Can You Be Fat AND Fit?
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The short answer is “yes“.
And as for what that means for your heart and/or all-cause mortality risk: it’s just as good as being fit at a smaller size, and furthermore, it’s better than being less fit at a smaller size.
Here’s the longer answer:
The science
A research team did a systematic review looking at multiple large cohort studies examining the associations between:
- Cardiorespiratory fitness and cardiovascular disease risk
- Cardiorespiratory fitness and all-cause mortality
- BMI and cardiovascular disease risk
- BMI and all-cause mortality
However, they also took this further, and tabulated the data such that they could also establish the cardiovascular disease mortality risk and all-cause mortality risk of:
- Unfit people with “normal” BMI
- Unfit people with “overweight” BMI
- Unfit people with “obese” BMI
- Fit people with “normal” BMI
- Fit people with “overweight” BMI
- Fit people with “obese” BMI
Before we move on, let’s note for the record that BMI is a woeful system in any case, for enough reasons to fill a whole article:
Now, with that in mind, let’s get to the results:
What they found
For cardiovascular disease mortality risk of unfit people specifically, compared to fit people of “normal” BMI:
- Unfit people with “normal” BMI: 2.04x higher risk.
- Unfit people with “overweight” BMI: 2.58x higher risk.
- Unfit people with “obese” BMI: 3.35x higher risk
So here we can see that if you are unfit, then being heavier will indeed increase your CVD mortality risk.
For all-cause mortality risk of unfit people specifically, compared to fit people of “normal” BMI:
- Unfit people with “normal” BMI: 1.92x higher risk.
- Unfit people with “overweight” BMI: 1.82x higher risk.
- Unfit people with “obese” BMI: 2.04x higher risk
This time we see that if you are unfit, then being heavier or lighter than “overweight” will increase your all-cause mortality risk.
So, what about if you are fit? Then being heavier or lighter made no significant difference to either CVD mortality risk or all-cause mortality risk.
Fit individuals, regardless of weight category (normal, overweight, or obese), had significantly lower mortality risks compared to unfit individuals in any weight category.
Note: not just “compared to unfit individuals in their weight category”, but compared to unfit individuals in any weight category.
In other words, if you are obese and have good cardiorespiratory fitness, you will (on average) live longer than an unfit person with “normal” BMI.
You can find the paper itself here, if you want to examine the data and/or method:
Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis
Ok, so how do I improve the kind of fitness that they measured?
They based their cardiorespiratory fitness on VO2 Max, which scientific consensus holds to be a good measure of how efficiently your body can use oxygen—thus depending on your heart and lungs being healthy.
If you use a fitness tracker that tracks your exercise and your heart rate, it will estimate your VO2 Max for you—to truly measure the VO2 Max itself directly, you’ll need a lot more equipment; basically, access to a lab that tests this. But the estimates are fairly accurate, and so good enough for most personal purposes that aren’t hard-science research.
Next, you’ll want to do this:
53 Studies Later: The Best Way to Improve VO2 Max
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Alzheimer’s Causative Factors To Avoid
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The Best Brains Bar Nun?
This is Dr. David Snowdon. He’s an epidemiologist, and one of the world’s foremost experts on Alzheimer’s disease. He was also, most famously, the lead researcher of what has become known as “The Nun Study”.
We recently reviewed his book about this study:
…which we definitely encourage you to check out, but we’ll do our best to summarize its key points today!
Reassurance up-front: no, you don’t have to become a nun
The Nun Study
In 1991, a large number (678) of nuns were recruited for what was to be (and until now, remains) the largest study of its kind into the impact of a wide variety of factors on aging, and in particular, Alzheimer’s disease.
Why it was so important: because the nuns were all from the same Order, had the same occupation (it’s a teaching Order), with very similar lifestyles, schedules, socioeconomic status, general background, access to healthcare, similar diets, same relationship status (celibate), same sex (female), and many other factors also similar, this meant that most of the confounding variables that confound other studies were already controlled-for here.
Enrollment in the study also required consenting to donating one’s brain for study post-mortem—and of those who have since died, indeed 98% of them have been donated (the other 2%, we presume, may have run into technical administrative issues with the donation process, due to the circumstances of death and/or delays in processing the donation).
