Tagged Heart

How the Right Foods May Lead to a Healthier Gut, and Better Health

How the Right Foods May Lead to a Healthier Gut, and Better Health

A diet full of highly processed foods with added sugars and salt promoted gut microbes linked to obesity, heart disease and diabetes.

Credit…Getty Images
Anahad O’Connor

  • Jan. 11, 2021, 11:00 a.m. ET

Scientists know that the trillions of bacteria and other microbes that live in our guts play an important role in health, influencing our risk of developing obesity, heart disease, Type 2 diabetes and a wide range of other conditions. But now a large new international study has found that the composition of these microorganisms, collectively known as our microbiomes, is largely shaped by what we eat.

By analyzing the diets, health and microbiomes of more than a thousand people, researchers found that a diet rich in nutrient-dense, whole foods supported the growth of beneficial microbes that promoted good health. But eating a diet full of highly processed foods with added sugars, salt and other additives had the opposite effect, promoting gut microbes that were linked to worse cardiovascular and metabolic health.

The researchers found that what people ate had a more powerful impact on the makeup of their microbiomes than their genes. They also discovered that a variety of plant and animal foods were linked to a more favorable microbiome.

One critical factor was whether people ate foods that were highly processed or not. People who tended to eat minimally processed foods like vegetables, nuts, eggs and seafood were more likely to harbor beneficial gut bacteria. Consuming large amounts of juices, sweetened beverages, white bread, refined grains, and processed meats, on the other hand, was associated with microbes linked to poor metabolic health.

“It goes back to the age-old message of eating as many whole and unprocessed foods as possible,” said Dr. Sarah E. Berry, a nutrition scientist at King’s College London and a co-author of the new study, which was published Monday in Nature Medicine. “What this research shows for the first time is the link between the quality of the food we’re eating, the quality of our microbiomes and ultimately our health outcomes.”

The findings could one day help doctors and nutritionists prevent or perhaps even treat some diet-related diseases, allowing them to prescribe personalized diets to people based on the unique makeup of their microbiomes and other factors.

Many studies suggest that there is no one-size-fits-all diet that works for everyone. The new study, for example, found that while some foods were generally better for health than others, different people could have wildly different metabolic responses to the same foods, mediated in part by the kinds of microbes residing in their guts.

“What we found in our study was that the same diet in two different individuals does not lead to the same microbiome, and it does not lead to the same metabolic response,” said Dr. Andrew T. Chan, a co-author of the study and a professor of medicine at Harvard Medical School and Massachusetts General Hospital. “There is a lot of variation.”

The new findings stem from an international study of personalized nutrition called Predict, which is the world’s largest research project designed to look at individual responses to food. Started in 2018 by the British epidemiologist Tim Spector, the study has followed over 1,100 mostly healthy adults in the United States and Britain, including hundreds of identical and nonidentical twins.

The researchers collected data on a wide range of factors that influence metabolism and disease risk. They analyzed the participants’ diets, microbiomes and body fat. They took blood samples before and after meals to look at their blood sugar, hormones, cholesterol and inflammation levels. They monitored their sleep and physical activity. And for two weeks they had them wear continuous glucose monitors that tracked their blood sugar responses to different meals.

The researchers were surprised to discover that genetics played only a minor role in shaping a person’s microbiome. Identical twins were found to share just 34 percent of the same gut microbes, while people who were unrelated shared about 30 percent of the same microbes. The composition of each person’s microbiome appeared instead to be driven more by what they ate, and the types of microbes in their guts played a strong role in their metabolic health.

The researchers identified clusters of so-called good gut bugs, which were more common in people who ate a diverse diet rich in high-fiber plants — like spinach, broccoli, tomatoes, nuts and seeds — as well as minimally processed animal foods such as fish and full-fat yogurt. They also found clusters of “bad” gut bugs that were common in people who regularly consumed foods that were highly processed. One common denominator among heavily processed foods is that they tend to contain very little fiber, a macronutrient that helps to nourish good microbes in the gut, the researchers said.

Among the “good” strains of gut microbes were Prevotella copri and Blastocystis, both of which were associated with lower levels of visceral fat, the kind that accumulates around internal organs and that increases the risk of heart disease. These microbes also appeared to improve blood sugar control, an indicator of diabetes risk. Other beneficial microbes were associated with reduced inflammation and lower spikes in blood fat and cholesterol levels after meals, all of which play a role in cardiovascular health.

The new study was funded and supported by Zoe Global, a health science company, as well as by the Wellcome Trust, a British nonprofit, and several public health groups.

Dr. Berry said the findings suggest that by looking at microbiome profiles they can identify people at high risk of developing metabolic diseases and intervene early on. She and her colleagues are now planning a clinical trial that will test whether telling people to change specific foods in their diets can alter levels of good and bad microbes in their guts and subsequently improve their health.

“We think there are lots of small changes that people can make that can have a big impact on their health that might be mediated through the microbiome,” she said.

A Better Way to Take Blood Pressure?

A Better Way to Take Blood Pressure?

A new analysis suggests that a difference in blood pressure between the left and right arms may signal increased risk for serious heart problems.

Nicholas Bakalar

  • Jan. 5, 2021, 5:00 a.m. ET

Doctors usually take a blood pressure reading in only one arm, but a new study in Hypertension suggests they should be checking both. The difference between the two readings may be a marker of increased risk for cardiovascular disease — and death.

Researchers combined data in 24 previous studies that measured bilateral blood pressure in 53,827 men and women over 18. The studies included only people examined in general health clinics, eliminating any who were seen in specialty heart settings.

In total, there were 4,939 deaths from any cause, including 1,435 deaths related to cardiovascular disease, and 5,800 fatal and nonfatal cardiovascular events, including heart attacks, episodes of angina or strokes. After adjusting for age, sex, smoking, and diagnoses of diabetes and hypertension, they found that for each 5 millimeter increase in the difference between left and right arm systolic readings (the top number), there was a 5 percent increase in the risk for death from any cause, a 6 percent increase in cardiovascular death and a 9 percent increase in the risk for a first cardiovascular event.

“This large study gives some precision to the numbers,” said the lead author, Christopher E. Clark, a senior clinical lecturer at the University of Exeter Medical School in England. “A 10 millimeter difference between arms means a 10 percent increase in risk, and that’s substantial enough to reclassify people into groups to be treated more aggressively.”

Does Coconut Oil Deserve Its Health Halo?

Personal Health

Does Coconut Oil Deserve Its Health Halo?

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol,” one expert said.

Credit…Gracia Lam
Jane E. Brody

  • Jan. 4, 2021, 5:00 a.m. ET

Coconut oil continues to be widely touted as a miracle food. Proponents, including a slew of celebrities, claim it promotes weight loss, lowers blood pressure and blood glucose, protects against heart disease, increases energy, reduces inflammation, erases wrinkles and even counters Alzheimer’s disease. Plus it tastes great, so what could be bad? And if you believe all that, I’ll offer to sell you the Brooklyn Bridge.

“When I see a product with a long list of things it’s supposed to fix, I know it can’t possibly be true,” said Marion Nestle, a New York University specialist on nutrition and food policy. “Coconut oil has acquired a healthful aura as a superfood and lots of people believe it’s true. They’re guilty of magical thinking and need to stop and think, ‘They’re trying to sell me something.’” Nonetheless, a survey conducted in 2016 found that 72 percent of Americans viewed coconut oil as a healthy food.

The time is long overdue to relieve coconut oil of a halo that scientific evidence shows it doesn’t deserve and instead give consumers a chance to use the $40 they may spend on a 32-ounce jar of coconut oil to invest in foods that can actually enhance their health.

I hope the science-based evidence that follows will convince you to relegate coconut oil to the status of, say, ice cream — an occasional treat best used in modest amounts because you enjoy its flavor and texture.

First, let’s examine exactly what it is. Coconut oil is not really an oil, at least not at room temperatures for most people living in the Northern Hemisphere. It’s more like butter or beef fat, solid when cold. That’s the first clue to the fact that, unlike most other oils derived from plants that primarily contain unsaturated fatty acids, coconut oil is a highly saturated fat, 87 percent saturated, in fact, far higher than butter (63 percent) or beef fat (40 percent). Most experts recommend limiting saturated fats, which can drive up cholesterol levels and lead to clogged arteries.

