TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.
This week’s topics include healthy lifestyle and Alzheimer’s, racial groups and Alzheimer’s risk, time-restricted eating and weight loss, and treating moderate to severe asthma in Black and Latinx adults.
1:50 8 a.m. to 6 p.m.
2:50 Watching what we’re eating
4:24 Lived longer with more healthy factors
5:24 Why lengthen life if we get Alzheimer’s
6:24 Easy things to modify
7:32 Use same therapy for exacerbations
8:35 Should increase compliance
9:45 Higher rate of Alzheimer’s for ethnic groups
10:45 No real regional or geographic difference
Elizabeth Tracey: Can a healthy lifestyle improve your life expectancy without Alzheimer’s disease?
Rick Lange, MD: Does time-restricted eating increase weight loss?
Elizabeth: What are the differences among different ethnic groups regarding Alzheimer’s disease?
Rick: And treating moderate-to-severe asthma in Black and Latinx adults.
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, since I celebrated Easter yesterday, really overindulging in lots of things that I ate, I’d actually like to turn to the New England Journal of Medicine to one of yours first and this notion of, “Hmm, what about timing of eating?”
Rick: It’s been clear that for obese people, caloric restriction is really the mainstay of treatment for weight reduction. The unfortunate thing is it’s difficult. The results are somewhat modest and sometimes not sustained.
There has been a great amount of interest in what’s called time-restricted eating — that is, you only eat for a certain part of the day. It’s like, for example, from 8:00 in the morning till 4:00 in the afternoon, and you fast the rest of the time. That’s been shown to reduce weight as well.
Does it have anything to do with the timing when you eat or is that just because when you’re doing that you’re restricting your caloric intake? What these investigators did was to evaluate the efficacy — and somewhat the safety — of time-restricted eating. They took 139 patients who were obese and they randomized them to caloric restriction. They reduced their caloric intake to about 25% of what they were normally doing — that’s half of them — and then the other half they did the same thing, but then they also restricted the time they took those calories in, from 8:00 am to 6:00 pm.
Does time-restricted eating improve weight loss? What they discovered was, it didn’t change anything at all. Both groups had the same amount of weight loss. Body fat and body mass index, waist circumference, height, blood pressure, and diabetes were equivalent in both groups. By the way, this study went on for a year. Caloric restriction is what reduces weight. It has nothing to do with when we eat.
Elizabeth: What about other parameters such as, how did people like restricting the time during which they actually consumed food?
Rick: It’s hard to know for sure because these are all individuals that were interested in being a part of the study. They were self-motivated. What I could tell you was 85% of the individuals enrolled in the study completed it.
Elizabeth: So I guess we just can’t get over the notion that we really have to pay attention to what it is we’re eating.
Rick: That is the calories. Now, by the way, I failed to mention that in these individuals that did time-restricted eating, they didn’t drink beverages afterwards during the fasting time. This shows the importance of watching what we’re eating.
Elizabeth: I think that we’ve spent a tremendous amount of time over these many years talking about ways to manage weight. I guess I would respectfully suggest that if reducing the duration of consuming food for somebody during the day is helpful for them, then OK, why not?
Rick: Absolutely. What these investigators mentioned is this is a great alternative for individuals that have trouble reducing their caloric intake. However one can best do that is the most appropriate way to reduce your weight.
Elizabeth: Since we are talking about healthy lifestyles then, let’s turn to the BMJ and this is a look at healthy lifestyle and life expectancy with and without Alzheimer’s dementia — an interesting study from the Chicago Health and Aging Project.
This part of their cohort was 2,400 + men and women who were 65 years and older. They developed a healthy lifestyle score and this was based on five modifiable lifestyle factors: a DASH style or Mediterranean style diet, late-life cognitive activities, moderate or vigorous physical activity, no smoking, and light to moderate alcohol consumption. They just gave them those five factors and they said, “What’s your score relative to these healthy lifestyles?”
They found that women aged 65 with four or five healthy factors had from that moment a life expectancy of 24.2 years and they lived 3.1 years longer than those with 0 or 1 healthy lifestyle factors. They spent about 11% of their remaining years with Alzheimer’s disease, where women who had 0 of those factors spent almost 20% of their remaining life with Alzheimer’s disease.
Then when we turn to the men, we find they also had a 5.7-year longer lifespan — those who had all those healthy lifestyle factors — than those who had 0 or 1. They spent 6.1% of their remaining years with Alzheimer’s disease versus 12% with Alzheimer’s disease among those who had either 0 or 1 of those healthier lifestyle factors. What this purports to do is sort of settle this issue of, does it help if we live longer, we develop Alzheimer’s, and we have a longer period of time with that?
Rick: Elizabeth, I thought this was a fascinating way to look at things because you’re right. What’s the benefit of lengthening life if we spend more of it either in poor health or with Alzheimer’s dementia? It cut the amount of time they spent with Alzheimer’s dementia in half, so you live longer, you’re less likely to get Alzheimer’s, and you’re less likely to have years with Alzheimer’s dementia. It really speaks to the importance of these lifestyle changes.
