed to follow the recommendations of the AHEI.  I scored an A but it was not a perfect A.  Even I can improve my dietary health by consuming more fruits and veggies.
   Here is the link to take the quiz and again, the AHEI info is explained below.

That blog post can be reread by clicking here.

Remember you can get a score between 0 and 10, I am giving you the extremes in these examples.

1. Vegetables (not counting potatoes)  You get ten points for having at least 5 servings a day.  A serving is a half cup or one cup if it is a green leafy vegetable (1 c = 236 .59 g).  If you consume no veggies or just potatoes, you get a score of zero.  Vegetables are associated with decrease risk of  CVD and some cancers.  Green leafy veggies are associated with decreased risk of diabetes.  Potatoes are not associated with either and may increase the risk of diabetes.
2. Whole Fruits (only) Ten points for 4 or more servings a day (NOT fruit juice) and a serving is one medium fruit or a half cup berries.  If you do not eat fruit on any day you get a 0.  Fruits decrease the risk of CVD and some cancers.  Fruit juice does not and can increase the risk of diabetes.
3. Whole Grains This is calculated in grams - you may eat a food, like oat meal that has 15g of whole grains in it.  To get a ten, women need 75g and men 90g per day.  Read your labels - only whole grains count, so looking at total grains can be confusing. Whole grains reduce the risk of CVD, colorectal cancer and diabetes.  Refined grains (the white stuff) increases these risks - avoid them.
4. Sugar Sweetened Beverages & Fruit Juice - (you know this includes soda and fruit drinks/ades).  You have to not drink any of this stuff to get your 10 points.  IF you drink one or more a day you get zero.  A serving is 8 ounces (226 g). The drinks are associated with weight gain and obesity, CVD, and diabetes.  See the note above re fruit juice.
5. Nuts, Beans (legumes), Vegetable Protein (tofu)  The constituents or make-up of these foods is very healthful - monounsaturated fats, micronutrients, etc. These lean proteins decrease the risk of CVD (esp when eating them instead of read meat).  Nuts reduce diabetes and weight gain (but watch them for calories).  To get 10 points consume one or more servings a day (serving size is small- 1 oz (28.35g) or 1 TBSP of peanut butter (not the crappy kind).  One serving a day will get you your 10 points.  Only go for 3 or 4 servings if it is in place of bad calories - like lunch meat.
6. Red and Processed Meats  Best scenario - 10 pts for less than one serving a MONTH.  If you have greater than or equal to 1.5 servings per day, you get 0 points.  A serving is 4 ounces of meat (steak, etc) or 1.5 ounces of processed meats (lunch meat, bacon).  Why?  Consuming red and processed meats increases the risk of CVD, CVA, diabetes, colorectol and other cancers. 
7. Trans fats -They increase the risk of CHD and diabetes and the scores are calculated as a % of total energy intake.  The best (10 points) is .5 or less a day -  if you consume 4 or greater - 0 points.  This is the equivalent of about ten calories in a 1800 calorie diet per day.  Trans fats have no health promoting properties, but do occur naturally in small amounts - making total elimination impossible.  Certainly it is better to choose prepared foods that are 100% trans free.
8. Fish - or long chain fatty acids (EPA+DHA)  Fish is associated with a decreased risk of cardiac arrhythmia - or irregular heartbeat and sudden cardiac death.  My father died from this. The goal is 250mg/d or two 4 ounce servings of fish per week (10 points). If you do not eat any fish you get 0 points.
9. PUFA  Instead of having a saturated fat item as the original HEI does, this index encourages poly unsaturated fat intake in place of saturated fats.  This is very important and ties into the concern that people misunderstand the fat problem and consume an overall low fat diet.  That is not healthy! Please read more here. (esp paragraph 3) Healthy oils are associated with decreased CHD and diabetes.  We should get 10 % of our total calories from these fats (10 points).  You cannot count your fish twice though.  You can count mono unsaturated fats, like olive oil.  This would be 180 calories in a 1800 calorie day.
10. Sodium/Salt  Too much sodium increases blood pressure, CVD, stomach cancer and all death.  The recommendations of 1500mg a day - no more - should get you your 10 points.
11. Alcohol  No alcohol = 2.5 points, Too much (greater than or equal to 2.5/d (women) 3.5/d men), = 0 points and Moderate = 10 points.  To get your ten points women have one half to one and a half drinks per day and men have 1.5 to 2 drinks a day.  Remember these few things - 1) alcohol HAS calories, 2) not everyone should drink - no matter what this says - and 3) a drink is 4 ounces of wine, or 12 ounces of beer or 1.5 ounces of booze.  So two drinks a day = 8 ounces of wine (possibly one glass at some bars!).  I drink two measured drinks a week, sometimes 3 so I guess I would get 5 to 8 points.

