What Matters Most For Your Heart?

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Eat More (Of This) For Lower Blood Pressure

Heart disease remains the world’s #1 killer. We’d say “and in the US, it’s no different”, but in fact, the US is #1 country for heart disease. So, it’s worse and perhaps some extra care is in order.

But how?

What matters the most

Is it salt? Salt plays a part, but it’s not even close to the top problem:

Hypertension: Factors Far More Relevant Than Salt

Is it saturated fat? Saturated fat from certain sources plays more of a role than salt, but other sources may not be so much of an issue:

Can Saturated Fats Be Heart-Healthy?

Is it red meat? Red meat is not great for the heart (or for almost anything else, except perhaps anemia):

The Whys and Hows of Cutting Meats Out Of Your Diet

…but it’s still not the top dietary factor.

The thing many don’t eat

All the above are foodstuffs that a person wanting a healthier heart and cardiovascular system in general might (reasonably and usually correctly) want to cut down, but there’s one thing that most people need more of:

Why You’re Probably Not Getting Enough Fiber (And How To Fix It)

And this is especially true for heart health:

❝Dietary fiber has emerged as a crucial yet underappreciated part of hypertension management.

Our comprehensive analysis emphasizes the evidence supporting the effectiveness of dietary fiber in lowering blood pressure and reducing the risk of cardiovascular events.❞

~ Dr. Francine Marques

Specifically, she and her team found:

  • Each additional 5g of fiber per day reduces blood pressure by 2.8/2.1 (systolic/diastolic, in mmHG)
  • Dietary fiber works in several ways to improve cardiovascular health, including via gut bacteria, improved lipids profiles, and anti-inflammatory effects
  • Most people are still only getting a small fraction (¼ to ⅓) of the recommended daily amount of fiber. To realize how bad that is, imagine if you consumed only ¼ of the recommended daily amount of calories every day!

You can read more about it here:

Dietary fiber critical in managing hypertension, international study finds

That’s a pop-science article, but it’s still very informative. If you prefer to read the scientific paper itself (or perhaps as well), you can find it below

Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control

Want more from your fiber?

Here’s yet another way fiber improves cardiometabolic health, hot off the academic press (the study was published just a couple of weeks ago):

How might fiber lower diabetes risk? Your gut could hold the clues

this pop-science article was based on this scientific paper

Gut Microbiota and Blood Metabolites Related to Fiber Intake and Type 2 Diabetes

Take care!

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  • Semaglutide for Weight Loss?

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    Semaglutide for weight loss?

    Semaglutide is the new kid on the weight-loss block, but it’s looking promising (with some caveats!).

    Most popularly by brand names Ozempic and Wegovy, it was first trialled to help diabetics*, and is now sought-after by the rest of the population too. So far, only Wegovy is FDA-approved for weight loss. It contains more semaglutide than Ozempic, and was developed specifically for weight loss, rather than for diabetes.

    *Specifically: diabetics with type 2 diabetes. Because it works by helping the pancreas to make insulin, it’s of no help whatsoever to T1D folks, sadly. If you’re T1D and reading this though, today’s book of the day is for you!

    First things first: does it work as marketed for diabetes?

    It does! At a cost: a very common side effect is gastrointestinal problems—same as for tirzepatide, which (like semaglutide) is a GLP-1 agonist, meaning it works the same way. Here’s how they measure up:

    As you can see, both of them work wonders for pancreatic function and insulin sensitivity!

    And, both of them were quite unpleasant for around 20% of participants:

    ❝Tirzepatide, oral and SC semaglutide has a favourable efficacy in treating T2DM. Gastrointestinal adverse events were highly recorded in tirzepatide, oral and SC semaglutide groups.❞

    ~ Zaazouee et al., 2022

    What about for weight loss, if not diabetic?