Nor is coconut oil a diet food. Like other vegetable oils, a tablespoon of coconut oil supplies 117 calories, 15 more than a tablespoon of butter.

Perhaps you’ve heard the claim that the primary fatty acid in coconut oil, called lauric acid, doesn’t act like a saturated fat in the body. Not true. Its action most closely mimics that of beef tallow and butter, both of which can promote atherosclerotic heart disease, the nation’s leading killer.

To better understand how coconut oil behaves when ingested, I consulted two experts, Dr. Frank M. Sacks, nutrition and cardiovascular disease specialist at Harvard’s T.H. Chan School of Public Health, and Dr. Philip Greenland, professor of cardiology at the Feinberg School of Medicine in Chicago.

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol, and the newest research has strengthened that early understanding,” Dr. Sacks told me. In preparing an editorial published last March in the journal Circulation, he said, “I could find nothing in the scientific literature to support advertising claims that coconut oil has some beneficial effects.”

Dr. Greenland echoed that assessment, stating that “the marketing of coconut oil is confusing. It’s trying to sell it as a healthy fat, but those who know its composition don’t think that at all.”

These and other experts part company with advertisers and advocates for coconut oil based on its chemical makeup and the well-established biological activity of different kinds of fatty acids.

“Fat can’t circulate by itself,” Dr. Greenland said, explaining that long-chain fatty acids like those prominent in beef tallow are absorbed into the bloodstream by fat-carrying particles called chylomicrons that deliver the fat to tissues throughout the body. Chylomicrons keep LDL cholesterol in circulation, giving it ample opportunity to get stuck in arteries. Fats that are mainly medium-chain fatty acids, on the other hand, are more water-soluble; they can be absorbed into the bloodstream without the assistance of chylomicrons and transported directly to the liver, where they are used for energy.

Although lauric acid is usually referred to as a medium-chain fatty acid, Dr. Sacks said, this label is really arbitrary. “Classifying lauric acid as a medium-chain fatty acid is a misnomer,” he wrote. “Rather than the number of carbon atoms in a fat,” he said, “what counts is how the fat is metabolized in the body. Lauric acid behaves like a long-chain fatty acid,” the kind that promotes atherosclerosis. In addition, coconut oil has two other long-chain fatty acids — myristic and palmitic — and all three have an artery-damaging effect on cholesterol levels in the blood.

One claim made for coconut oil is undisputed: It can raise blood levels of HDL cholesterol, which has long been thought to protect against heart disease. However, a clear-cut health benefit of HDL cholesterol has yet to be demonstrated in people. As Dr. Sacks reported, “Genetic studies and HDL-raising drugs have not so far supported a causal relationship between HDL cholesterol and cardiovascular disease. HDL is composed of a huge array of subparticles that may have adverse or beneficial actions. It is unknown which, if any, foods or nutrients that raise HDL cholesterol do so in a way that reduces atherosclerosis and coronary events.”

Ditto, said Dr. Greenland. “Efforts to raise HDL have not led to beneficial clinical improvements.”

Proponents are also fond of citing the fact that a number of Indigenous populations — including Polynesians, Melanesians, Sri Lankans and Indians — consume rather large amounts of coconut products without suffering high rates of cardiovascular disease. However, most of these people have traditionally eaten coconut flesh or squeezed coconut cream as part of a diet that is low in processed foods and rich in fruits and vegetables, with fish as the main source of protein. They are also far more active physically than typical Westerners.

But even that is now changing, a New Zealand research team reported, with the “imports of unhealthy foods such as corned beef, fast food and processed ingredients, leading to huge increases in obesity and poor health.”

The team’s review of 21 studies of coconut oil consumption prompted the conclusion that consuming coconut products that contain fiber, such as coconut flesh and flour, in a diet rich in polyunsaturated fats and absent in excessive calories from refined carbohydrates would not pose a risk for heart disease. But the researchers found no evidence that could justify substituting coconut oil for other unsaturated plant oils.

Or as Dr. Nestle put it, “If you like the way it tastes, in limited amounts it’s fine, but it’s by no means a superfood.” However, she added, if you want to use coconut oil on your hair or skin, no problem.

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Credit…Emily Rose Bennett for The New York Times

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Significant numbers of coronavirus patients experience long-term symptoms that send them back to the hospital, taxing an already overburdened health system.

Credit…Emily Rose Bennett for The New York Times

Pam Belluck

  • Dec. 30, 2020, 3:00 a.m. ET

The routine things in Chris Long’s life used to include biking 30 miles three times a week and taking courses toward a Ph.D. in eight-week sessions.

But since getting sick with the coronavirus in March, Mr. Long, 54, has fallen into a distressing new cycle — one that so far has landed him in the hospital seven times.

Periodically since his initial five-day hospitalization, his lungs begin filling again; he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signaling yet another bout of pneumonia.

Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Mich., for several days, sometimes in intensive care.

“This will never go away,” he said, describing his worst fear. “This will be my going-forward for the foreseeable future.”

Nearly a year into the pandemic, it’s clear that recovering from Covid-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or by the body’s efforts to defeat the virus.

Even as vaccines give hope for stopping the spread of the virus, the surge of new cases portends repeated hospitalizations for more patients, taxing medical resources and turning some people’s path to recovery into a Sisyphean odyssey that upends their lives.

“It’s an urgent medical and public health question,” said Dr. Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital in New York, who, with another assistant professor, Dr. Anuradha Lala, is studying readmissions of Covid-19 patients.

Data on rehospitalizations of coronavirus patients are incomplete, but early studies suggest that in the United States alone, tens of thousands or even hundreds of thousands could ultimately return to the hospital.

A study by the Centers for Disease Control and Prevention of 106,543 coronavirus patients initially hospitalized between March and July found that one in 11 was readmitted within two months of being discharged, with 1.6 percent of patients readmitted more than once.

In another study of 1,775 coronavirus patients discharged from 132 V.A. hospitals in the pandemic’s early months, nearly a fifth were rehospitalized within 60 days. More than 22 percent of them needed intensive care, and 7 percent required ventilators.

And in a report on 1,250 patients discharged from 38 Michigan hospitals from mid-March to July, 15 percent were rehospitalized within 60 days.

Recurring admissions don’t just involve patients who were severely ill the first time around.

“Even if they had a very mild course, at least one-third have significant symptomology two to three months out,” said Dr. Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert Medical School and Lifespan hospitals, who co-wrote another report. “There is a wave of readmissions that is building, because at some point these people will say ‘I’m not well.’”

Many who are rehospitalized were vulnerable to serious symptoms because they were over 65 or had chronic conditions. But some younger and previously healthy people have returned to hospitals, too.

When Becca Meyer, 31, of Paw Paw, Mich., contracted the coronavirus in early March, she initially stayed home, nursing symptoms such as difficulty breathing, chest pain, fever, extreme fatigue and hallucinations that included visions of being attacked by a sponge in the shower.

Ms. Meyer, a mother of four, eventually was hospitalized for a week in March and again in April. She was readmitted for an infection in August and for severe nausea in September, according to medical records, which labeled her condition “long haul Covid-19.”

Because she couldn’t hold down food, doctors discharged her with a nasal feeding tube connected to protein-and-electrolyte formula on a pole, which, she said, “I’m supposed to be attached to 20 hours a day.”

Feeding tube issues required hospitalization for nearly three weeks in October and a week in December. She has been unable to resume her job in customer service, spent the summer using a walker, and has had a home health nurse for weeks.

“It’s been a roller coaster since March and I’m now in the downswing of it, where I’m back to being in bed all the time and not being able to eat much, coughing a lot more, having more chest pain,” she said.

Readmissions strain hospital resources, and returning patients may be exposed to new infections or develop muscle atrophy from being bedridden. Mr. Long and Ms. Meyer said they contracted the bacterial infection C. difficile during rehospitalizations.

