Tag Archives: lifespan

LP(a), cardiovascular disease, and all-cause mortality: What’s optimal?

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Very low, low, and high-density lipoproteins (VLDL, LDL, HDL, respectively) are commonly measured on the standard blood chemistry panel as measures of cardiovascular disease risk. Not included on that panel is another lipoprotein, Lp(a), which is a modified form of LDL. What’s the relationship between Lp(a) with disease risk?

A meta-analysis of 36 studies that included 126,634 subjects reported that Lp(a) > 30 mg/dL (65 nmol/L) was significantly associated with an increased risk for heart attacks, coronary heart disease-related deaths, and ischemic strokes (Erqou et al.  2009):

Screen Shot 2019-08-31 at 8.32.04 PM

Investigating further, of 2,100 candidate genes that were evaluated for predicting heart disease risk, genetic variation in the LPA gene was the strongest genetic risk factor (Clarke et al. 2009). Of the Lp(a)-related genes, SNPs for rs3798220 (increased risk allele = C) and rs10455872 (increased risk allele = G) were associated with a 92% and a 70% increased risk for coronary heart disease, respectively.

Based on these data, Lp(a) values less than 50 mg/dL (108 nmol/L) have been recommended, with 1-3 grams/day of niacin, which reduces Lp(a) levels, as the primary treatment for minimizing cardiovascular disease risk (Nordestgaard et al. 2010).

However, cardiovascular disease is only 1 outcome. What’s the data for Lp(a) and risk of death from all causes, not just cardiovascular disease-related deaths? In a study of 10,413 adults (average age, 55y), the lowest risk of death from all causes was reported for Lp(a) values of 270 mg/L (equivalent to 27 mg/dL, and 58 nmol/L). The log of 270 is 2.43, which corresponds to the lowest mortality risk on the chart below (Sawabe et al. 2012):

Screen Shot 2019-09-01 at 11.54.55 AM

Interestingly, all-cause mortality risk was significantly increased only for Lp(a) values < 80 mg/L (log 80 = 1.90; equivalent to 17 nmol/L), when compared with intermediate (80 – 550 mg/L; log values from 1.9 – 2.7 on the chart; equivalent to 17 – 118 nmol/L) and high Lp(a) (> 550 mg/L; log values > 2.7 on the chart; equivalent to > 118 nmol/L).

In addition to low Lp(a) values, an increased risk of death from all causes (and a shorter lifespan) have also been reported for high Lp(a). When compared with Lp(a) < 21 nmol/L, Lp(a) > 199 nmol/L was associated with a 20% increased all-cause mortality risk (Langsted et al. 2019). In addition, median lifespan was 1.4 years shorter for subjects that had  Lp(a) values > 199 nmol/L, when compared with < 21 nmol/L.

Based on the studies of Sawabe and Langsted, both low and high Lp(a) values may be bad for disease risk. What are my Lp(a) values?

I’ve been tracking Lp(a) for the past 14 years, first, approximately 1x/year until I was 40, and second, 9 times since 2015, when I started daily nutrition tracking. In addition, I’ve measured it 4x in 2019, with the goal of getting it closer to the 58 nmol/L value of the Sawabe study. When I first started measuring Lp(a) in 2005, it was ~150 nmol/L, which is way higher than the < 65 nmol/L that was reported for reduced cardiovascular disease risk in the Erqou meta-analysis, and the 58 nmol/L value that was reported for maximally reduced all-cause mortality risk in the Sawabe study:

Picture1

Fortunately, I was able to reduce my Lp(a) levels from those first values to levels closer to ~100 nmol/L, which is still too high. For the first 8 Lp(a) measurements, I didn’t track my nutrition, so I can’t say which factors helped me to reduce it. Also, note that I didn’t include the blood test measurement where I tried high dose niacin (3 g/day), which reduced my Lp(a) to 84 nmol/L, but also worsened my liver function,. My liver enzymes, AST and ALT doubled on high-dose niacin! What good is a reduced risk for cardiovascular disease if my risk for liver disease simultaneously goes up? Obviously, I quickly discontinued use of niacin to reduce Lp(a).

