Aspirin, CVD Risk, & Potential Counter-Risks
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Aspirin Pros & Cons
In Tuesday’s newsletter, we asked your health-related opinion of aspirin, and got the above-depicted, below-described set of responses:
- About 42% said “Most people can benefit from low-dose daily use to lower CVD risk”
- About 31% said “It’s safe for occasional use as a mild analgesic, but that’s all”
- About 28% said “We should avoid aspirin; it can cause liver and/or kidney damage”
So, what does the science say?
Most people can benefit from low-dose daily aspirin use to lower the risk of cardiovascular disease: True or False?
True or False depending on what we mean by “benefit from”. You see, it works by inhibiting platelet function, which means it simultaneously:
- decreases the risk of atherothrombosis
- increases the risk of bleeding, especially in the gastrointestinal tract
When it comes to balancing these things and deciding whether the benefit merits the risk, you might be asking yourself: “which am I most likely to die from?” and the answer is: neither
While aspirin is associated with a significant improvement in cardiovascular disease outcomes in total, it is not significantly associated with reductions in cardiovascular disease mortality or all-cause mortality.
In other words: speaking in statistical generalizations of course, it may improve your recovery from minor cardiac events but is unlikely to help against fatal ones
The current prevailing professional (amongst cardiologists) consensus is that it may be recommended for secondary prevention of ASCVD (i.e. if you have a history of CVD), but not for primary prevention (i.e. if you have no history of CVD). Note: this means personal history, not family history.
In the words of the Journal of the American College of Cardiology:
❝Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk (S4.6-1–S4.6-8).
Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (S4.6-9).
Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (S4.6-10).❞
~ Dr. Donna Arnett et al. (those section references are where you can find this information in the document)
Read in full: Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology
Or if you’d prefer a more pop-science presentation:
Many older adults still use aspirin for CVD prevention, contrary to clinical guidance
Aspirin can cause liver and/or kidney damage: True or False?
True, but that doesn’t mean we must necessarily abstain, so much as exercise caution.
Aspirin is (at recommended doses) not usually hepatotoxic (toxic to the liver), but there is a strong association between aspirin use in children and the development of Reye’s syndrome, a disease involving encephalopathy and a fatty liver. For this reason, most places have an official recommendation that aspirin not be used by children (cut-off age varies from place to place, for example 12 in the US and 16 in the UK, but the key idea is: it’s potentially dangerous for those who are not fully grown).
Aspirin is well-established as nephrotoxic (toxic to the kidneys), however, the toxicity is sufficiently low that this is not expected to be a problem to otherwise healthy adults taking it at no more than the recommended dose.
For numbers, symptoms, and treatment, see this very clear and helpful resource:
An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose
Take care!
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The Midlife Cyclist – by Phil Cavell
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Whether stationary cycling in your living room, or competing in the Tour de France, there’s a lot more to cycling than “push the pedals”—if you want to get good benefits and avoid injury, in any case.
This book explores the benefits of different kinds of cycling, the biomechanics of various body positions, and the physiology of different kinds of performance, and the impact these things have on everything from your joints to your heart to your telomeres.
The style is very much conversational, with science included, and a readiness to acknowledge in cases where the author is guessing or going with a hunch, rather than something being well-evidenced. This kind of honesty is always good to see, and it doesn’t detract from where the science is available and clear.
One downside for some readers will be that while Cavell does endeavour to cover sex differences in various aspects of how they relate to the anatomy and physiology (mostly: the physiology) of cycling, the book is written from a male perspective and the author clearly understands that side of things better. For other readers, of course, this will be a plus.
Bottom line: if you enjoy cycling, or you’re thinking of taking it up but it seems a bit daunting because what if you do it wrong and need a knee replacement in a few years or what if you hurt your spine or something, then this is the book to set your mind at ease, and put you on the right track.
Click here to check out The Midlife Cyclist, and enjoy the cycle of life!
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The Osteoporosis Breakthrough – by Dr. Doug Lucas
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“Osteoporosis” and “break” often don’t go well together, but here they do. So, what’s the breakthrough here?
There isn’t one, honestly. But if we overlook the marketing choices and focus on the book itself, the content here is genuinely good:
The book offers a comprehensive multivector approach to combatting osteoporosis, e.g:
- Diet
- Exercise
- Other lifestyle considerations
- Supplements
- Hormones
- Drugs
The author considers drugs a good and important tool for some people with osteoporosis, but not most. The majority of people, he considers, will do better without drugs—by tackling things more holistically.