“Readmissions have been associated, even before Covid, with worse patient outcomes,” Dr. Mylonakis said.

Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.

Dr. Lala, who co-wrote the study, said the thinking at overstretched hospitals was “we have a lack of resources, so if the patients are stable get them home.” But, she added, “the fact that length of stay was indeed shorter for those patients who return is begging the question of: Were we kicking these people out the door too soon?”

Many rehospitalized patients have respiratory problems, but some have blood clots, heart trouble, sepsis, gastrointestinal symptoms or other issues, doctors report. Some have neurological symptoms like brain fog, “a clear cognitive issue that is evident when they get readmitted,” said Dr. Vineet Chopra, chief of hospital medicine at the University of Michigan, who co-wrote the Michigan study. “It is there, and it is real.”

Dr. Laurie Jacobs, chairwoman of internal medicine at Hackensack University Medical Center, said causes of readmissions vary.

“Sometimes there’s a lot of push to get patients out of the hospital, and they want to get out of the hospital and sometimes they’re not ready,” so they return, she said. But some appropriately discharged patients develop additional problems or return to hospitals because they lack affordable outpatient care.

Antibiotics and other medications belonging to Mr. Long.
Antibiotics and other medications belonging to Mr. Long.Credit…Emily Rose Bennett for The New York Times

Mr. Long’s ordeal began on March 9. “I couldn’t stand up without falling over,” he said.

His primary physician, Dr. Benjamin Diaczok, immediately told him to call an ambulance.

“I crawled out to the front door,” recalled Mr. Long. He was barefoot and remembers sticking out his arm to prop open the door for the ambulance crew, who found him facedown.

He awoke three days later, in the hospital, when he accidentally pulled out the tubes to the ventilator he’d been hooked up to. After two more days, he’d stabilized enough to return to the apartment where he lives alone, an hour north of Detroit.

Mr. Long had some previous health issues, including blood clots in his lungs and legs several years ago and an irregular heartbeat requiring an implanted heart monitor in 2018. Still, before Covid-19, he was “very high-functioning, very energetic,” Dr. Diaczok said.

Now, Mr. Long said: “I’ve got scarred lungs, pulmonary fibrosis, and I’m running right around 75-to-80 percent lung capacity.”

He was rehospitalized in April, May, June, July, August and September, requiring oxygen and intravenous antibiotics, potassium and magnesium.

“Something must have happened to his lungs that is making them more prone for this,” Dr. Diaczok said.

Mr. Long, a former consultant on tank systems for the military, is also experiencing brain fog that’s forced a hiatus from classes toward a Ph.D. in business convergence strategy.

“I read 10 pages in one of my textbooks and then five minutes later, after a phone call, I can’t remember what I read,” he said.

“It’s horrible, ”Dr. Diaczok said. “This is a man that thinks for a living, and he can’t do his job.”

And his heart arrhythmia, controlled since 2018, has resurfaced. Unless Mr. Long, who is 6-foot-7, sleeps at an incline on his couch, his heart skips beats, causing his monitor to prompt middle-of-the-night calls from his doctor’s office. Unable to lie in bed, “I don’t sleep through the night.”

Small exertions — “just to stand up to go do the dishes” — are exhausting. In July, he tried starting physical therapy but was told he wasn’t ready.

In August, he got up too fast, fell and “I was very confused,” he recalled. During that hospital readmission, doctors noted “altered mental status” from dehydration and treated him for pneumonia and functional lung collapse.

In late October, Mr. Long developed pneumonia again, but under Dr. Diaczok’s guidance, managed at home with high-dose oral antibiotics.

In December, when a pulmonologist administered a breathing test, “I couldn’t make it six seconds,” he said.

Mr. Long repeatedly measures his temperature and pulse oxygen, and can feel in his chest when “trouble’s coming,” he said. Determined to recover, he tries to walk short distances. “Can I make it to take out the trash?” he’ll ask himself. On a good day, he’ll walk eight feet to his mailbox.

“I’m going to be around to walk my daughters down the aisle and see my grandkids,” said Mr. Long, voice cracking. “I’m not going to let this thing win.”

Covid 'Long-Haulers' Need Medical Attention, Experts Urge

Covid Survivors With Long-Term Symptoms Need Urgent Attention, Experts Say

In a two-day meeting sponsored by the N.I.H., officials acknowledged an insufficient understanding of the issues and warned of a growing public health problem.

Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.
Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.Credit…Schaun Champion for The New York Times
Pam Belluck

By

  • Dec. 4, 2020, 12:06 p.m. ET

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors.

“This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.

While the number of people affected is still unknown, he said, if long-term symptoms afflict even a small proportion of the millions of people infected with the coronavirus, it is “going to represent a significant public health issue.”

Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling with a complex and lasting mix of symptoms.

The Centers for Disease Control and Prevention recently posted a list of some long-term symptoms, including fatigue, joint pain, chest pain, brain fog and depression, but doctors and researchers said they still know little about the extent or cause of many of the problems, which patients will develop them or how to address them.

Over the last several months, coronavirus patients with lingering, debilitating health issues have been widely referred to as “Covid long-haulers.” But some survivors and experts feel that name trivializes the experience, lessening its importance as a medical syndrome which doctors and insurers should recognize, diagnose and try to treat. One of the pressing issues patients and experts are now weighing is what official medical term should be adopted to describe the collection of post-Covid symptoms.

“We need to dig in and do the work that needs to be done to help relieve the suffering and stop this madness,” said Dr. Michael Haag, an infectious disease expert from the University of Alabama at Birmingham, who was a co-chair of a session.

In an inadvertent but stark illustration of the difficulty of the recovery process, two of the four patients scheduled to speak at the meeting were unable to because they had recently been rehospitalized. “Those individuals had their acute illness several months ago and they’ve been suffering pretty mightily since then,” Dr. Haag said. “And the fact that they’re still struggling with this gives extra power to what we’re trying to do today.”

Dr. John Brooks, the chief medical officer of the C.D.C.’s Covid response, the co-chairman with Dr. Haag of one session, said he expected long-term post-Covid symptoms would affect “on the order of tens of thousands in the United States and possibly hundreds of thousands.”

He added, “If you were to ask me what do we know about this post-acute phase, I really am hard pressed to tell you that we know much. This is what we’re really working on epidemiologically to understand what is it, how many people get it, how long does it last, what causes it, who does it affect, and then of course, what can we do to prevent it from happening.”

[Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]

Presentations from Covid-19 survivors — including Dr. Peter Piot, a world-renowned infectious disease expert who helped discover the Ebola virus — made it clear that for many people, recovering from the disease is not like flipping a switch.

Dr. Piot, who is the director of the London School of Hygiene and Tropical Medicine and a special adviser on Covid-19 research to the president of the European Commission, said he contracted the coronavirus in March and was hospitalized for a week in April. The acute phase of his illness involved some, but not all, of the classic disease symptoms. For example, his oxygen saturation was very low, but he did not develop shortness of breath or a cough until after he got home from the hospital.

For the next month, he experienced a rapid heart rate several hours a day, he said. For nearly four months, he experienced extreme fatigue and insomnia. “What I found most frustrating personally was that I couldn’t do anything,” said Dr. Piot, who now considers himself recovered except for needing more sleep than before his infection. “I just had to wait for improvement.”

Chimére Smith, 38, a teacher in Baltimore who has not been able to work since becoming sick in March, said she had struggled for months to have her symptoms, which included loss of vision in one eye, taken seriously by doctors.

“It’s been a harrowing task and the task and the journey continues,” she said.

Ms. Smith, who is Black, said it was especially important to inform people in underserved communities that long-term effects are “as real and possible as dying from the virus itself.”

The condition, she said, “not only needs to be explored, but it needs to be explained to the same group of people who suffer with being stricken with it the most, and that’s the minority population. I am not just here today for me; I am here for us.”

Hannah Davis, 32, a researcher and artist in Brooklyn, described neurological and cognitive symptoms that began in late March. “I forgot my partner’s name,” she said. “I forgot about sleep. I would regularly pick up a hot pan, burn myself, put it down, and literally do it again. I forgot how to shower. I forgot how to dress myself.”