Also note the data on the chart since 2015, when I started daily nutritional tracking. Over that period, my average value over 9 Lp(a) measurements is 95.3 nmol/L. Although my average Lp(a) is still higher than it should be, it’s better than my pre-tracking Lp(a) average value of 115.6 nmol/L (p-value = 0.03 for the between-group comparison). In addition, on my last 3 measurements, my Lp(a) values were 75, 82, and 79 nmol/L. How have I been reducing it?

As I’ve mentioned in many blog posts, I’ve been weighing, logging, and tracking my nutrient intake since 2015. When I blood test, I can use the average dietary intake that corresponds to the blood test result, and with enough blood test results, I can look at correlations between my diet with blood test variables. Based on this approach, one possibility is my daily sodium intake. Shown below is a moderately strong correlation (r = 0.61, R^2 = 0.366) between my daily sodium intake with Lp(a). The higher my sodium intake, the lower my Lp(a) values.

lpa vs na.png

Can the strength of this approach be improved? Interestingly, I identified another moderately strong correlation (r = 0.69) between my lycopene intake with Lp(a): the higher my lycopene intake, the higher my Lp(a)! I then decided to include both sodium and lycopene in a linear regression model, and the correlation for both of these nutrients with Lp(a) is 0.90! So what will I do with this info?

The highest that my average dietary sodium intake has been in any blood testing period is ~2500 mg. Sodium levels higher than that seem to negatively affect my sleep, so I’m not interested in going higher than 2500 mg/day. Also, there may be a plateau effect for sodium, as values ~2500 mg/day didn’t associate with significantly lower Lp(a) values when compared with 2300 mg/day. I can, in contrast, reduce my lycopene intake, which comes almost exclusively from my daily watermelon intake. I usually eat ~7 oz/day, and for my next blood test I’ll reduce this to 5 oz/day. Based on the regression equation that includes sodium and lycopene, with a 2300 mg sodium intake and the amount of lycopene that corresponds to 5 oz. of daily watermelon (~6700 micrograms, down from ~9000 micrograms), I should expect to see a Lp(a) value ~67 nmol/L on my next blood test. If not, I’ll repeat this approach, looking for strong correlations between my diet with Lp(a), followed by tweaking my diet to obtain biomarker results that are close to optimal. Stay tuned my my next blood test data, coming in about 2 weeks!

If you’re interested, please have a look at my book!

 

References

Clarke, R., J. F. Peden, J. C. Hopewell, T. Kyriakou, A. Goel, S. C. Heath, S. Parish, S. Barlera, M. G. Franzosi, S. Rust, et al. 2009. Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N. Engl. J. Med. 361: 2518–2528.

Erqou, S., S. Kaptoge, P. L. Perry, A. E. Di, A. Thompson, I. R. White, S. M. Marcovina, R. Collins, S. G. Thompson, and J. Danesh. 2009. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 302: 412–423.

Langsted A, Kamstrup PR, Nordestgaard BG. High lipoprotein(a) and high risk of mortality. Eur Heart J. 2019 Jan 4. [Epub ahead of print].

Sawabe M, Tanaka N, Mieno MN, Ishikawa S, Kayaba K, Nakahara K, Matsushita S; JMS Cohort Study Group. Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study). PLoS One. 2012; 7(4): e31954. PLoS One. 2012;7(4):e31954.

Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, Ginsberg H, Amarenco P, Catapano A, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Reiner Z, Taskinen MR, Tokgözoglu L, Tybjærg-Hansen A; European Atherosclerosis Society Consensus Panel. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010 Dec;31(23):2844-53.

100 Days Of Dietary Data

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I’ve posted individual dietary days as an example of what and how much I eat (https://michaellustgarten.wordpress.com/2015/12/31/130-grams-of-fiber-2400-calories/). However, a few days of examples may not represent the whole dietary picture. To address this, below is my average nutrient intake for the past 100 days (from October 24, 2018-Feb 5 2019):

100 days of nutrition.png

Notice that my average values for many of these variables (i.e. potassium, selenium, Vitamin C, Vitamin K, etc.) are way above the RDA. For more info on that, I have several blog posts that explain the “why” behind that. Where am I getting those nutrients from? Shown below are 100-day averages for my food intake, ranked in order from most consumed (in grams, or ounces, if it’s a drink) to least:

100 days of foods.png

During the past 100 days, my top 5 foods in terms of daily intake include carrots, strawberries, red peppers, watermelon, and cauliflower. Scroll through the list to see how much I average on a daily basis for each food!