Some abbreviations used:
CVD - cardiovascular disease (includes all types of heart disease)
CHD - coronary heart disease (one type of heart disease)
CVA  - cerebrovascular accident (stroke)

A Billion Dollar Disease

   A couple of weeks ago, I read a post by Cris Frangold.  Cris pronounces a love for investing and writing about it.  I would consider him or her a financial blogger, with a  focus on medical services and the health sector.
   The piece that I read in Seeking Alpha regarded the value of Merck and purchasing its stock.  One reason offered to invest in the company was its drug Januvia.  Januvia is meant to treat the symptoms of type 2 diabetes.  Cris noted that 2012 Q2 sales of the drug were over 1billion dollars. Then he or she said:

Januvia has a potential to be a real moneymaker because the American Diabetes Association estimates that 25.8 Americans, or 8.3% of the population have Type 1 and Type 2 diabetes - the majority are Type 2.

   Type 2 diabetes in adults and children is related to diet - diet as it produces obesity.  It appears that excess body fat leads to metabolic dysfunction or disregulation so that blood sugar, blood pressure, and cholesterol irregularities follow.   Our diabetes rates have doubled in the past 30 years in tandem with our increase in obesity.  The 30 year trend of rising weights has been attributed to an increase in availability and consumption of high calorie, nutrient poor foods and beverages.
   Sure we can make billions on treatment and millions investing in those treatment options, but isn't there a better response?  I suggest that there is.  Investing in a diabetes drug means counting on a disease to continue, needing it to continue in order to enhance a portfolio or fund a retirement account.  That seems to be a good example of maleficence.    
   What of the better good?  I say the noble thing to do is invest in the food environment so that meals and drinks contain reasonable amounts of sat fat, sugar and calories.  And yes - sometimes that takes a mandate.

 American Diabetic Association
National Diabetes Information Clearinghouse.  Program of the National Institutes of Health

Corn is for Cows and other secrets from Italy

   I stopped eating canned corn and corn on the cob along with peas and potatoes sometime early in the 2000s.  I made this decision because they are starchy vegetables.  Starchy vegetables are higher in calories than non starchy ones (e.g. green beans, summer squash, kale) and have a higher active sugar content (carbohydrates). This starch content makes them have a higher glycemic index and glycemic load.  The glycemic issue regards how the body responds to the food.  These vegetables break down very quickly, spiking the body's blood sugar.  This does not happen with other complex carbs like whole grains and non-starchy vegetables.  Foods that turn to sugar quickly  require an insulin response - the body needs to get the sugar out of the blood.  Foods that turn to sugar and are digested quickly are the ones that we should avoid, according to the HSPH Nutritionsource, as they have been linked to diabetes and other diseases.  This includes ALL of the refined carbs (e.g. sugar, pastries, etc) and some complex carbs (peas, corn and potatoes).  The MayoClinic offers a nice list of non starchy vegetables.
Read more from nutritionists and Harvard scientists Here.
   You may recall from the posts about the revisions to the National School Lunch Program that the IOM suggested that children also limit starchy vegetables.  
   Because corn has been in the news a lot lately, I recalled something that happened back in 1983 that looking back,  I should have paid more attention too.  First, in case you missed it, the price of corn is much higher this year because of severe drought conditions leading to crop loss.  In the US, corn is used to feed cattle, make sugary syrups and to create ethanol.  I believe it was intended for only one of those uses and I certainly blame the second one for the influx of super calorically dense foods and drinks.  Now let me tell you what happened in 1983....
   I was in high school and my parents participated in the foreign exchange student program.  The young lady who came to stay with us, and who is my dear friend to this very day, is from Italy.  On one of her first nights in our home, before she came to know us, we served corn as part of our dinner.  Our guest sat aghast, painfully stricken and at a loss for what to do.  It was many weeks later before she admitted to us that she could not understand why we would serve her corn. "Corn is what we feed cows."
    Now it is time to consider her wisdom.  The diabetes rates in Italy are half that of the US and the heart disease rates are about a third less.  Add that to the longevity and the healthy cholesterol levels of Italians and I think we can start to make some connections.