    It works just the same! With just the same likelihood of gastro-intestinal unpleasantries, though. There’s a very good study that was done with 1,961 overweight adults; here it is:

    Once-Weekly Semaglutide in Adults with Overweight or Obesity

    The most interesting things here are the positive results and the side effects:

    ❝The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).❞

    ~ Wilding et al., 2021

    In other words: if you take this, you’re almost certainly going to get something like 6x better weight loss results than doing the same thing without it.

    ❝Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%])❞

    ~ ibid.

    In other words: you have about a 3% chance of having unpleasant enough side effects that you don’t want to continue treatment (contrast this with the 20%ish chance of unpleasant side effects of any extent)!

    Any other downsides we should know about?

    If you stop taking it, weight regain is likely. For example, a participant in one of the above-mentioned studies who lost 22% of her body weight with the drug’s help, says:

    ❝Now that I am no longer taking the drug, unfortunately, my weight is returning to what it used to be. It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food. I hope that, if the drug can be approved for people like me, my [doctor] will be able to prescribe the drug for me in the future.❞

    ~ Jan, a trial participant at UCLH

    Source: Gamechanger drug for treating obesity cuts body weight by 20% <- University College London Hospitals (NHS)

    Is it injection-only, or is there an oral option?

    An oral option exists, but (so far) is on the market only in the form of Rybelsus, another (slightly older) drug containing semaglutide, and it’s (so far) only FDA-approved for diabetes, not for weight loss. See:

    A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes ← for the science

    FDA approves first oral GLP-1 treatment for type 2 diabetes ← For the FDA statement

    Where can I get these?

    Availability and prescribing regulations vary by country (because the FDA’s authority stops at the US borders), but here is the website for each of them if you’d like to learn more / consider if they might help you:

    Rybelsus / Ozempic / Wegovy

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  • How & Why Non-Sleep Deep Rest Works (And What Activities Trigger The Same State)

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    Stress is a natural response that evolved over thousands of years to help humans meet challenges by priming the body and mind for action. However, chronic stress is harmful, as it diverts energy away from essential processes like cell maintenance and repair, leading to deterioration of health (physical and mental).

    Counteracting this requires intentional periods of deep rest… But how?

    Parasympathetic Response

    Practices as diverse as mindfulness meditation, yoga, prayer, tai chi, qigong, knitting, painting, gardening, and sound baths can help induce states of deep rest—these days often called “Non-Sleep Deep Rest” (NSDR), to differentiate it from deep sleep.

    How it works: these activities send signals to the brain that the body is safe, initiating biological changes that…

    • protect chromosomes from DNA damage
    • promote cellular repair, and
    • enhance mitochondrial function.

    If we then (reasonably!) conclude from this: “so, we must embrace moments of stillness and mindfulness, and allow ourselves to experience the ease and safety of the present”, that may sound a little wishy-washy, but the neurology of it is clear, the consequences of that neurological response on every living cell in the body are also clear, so by doing NSDR (whether by yoga nidra or knitting or something else) we can significantly improve our overall well-being.

    Note: the list of activities above is far from exhaustive, but do be aware that this doesn‘t mean any activity you enjoy and do to unwind will trigger NSDR. On the contrary, many activities you enjoy and do to unwind may trigger the opposite, a sympathetic nervous system response—watching television is a common example of this “wrong choice for NSDR”. Sure, it can be absorbing and a distraction from your daily stressors, but it also can be exciting (both cognitively and neurologically and thus also physiologically), which is the opposite of what we want.

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Non-Sleep Deep Rest: A Neurobiologist’s Take

    Take care!

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  • The Vagus Nerve (And How You Can Make Use Of It)

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    The Vagus Nerve: The Brain-Gut Highway

    The longest cranial nerve is the vagus nerve; it runs all the way from your brain to your colon. It’s very important, and (amongst other tasks) it largely regulates your parasympathetic nervous system, and autonomous functions like:

    • Breathing
    • Heart rate
    • Vasodilation & vasoconstriction
    • Blood pressure
    • Reflex actions (e.g. coughing, sneezing, swallowing, vomiting, hiccuping)

    That’s great, but how does knowing about it help us?