Months later, some things have improved, but she still struggles to remember things, saying “I feel like I am basically on a 48-hour memory cycle.”

Ms. Davis is part of a long-term Covid survivor group called Body Politic and said a survey of 3,800 of its members in 56 countries has found that 85 percent report cognitive dysfunction, 81 percent had numbness and other neurological sensations, nearly half had speech and language issues and nearly three-quarters had some difficulty working at their jobs.

Clinics treating Covid survivors are seeing a striking number of people with brain fog and other thinking problems, as well as psychological issues, doctors participating in the workshop said.

“Approximately three months after their acute illness, more than half of our patients have at least a mild cognitive impairment,” said Dr. Ann Parker, who co-directs a post-Covid clinic at Johns Hopkins. “We’re also seeing substantial mental health impairments.”

Dr. Janet Diaz, head of clinical care for the World Health Organization’s Covid-19 response, said the agency is planning a meeting focused on long-term coronavirus effects and will soon start collecting data on post-Covid symptoms and medical visits.

She said that while doctors are accustomed to prolonged recovery challenges for people hospitalized for serious illnesses, the lingering symptoms in younger people and those who were not hospitalized for the coronavirus “urgently needs to be better understood and investigated.”

How Exercise Changes Our Blood

While we exercise, we raise and lower the levels of hundreds of molecules in our bloodstreams that are related to our metabolic health, even if we work out for only a few minutes, according to a complex and encouraging new study of the molecular effects of being active. The study, which involved more than 1,000 men and women, adds to growing evidence that exercise improves our health in large part by transforming the numbers and types of cells inside of us.

There is at this point, of course, no reasonable debate about whether exercise is good for us. It is. Countless studies show that people who are active are less likely than more-sedentary people to develop or die from a host of health problems, including heart disease, diabetes, dementia, cancer, obesity and many others. Active people also tend to live longer and feel happier.

But we still know surprisingly little about just how exercise changes us for the better. What are the many, interconnected biological steps and transmutations that allow a walk today to add to our life span decades from now?

That question has been driving considerable interest recently in research looking at exercise “omics” — the study of all of the molecules in our blood or other tissues that are part of a particular biological process. Genomics, for instance, quantifies the many, many molecules involved in genetic activities. Proteomics does the same for proteins, microbiomics for the multiple contents of our microbiomes and metabolomics for molecules related to metabolic processes. (There can be overlap between various ’omics, obviously.)

Understanding how exercise affects the levels of the various molecules within us is important, because these changes are likely to be the preliminary step in a complex cascade of further biological actions that contribute to better health. Increase some molecules, decrease others, and you jump-start inter-organ messaging, gene expression and other processes that subsequently alter how we make and use insulin, burn or store fat, respond to cholesterol and so on.

A number of important recent studies have delved into the ’omics of exercise, including a fascinating experiment showing that a short workout rapidly changes the levels of 9,815 molecules in people’s bloodstreams. But that study, like most other examinations of exercise and ’omics, involved relatively few volunteers — 36, in that case — and did not link molecular changes with subsequent health outcomes.

So, for the new study, which was published in September in Circulation, researchers at Massachusetts General Hospital in Boston and other institutions decided to up the number of exercisers whose ’omics would be parsed and also try to find connections between the ’omics data and later health.

Conveniently, they had access to a large group of potential volunteers among men and women already enrolled in the long-term Framingham Heart Study, which is overseen primarily by researchers at Massachusetts General Hospital. The scientists now asked 411 middle-aged volunteers enrolled in the study to visit the lab and exercise, by pedaling to exhaustion on a stationary bicycle. Most riders’ efforts lasted for a little less than 12 minutes. The researchers drew blood before the ride and afterward, within about a minute of when, worn out, the cyclists quit.

The scientists then ran the blood samples through a mass spectrometer, a machine that counts and quantifies molecules. The researchers focused on metabolites, which are molecules related to metabolic processes. The label “metabolite” is somewhat arbitrary, but for this study, the researchers focused mostly on molecules that could affect people’s insulin, fat burning, cholesterol, blood sugar and other aspects of cellular fueling.

They found plenty. Of 588 metabolites checked, the levels of more than 80 percent generally grew or dropped during the short rides. To reinforce those findings, the scientists repeated the experiment with another 783 Framingham volunteers, checking their blood before and after exercise for changes in about 200 of the molecules that had been most altered in the first group. Again, these metabolites changed in the same ways as before.

Last and perhaps most intriguing, the researchers created what they called molecular “signatures” of the levels of a few, representative metabolites that changed with exercise. They then looked for these same patterns of metabolites in stored blood samples gathered decades before from past Framingham participants, while also checking to see if and when any of these volunteers had passed away.

The relevant signatures popped up in some of the blood samples, the researchers found, and these samples tended to be from people who had not died prematurely, suggesting that the kinds of metabolite changes that occur with exercise might influence and improve health well into the future.

That idea is “speculative,” though, says Dr. Gregory Lewis, the section head of the heart failure program and director of the cardiopulmonary exercise laboratory at Massachusetts General Hospital, who oversaw the new study. The decades-old blood samples were drawn during standard medical testing, not after exercise, he says, so some people with desirable metabolite signatures might have been born that way and not needed workouts to remodel their metabolites.

Even among the current volunteers, he points out, different people’s molecules responded somewhat differently to their exercise. Over all, people with obesity developed fewer changes than leaner riders, suggesting they might somehow resist some of the benefits of exercise. Men and women, as groups, also showed slightly discordant molecular signatures, but age did not influence people’s molecular responses.

Larger future ’omics studies should help scientists tease out how and why we each react as we do to exercise, Dr. Lewis says, and enable researchers to define more-precise molecular signatures that might indicate, with a blood test, how fit someone is or how their bodies may respond to different types of exercise.

But for now, the current study underscores just how pervasive and immediate the effects of exercise can be. “This was barely 10 minutes of exercise,” Dr. Lewis says, “but it shifted so much” inside people.

Weight Has Greater Impact on Diabetes Than Heart Disease

Photo

Carrying excess weight may have a greater impact on the risk for diabetes than it does on the risk for heart disease or early death, a new study has found.

To look at the effect of obesity independent of genetics, Swedish researchers followed 4,046 pairs of identical twins whose average age was 58. One of the twins was overweight, and the other was not. Since identical twins have the same genes, their weight difference could not be attributed to genetics. The study is in JAMA Internal Medicine.

After accounting for physical activity, smoking and educational level, the researchers found that having a higher body mass index, or B.M.I. — even among those in the obese range of 30 or higher — was not associated with an increased risk for heart attack or death. But a high B.M.I. was associated with an increased risk for diabetes.

“Based on these results, the association between obesity and cardiovascular disease is explained by genetic, not environmental, factors,” said the lead author, Peter Nordstrom, a professor of geriatric medicine at Umea University. “Unfortunately, this also means that environmental factors that reduce obesity do not reduce the risk of cardiovascular disease or death. But they most certainly decrease the risk for diabetes.”

Rediscovering the Kitchen, and Other Tips for Heart Health

Photo

Credit Paul Rogers

First the bad news: After decades of major progress in reducing deaths from diseases of the heart and blood vessels, the decline in cardiovascular mortality has slowed significantly, according to the latest report from the Centers for Disease Control and Prevention. The researchers called their findings alarming, suggesting that cardiovascular benefits from medical interventions may have reached a saturation point and that further improvements depend largely on changes in society and personal behavior.

The new data, published in June in JAMA Cardiology, covered the years from 2000 through 2014. From 2000 through 2010, the annual rates of decline for all cardiovascular deaths heart diseases and stroke averaged 3.69 percent for men and 3.98 percent for women. But since 2011, the rates of decline dropped to a mere 0.23 percent for men and 1.17 percent for women.