How the study was undertaken
We don’t have enough space to describe the entire methodology here, but the gist of it is:
- Genetic testing for relevant genetic factors
- Data gathered about lives so far, including not just medical records but also autobiographies that the nuns wrote when they took their vows (at ages 19–21)
- Extensive ongoing personal interviews about habits, life choices, and attitudes
- Yearly evaluations including memory tests and physical function tests
- Brain donation upon death
What they found
Technically, The Nun Study is still ongoing. Of the original 678 nuns (aged 75–106), three are still alive (based on the latest report, at least).
However, lots of results have already been gained, including…
Genes
A year into the study, in 1992, the “apolipoprotein E” (APOE) gene was established as a likely causative factor in Alzheimer’s disease. This is probably not new to our readers in 2024, but there are interesting things being learned even now, for example:
The Alzheimer’s Gene That Varies By Race & Sex
…but watch out! Because also:
Alzheimer’s Sex Differences May Not Be What They Appear
Words
Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:
- Longer sentences
- Positive outlook
- “Idea density”
That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).
Want to spruce up yours? You might like to check out:
Reading, Better: Reading As A Cognitive Exercise
…for specific, evidence-based ways to tweak your reading to fight cognitive decline.
Food
While the dietary habits of the nuns were fairly homogenous, those who favored eating more and cooked greens, beans, and tomatoes, lived longer and with healthier brains.
See also: Brain Food? The Eyes Have It!
Other aspects of brain health & mental health
The study also found that nuns who avoided stroke and depression, were also less likely to get dementia.
For tending to these, check out:
- Two Things You Can Do To Improve Stroke Survival Chances
- Depression, And The Mental Health First-Aid That You’ll Hopefully Never Need
- Behavioral Activation Against Depression & Anxiety
Community & Faith
Obviously, in this matter the nuns were quite a homogenous group, scoring heavily in community and faith. What’s relevant here is the difference between the nuns, and other epidemiological studies in other groups (invariably not scoring so highly).
Community & faith are considered, separately and together, to be protective factors against dementia.
Faith may be something that “you have it or you don’t” (we’re a health science newsletter, not a theological publication, but for the interested, philosopher John Stuart Mill’s 1859 essay “On Liberty“ makes a good argument for it not being something one can choose, prompting him to argue for religious tolerance, on the grounds that religious coercion is a futile effort precisely because a person cannot choose to dis/believe something)
…but community can definitely be chosen, nurtured, and grown. We’ve written about this a bit before:
You might also like to check out this great book on the topic:
Purpose: Design A Community And Change Your Life – by Gina Bianchini
Want more?
We gave a ground-up primer on avoiding Alzheimer’s and other dementias; check it out:
How To Reduce Your Alzheimer’s Risk
Take care!
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What does it mean to be transgender?
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Transgender media coverage has surged in recent years for a wide range of reasons. While there are more transgender television characters than ever before, hundreds of bills are targeting transgender people’s access to medical care, sports teams, gender-specific public spaces, and other institutions.
Despite the increase in conversation about the transgender community, public confusion around transgender identity remains.
Read on to learn more about what it means to be transgender and understand challenges transgender people may face.
What does it mean to be transgender?
Transgender—or “trans”—is an umbrella term for people whose gender identity or gender expression does not conform to their sex assigned at birth. People can discover they are trans at any age.
Gender identity refers to a person’s inner sense of being a woman, a man, neither, both, or something else entirely. Trans people who don’t feel like women or men might describe themselves as nonbinary, agender, genderqueer, or two-spirit, among other terms.
Gender expression describes the way a person communicates their gender through their appearance—such as their clothing or hairstyle—and behavior.
A person whose gender expression doesn’t conform to the expectations of their assigned sex may not identify as trans. The only way to know for sure if someone is trans is if they tell you.
Cisgender—or “cis”—describes people whose gender identities match the sex they were assigned at birth.
How long have transgender people existed?
Being trans isn’t new. Although the word “transgender” only dates back to the 1960s, people whose identities defy traditional gender expectations have existed across cultures throughout recorded history.
How many people are transgender?
A 2022 Williams Institute study estimates that 1.6 million people over the age of 13 identify as transgender in the United States.
Is being transgender a mental health condition?
No. Conveying and communicating about your gender in a way that feels authentic to you is a normal and necessary part of self-expression.
Social and legal stigma, bullying, discrimination, harassment, negative media messages, and barriers to gender-affirming medical care can cause psychological distress for trans people. This is especially true for trans people of color, who face significantly higher rates of violence, poverty, housing instability, and incarceration—but trans identity itself is not a mental health condition.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity, or their internal sense of gender. A 2021 study of trans adults pursuing gender-affirming medical care found that most participants started experiencing gender dysphoria by the time they were 7.