    Because of vagal maneuvers! This means taking an action to stimulate the vagus nerve, and prompt it to calm down various bodily functions that need calming down. This can take the form of:

    • Massage
    • Electrostimulation
    • Diaphragmatic breathing

    Massage is perhaps the simplest; “vagus” means “wandering”, and the nerve is accessible in various places, including behind the ears. That’s the kind of thing that’ easier to show than tell, though, so we’ll include a video at the end.

    Electrostimulation is the fanciest, and has been used to treat migraines and cluster headaches. Check out, for example:

    Update on noninvasive neuromodulation for migraine treatment-Vagus nerve stimulation

    Diaphragmatic breathing means breathing from the diaphragm—the big muscular tissue that sits under your lungs. You might know it as “abdominal breathing”, and refers to breathing “to the abdomen” rather than merely to the chest.

    Even though your lungs are obviously in your chest not your abdomen, breathing with a focus on expanding the abdomen (rather than the chest) when breathing in, will result in much deeper breathing as the diaphragm allows the lungs to fill downwards as well as outwards.

    Why this helps when it comes to the vagus nerve is simply that the vagus nerve passes by the diaphragm, such that diaphragmatic breathing will massage the vagus nerve deep inside your body.

    More than just treating migraines

    Vagus nerve stimulation has also been researched and found potentially helpful for managing:

    All this is particularly important as we get older, because vagal response reduces with age, and vagus nerve stimulation, which improves vagal tone, makes it easier not just to manage the aforementioned maladies, but also simply to relax more easily and more deeply.

    See: Influence of age and gender on autonomic regulation of heart

    We promised a video for the massage, so here it is:

    !

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  • What Does “Balance Your Hormones” Even Mean?

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    Hormonal Health: Is It Really A Balancing Act?

    Have you ever wondered what “balancing your hormones” actually means?

    The popular view is that men’s hormones look like this:

    Testosterone (less) ⟷ Testosterone (more)

    …And that women’s hormones look more like this:

    ♀︎ Estrogen ↭ Progesterone ⤵︎

    ⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦

    DHEA ↪︎ Gonadotrophin ⤾

    ↪︎ Testosterone? ⥅⛢

    Clear as mud, right?

    But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!

    How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?

    The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.

    In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.

    Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.

    Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.

    So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!

    What, then, can we do to untangle the confusion of these hormones?

    Well first, let’s understand what they do, in the most simple terms possible:

    • Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
    • Progesteronesecondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
    • Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
      • (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
      • DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
    • Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
    • FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
    • Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.

    Sooooooo…

    What, for most women, most often is meant by a “hormonal imbalance” is:

    • Low levels of E and/or P
    • High levels of DHEA and/or T
    • Low or High levels of FSH

    In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.

    Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)

    In the case of high levels of DHEA and/or T, then that’s a bit more complex:

    • Taking E will antagonize (counteract) the unwanted T.
    • Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
    • Taking spearmint or saw palmetto will lower testosterone’s effects
      • Scientists aren’t sure how or why spearmint works for this
      • Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.

    In the case of low levels of FSH, eating leafy greens will help.

    In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.

    What can I eat to boost my estrogen levels naturally?

    A common question. The simple answer is:

    • Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
    • Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
    • Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
    • Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!

    Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.

    On the contrary, most of the same foods support good testosterone-related health in men.

    The bottom line:

    • Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
    • We can support our body’s natural hormonal functions with good diet, though.
    • Our hormones naturally fluctuate, and are broadly self-correcting.
    • If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.

    In case you missed it…

    We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.

    Check it out here: Healthy Hormones And How To Hack Them

    Want to read more?

    Anthea Levi, RD, takes much the same view:

    ❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞

    Read: Are Hormone-Balancing Products a Scam?