Please have a look at my book, if you’re interested!

Optimizing Biological Age: Is Calorie Restriction Essential?

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My goal is to break the world record for lifespan, 122 years, which is currently held by Jean Calment. How do I plan to do that? A good start would be calorie restriction (CR), a diet where you eat 10-30%+ less calories than your normal intake. CR is the gold standard for increasing lifespan in a variety of organisms, including yeast, flies, worms, and rodents (McDonald et al. 2010).

With the goal of maximizing my health and lifespan, in April 2015, I started a CR diet. Inherent in that was weighing all my food and recording it on an online website that tracks macro-and micro-nutrients. From then until March 2016, I was pretty good at keeping my calories relatively low, as I averaged 2302 calories. However, since 3/2016, it’s been exceedingly difficult to keep my calories that low, as I’ve averaged 2557 calories/day. So is having a higher calorie intake worse for my lifespan goal than a lower calorie intake?

Maybe not. In addition to tracking my daily nutrition since 2015, I’ve also had regular blood testing performed. I’ve measured the typical things that you get at a yearly checkup, including the lipid profile (triglycerides, total cholesterol, LDL, HDL, VLDL) markers of kidney and liver  function (BUN, creatinine, uric acid, and ALT, AST, respectively), and the complete blood count (red and white blood cells, and their differentials). By tracking my daily nutrition and circulating biomarkers, I’m able to quickly intervene on any potential aging and disease-related mechanisms by using my diet to optimize my circulating biomarkers.

On my quest for optimal health and lifespan, biological age is more important than my chronological age (I’m 46y). So what’s my biological age? Between 2016-2019, the group at Insilico Medicine published 2 papers that included circulating biomarker data from more than 200,000 people (Putin et al. 2015, Mamoshina et al. 2018) to derive a biological age predictor (aging.ai). So what’s my biological age?

Shown below is my predicted biological age over 13 blood tests from 3/2016 to 6/2019:

agingai2

Although I wasn’t on a CR diet during that time, my average biological age was 29.2 years, which is ~34% younger than my chronological age. Would my biological age be even younger with a lower calorie intake? I’m working on reducing my calorie intake again (it’s not easy for me), so stay tuned for that!

Here are the my biomarker values corresponding to each blood test, for anyone who wants to double check the results:
agingai2 values

References

Mamoshina P, Kochetov K, Putin E, Cortese F, Aliper A, Lee WS, Ahn SM, Uhn L, Skjodt N, Kovalchuk O, Scheibye-Knudsen M, Zhavoronkov A. Population specific biomarkers of human aging: a big data study using South Korean, Canadian and Eastern European patient populations. J Gerontol A Biol Sci Med Sci. 2018 Jan 11.

McDonald RB, Ramsey JJ. Honoring Clive McCay and 75 years of calorie restriction research. J Nutr. 2010 Jul;140(7):1205-10.

Putin E, Mamoshina P, Aliper A, Korzinkin M, Moskalev A, Kolosov A, Ostrovskiy A, Cantor C, Vijg J, Zhavoronkov A. Deep biomarkers of human aging: Application of deep neural networks to biomarker development. Aging (Albany NY). 2016 May;8(5):1021-33.

If you’re interested, please have a look at my book:

Homocysteine and All-Cause Mortality Risk

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On a recent blood test, my plasma level of homocysteine (Hcy) was 11.9 uMol. Is that optimal minimizing disease risk and maximizing longevity? Let’s have a look at the literature.