When trans people don’t receive the support they need to manage gender dysphoria, they may experience depression, anxiety, social isolation, suicidal ideation, substance use disorder, eating disorders, and self-injury.
How do trans people manage gender dysphoria?
Every trans person’s experience with gender dysphoria is unique. Some trans people may alleviate dysphoria by wearing gender-affirming clothing or by asking others to refer to them by a new name and use pronouns that accurately reflect their gender identity. The 2022 U.S. Trans Survey found that nearly all trans participants who lived as a different gender than the sex they were assigned at birth reported that they were more satisfied with their lives.
Some trans people may also manage dysphoria by pursuing medical transition, which may involve taking hormones and getting gender-affirming surgery.
Access to gender-affirming medical care has been shown to reduce the risk of depression and suicide among trans youth and adults.
To learn more about the trans community, visit resources from the National Center for Transgender Equality, the Trevor Project, PFLAG, and Planned Parenthood.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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An RSV vaccine has been approved for people over 60. But what about young children?
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The Therapeutic Goods Administration (TGA) has approved a vaccine against respiratory syncytial virus (RSV) in Australia for the first time. The shot, called Arexvy and manufactured by GSK, will be available by prescription to adults over 60.
RSV is a contagious respiratory virus which causes an illness similar to influenza, most notably in babies and older adults.
So while it will be good to have an RSV vaccine available for older people, where is protection up to for the youngest children?
A bit about RSV
RSV was discovered in chimpanzees with respiratory illness in 1956, and was soon found to be a common cause of illness in humans.
There are two key groups of people we would like to protect from RSV: babies (up to about one year old) and people older than 60.
Babies tend to fill up hospitals during the RSV season in late spring and winter in large numbers, but severe infection requiring admission to intensive care is less common.
In babies and younger children, RSV generally causes a wheezing asthma-like illness (bronchiolitis), but can also cause pneumonia and croup.
Although there are far fewer hospital admissions among older people, they can develop severe disease and die from an infection.
Babies account for the majority of hospitalisations with RSV.
Prostock-studio/ShutterstockRSV vaccines for older people
For older adults, there are actually several RSV vaccines in the pipeline. The recent Australian TGA approval of Arexvy is likely to be the first of several, with other vaccines from Pfizer and Moderna currently in development.
The GSK and Pfizer RSV vaccines are similar. They both contain a small component of the virus, called the pre-fusion protein, that the immune system can recognise.
Both vaccines have been shown to reduce illness from RSV by more than 80% in the first season after vaccination.
In older adults, side effects following Arexvy appear to be similar to other vaccines, with a sore arm and generalised aches and fatigue frequently reported.
Unlike influenza vaccines which are given each year, it is anticipated the RSV vaccine would be a one-off dose, at least at this stage.
Protecting young children from RSV
Younger babies don’t tend to respond well to some vaccines due to their immature immune system. To prevent other diseases, this can be overcome by giving multiple vaccine doses over time. But the highest risk group for RSV are those in the first few months of life.
To protect this youngest age group from the virus, there are two potential strategies available instead of vaccinating the child directly.
The first is to give a vaccine to the mother and rely on the protective antibodies passing to the infant through the placenta. This is similar to how we protect babies by vaccinating pregnant women against influenza and pertussis (whooping cough).
The second is to give antibodies directly to the baby as an injection. With both these strategies, the protection provided is only temporary as antibodies wane over time, but this is sufficient to protect infants through their highest risk period.
Women could be vaccinated during pregnancy to protect their baby in its first months of life.
Image Point Fr/ShutterstockAbrysvo, the Pfizer RSV vaccine, has been trialled in pregnant women. In clinical trials, this vaccine has been shown to reduce illness in infants for up to six months. It has been approved in pregnant women in the United States, but is not yet approved in Australia.
An antibody product called palivizumab has been available for many years, but is only partially effective and extremely expensive, so has only been given to a small number of children at very high risk.
A newer antibody product, nirsevimab, has been shown to be effective in reducing infections and hospitalisations in infants. It was approved by the TGA in November, but it isn’t yet clear how this would be accessed in Australia.
What now?
RSV, like influenza, is a major cause of respiratory illness, and the development of effective vaccines represents a major advance.