These findings point to near stagnation in controlling cardiovascular diseases and deaths, Dr. Stephen Sidney and colleagues wrote. And, they noted, the reasons are not difficult to discern. Based on data from the latest National Health and Nutrition Examination Survey in 2011-12, Americans did better in controlling three major risk factors smoking, high blood pressure and elevated cholesterol, often with the help of medication but many more people became obese and developed Type 2 diabetes.

According to data from the survey, the prevalence of adult obesity rose from 22.9 percent in 1988-1994 to 34.9 percent in 2011-12, and the C.D.C. found that the prevalence of diabetes nearly tripled, from 2.5 percent in 1990 to 7.2 percent in 2013.

Furthermore, the national survey showed, the percentage of adults who in 2012 were consuming an ideal diet that could minimize life-threatening damage to blood vessels was near zero.

Its not that these grim data were unexpected. Four years ago, Dr. Richard J. Jackson, a professor and former chairman of environmental health sciences at the University of California, Los Angeles, predicted that the current generation of young Americans (those born since 1980) may be the first to live shorter lives than their parents.

Even earlier, in 2007, Dr. Earl S. Ford of the C.D.C. and Dr. Simon Capewell of the University of Liverpool wrote that unless measures were taken to transform the abhorrent risk factor profile that currently characterizes much of the U.S. population and dangerous trends were reversed, mortality rates among younger adults may represent the leading edge of a brewing storm.

Now for the good news: Neither medical innovations nor genetic interventions are needed to turn the tide on cardiovascular diseases and deaths and restore their once-significant declines. And the very same changes needed to improve cardiovascular health may also help prevent many common cancers, diabetes, arthritis, cognitive decline, depression and osteoporosis.

Dr. Donald M. Lloyd-Jones, a chief architect of a 2010 strategic plan to improve cardiovascular health, said: The whole may be greater than the sum of the parts. We shouldnt assume that chronic diseases automatically occur with aging. Living healthfully until we die is an achievable goal.

Dr. Lloyd-Jones, a cardiologist and preventive medicine specialist at the Northwestern University Feinberg School of Medicine in Chicago, chaired an American Heart Association committee of experts that adopted the recommended changes. Instead of focusing on the negative, the plan aims to achieve ideal cardiovascular health through ideal health behaviors and ideal health factors.

Heres how the committee defined ideal: No smoking; maintaining a body mass index below 25; being physically active; following current dietary guidelines; and maintaining an untreated total cholesterol level of less than 200 milligrams, an untreated blood pressure level of less than 120 over 80, and a fasting blood glucose level of less than 100 milligrams.

The committee had hoped that fostering these seven health behaviors and targets would, by 2020, improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

But current trends project at best a 6 percent improvement.

Although most of us are born with the potential for ideal cardiovascular health, fewer than half of all adolescents have retained five or more of the seven behaviors and factors at ideal levels, Dr. Lloyd-Jones wrote in 2014. And things get progressively worse with age until ideal cardiovascular health becomes rare above age 60, he said.

Still, he has not given up hope for a better result.

Now for the details. First and foremost, quit smoking or never start. Heart risks drop significantly within a year of quitting and eventually reach those of a nonsmoker.

Next, get regular physical exercise, at least 150 minutes a week of moderate physical activity or 75 minutes a week of vigorous activity, or a combination of the two. Keep in mind that this is the minimum amount of physical activity needed to glean health benefits. More is better.

Exercise should be part of your daily routine, like brushing your teeth. I do a combination of moderate and vigorous exercise every day. It energizes me and helps me control my weight without having to watch every calorie.

As for diet, the committee recommended focusing on foods, not nutrients. (As Dr. Lloyd-Jones put it, We dont eat nutrients.) It refrained from suggesting how many calories people should eat, since caloric needs vary tremendously based on an individuals basal metabolic rate, body size, lean body mass and physical activity.

Rather, it suggested a version of the DASH diet (for Dietary Approaches to Stop Hypertension) that was successfully tested by the National Heart, Lung and Blood Institute. It calls for four and a half or more cups of fruits and vegetables a day; two or more 3.5-ounce servings of fish each week; three ounces of fiber-rich whole grains a day; at most 36 ounces of sugar-sweetened drinks (less than 450 calories, or the equivalent in other sweets) a week; four or more weekly servings of nuts, legumes and seeds; and no more than two servings a week of processed meats.

At the same time, limit saturated fats to less than 7 percent of total calories and daily sodium to 1,500 milligrams for people with high blood pressure and no more than 2,300 milligrams (or one teaspoon of salt) for everyone else. Currently, Americans consume an average of 3,500 milligrams of sodium a day, most of it from processed and restaurant foods.

Which brings me to a final recommendation of my own: Rediscover your kitchen. No matter how busy you are, finding time to prepare healthy foods for yourself and your family should be a top priority.

Related:

For more fitness, food and wellness news, follow us on Facebook and Twitter, or sign up for our newsletter.

Being Unfit May Be Almost as Bad for You as Smoking

Photo

Credit Getty Images

Being out of shape could be more harmful to health and longevity than most people expect, according to a new, long-term study of middle-aged men. The study finds that poor physical fitness may be second only to smoking as a risk factor for premature death.

It is not news that aerobic capacity can influence lifespan. Many past epidemiological studies have found that people with low physical fitness tend to be at high risk of premature death. Conversely, people with robust aerobic capacity are likely to have long lives.

But most of those studies followed people for about 10 to 20 years, which is a lengthy period of time for science but nowhere near most of our actual lifespans. Some of those studies also enrolled people who already were elderly or infirm, making it difficult to extrapolate the findings to younger, healthier people.

So for the new study, which was published this week in the European Journal of Preventive Cardiology, researchers from the University of Gothenburg in Sweden and other institutions turned to an impressively large and long-term database of information about Swedish men.

The data set, prosaically named the Study of Men Born in 1913, involved exactly that. In 1963, almost 1,000 healthy 50-year-old men in Gothenburg who had been born in 1913 agreed to be studied for the rest of their lives, in order to help scientists better understand lifetime risks for disease, especially heart disease.

The men completed baseline health testing in 1963, including measures of their blood pressure, weight and cholesterol, and whether they exercised and smoked. Four years later, when the volunteers were 54, some underwent more extensive testing, including an exercise stress test designed to precisely determine their maximum aerobic capacity, or VO2 max. Using the results, the scientists developed a mathematical formula that allowed them to estimate the aerobic capacity of the rest of the participants.

Aerobic capacity is an interesting measure for scientists to study, because it is affected by both genetics and lifestyle. Some portion of our VO2 max is innate; we inherit it from our parents. But much of our endurance capacity is determined by our lifestyle. Being sedentary lowers VO2 max, as does being overweight. Exercise raises it.

Among this group of middle-aged men, aerobic capacities ranged from slight to impressively high, and generally reflected the men’s self-reported exercise habits. Men who said that they seldom worked out tended to have a low VO2 max. (Because VO2 max is more objective than self-reports about exercise, the researchers focused on it.)

To determine what impact fitness might have on lifespan, the scientists grouped the men into three categories: those with low, medium or high aerobic capacity at age 54.

Then they followed the men for almost 50 years. During that time, the surviving volunteers completed follow-up health testing about once each decade. The scientists also tracked deaths among the men, based on a national registry.

Then they compared the risk of relatively early death to a variety of health parameters, particularly each man’s VO2 max, blood pressure, cholesterol profile and history of smoking. (They did not include body weight as a separate measure, because it was indirectly reflected by VO2 max.)

Not surprisingly, smoking had the greatest impact on lifespan. It substantially shortened lives.

But low aerobic capacity wasn’t far behind. The men in the group with the lowest VO2 max had a 21 percent higher risk of dying prematurely than those with middling aerobic capacity, and about a 42 percent higher risk of early death than the men who were the most fit.

Poor fitness turned out to be unhealthier even than high blood pressure or poor cholesterol profiles, the researchers found. Highly fit men with elevated blood pressure or relatively unhealthy cholesterol profiles tended to live longer than out-of-shape men with good blood pressure and cholesterol levels.

Of course, this study found links between poor fitness and shortened lifespans. It cannot prove that one caused the other, or explain how VO2 max might affect lifespan. However, the findings raise the possibility, as the scientists speculate, that by strengthening the body, better fitness may lower the risk of a variety of chronic diseases.

