The Lucky Years: How to Thrive in the Brave New World of Health (28 page)

Although Autier and his team didn’t look at the biggest alleged benefit of vitamin D—protection against bone fractures—we have plenty of other studies to turn to and see that indeed, vitamin D doesn’t help. We’ve long heard that vitamin D is associated with bone health, but it turns out that you can’t get that benefit from a pill. As an aside, vitamin D isn’t found in breast milk, likely because Mother Nature intended babies to get a little sunlight into their day. Maybe we’re not supposed to consume vitamin D; we’ve evolved to make it in our skin using safe levels of UV rays that won’t increase risk for skin cancer. In fact, in the same issue of
The Lancet
where Autier’s study landed, a study done by Ian Reid and colleagues at the University of Auckland evaluated the vitamin D–bone health question.
²⁴
They evaluated 23 studies with 4,082 participants, all designed to see if supplemental vitamin D improves bone density. And they arrived at the same conclusion: “Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.” To put it bluntly, vitamin D supplements are a waste of money. The whole notion that “more is better” needs to be dropped. We may want to do more in some areas of our lives, but this clearly shouldn’t be one of them.

After another new report was published in the
Annals of Internal Medicine
, the US Preventive Services Task Force issued a statement in early 2015 saying that routine screening of asymptomatic patients for vitamin D deficiency was not necessary.
²⁵
They cited what the
Annals
report found: there simply wasn’t enough evidence to support the benefits or harms of screening for vitamin D deficiency.

Those who’ve
followed my advice or read my previous writings know that I have no problem with people taking vitamins and supplements to address a true deficiency or condition, such as pregnancy. My frustration with the vitamin industry is actually less targeted at low-dose multivitamins and more geared to the megadose and stand-alone products that doctors recommend to patients without valid data to support their use, leaving many people confused and wasting money. Fish oil, for example, is the third most widely used dietary supplement, after vitamins and minerals. Many Americans—at least 10 percent by some estimates—take fish oil regularly in the belief that the omega-3 fatty acids in these supplements protect their heart.
²⁶
But once again, the data doesn’t speak this wisdom. The vast majority of clinical trials haven’t found any conclusive evidence that fish oil supplements lower the risk of heart attack and stroke. Dozens of rigorous studies, most of which examined whether fish oil could prevent cardiovascular events in people who are at high risk, were published between 2005 and 2012 in the world’s top medical journals.
²⁷
These studies looked at people who were at high risk for heart problems, such as those with high cholesterol, high blood pressure, type 2 diabetes, or a history of heart disease. In all but two of these studies fish oil showed no benefit compared with a placebo.

Theoretically, it’s reasonable to think that fish oil improves cardiovascular health. After all, most of these supplements contain two megastar omega-3 fatty acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These fatty acids have been shown to reduce inflammation and have a blood-thinning effect, both of which factor into risk for cardiovascular events. The FDA has even approved at least three fish oil supplements that require a prescription; they are marketed for the treatment of high triglycerides (blood fats), a risk factor for heart disease. Despite the touted benefits of omega-3 fatty acids, they have not been observed in most large clinical trials. Only a change in a single lab test has been noted, which is quite meaningless.

The praise for fish oil began in the 1970s when the Danish scientists Drs. Hans Olaf Bang and Jorn Dyerberg noticed that Inuits living in northern Greenland enjoyed unusually low rates of cardiovascular
disease. They credited this phenomenon to the Inuits’ diet of omega-3-rich fats found in fish, seal, and whale blubber. But George Fodor, a cardiologist at the University of Ottawa, later pointed out the flaws in a lot of this early research, reckoning that the rate of heart disease among the Inuits was sorely underestimated. Fish oil supplements retained their halo effect, however, and this persists today.

Several studies that commenced in the 1990s also buoyed the case for fish oil. One study from Italy that was met with much fanfare, for example, found that heart attack survivors who were given a gram of fish oil daily had lower death rates compared with patients taking vitamin E.
²⁸
These findings, published in 2002, motivated organizations like the American Heart Association to recommend fish oil supplements to people with heart conditions. But soon enough, people who didn’t have any heart conditions or even risk factors for cardiovascular disease followed in a precautionary move.

No real benefit has been shown in recent studies, either, including one that involved the same Italian researcher who published those positive outcomes with fish oil more than a decade earlier. This study, featured in the
New England Journal of Medicine
in 2013, involved a clinical trial of 12,000 people and found that a daily gram of fish oil did not lower the death rate from heart attacks and strokes in people with atherosclerosis.
²⁹
Atherosclerosis is a disease characterized by a buildup of fats, cholesterol, and other substances (collectively called plaques) in and on your artery walls. I should add that the early fish oil studies occurred in an era when cardiovascular disease was treated differently than it is today. Now we have powerful drugs at our disposal that can treat heart disease more effectively. Most of the cardiologists I know tell their patients to skip fish oil supplements and instead eat fatty fish at least twice a week. After all, fish contains an assortment of nutrients other than EPA and DHA. But many general practitioners will indeed recommend fish oil to their patients, as well as take it themselves despite the lack of incontrovertible data. Which highlights the fact that doctors don’t always know what’s right and want more research to be conducted to confirm or refute their thinking. That will happen in the Lucky Years.

One of the most common questions I get now is “My doctor told me to take
X
. What do I do?” The answer is simple: Ask your doctor “Why, and based on what data?” That’s the conversation we all should be having, rather than reducing every health topic down to “This is categorically good” and “That is always bad.” And I love it when I hear people say to me, “Thanks for explaining,” as they let out a sigh of relief. I want people on as few drugs and supplements as possible, but at the same time I want people to employ the power of modern technologies—and medicines—whenever appropriate so that they may realize the ultimate goal: to take control of their health for a quality, long life.