While the approval of the first vaccine for older people is an important step, many details are yet to be made available, including the cost and the timing of availability. GSK has indicated its vaccine should be available soon. While the vaccine will initially only be available on private prescription (with the costs paid by the consumer), GSK has applied for it to be made free under the National Immunisation Program.
In the near future, we expect to hear further news about the other vaccines and antibodies to protect those at higher risk from RSV disease, including young children.
Allen Cheng, Professor of Infectious Diseases, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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No, COVID-19 vaccines don’t cause ‘turbo cancer’
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What you need to know
- COVID-19 vaccines do not cause “turbo cancer” or contain SV40, a virus that has been suspected of causing cancer.
- There is no link between rising cancer rates and COVID-19 vaccines.
- Staying up to date on COVID-19 vaccines is a safe, free way to support long-term health.
Myths that COVID-19 vaccines cause cancer have been circulating since the vaccines were first developed. These false claims resurfaced last month after Princess Kate Middleton announced that she is undergoing cancer treatment, with some vaccine opponents falsely claiming Middleton has a “turbo cancer” caused by COVID-19 vaccines.
Here’s what we know: “Turbo cancer” is a made-up term for a fake phenomenon, and there is strong evidence that COVID-19 vaccines do not cause cancer or increase cancer risk.
Read on to learn how to recognize false claims about COVID-19 vaccines and cancer.
Do COVID-19 vaccines contain cancer-causing ingredients?
No. Some vaccine opponents claim that COVID-19 vaccines contain SV40, a virus that has been suspected of causing cancer. This claim is false.
A piece of SV40’s DNA sequence—called a “promoter”—was used as starting material to develop COVID-19 vaccines, but the virus itself is not present in the vaccines. The promoter does not contain the part of the virus that enters the cell nucleus, so it poses no risk.
COVID-19 vaccines and their ingredients have been rigorously studied in millions of people worldwide and have been determined to be safe. The National Cancer Institute and the American Cancer Society agree that COVID-19 vaccines do not increase cancer risk or accelerate cancer growth.
Why are cancer rates rising in the U.S.?
Since the 1990s, cancer rates have been on the rise globally and in the U.S., most notably in people under 50. Increased cancer screening may partially explain the rising number of cancer diagnoses. Exposure to air pollution and lifestyle factors like tobacco use, alcohol use, and diet may also be contributing factors.
What are the benefits of staying up to date on COVID-19 vaccines?
Staying up to date on COVID-19 vaccines is a safe way to protect our long-term health. COVID-19 vaccines prevent severe illness, hospitalization, death, and long COVID.
The CDC says staying up to date on COVID-19 vaccines is a safer and more reliable way to build protection against COVID-19 than getting sick from COVID-19.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Can Ginkgo Tea Be Made Safe? (And Other Questions)
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I’d be interested in OTC prostrate medication safety and effectiveness.❞
Great idea! Sounds like a topic for a main feature one day soon, but while you’re waiting, you might like this previous main feature we did, about a supplement that performs equally to some prescription BPH meds:
❝Was very interested in the article on ginko bilboa as i moved into a home that has the tree growing in the backyard. Is there any way i can process the leaves to make a tea out of it.❞
Glad you enjoyed! First, for any who missed it, here was the article on Ginkgo biloba:
Ginkgo Biloba, For Memory And, Uh, What Else Again?
Now, as that article noted, Ginkgo biloba seeds and leaves are poisonous. However, there are differences:
The seeds, raw or roasted, contain dangerous levels of a variety of toxins, though roasting takes away some toxins and other methods of processing (boiling etc) take away more. However, the general consensus on the seeds is “do not consume; it will poison your liver, poison your kidneys, and possibly give you cancer”:
Ginkgo biloba L. seed; A comprehensive review of bioactives, toxicants, and processing effects
The leaves, meanwhile, are much less poisonous with their ginkgolic acids, and their other relevant poison is very closely related to that of poison ivy, involving long-chain alkylphenols that can be broken down by thermolysis, in other words, heat:
However, this very thorough examination of the potential health benefits and risks of ginkgo tea, comes to the general conclusion “this is not a good idea, and is especially worrying in elders, and/or if taking various medications”:
In summary:
- Be careful
- Avoid completely if you have a stronger-than-usual reaction to poison ivy
- If you do make tea from it, green leaves appear to be safer than yellow ones
- If you do make tea from it, boil and stew to excess to minimize toxins
- If you do make tea from it, doing a poison test is sensible (i.e. start with checking for a skin reaction to a topical application on the inside of the wrist, then repeat at least 6 hours later on the lips, then at least 6 hours later do a mouth swill, then at least 12 hours later drink a small amount, etc, and gradually build up to “this is safe to consume”)
For safety (and legal) purposes, let us be absolutely clear that we are not advising you that it is safe to consume a known poisonous plant, and nor are we advising you to do so.