This study also involved men — and Swedish men at that. So whether the findings are applicable to other people, particularly women, is uncertain.

But “there is no reason not to think” that the rest of us would also share any beneficial associations between fitness and longevity, said Per Ladenvall, a researcher at the Sahlgrenska Academy at the University of Gothenburg, who led the study. Past studies involving women have found such links, he said.

Encouragingly, if you now are concerned about the state of your particular aerobic capacity, you most likely can increase it just by getting up and moving. “Even small amounts of physical activity,” Dr. Ladenvall said, “may have positive effects on fitness.”

Can Statins Cause Diabetes?

Photo

Credit Stuart Bradford

Do you have a health question? Submit your question to Ask Well.

Related:

For more fitness, food and wellness news, follow us on Facebook and Twitter, or sign up for our newsletter.

Cutting Sugar Rapidly Improves Heart Health Markers

Photo

Credit

Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days, a study in Atherosclerosis found.

For the study, researchers evaluated 37 children ages 9 to 18 who were obese and at high risk for heart disease and Type 2 diabetes. The children were given food and drinks totaling the same number of calories, fat, protein and carbohydrates as their typical diets.

The only change was their sugar intake: The researchers swapped foods high in added sugars, like pastries and sweetened yogurts, for options like bagels and pizza. This lowered dietary sugar from 28 percent to 10 percent, and fructose from 12 percent to 4 percent of total calories.

After nine days, the researchers found a 33 percent drop in triglycerides, a type of fat tied to heart disease; a 49 percent reduction in a protein called apoC-III that is tied to high triglyceride levels; and dramatic reductions in small, dense LDL cholesterol, a risk factor for heart disease.

Though this study is small and short-term, it builds on this group’s previous research implicating added sugars as a contributor to metabolic disorders and heart disease.

“Sugar calories are not like other carbohydrate calories,” said Dr. Robert Lustig, a co-author of the study and professor of pediatrics at Benioff Children’s Hospital at the University of California, San Francisco. “Without changing total carbohydrate, or fat, or protein, we were able to accomplish this enormous improvement in their cardiovascular risk factors,” unrelated to weight loss, he said.

Ask Well: Exercising on ‘Smog Alert’ Days

Photo

Smog hangs over New York City in 1966.

Smog hangs over New York City in 1966.Credit Neal Boenzi/The New York Times

Do you have a health question? Submit your question to Ask Well.

Related:

For more fitness, food and wellness news, follow us on Facebook and Twitter, or sign up for our newsletter.

The Surprising Health Benefits of an Electric Bike

Photo

Credit Getty Images

In the Tour de France, equipping your bike with a small electric motor is called mechanical doping, and is considered cheating. But for the rest of us, an electrified bicycle might be a way to make exercise both tolerable and practical, according to an encouraging new study of bicycle commuting.

Exercise is necessary in our lives, as we all know by now. People who are physically active are much less likely than sedentary people to develop heart disease, diabetes, cancer, stroke, depression, disabilities in old age, or to die prematurely.

But statistics show that, despite its benefits, a majority of us never exercise. When researchers ask why, most people offer the same two excuses — they don’t have time to fit exercise into their lives or they aren’t fit enough to undertake exercise.

Potentially, electric bicycles could address those concerns. Their motors shore up your pedaling as needed—or, with some electric bikes, do the pedaling for you—making climbing hills or riding for long distances less taxing and daunting than the same ride on a standard bicycle.

In the process, they could make cycling a palatable alternative to commuting by car, allowing people with jammed daily schedules to work out while getting to work.

But the value of electric bicycles has so far been mostly notional. Few of us have seen, let alone ridden, an electric bike and there is scant scientific evidence supporting—or refuting—the potential health benefits of using the machines.

So for the new experiment, which was published last month in the European Journal of Applied Physiology, researchers at the University of Colorado, Boulder, decided to see what would happen if they gave a group of out-of-shape men and women zippy electric bikes and suggested that they begin riding to work.

Notably, the researchers only studied motorized bikes that assist the rider rather than doing all the work for them, like a moped. They used electric bikes that require the rider to pedal in order to receive assistance from the motor.

The researchers wanted to determine whether these bikes — even with the added assistance of a motor — would provide a meaningful workout for people who previously had not been exercising much. They also wanted to see whether such bikes were fundamentally safe, given that they enable even novice riders to achieve speeds of 20 miles per hour or higher. (The Boulder city government partially funded the study as part of an assessment of whether to allow electric bikes on municipal bike paths. Additional funding came from local bike shops and Skratch Labs, a sports nutrition company in Boulder.)

The researchers first brought their 20 sedentary volunteers into the lab to check their body composition, aerobic fitness, blood sugar control, blood pressure and cholesterol profiles. Then they provided each with an electric bicycle, heart rate monitor, GPS device, instructions on the use of all of this equipment, and asked each volunteer to don the monitors and ride his or her new bike to and from work at least three times a week for the next month, spending at least 40 minutes in the saddle on those days.

The volunteers were directed to choose whatever speed and effort felt comfortable for them.

Then the researchers loosed the novice riders onto Boulder’s roads and bike paths.

A month later, the volunteers returned to the lab to repeat the original tests and turn over heart rate and GPS data. All of them had ridden at least the prescribed minimum of 40 minutes three times per week and in fact, according to their monitor data, most had ridden more than required, several about 50 percent more.

The riders also had ridden with some intensity. Their heart rates averaged about 75 percent of each person’s maximum, meaning that even with the motor assist, they were getting a moderate workout, comparable to brisk walking or an easy jog.

But thankfully none had crashed and hurt themselves (or anyone else). In fact, “we found that participants rode at a reasonable average speed of about 12 miles per hour,” said James Peterman, a graduate student at U.C. Boulder who led the study.

Perhaps most important, the riders were healthier and more fit now, with significantly greater aerobic fitness, better blood sugar control, and, as a group, a trend toward less body fat.

They also reported finding the riding to “be a blast,” said William Byrnes, the study’s senior author and director of the university’s Applied Exercise Science Laboratory. “It’s exercise that is fun.”

Several participants have bought electric bikes since the study ended, he said. He also rides an electric bike to and from campus.

Electric bikes are unlikely to be a solution for everyone who is pressed for time or reluctant to exercise, though. The bikes are pricey, typically retailing for thousands of dollars.

They also offer less of a workout than non-motorized bicycles. Mr. Peterman, an accomplished bike racer who placed fifth in the time trial at the United States National Cycling Championships last week admits that motorized bicycles are unlikely to goose the fitness of well-trained athletes.

But for the many other people who currently do not exercise or have never considered bike commuting, there is much to be said for knowing that, if needed, you can get a little help pedaling up that next hill.

Related:

Interested in running? Sign up to receive practical tips, expert advice, exclusive content and a bit of motivation delivered to your inbox every week to help you on your running journey.

Ask Well: Is Watermelon Good for You?

Photo

Credit Karsten Moran for The New York Times

Do you have a health question? Submit your question to Ask Well.

Related:

For more fitness, food and wellness news, follow us on Facebook and Twitter, or sign up for our newsletter.

A-Fib Is More Dangerous for Blacks Than Whites

Photo

Atrial fibrillation, or A-fib, an irregular heartbeat associated with various types of cardiovascular problems, is more dangerous, and more often fatal, in black people than in whites, a new study has found.

Researchers studied 15,080 people, average age 54, of whom 3,831 were black. They followed them for an average of 20 years. The findings were published in JAMA Cardiology.

The rate of atrial fibrillation was higher among whites than blacks, and both white and black people with A-fib had increased risks of stroke, heart failure and coronary heart disease. Those with A-fib also had an increased risk of dying from these and other causes.

But even though rates of A-fib were higher in whites than blacks, the actual effect of A-fib led to much higher rates of disease in blacks than in whites. Compared with white people with A-fib, blacks with the condition were more than twice as likely to have a stroke, 42 percent more likely to go into heart failure, 76 percent more likely to have coronary heart disease, and nearly twice as likely to die prematurely.