• • •

The ultimate lesson here is to watch out for absolute, declaratory statements made by both media and experts alike, especially when they are taken out of context: “Reverse heart disease with this diet” . . . “Ax acne using this ingredient” . . . “Drink this smoothie to lose up to ten pounds a week” . . . “Look ten years younger by doing/taking the following” . . . “
X
will kill you” . . . “
Y
will make you fat” . . . “And
Z
will cure you . . .” Remember the three statements at the beginning of this chapter? Those are the kind of absolute announcements I’m talking about, and the answer to my pop quiz, if you hadn’t already guessed, is that none of them is debatable; they’re all false. Data is everywhere today, some of it sound but much of it questionable or in need of more study and explanation. Know where your data is coming from. Ask who, what, where, when, and
why
. If you learn how to look for reliable data, it will help you determine what is truly “best” for you.

Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.

—Plato

F
or centuries, we’ve known that exercise does a body good, even if the underlying scientific explanations were unknown or unclear. In the past decade, however, we’ve made huge strides in deciphering the extraordinary relationship between physical fitness and total health. This has been made possible by the latest technology and recent novel collaborations among various fields of science and medicine. The latest research has allowed us to measure, analyze, and understand biologically what happens when we flex our muscles, take a brisk walk, join a group fitness class, pedal a bicycle, pick up heavy boxes, or train for an athletic event.

We have been active animals in constant pursuit of survival since the birth of humankind. In fact, our genetic makeup requires and
expects
our bodies to be physically challenged via regular exercise. But as we are well aware, only a small percentage of us cater to our body’s need to move frequently. Modern technology has its benefits, but it also has its drawbacks when it facilitates sitting all day. Most everything we need can be obtained without having to exert much effort, much less get off our butts. We didn’t evolve over the past millions of years to thrive in a sitting position, and that fact has played into the rates of chronic illnesses that can be associated with being sedentary, such as diabetes and heart disease (“sitting diseases”).

If we could go back in time to observe how ancient cultures took to sitting, we’d notice that many sat upright on floors in the cross-legged position, kneeled, or sat with “tent knees” with their buttocks and feet on the ground, knees bent. These positions require balance and coordination, as well as strength in the legs, glutes, and back. Now we use chairs and couches that have the unfortunate effect of putting the body in positions that are not ideal for its natural mechanics and circulation.

Nearly 80 percent of adult Americans do not get the recommended amounts of exercise each week.
¹
A 2012 study led by Harvard researchers and published in
The Lancet
determined that inactivity is tied to more than 5 million deaths worldwide—more than those caused by smoking!
²
A survey of nearly thirty thousand women in the United States done the following year found that those who sat nine or more hours a day were more likely to be depressed than those who sat fewer than six hours a day.
³
Some of the biological reasoning makes common sense: your circulation is reduced when you’re sitting down, and as a result the flow of feel-good hormones to your brain is also reduced.

This is partly why the headlines in the past couple of years have declared inactivity, especially prolonged sitting, as the “new smoking.” You may even have read articles suggesting that no matter how fit you are, if you sit for most of the day, you face a higher risk of numerous health challenges and premature death. So even if you exercise hard for an ambitious hour or more a day, you’re still putting your health at risk if you’re
mostly stationary the rest of the day. And we all know how easy this can be if you spend your days driving in your car, working at a desk, and interacting with lots of screens, from computers and tablets to cell phones and televisions. Sitting too much despite exercise is akin to smoking despite exercise.

Being in a seated position is not in itself harmful. But sitting for prolonged periods over and over again entails biological effects that negatively influence things like blood fats, blood sugar balance, resting blood pressure, and many hormones, some of which help control your metabolism, appetite, and the volume of food you eat. The body essentially turns off at the metabolic activity level when it’s idle for a long time. As your circulation slows down, your body uses less of your blood sugar and burns less fat, both of which increase your risk of heart disease and diabetes—two of our leading killers today. New science is showing the impact that being immobile has on certain genes. For example, one pivotal gene that’s been identified is called lipid phosphate phosphatase 1, or LPP1. We think this gene helps to keep our cardiovascular system healthy by preventing dangerous blood clotting and inflammation. But it’s significantly suppressed when the body is idle for a few hours, so it can’t do its job to maintain cardio health. Even exercise won’t impact this gene if the muscles have been inactive most of the day. In other words, LPP1 is apparently sensitive to sitting but resistant to exercise.

Makes me wonder: If all of the people who take vitamins and supplements stopped doing so and instead focused on increasing their movement throughout the day by just 10 percent, how much chronic disease and early death could we avoid? Probably a lot.

In 2010, the World Health Organization published its “Global Recommendations on Physical Activity for Health,” which resembles the American guidelines that were last published in 2008.
⁴
Physical activity, the WHO pointed out, is the fourth leading risk factor for global mortality. And sedentary living is unfortunately on the rise across the globe. When you look at the top five risk factors for mortality, however, all of them are interrelated:

These risk factors account for nearly 40 percent of global mortality. Physical inactivity may only account for 6 percent, but it’s closely related to the other factors, as it paves the way for high blood pressure, high blood glucose, and being overweight or obese. There is also evidence that exercise helps people lessen or eradicate their smoking habits. After all, when you exercise regularly, you tend to avoid activities that send your health in the other direction. With fitness comes the inspiration to eat better, move more, and generally live better.