But the hopefully only-ever theoretical knowledge of how to do a poison test is a good life skill, just in case
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Saunas: Health Benefits (& Caveats)
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The Heat Is On
In Tuesday’s newsletter, we asked you your (health-related) opinion on saunas, and got the above-depicted, below-described, set of responses:
- About 53% said it is “a healthful activity with many benefits”
- About 25% said it is “best avoided; I feel like I’m dying in there”
- About 12% said “it feels good and therefore can’t be all bad”
So what does the science say?
The heat of saunas carries a health risk: True or False?
False, generally speaking, for any practical purposes. Of course, anything in life comes with a health risk, but statistically speaking, your shower at home is a lot more dangerous than a sauna (risk of slipping with no help at hand).
It took a bit of effort to find a paper on the health risks of saunas, because all the papers on PubMed etc coming up for those keywords were initially papers with “reduces the risk of…”, i.e. ways in which the sauna is healthy.
However, we did find one:
❝Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, and severe aortic stenosis.
Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction.
Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided. ❞
~ Dr. Matti Hannuksela & Dr. Samer Ellahham
Source: Benefits and risks of sauna bathing
So, very safe for most people, safe even for most people with heart disease, but there are exceptions so check with your own doctor of course.
And drinking alcohol anywhere is bad for the health, but in a sauna it’s a truly terrible idea. As an aside, please don’t drink alcohol in the shower, either (risk of slipping with no help at hand, and this time, broken glass too).
On the topic of it being safe for most people’s hearts, see also:
Beneficial effects of sauna bathing for heart failure patients
As an additional note, those who have a particular sensitivity to the heat, may (again please check with your own doctor, as your case may vary) actually benefit from moderate sauna use, to reduce the cardiovascular strain that your body experiences during heatwaves (remember, you can get out of a sauna more easily than you can get out of a heatwave, so for many people it’s a lot easier to do moderation and improve thermoregulatory responses):
Sauna usage can bring many health benefits: True or False?
True! Again, at least for most people. As well as the above-discussed items, here’s one for mortality rates in healthy Finnish men:
Not only that, also…
❝The Finnish saunas have the most consistent and robust evidence regarding health benefits and they have been shown to decrease the risk of health outcomes such as hypertension, cardiovascular disease, thromboembolism, dementia, and respiratory conditions; may improve the severity of musculoskeletal disorders, COVID-19, headache and flu, while also improving mental well-being, sleep, and longevity.
Finnish saunas may also augment the beneficial effects of other protective lifestyle factors such as physical activity.
The beneficial effects of passive heat therapies may be linked to their anti-inflammatory, cytoprotective and anti-oxidant properties and synergistic effects on neuroendocrine, circulatory, cardiovascular and immune function.
Passive heat therapies, notably Finnish saunas, are emerging as potentially powerful and holistic strategies to promoting health and extending the healthspan in all populations. ❞
~ Dr. Jari Laukkanen & Dr. Setor Kunutsor
(the repeated clarification of “Finnish sauna” is not a matter of fervent nationalism, by the way, but rather a matter of disambiguating it from Swedish sauna, which has some differences, most notably a lack of steam)
That reminds us: in Scandinavia, it is usual to use a sauna naked, and in Finland in particular, it is a common social activity amongst friends, coworkers, etc. In the US, many people are not so comfortable with nudity, and indeed, many places that provide saunas, may require the wearing of swimwear. But…
Just one problem: if you’re wearing swimwear because you’ve just been swimming in a pool, you now have chlorinated water soaked into your swimwear, which in the sauna, will become steam + chlorine gas. That’s not so good for your health (and is one reason, beyond tradition and simple normalization, for why swimwear is usually not permitted in Finnish saunas).
Want to read more?
You might like our previous main feature,
Turning Up The Heat Against Diabetes & Alzheimer’s ← you guessed it, sauna may be beneficial against these too
Take care!
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