The reason for the finding is not clear, but the study had no data on treatment or treatment disparities, which might partly explain the outcomes.

Still, the lead author, Dr. Jared W. Magnani, an associate professor of medicine at the University of Pittsburgh, said that “the extensive health-related differences here are likely fueled by racial disparities. We need a preventive health system for all Americans, and we don’t have that in place.”

Eat Whole Grains, Live Longer?

Photo

Credit Karsten Moran for The New York Times

Two large review studies have reached the same conclusion: Eating whole grains is associated with significant reductions in the risk for premature death.

One report, in BMJ, found that whole grain consumption was associated with a reduction in the risk for death from cancer, coronary heart disease, respiratory disease, infectious disease and diabetes. Using data from 45 studies, researchers calculated that compared with eating none, eating 90 grams of whole grains a day reduced the risk for all-cause mortality by 17 percent.

The other analysis, in Circulation, used data from 14 prospective studies with 786,076 participants and found that compared with those who ate the least whole grain foods, those who ate the most had a 16 percent reduced risk for all-cause mortality and an 18 percent reduced risk for cardiovascular mortality. Each 16-gram increase in whole grain intake reduced mortality risk by 7 percent.

A slice of 100 percent whole grain bread contains about 16 grams of whole grains, and current dietary guidelines recommend 48 grams or more of whole grains daily.

The senior author of the Circulation study, Dr. Qi Sun, an assistant professor of nutrition at Harvard, cautions that eating whole grains is not a panacea.

“You shouldn’t hope that you will cure diseases with whole grain foods,” he said. “You still have to pay attention to other good dietary and behavioral practices.”

Churchgoers May Live Longer

Photo

St. Patrick’s Cathedral in Manhattan.

St. Patrick’s Cathedral in Manhattan.Credit Chang W. Lee/The New York Times

Going to church may lower the risk for premature death, a new study suggests.

Researchers used data from a long-term study of 75,534 women that tracked their health and lifestyle, including their attendance at religious services, over 16 years through 2012. The report is in JAMA Internal Medicine.

After controlling for more than two dozen factors, they found that compared with those who never went to church, going more than once a week was associated with a 33 percent lower risk for death from any cause, attending once a week with a 26 percent lower risk, and going less than once a week a 13 percent lowered risk. Risks for mortality from cardiovascular disease and cancer followed a similar pattern.

The researchers statistically eliminated the possibility of reverse causation — that is, that healthy people go to church more than unhealthy ones. And they found that some variables, such as social support and a tendency not to smoke, contributed to the effect. But no matter how they analyzed the data, the effect of church attendance alone seemed to have benefits.

“This suggests that there is something powerful about the communal religious experience,” said the senior author, Tyler J. VanderWeele, a professor of epidemiology at Harvard. “These are systems of thought and practice shaped over millennia, and they are powerful.”

Migraines Tied to Increased Risk of Heart Problems

Photo

Women who suffer from migraines are at higher risk of developing cardiovascular disease than women who aren’t plagued by the severe headaches, and they are more likely to have a stroke, heart attack or to die of heart disease, a new study reports.

The report, published in BMJ, is an analysis from the Nurses Health Study II, a Harvard study that tracked 115,541 women aged 25 to 42, from 1989 through June 2011. At the study start, 15 percent said they had migraines.

Over the course of two decades, 1,329 heart attacks, strokes or other heart events occurred, and 223 women died of heart disease. The researchers adjusted for smoking and other risk factors and found that the migraine sufferers had a 50 percent greater risk of major cardiovascular disease over all.

Women who had migraines were 39 percent more likely to have a heart attack, 62 percent more likely to have a stroke and 73 percent more likely to have other heart problems or to require a procedure like angioplasty. Migraines were also associated with a 37 percent greater risk of dying of heart disease.

The study is not the first one to find an association between migraines and cardiovascular disease. But experts say they are hard-pressed to explain the link and can only advise migraine sufferers to be aware of the risk and pay attention to signs of a possible heart attack or stroke.

A Low-Salt Diet May Be Bad for the Heart

Photo

Credit Tony Cenicola/The New York Times

People with high blood pressure are often told to eat a low-sodium diet. But a diet that’s too low in sodium may actually increase the risk for cardiovascular disease, a review of studies has found.

Current guidelines recommend a daily maximum of 2.3 grams of sodium a day — the amount found in a teaspoon of salt — for most people, and less for the elderly or people with hypertension.

Researchers reviewed four observational studies that included 133,118 people who were followed for an average of four years. The scientists took blood pressure readings, and estimated sodium consumption by urinalysis. The review is in Lancet.

Among 69,559 people without hypertension, consuming more than seven grams of sodium daily did not increase the risk for disease or death, but those who ate less than three grams had a 26 percent increased risk for death or for cardiovascular events like heart disease and stroke, compared with those who consumed four to five grams a day.

In people with high blood pressure, consuming more than seven grams a day increased the risk by 23 percent, but consuming less than three grams increased the risk by 34 percent, compared with those who ate four to five grams a day.

The lead author, Andrew Mente, an epidemiologist at McMaster University in Toronto, said that eating less salt does indeed lower blood pressure.

“But low sodium intake may be harmful,” he added. “It’s important not to rely on blood pressure alone, but rather to look at actual clinical events — heart attack, stroke, mortality.”

Can High-Intensity Exercise Help Me Lose Weight? And Other Questions, Answered

Photo

Credit Getty Images

I recently wrote about a study showing that one minute of intense interval training, tucked into a workout that was, in total, 10 minutes long, produced comparable health and fitness benefits to 45 minutes of more moderate, uninterrupted endurance training.

Readers posted almost 400 comments to the article and flooded the Internet and my inbox with questions and sentiments about extremely short workouts. Given the extent of the response and the astuteness of the questions, I thought I would address some of the issues that arose over and over.

Q. Are high-intensity interval workouts actually better for you than longer, endurance-style workouts — or just shorter?

A. Better is such a subjective word. At the moment, the two types of workouts appear to be largely equivalent to each other in terms of a wide variety of health and fitness benefits.

In the study that I wrote about, “1 Minute of All-Out Exercise May Equal 45 Minutes of Moderate Exertion,” for instance, three months of high-intensity interval training practiced three times per week led to approximately the same improvements in aerobic endurance, insulin resistance and muscular health as far longer sessions of moderate pedaling on a stationary bicycle.

One type of workout was not more beneficial than the other, in other words, but one required much, much less time.

Other studies have generally produced similar results, although, to be honest, the science related to interval training for health purposes and not simply for athletic performance remains scant. An interesting new review of past research to be published in June did conclude that, for overweight and obese children, short sessions of intense intervals may lead to greater improvements in endurance and blood pressure than longer bouts of moderate exercise, although the authors did not discuss how best to get children to complete frequent interval sessions.

The upshot of the available science is that if you currently have the time and inclination to complete long-ish, moderate workouts — if you enjoy running, cycling, swimming, walking or rowing for 30 minutes or more, for instance — by all means, continue.

If, on the other hand, you frequently skip workouts because you feel that you do not have enough time to exercise, then very brief, high-intensity intervals may be ideal for you. They can robustly improve health and fitness without overcrowding schedules.

Q.

What about combining brief high-intensity workouts with longer, endurance workouts?

A.

Alternating high-intensity workouts with endurance-style workouts may yield the greatest health and fitness gains of all.

In a 2014 study, a group of sedentary adults began either a standard endurance-training program, in which they pedaled a bicycle moderately for 30 minutes five times a week, or swapped one of those bike rides for an interval session. All of the participants wound up significantly more aerobically fit after 12 weeks.

But the men and women who had completed one interval session per week had developed slightly more overall endurance than the other volunteers. As a result, they had lowered their risk for premature death by about an additional 18 percent, the study’s authors conclude.

Q.

Do I have to use a stationary bicycle for interval training?

A.