The advice here is sound and covers all reasonable angles without getting hung up on the idea of there being a single magical solution for all.
Bottom line: if you’re looking for a book that’s a one-stop-shop for strategies against osteoporosis, this is a good option.
Click here to check out The Osteoporosis Breakthrough, and keep your bones strong!
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Protein: How Much Do We Need, Really?
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Mythbusting Protein!
Yesterday, we asked you for your policy on protein consumption. The distribution of responses was as follows:
- A marginal majority (about 55%) voted for “Protein is very important, but we can eat too much of it”
- A large minority (about 35%) voted for “We need lots of protein; the more, the better!”
- A handful (about 4%) voted for “We should go as light on protein as possible”
- A handful (6%) voted for “If we don’t eat protein, our body will create it from other foods”
So, what does the science say?
If we don’t eat protein, our body will create it from other foods: True or False?
Contingently True on an absurd technicality, but for all practical purposes False.
Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize and absolutely must get from food. Normally, we get those amino acids from protein in our diet, and we can also supplement them by buying amino acid supplements.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
However, to get the requisite amino acid amounts, without consuming actual protein, would require gargantuan amounts of supplementation (bearing in mind bioavailability will never be 100%, so you’ll always need to take more than it seems), using supplements that will have been made by breaking down proteins anyway.
So unless you live in a laboratory and have access to endless amounts of all of the required amino acids (you can’t miss even one; you will die), and are willing to do that for the sake of proving a point, then you do really need to eat protein.
Your body cannot, for example, simply break down sugar and use it to make the protein you need.
On another technical note… Do bear in mind that many foods that we don’t necessarily think of as being sources of protein, are sources of protein.
Grains and grain products, for example, all contain protein; we just don’t think of them as that because their macronutritional profile is heavily weighted towards carbohydrates.
For that matter, even celery contains protein. How much, you may ask? Almost none! But if something has DNA, it has protein. Which means all plants and animals (at least in their unrefined forms).
So again, to even try to live without protein would very much require living in a laboratory.
We can eat too much protein: True or False?
True. First on an easy technicality; anything in excess is toxic. Even water, or oxygen. But also, in practical terms, there is such a thing as too much protein. The bar is quite high, though:
❝Based on short-term nitrogen balance studies, the Recommended Dietary Allowance of protein for a healthy adult with minimal physical activity is currently 0.8 g protein per kg bodyweight per day❞
❝To meet the functional needs such as promoting skeletal-muscle protein accretion and physical strength, dietary intake of 1.0, 1.3, and 1.6 g protein per kg bodyweight per day is recommended for individuals with minimal, moderate, and intense physical activity, respectively❞
❝Long-term consumption of protein at 2 g per kg bodyweight per day is safe for healthy adults, and the tolerable upper limit is 3.5 g per kg bodyweight per day for well-adapted subjects❞
❝Chronic high protein intake (>2 g per kg bodyweight per day for adults) may result in digestive, renal, and vascular abnormalities and should be avoided❞
Source: Dietary protein intake and human health
To put this into perspective, if you weigh about 160lbs (about 72kg), this would mean eating more than 144g protein per day, which grabbing a calculator means about 560g of lean beef, or 20oz, or 1¼lb.
If you’re eating quarter-pounder burgers though, that’s not usually so lean, so you’d need to eat more than nine quarter-pounder burgers per day to get too much protein.
High protein intake damages the kidneys: True or False?
True if you have kidney damage already; False if you are healthy. See for example:
- Effects of dietary protein restriction on the progression of advanced renal disease in the modification of diet in renal disease study
- A high protein diet has no harmful effects: a one-year crossover study in healthy male athletes
High protein intake increases cancer risk: True or False?
True or False depending on the source of the protein, so functionally false:
- Eating protein from red meat sources has been associated with higher risk for many cancers
- Eating protein from other sources has been associated with lower risk for many cancers
Source: Red Meat Consumption and Mortality Results From 2 Prospective Cohort Studies
High protein intake increase risk of heart disease: True or False?
True or False depending on the source of the protein, so, functionally false:
- Eating protein from red meat sources has been associated with higher risk of heart disease
- Eating protein from other sources has been associated with lower risk of heart disease
Source: Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women
In summary…
Getting a good amount of good quality protein is important to health.
One can get too much, but one would have to go to extremes to do so.