A 2017 meta-analysis of 11 studies including 27,737 participants showed an increased risk of death from all causes (“all-cause mortality”; ACM) as circulating levels of homocysteine increase (Fan et al. 2017):

hcy acm.png

When looking at meta-analyses, it’s important to examine each of the individual studies. Here are the data for the 11 included studies:

  • Kark et al. 1999: 1,788 older adults, average age 65y, followed for 9-11 years. Compared with values less than 8.5 uMol, subjects with elevated homocysteine (> 14.7) had a 2-fold higher risk of death from all causes.
  • Bostom et al. 1999: 1,933older adults, verage age, 70y, median follow-up, 10y. Subjects with values > 14.3 uMol had 2-fold ACM risk, when compared with < 14.3.
  • Hoogeveen et al. 2000: 811 older adults (average age, 65y), 5 yr follow-up. Non- diabetics had a 34% increased ACM risk (p=0.08), but diabetics had 2.5-fold increased ACM risk after a 5-yr follow-up.
  • Vollset et al. 2001: 4,766 older adults (age range, 65-67y at study entry), median 4 yr follow-up. Compared with 5.1-8.9 uMol, values greater than 12 were significantly associated with a 2.4-4.5 increased ACM risk.
  • Acevedo et al. 2003. 3,427 subjects, average age 56y, ~3yr follow-up. ACM risk lowest for < 9.4 uMol, compared with > 14.4.
  • González et al. 2007: 215 older adults (average age, 75y), median 4 yr follow-up. Compared with < 8.7 uMol, values > 16.7 had 2.3-fold increased ACM risk.
  • Dangour et al. 2008: 853 older adults (average age, 79y), ~7.6y follow-up. Homocysteins > 19.4 uMol associated with ~2-fold higher ACM risk, when compared with < 9.8.
  • Xiu et al. 2012: 1,412 older adults (average age, ~75y), up to 10 year follow-up. 1.8-fold higher ACM risk comparing those with >14.5 uMol with < 9.3.
  • Waśkiewicz et al. 2012: 7,165 middle aged adults, ~5yr follow- up. 1.8-fold increased ACM risk for subjects with homocysteine > 10.5 uMol(average age, 52y) when compared with < 8.2 (avg age, 40y).
  • Wong et al. 2013: 4,248 older men, average age ~77y, ~5yr follow-up. 1.5-fold increased ACM risk for homocysteine values > 15 uMol.
  • Swart et al. 2012: 1,117 older adults (average age, 75y), up to a 7yr follow-up. In 543 men, homocysteine was not associated with ACM risk. In 574 women, 1.7 to 1.9-fold higher ACM risk when comparing  > 12.7 and >15.6 vs < 10.3 uMol.

Not included in their analysis:

  • Petersen et al. 2016: 670 subjects, average age 65y, average follow-up 14.5y. Subjects with homocysteine values ≥ 10.8 μmol/l  had a significant higher incidence of all-cause mortality:

hcy 2

In sum, the evidence appears consistent across these 12 studies that elevated homocysteine is associated with an increased risk of death from all causes. Based on the Fan et al. (2016) meta-analysis, lower appears better, with values < 5 uMol associated with maximally reduced ACM risk. Also based on that data, my ACM risk is ~1.5-fold increased!

To see how dietary changes and supplements have impacted my homocysteine levels, see this link: https://michaellustgarten.wordpress.com/2018/03/23/reducing-homocysteine-updates/

If you’re interested, please have a look at my book:

References:

Bostom AG, Silbershatz H, Rosenberg IH, Selhub J, D’Agostino RB, Wolf PA, Jacques PF, Wilson PW. Nonfasting plasma total homocysteine levels and all-cause and cardiovascular disease mortality in elderly Framingham men and women. Arch Intern Med. 1999 May 24;159(10):1077-80.

Dangour AD, Breeze E, Clarke R, Shetty PS, Uauy R, Fletcher AE. Plasma homocysteine, but not folate or vitamin B-12, predicts mortalityin older people in the United Kingdom. J Nutr. 2008 Jun;138(6):1121-8.

Fan R, Zhang A, Zhong F. Association between Homocysteine Levels and All-cause Mortality: A Dose-Response Meta-Analysis of Prospective Studies. Sci Rep. 2017 Jul 6;7(1):4769.

González S, Huerta JM, Fernández S, Patterson AM, Lasheras C. Homocysteine increases the risk of mortality in elderly individuals. Br J Nutr. 2007 Jun;97(6):1138-43.