Most recent studies of high-intensity intervals have involved computerized stationary bicycles because scientists can easily monitor the riders’ pace and intensity. But there is nothing magical about the equipment. The key to high-intensity interval training is the intensity, which most of us can gauge either with a heart rate monitor or our own honest judgment.

For moderate exercise, your heart rate typically should be between 70 and 85 percent of your maximum. (I recently wrote about how to determine your individual maximum heart rate.) This intensity would feel like about an 8 on an arduousness scale of 1 to 10.

During an intense interval, however, your heart rate should rise to 90 percent of your maximum heart rate, or above. Think of this as feeling like about a 9.5 on the 10-point scale. You maintain that intensity for only 10 or 20 seconds at a time, however, followed by several minutes of very easy exercise before repeating the intense work.

Almost any type of exercise can be used for interval training, including running up the stairs in your office’s stairwell during your lunch hour, said Martin Gibala, a professor of kinesiology at McMaster University in Hamilton, Ontario, and an expert on intervals. (His book about the science and practical implications of high-intensity interval training will be published in early 2017.)

Q.

Will high-intensity intervals help me to lose weight?

A.

Few studies have yet looked at the long-term effects on body weight of exercising exclusively with high-intensity intervals, although some experiments do hint that high-intensity interval training can reduce body fat, at least in the short term.

In a 2015 study, for example, overweight, out-of-shape men who began either to jog or otherwise exercise moderately for an hour five days per week for six weeks or to complete intensive interval training for a few minutes per week all dropped body fat and about the same percentages of fat, despite very different amounts of exercise. Likewise, a group of women recovering from breast cancer who were assigned either to moderate exercise or brief interval training for three weeks lost comparable amounts of body fat during the study.

But these were small-scale, brief experiments. Whether interval training helps or hinders long-term weight control is still unknown.

Related:

Interested in running? Sign up to receive practical tips, expert advice, exclusive content and a bit of motivation delivered to your inbox every week to help you on your running journey.

Think Like a Doctor: Sick at the Wedding

Photo

Credit Anna Parini

The Challenge: Can you figure out what is wrong with a 38-year-old man who suffers from fevers, insomnia and night sweats after traveling to the mountains of Colorado to be his brother’s best man?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a real-life medical mystery. Below you will find the story of a 38-year-old marketing executive from the Boston area who suddenly becomes sick when he takes his family to his brother’s destination wedding in the Rockies. Within a day of their arrival, the man begins to feel sick, though the rest of his family feels fine.

As usual, the first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” along with that feeling of satisfaction that comes from solving a difficult but really cool case.

The Patient’s Story

“Either you are getting in the car with me to go back to the hospital, or I’m calling an ambulance,” the woman announced. “It’s totally up to you.”

Her husband, 38 and never sick a day in his life, had been desperately ill for more than a week. He’d just gotten out of the hospital that morning, and after being home for less than 12 hours he was worse than ever. Though she couldn’t bring herself to say it out loud, she was worried he might be dying. And though he didn’t say anything, so was he.

It had started at his brother’s wedding, one of those destination events in the mountains of Colorado. And almost from the moment he stepped off the plane, he’d started to feel awful. His head ached. So did his body. His eyes were puffy, and his whole face looked swollen. He couldn’t eat, and he couldn’t sleep. When he went to bed that first night, he tossed and turned, though he felt exhausted. In the morning, when he dragged himself out of bed, the sheets were soaked with sweat.

Just the Altitude?

At first he wrote it off as altitude sickness. The resort was 11,000 feet above sea level, and he’d never been this high up. Though his wife and the kids felt fine, there were others in the wedding party who were feeling the effects of the altitude as badly as he did. One of the bridesmaids fainted at the rehearsal dinner. And an elderly aunt had to leave before the wedding.

The day of the wedding it snowed – in May. The kids were thrilled. His wife took them sledding. He’d spent the day in bed, trying – mostly unsuccessfully — to get some sleep. That afternoon the wedding service seemed to last forever. The tuxedo felt like a straitjacket. There was a pressure in his chest that made it hard to breathe. But he’d stood at the front of the church, proud to be best man to his younger brother.

After the service, the photographer led them outside, trying to capture the spring blossoms covered with snow that made the setting so extraordinary, and he worked hard to exhibit an enthusiasm he was too sick to feel.

By the time he made it to the dinner reception, his whole body shook with violent chills, and his head was pounding. His collar felt so tight he could hardly swallow. He’d been working on his toast for days, so his wife talked to the D.J. and changed the order of the toasts so that he could give his toast early. After completing it, he made his apologies, went back to the hotel and climbed into bed.

Feeling Worse and Worse

He figured he’d feel better when they got to the lower altitudes of Denver, where they’d arranged to spend their last night. But he didn’t. Even when he traveled back to Boston, down at sea level, he didn’t feel any better. He had some business in the city so was staying at a hotel while his wife took the two kids back to their home, an hour away. She was worried but he reassured her he’d be O.K.

But that night, alone in his hotel room, he felt so bad he began to get scared. If this was altitude sickness, he should be better by now. Everything he read on the Internet said so.

Finally he could take it no more. He went to the front desk and asked for a taxi and went to the closest emergency room, at Massachusetts General Hospital.

An Inflamed Heart

Because of his chest tightness, the doctors at Mass General ordered an EKG. To his surprise, it was abnormal, and he was rushed to the cardiac care unit. He hadn’t had a heart attack; they were sure of that. But something had damaged his heart.

After dozens of tests, the doctors told him he had something called myocarditis, an inflamed heart muscle, though they couldn’t tell him why. For three days they searched for the cause of injured muscle. Myocarditis is often due to a viral infection, but the doctors wanted to make sure they didn’t miss anything treatable.

At the top of their list, they worried that he had picked up some kind of tick-borne infection while in rural Colorado. None of the tests came back positive, but they sent him home to finish up a week of the antibiotic doxycycline, just in case.

You can read the notes from Mass General and the infectious disease specialist here.

Admission Note

Infectious Disease Notes

A Short Trip Home

In the hospital he felt a little better. His chest didn’t hurt, and his heart wasn’t racing. His fever went down. On his way home he felt like he was on the mend. His wife wasn’t so sure. And a couple of hours later, when she looked in on him again, she was frightened by how sick he looked.

He was pale and sweaty – the way he’d been in the mountains. And the shaking and fevers were back. His headache was so bad that he was crying with pain, something she’d never seen before. She called Mass General. The doctor there said that if she was worried she should bring him right back. But the prospect of an hour-long drive seemed daunting. She decided to take him to the local hospital one town over.

So, did he want her to call an ambulance, or should they go by car?

Back to the Hospital

The patient’s wife dropped off the kids at a friend’s house, then drove him to Anna Jaques Hospital in Newburyport, Mass. It was late by the time they arrived and the emergency room was quiet.

Dr. Domenic Martinello knocked at the entrance to their hospital cubicle. The patient’s wife looked up expectantly, her face tight with exhaustion. The patient lay motionless on the stretcher; his eyes were sunken, and his skin hung off his face as if he hadn’t eaten much recently. His voice was soft but raspy, and every time he swallowed, his lips tightened in a grimace of pain.

Together, husband and wife recounted the events of the past few days: the wedding, the fevers, headaches, pain in his chest, in his neck and in his throat, the four days in the hospital in Boston.

It was certainly a confusing picture, and Dr. Martinello wasn’t sure what to make of the diagnosis of myocarditis. But the patient had no chest pain now, only the headache, sore neck and painful throat.

He quickly examined him. The patient’s skin was warm and sweaty, and his neck was stiff and tender, especially on the right. He was going to approach this systematically, he told the couple. First he would get a head CT, then a scan of the neck, and then he would do a lumbar puncture – a spinal tap. He felt optimistic that one of those tests would give him an answer.

You can see Dr. Martinello’s note here.

Hospital Note

Solving the Mystery

Dr. Martinello did get an answer. But it wasn’t the one he was expecting.

The first reader to identify the cause of this man’s illness gets a copy of my book and the pleasure of making a difficult diagnosis. The answer will be posted Friday afternoon on Well.

Rules and Regulations: Post your questions and diagnosis in the comments section below. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.