The source of protein matters:
- Red meat is associated with many health risks, but that’s not necessarily the protein’s fault.
- Getting plenty of protein from (ideally: unprocessed) sources such as poultry, fish, and/or plants, is critical to good health.
- Consuming “whole proteins” (that contain all 9 amino acids that we can’t synthesize) are best.
Learn more: Complete proteins vs. incomplete proteins (explanation and examples)
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Breakfasting For Health?
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Breakfast Time!
In yesterday’s newsletter, we asked you for your health-related opinions on the timings of meals.
But what does the science say?
Quick recap on intermittent fasting first:
Today’s article will rely somewhat on at least a basic knowledge of intermittent fasting, what it is, and how and why it works.
Armed with that knowledge, we can look at when it is good to break the fast (i.e. breakfast) and when it is good to begin the fast (i.e. eat the last meal of the day).
So, if you’d like a quick refresher on intermittent fasting, here it is:
Intermittent Fasting: We Sort The Science From The Hype
And now, onwards!
One should eat breakfast first thing: True or False?
True! Give or take one’s definition of “first thing”. We did a main feature about this previously, and you can read a lot about the science of it, and see links to studies:
The Circadian Rhythm: Far More Than Most People Know
In case you don’t have time to read that now, we’ll summarize the most relevant-to-today’s-article conclusion:
The optimal time to breakfast is around 10am (this is based on getting sunlight around 8:30am, so adjust if this is different for you)
It doesn’t matter when we eat; calories are calories & nutrients are nutrients: True or False?
Broadly False, for practical purposes. Because, indeed calories are calories and nutrients are nutrients at any hour, but the body will do different things with them depending on where we are in the circadian cycle.
For example, this study in the Journal of Nutrition found…
❝Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain.
Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.❞
Read in full: Meal Frequency and Timing Are Associated with Changes in Body Mass Index
We should avoid eating too late at night: True or False?
False per se, True in the context of the above. Allow us to clarify:
There is nothing inherently bad about eating late at night; there is no “bonus calorie happy hour” before bed.
However…
If we are eating late at night, that makes it difficult to breakfast in the morning (as is ideal) and still maintain a >16hr fasting window as is optimal, per:
❝the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake❞
~ Dr. Françoise Wilhelmi de Toledo et al.
So in other words: since the benefits of intermittent fasting start at 12 hours into the fast, you’re not going to get them if you’re breakfasting at 10am and also eating in the evening.
Summary:
- It is best to eat breakfast around 10am, generally (ideally after some sunlight and exercise)
- While there’s nothing wrong with eating in the evening per se, doing so means that a 10am breakfast will eliminate any fasting benefits you might otherwise get
- If a “one meal a day, and that meal is breakfast” lifestyle doesn’t suit you, then one possible good compromise is to have a large breakfast, and then a smaller meal in the late afternoon / early evening.
One last tip: the above is good, science-based information. Use it (or don’t), as you see fit. We’re not the boss of you:
- Maybe you care most about getting the best circadian rhythm benefits, in which case, prioritizing breakfast being a) in the morning and b) the largest meal of the day, is key
- Maybe you care most about getting the best intermittent fasting benefits, in which case, for many people’s lifestyle, a fine option is skipping eating in the morning, and having one meal in the late afternoon / early evening.
Take care!
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Protein vs Sarcopenia
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Protein vs Sarcopenia
This is Dr. Gabrielle Lyon. A medical doctor, she’s board-certified in family medicine, and has also engaged in research and clinical practice in the fields of geriatrics and nutritional sciences.
A quick note…
We’re going to be talking a bit about protein metabolism today, and it’s worth noting that Dr. Lyon personally is vehemently against vegetarianism/veganism, and considers red meat to be healthy.
Scientific consensus on the other hand, holds that vegetarianism and veganism are fine for most people if pursued in an informed and mindful fashion, that white meat and fish are also fine for most people, and red meat is simply not.
If you’d like a recap on the science of any of that:
- Protein: How Much Do We Need, Really?
- Plant vs Animal Protein: Diversity is Key
- Do We Need Animal Products to be Healthy?
Nevertheless, if we look at the science that she provides, the advice is sound when applied to protein in general and without an undue focus on red meat.
How much protein is enough?
In our article linked above, we gave 1–2g/kg/day
Dr. Lyons gives the more specific 1.6g/kg/day for adults older than 40 (this is where sarcopenia often begins!) and laments that many sources offer 0.8g/kg.