The one thing we didn’t say is these are all healthy lifestyles and we didn’t tell how long they have been doing it. But, again, these things are all fairly simple things to do and it implies that even if you start at age 65 there may be some benefits.
Elizabeth: Yeah. That was exactly the question I had, when do you have to start in order to reap these benefits? One thing that they did do in here also is they adjusted for all those other covariates that are a part of this equation: age, race, marital status, education, genetic risk factors, and comorbidities. It rendered these results slightly more powerful, I think.
Rick: Again, I want people to realize these are fairly easy things to modify and the benefit — both in terms of duration of life, quality of life, and cognitive function — is pretty substantial.
Elizabeth: Let us turn back to the New England Journal of Medicine.
Rick: This is a study to do with treating moderate-to-severe asthma in Black and Latinx adults. The reason why we concentrated on those is because they have a higher morbidity and mortality than Caucasians. Now we know that maintenance therapy using a combination of inhaled steroids and a long-acting beta agonist, called a LABA, administered twice a day can reduce overall exacerbations, hospitalizations, and even death.
What we don’t know, however, is how do you treat those times where asthma recurs even in the setting of that. There are two possibilities. One is to use a short-acting beta agonist, or the other is, “Hey, let’s take this therapy we are using twice a day and let’s just give another dose.” That’s the origin of this study.
It’s a large study of over 1,200 adults, about half Black, about half Latinx. Half of them they said do what you’re doing and the other half, they said, “Listen, take the same therapy you normally take twice a day and use that in times where you’re having recurrence.” They followed these individuals for over the course of about 15 months.
What they had discovered was that treating them with the same medication decreased severe or moderate asthma by about 15%. It also decreased hospitalizations. It decreased missed days from work and use of other inhalers as well, in between the maintenance therapy first time in African Americans, or Blacks, and Latinx adults.
Elizabeth: Let’s talk about compliance because compliance is an issue, I think, in a lot of these things that require people to scrutinize how they are feeling and then to respond to that before things get to a place where it’s urgent.
Rick: Yeah. Compliance was actually fairly good. These are motivated individuals.
Elizabeth: I guess the other thing I would say is that if it’s something that you’ve already got on hand and you don’t need to have a special medicine hanging out just for rescue, it’s probably going to be better or utilized more often.
Rick: Absolutely, and you’re using it twice a day already. You don’t have to carry around multiple inhalers. You just take it with you and you use it in the same way that you normally do. If anything, this should increase compliance and make it easier for individuals.
Elizabeth: We’d like things that make it easier. Let’s turn finally to JAMA. This is a look at race and ethnicity with regard to the incidence of dementia among older adults.
I didn’t realize previous to this study that this was an area where we really didn’t know very much. This is a VA study. It’s among the Veterans Health Administration population, which is a defined population just because that’s its nature.
What they wanted to do was look at dementia incidence across 5 racial and ethnic groups and by U.S. geographic region. They have their whole huge cohort of older veterans who get care in the largest integrated health care system in the United States.
They had just a little bit less than 2 million participants, 55 years or older, evaluated between October of 1999 to September of 2019. They had self-reported racial and ethnic data. They also had their residential Zip codes.
Basically, compared with white participants, if you were an American Indian or an Alaska Native, you had a higher rate of Alzheimer’s disease. It was also higher for Asian participants, Blacks, and Hispanics — highest for Hispanics and for Blacks.
Rick: In fact, the difference between whites and Asians or Native Americans was actually minimal. It was about twice as high in Hispanics and 50% higher in Blacks. What you have to remember is when we are talking about Hispanics there is a lot of different cultures by the way. Unfortunately, we don’t know any more about that.
The other thing we don’t know is about we know that dementia is tied to educational efforts and we don’t know anything about that. They tried to assess that by saying what Zip code did they grow up in, but we really don’t know that.
The nice thing about this study is it’s large. Secondly, is everybody receives the same healthcare so that takes that out of the equation. Because we know that access to healthcare or access to diagnosis, access to controlling risk factors, like hypertension and diabetes, could contribute to dementia. Because they were able to look throughout the entire country, they were able to assess whether there were regional or geographic differences. What they discovered is there is a little bit of geographic difference, but it didn’t matter really what geography looked like. The story was the same for Hispanics and for African Americans. Their risk was higher.
Elizabeth: Yeah. Some of the other things that they teased out they did take a look at the cardiovascular risk factors and known associations with dementia. I found it really interesting that based on their data from the Indian Health Service, this association between hypertension and dementia it wasn’t there.
Rick: Yep. Populations, again, are very different and now we need to look at OK, what’s the reason. Other than identifying the differences in ethnicity and race, now we need to try to find the reasons behind it.
Elizabeth: On that note, then that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.