Hoogeveen EK, Kostense PJ, Jakobs C, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD. Hyperhomocysteinemia increases risk of death, especially in type 2 diabetes : 5-year follow-up of the Hoorn Study. Circulation. 2000 Apr 4;101(13):1506-11.

Kark JD, Selhub J, Adler B, Gofin J, Abramson JH, Friedman G, Rosenberg IH. Nonfasting plasma total homocysteine level and mortality in middle-aged and elderly men and women in Jerusalem. Ann Intern Med. 1999 Sep 7;131(5):321-30.

Petersen JF, Larsen BS, Sabbah M, Nielsen OW, Kumarathurai P, Sajadieh A. Long-term prognostic significance of homocysteine in middle-aged and elderly. Biomarkers. 2016 Sep;21(6):490-6.

Swart KM, van Schoor NM, Blom HJ, Smulders YM, Lips P. Homocysteine and the risk of nursing home admission and mortality in older persons. Eur J Clin Nutr. 2012 Feb;66(2):188-95.

Waśkiewicz A, Sygnowska E, Broda G. Homocysteine concentration and the risk of death in the adult Polish population. Kardiol Pol. 2012;70(9):897-902.

Wong YY, Almeida OP, McCaul KA, Yeap BB, Hankey GJ, Flicker L. Homocysteine, frailty, and all-cause mortality in older men: the health in men study. J Gerontol A Biol Sci Med Sci. 2013 May;68(5):590-8.

Vollset SE, Refsum H, Tverdal A, Nygård O, Nordrehaug JE, Tell GS, Ueland PM. Plasma total homocysteine and cardiovascular and noncardiovascular mortality: the Hordaland Homocysteine Study. Am J Clin Nutr. 2001 Jul;74(1):130-6.

PRAL, Mortality Risk, and Lifespan

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Within the body, meat, grains, and nuts are generally acid-forming, whereas vegetables and fruits are alkaline-forming. Is the distinction between whether your diet is acid- or alkaline-forming important for optimal health and lifespan? In an earlier post, I discussed the importance of PRAL (potential renal acid load) by correlating it with serum bicarbonate and mortality risk (https://michaellustgarten.wordpress.com/2016/02/07/using-diet-to-optimize-circulating-biomarkers-serum-bicarbonate/).

More recent data (a 15-year study of 81, 697 older adults; average age ~61y; Xu et al. 2016) has examined the association between PRAL with risk of death from all causes. In women, acidic PRAL values ( > 0) were associated with a significantly increased risk of death from all causes, as were alkaline PRAL values (< -5.6). In addition, very acidic (~40) and very alkaline (-30) PRAL values were associated with the highest risk for all-cause mortality:

pral-acm-men

Similarly, in men, when compared with a PRAL = 0, both alkaline (PRAl < -5.6) and acidic (> 29.8) values were associated with increased all-cause mortality risk.

pral-acm-women

While this data suggests that eating too much meat, grains, and/or nuts may not be optimal for health, it also suggests that eating too much alkaline-forming food, including veggies and fruits, may also not be optimal! My high veggie-based diet yields a very negative PRAL, ~-120 (~ -0.05 PRAL units/calorie), which would seem to put me at increased all-cause mortality risk. To further investigate, I decided to look at the PRAL values of long-lived societies.

The PRAL formula, as reported by Remer and Manz (1994) is:

PRAL = (0.49 * protein intake in g/day) + (0.037 * phosphorus intake in mg/day) – (0.02 * potassium intake in mg/day) – (0.013 * calcium intake in mg/day) – (0.027 * magnesium intake in mg/day).

Life expectancy for Seventh-Day Adventist women is 85 years, a value that is the highest in the world (Fraser and Shavlik 2001). What’s the average daily PRAL value for that population?

