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 hangriness, physical activity and poor diet, the state of men’s health, and alcohol use and risk.
0:35 Outrunning a bad diet
1:35 Best outcome with both exercise and good diet
2:35 Need policy level intervention
3:00 Commonwealth report on health for U.S. men
4:00 Least likely to have a regular doctor
5:01 ED visits instead
5:40 Alcohol consumption and impact
6:41 204 countries and territories
7:42 Change to none if you’re younger than 40
9:20 Accounting for a number of traits
10:20 Changes in insulin or other hormones
11:20 Only 58% had breakfast
Elizabeth: Is hangry a real thing?
Rick: Alcohol consumption and global health.
Elizabeth: The really rather sad state of health for American men.
Rick: And can you outrun a bad diet?
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: Welcome back from France, Rick, and I think we should start with, “Can you outrun a bad diet?” You just were in France indulging yourself a lot with French food and riding a bicycle. This is in the BMJ. What are we going to learn about this issue?
Rick: I don’t know if you sent this to me as a pointed message about what I was doing, both eating great French food and drinking wine, at the same time bicycling, trying to burn all the calories. But everybody who is listening to us knows that it’s good for your health to be involved in moderate to vigorous physical activity. They also know it’s good to eat a healthy diet. But there are very few studies that have actually looked at the interaction. There have been some small studies that suggest that if people do high-intensity exercise, they can overcome a bad diet.
That’s exactly what the authors tried to address. They examined the independent and interactive associations of physical activity and diet, looking at all-cause mortality, cardiovascular mortality, and also adipose-related cancer mortality — over 346,000 individuals with a follow up of 11 years.
Unfortunately, you can’t outrun a bad diet. To get the best outcome for reducing overall mortality, cardiovascular mortality, and reducing obesity-related cancer mortality, you had the best outcome when you had both a good diet and you are also involved in moderate physical activity. One didn’t overcome the other.
Elizabeth: Yeah. So much for that whole fat or fit issue that we have been hearing so much about for such a long time. I think it’s such a challenge trying to get all of these factors in place in order to make sure that we get on that trajectory of avoiding disease and all sorts of other conditions as we age.
Rick: When we talk about men of the United States… in fact, I’ll preface your next article. We’re going to talk about the fact that in the United States there are more preventable deaths than the other 10 high-income countries. I mean, these are preventable. How do we do that? Well, it’s as simple as a good diet, a lot of fruits and vegetables, fish, and little red and processed meat, and also [involvement] in moderate physical activity for 150 minutes or more per week.
Elizabeth: I would just sum that up by saying, look, we really need to have policy-level interventions that get people active very early in life, instruct them about what constitutes a healthy diet, and put all those pieces in place really early so people can just start those things as habits.
Rick: Right. I mean, it starts at K–12 with what we feed the kids in school and whether we have PE courses or not. Let’s segue into your study and let’s talk about the Commonwealth report.
Elizabeth: This is an interesting thing for us, but I think that this is such a significant issue and I thought that this dataset was just so compelling. The Commonwealth Fund then took a look at this question, are financial barriers affecting the healthcare habits of American men? They subtitled this, “A comparison of healthcare use, affordability and outcomes among men in the U.S. and other high-income countries.” Beautiful graphics. I definitely think everyone ought to take a look at these things.
They looked across 11 high-income countries and they looked at the rates of avoidable death, chronic conditions, and mental health needs for men. They found that those needs of mental healthcare, care for chronic conditions, and the incidence of avoidable deaths, men in the U.S. outstrip everybody else in this analysis.
Interestingly, men in the U.S. have the lowest rate of prostate cancer-related death. Men in Canada, the United States, and Sweden are the least likely to have a regular doctor and have among the highest rates of ED use for conditions that could have been managed in a doctor’s office. They skip needed care because of costs. Those with lower income or frequent financial stress are least likely to get preventive care, have trouble affording their care, and most likely to have physical and mental health conditions.