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  • Balanced Energy Cake Bars

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    Unlike a lot of commercially available products, these bars won’t spike your blood sugars in the same way. There’s technically plenty of sugar in them, mostly from the chopped dates, but they’re also full of fiber, protein, and healthy fats. This means they can give you an energy boost (along with lots of gut-healthy, heart-healthy, and brain-healthy ingredients) without any crash later. They’re also delicious, and make for a great afternoon snack!

    You will need

    • 1 cup oats
    • 15 Medjool dates, pitted and soaked in hot water for 15 minutes
    • 3 carrots, grated
    • 4oz almond butter
    • 2 tbsp tahini
    • 2 tbsp flaxseeds, milled
    • 1 tbsp sesame seeds, toasted
    • Optional: your choice of dried fruit and/or chopped nuts (mix it up; diversity is good!)

    Method

    (we suggest you read everything at least once before doing anything)

    1) Steam the grated carrots for 3–4 minutes; pat dry and allow to cool

    2) Drain and pat dry the dates, roughly chop them and add them to a bowl with the carrots. Because we chopped the dates rather than blended them (as many recipes do), they keep their fiber, which is important.

    3) Add the oats, seeds, almond butter, and tahini. Also add in any additional dried fruit and/or chopped nuts you selected for the optional part. Mix well; the mixture should be quite firm. If it isn’t, add more oats.

    4) Press the mixture into a 10″ square baking tin lined with baking paper. Refrigerate for a few hours, before cutting into bar shapes (or squares if you prefer). These can now be eaten immediately or stored for up to a week.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • How Much Difference Do Probiotic Supplements Make, Really?

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    How Much Difference Do Probiotic Supplements Make?

    There are three main things that get talked about with regard to gut health:

    • Prebiotics (fibrous foods)
    • Probiotics (things containing live “good” bacteria)
    • Postbiotics (things to help them thrive)

    Today we’ll be talking about probiotics, but if you’d like a refresher on general gut health, here’s our previous main feature:

    Making Friends With Your Gut (You Can Thank Us Later)

    What bacteria are in probiotics?

    There are many kinds, but the most common by far are Lactobacillus sp. and Bifidobacteria sp.

    Taxonomical note:sp.” just stands for “species”. The first name is the genus, which contains a plurality of (sometimes, many) species.

    Lactobacillus acidophilus, also written L. acidophilus, is a common species of Lactobacillus sp. in probiotics.

    Bifidobacterium bifidum, also written B. bifidum, is a common species of Bifidobacterium sp. in probiotics.

    What difference do they make?

    First, and perhaps counterintuitively, putting more bacteria into your gut has a settling effect on the digestion. In particular, probiotics have been found effective against symptoms of IBS and ulcerative colitis, (but not Crohn’s):

    Probiotics are also helpful against diarrhea, including that caused by infections and/or antibiotics, as well as to reduce antibiotic resistance:

    Probiotics also boost the immune system outside of the gut, too, for example reducing the duration of respiratory infections:

    Multi-Strain Probiotic Reduces the Duration of Acute Upper Respiratory Disease in Older People: A Double-Blind, Randomised, Controlled Clinical Trial

    You may recallthe link between gut health and brain health, thanks in large part to the vagus nerve connecting the two:

    The Brain-Gut Highway: A Two-Way Street

    No surprises, then, that probiotics benefit mental health. See:

    There are so many kinds; which should I get?

    Diversity is good, so more kinds is better. However, if you have specific benefits you’d like to enjoy, you may want to go stronger on particular strains:

    Choosing an appropriate probiotic product for your patient: An evidence-based practical guide

    Where can I get them?

    We don’t sell them, but here’s an example product on Amazon, for your convenience.

    Alternatively, you can check out today’s sponsor, who also sell such; we recommend comparing products and deciding which will be best for you

    Enjoy!

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