To be clear, that “per kilogram” means per kilogram of your bodyweight. For Americans, this means dividing lbs by 2.2 to get the kg figure.
Why so much protein?
Protein is needed to rebuild not just our muscles, but also our bones, joint tissues, and various other parts of us:
We Are Such Stuff As Fish Are Made Of
Additionally, our muscles themselves are important for far more than just moving us (and other things) around.
As Dr. Lyon explains: sarcopenia, the (usually age-related) loss of muscle mass, does more than just make us frail; it also messes up our metabolism, which in turn messes up… Everything else, really. Because everything depends on that.
This is because our muscles themselves use a lot of our energy, and/but also store energy as glycogen, so having less of them means:
- getting a slower metabolism
- the energy that can’t be stored in muscle tissue gets stored somewhere else (like the liver, and/or visceral fat)
So, while for example the correlation between maintaining strong muscles and avoiding non-alcoholic fatty liver disease may not be immediately obvious, it is clear when one follows the metabolic trail to its inevitable conclusion.
Same goes for avoiding diabetes, heart disease, and suchlike, though those things are a little more intuitive.
How can we get so much protein?
It can seem daunting at first to get so much protein if you’re not used to it, especially as protein is an appetite suppressant, so you’ll feel full sooner.
It can especially seem daunting to get so much protein if you’re trying to avoid too many carbs, and here’s where Dr. Lyon’s anti-vegetarianism does have a point: it’s harder to get lean protein without meat/fish.
That said, “harder” does not mean “impossible” and even she acknowledges that lentils are great for this.
If you’re not vegetarian or vegan, collagen supplementation is a good way to make up any shortfall, by the way.
And for everyone, there are protein supplements available if we want them (usually based on whey protein or soy protein)
Anything else we need to do?
Yes! Eating protein means nothing if you don’t do any resistance work to build and maintain muscle. This can take various forms, and Dr. Lyon recommends lifting weights and/or doing bodyweight resistance training (calisthenics, Pilates, etc).
Here are some previous articles of ours, consistent with the above:
- Resistance Is Useful! (Especially As We Get Older)
- Overdone It? How To Speed Up Recovery After Exercise
- How To Do HIIT (Without Wrecking Your Body)
- Exercises To Do (And Ones To Avoid) If You Have Osteoporosis
Take care!
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Gut-Healthy Labneh Orecchiette
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Labneh (a sort of yogurt-cheese made from strained yogurt) is a great probiotic, and there’s plenty of resistant starch in this dish too, from how we cook, cool, and reheat the pasta. Add to this the lycopene from the tomatoes, the ergothioneine from the mushrooms, and the healthful properties of the garlic, black pepper, and red chili, and we have a very healthy dish!
You will need
- 10 oz labneh (if you can’t buy it locally, you can make your own by straining Greek yogurt through a muslin cloth, suspended over a bowl to catch the water that drips out, overnight—and yes, plant-based is also fine if you are vegan, and the gut benefits are similar because unlike vegan cheese, vegan yogurt is still fermented)
- 6 oz wholegrain orecchiette (or other pasta, but this shape works well for this sauce)
- ¼ bulb garlic, grated
- Juice of ½ lemon
- Large handful chopped parsley
- Large handful chopped dill
- 9 oz cherry tomatoes, halved
- 9 oz mushrooms (your choice what kind), sliced (unless you went for shiitake or similar, which don’t need it due to already being very thin)
- 2 tsp black pepper, coarse ground
- 1 tsp red chili flakes
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Cook the pasta as you normally would. Drain, and rinse with cold water. Set aside.
2) Combine the labneh with the garlic, black pepper, dill, parsley, and lemon juice, in a large bowl. Set aside.
3) Heat a little olive oil in a skillet; add the chili flakes, followed by the mushrooms. Cook until soft and browned, then add the tomatoes and fry for a further 1 minute—we want the tomatoes to be blistered, but not broken down. Stir in the MSG/salt, and take off the heat.
4) Refresh the pasta by passing a kettle of boiling water through it in a colander, then add the hot pasta to the bowl of labneh sauce, stirring to coat thoroughly.
5) Serve, spooning the mushrooms and tomatoes over the labneh pasta.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- Lycopene’s Benefits For The Gut, Heart, Brain, & More
- “The Longevity Vitamin” (That’s Not A Vitamin)
Take care!
Don’t Forget…
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