  • Average daily dietary data in both vegetarian and non-vegetarian Seventh-Day Adventist women (average age, ~72y) has been reported (Nieman et al. 1989). For vegetarians, total calories = 1452; protein = 47g; phosphosphorus = 889 mg; potassium = 2628 mg; calcium = 628 mg; magnesium = 283 mg. These values yield an alkaline PRAL = -33.2. Because higher amounts of these nutrients can result from an increased calorie intake, it’s important to divide PRAL by the average daily calorie value, thereby yielding  PRAL/calorie. For vegetarian Adventists, this value = -0.02.
  • In non-vegetarian Adventists, total calories = 1363; protein = 55g; phosphosphorus = 892 mg; potassium = 2342 mg; calcium = 633 mg; magnesium = 228 mg. These values also yield an alkaline PRAL = -25.5, and PRAL/calorie = -0.019.

Life expectancy for those who live on the island of Okinawa is among the longest in the world (Miyagi et al. 2003). What’s the average daily PRAL value for Okinawan older adults?

  • The average daily dietary data for 75-year old Okinawans  has been reported (Willcok et al. 2007): total calories, 1785; protein, 39g; phosphosphorus, 864 mg; potassium, 5200 mg; calcium, 505 mg; magnesium, 396 mg. These values also yield an  yield a very alkaline PRAL value = -87.4, and PRAL/calorie =  -0.049. Interestingly, these values are very close to my very alkaline PRAL values of -121, and PRAL/calorie = ~-0.05!

My goal is not just to get to 75 in great health, but to live past 100 (and far beyond). What’s the data in centenarians? Unfortunately, I could only find 2 studies that included dietary data for that age group.

  • In a study of 30 Chinese centenarians (average age, 103y), daily dietary values of 1220 calories, 39g protein, 603 mg phosphorus, 1433 mg potassium, 482 mg calcium, and 355 mg magnesium were reported (Cai et al. 2016), thereby yielding an average daily PRAL value = -20.3, and PRAL/calorie = -0.017.
  • Similarly, in a larger study of 104 Japanese centenarians (average age, 100y), daily dietary values of 1137 calories, 44g protein, 676 mg phosphorus, 1695 mg potassium, 414 mg calcium, and 154 mg magnesium were reported (Shimizu et al. 2003), thereby yielding an average daily PRAL value = -16.3, and PRAL/calorie = -0.014.

In contrast to the data of Xu et al. (2016), these data suggest that an alkaline diet may indeed be optimal for lifespan.

So what’s your dietary PRAL value?

If you’re interested, please have a look at my book!

References

Cai D, Zhao S, Li D, Chang F, Tian X, Huang G, Zhu Z, Liu D, Dou X, Li S, Zhao M, Li Q.  Nutrient Intake Is Associated with Longevity Characterization by Metabolites and Element Profiles of Healthy Centenarians. Nutrients. 2016 Sep 19;8(9).

Fraser GE, Shavlik DJ. Ten years of life: Is it a matter of choice? Arch Intern Med. 2001 Jul 9;161(13):1645-52.

Miyagi S, Iwama N, Kawabata T, Hasegawa K. Longevity and diet in Okinawa, Japan: the past, present and future. Asia Pac J Public Health. 2003;15 Suppl:S3-9.

Nieman DC, Underwood BC, Sherman KM, Arabatzis K, Barbosa JC, Johnson M, Shultz TD. Dietary status of Seventh-Day Adventist vegetarian and non-vegetarian elderly women. J Am Diet Assoc. 1989 Dec;89(12):1763-9.

Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr. 1994;59:1356-1361.

Shimizu K, Takeda S, Noji H, Hirose N, Ebihara Y, Arai Y, Hamamatsu M, Nakazawa S, Gondo Y, Konishi K. Dietary patterns and further survival in Japanese centenarians. J Nutr Sci Vitaminol (Tokyo). 2003 Apr;49(2):133-8.

Willcox BJ, Willcox DC, Todoriki H, Fujiyoshi A, Yano K, He Q, Curb JD, Suzuki M. Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann N Y Acad Sci. 2007 Oct;1114:434-55.

Xu H, Åkesson A, Orsini N, Håkansson N, Wolk A, Carrero JJ. Modest U-Shaped Association between Dietary Acid Load and Risk of All-Cause and Cardiovascular Mortality in Adults. J Nutr. 2016 Aug;146(8):1580-5.