(Ah the days of mashed potatoes, peas, corn and gravy.  We would make a place in the middle of the potatoes and fill it with another starchy vegetable and cover it in gravy. All role modeled by dear old dad.  Perhaps this explains all the heart disease and diabetes in my  family.)  PS - I do enjoy Asian baby corn.

Your Numbers - Your Risks

   Before we move on to another topic, I want to assure myself that the information I shared with you yesterday made some kind of impact.

from the American Heart Association website

   Did you view any food labels today?  Were the trans fat grams high or low?  If they were not 0 to 0.5  then they were high.
   Do you have any existing health condition that makes avoiding trans fat especially important?  (heart disease, high blood pressure, diabetes)
   Is there any reason to avoid trans fats if you do not have those conditions?  YES.  Do normal weight people need to avoid trans fats? YES.  Do people who exercise every day? YES.
   Not sure what I am talking about?  Maybe you missed yesterday's post. You can review it here.



 

Soda and Heart Disease

Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men

Koning,L. Malik, V., Kellogg, M., Rimm, E., Willett, W.,  Hu, F. Circulation. 2012

The above named scientists reviewed two very big longitudinal studies.  The people involved in the studies were men (health care professionals) and women (nurses).  The people joined the study several decades ago.  They answered questions about their health and diet and had lab work completed.  As the years passed, they continued to give information on their diet and lifestyle, diseases that they contracted (confirmed by records) and more blood samples at certain times.  This is the kind of study that is helpful in establishing links between what people do - or what they are exposed to - and disease occurrence. 

A person is interviewed and measured (weight, blood pressure, insulin test, etc) at the start.  This is their baseline.  They do not have any indication of heart disease or lung problems (if they do, they are not included in the study, for instance).  Every year or so they tell about their diet and behavior and when a disease does present itself, the scientists can associate that disease with something that happened in between.  This is not a randomized controlled experiment - which is the only kind of study that can really show cause.  It is however, a very good study and when you have thousands of people instead of ten or twenty the links from lifestyle to disease appear much stronger.  Even then, the link is found in a big sample of people and applies to big samples of people - it is not individual risk.

In this study, the scientists found that sugar sweetened beverages, (soda, juices and such, but mostly soda) were associated a higher risk of heart disease.  The important part is that they know why..  Just as being overweight doesn't cause heart disease directly, drinking soda doesn't lead straight to a heart attack.  If scientists can find the in between factor, the mechanics, and they make biological sense -it contributes to the "evidence".  

Here they found that the SSB consumption did change biomarkers or under the skin conditions that are themselves associated with heart disease.  People who drank several sodas a day compared to those who drank none, had higher triglycerides, lower HDL, more inflammation (CRP, inter luekin 6, TNf) and their leptin (appetite suppression) hormone was less effective.  The researchers expect that process is being triggered by the fructose.  Those who drank the most soda had about 20% higher risk of heart disease. 

The people in the study, again, were health care professionals.  They did not drink that much soda to begin with and may not be representative of the larger US population.  However, there is every reason to believe that drinking a lot of soda is not good for people. (it is important to note that in data analysis, there are procedures that allow us to pretend that everyone was the same weight and ate the same way - so that the impact on these biomarkers could be attributed to the soda and not some other part of the persons life)

The best part of the article is this statement - for my personal reasons: From p 14 in the above referenced study - 

Our results highlight the need for cautious interpretation of studies reporting positive associations between diet drinks and cardiometabolic and cardiovascular outcomes.

What that means is that they do not at this time support the hypothesis or suggestion that diet drinks cause the same problems as regular soda.  Yeah me! (cardiometabolic - think heart - so blood pressure, cholesterol, blood fats, inflammation - and metabolic - digestion and enzymes - insulin resistance, appetite control)