Rick: As you mentioned, it’s the Commonwealth Fund 2020 International Health Policy Survey and they combine that with the Organization for Economic Cooperation and Development data as well to compare healthcare accessibility, affordability, and health status.
I thought it was, on the one hand, very interesting is that the United States by far has the lowest rate of prostate cancer-related deaths. That means we’re usually getting a PSA test. But in terms of preventable things, we have a higher incidence of hypertension, but we are not screening and regularly taking care of alcohol-related deaths, tobacco-related deaths, treatment of hypertension, regular visits to the primary care physician. In fact, we usually aggregate that to emergency departments, especially in lower-income men, and so these are ways that we can positively impact to health in men across the U.S.
Elizabeth: Of course, this report doesn’t mention suicidality, but we know very well that among American men, that’s increasing enormously also. I think that the underpinnings of mental health, this unmet mental health need, clearly points to that.
Rick: Yep. At the end, they conclude that what we need to do in the U.S. is we need to expand access to affordable and comprehensive health care coverage to help reduce these disparities. Those are the things that are available in high-income countries that were mentioned.
Elizabeth: Your next one, sir.
Rick: Let’s talk about alcohol consumption by amount and look at the population risk across geography, age, and sex of the individuals as well.
Many studies that have shown that there are some deleterious effects related to alcohol consumption of any type: increased incidence of liver cirrhosis, breast cancer, and tuberculosis as well as injuries. At the same time, there are studies that have shown that a small amount of alcohol can actually lower the risk of cardiovascular disease and type 2 diabetes. Hence, the recommendation that men should have no more than one or two drinks on a daily basis and that women should have no more than a drink a day.
But it’s really not been looked at by either age or underlying comorbid conditions. This study did that. They looked at 22 different health outcomes that may be affected by alcohol use and estimate what the theoretical minimum risk level of alcohol that would actually lower mortality. At what point does drinking actually increase your risk compared to non-drinkers?
They looked at 204 different countries and territories. First of all, the number of individuals globally that drink too much alcohol is 1.03 billion men and 314 million women worldwide.
Interestingly enough, under the age of 40 there is no minimum level of alcohol that actually improves your overall health outcomes. Above the age of 40, particularly those above the age of 65, a small amount of alcohol can actually reduce overall mortality. That’s more likely because these individuals have chronic conditions that the alcohol may benefit, so we need to re-message it. Under the age of 40, there is no amount of alcohol that actually improves your overall outcome. Over the age of 40, just a modest amount.
Elizabeth: Let’s mention that this is in The Lancet. I think it’s just really difficult to interdict any of this behavior relative to alcohol consumption because it’s so entrenched societally and there is such acceptance of it that reframing this message to, “Hey. If you’re younger than 40, you really shouldn’t be drinking any alcohol” — I don’t know, Rick. I don’t know if we’re going to live long enough to see anything that changes with that.
Rick: It’s a message that needs to be told and this is the first study that I know of that’s actually looked at it by age like that. We just need to keep beating the drum.
Elizabeth: Of course, we do know that alcohol consumption increased tremendously during the pandemic. That’s something else that’s going to take a little while to taper down, I think.
Rick: Yep. Probably the group we need to target most is ages 15 to 39 males; 77% of individuals consuming harmful alcohol amounts in 2020 were male — 59% were male and under the age of 40.
Elizabeth: Okay. All we have to do is figure out how to message those folks. Finally, let’s turn to PLOS ONE. This is a look at this notion of “hangry.” That’s, of course, the conjunction of hungry and angry. It was coined interestingly by an Olympian.
This is a study that actually assesses, is that true? Do you really get more angry when you’re hungry? These folks enrolled 64 participants from Central Europe and they had a 21-day experience sampling phase in which they reported hunger, anger, irritability, pleasure, and arousal at five different time points each day.
Their total number of responses was over 9,000. They were asking them about greater levels of self-reported hunger. Sure enough, these were associated with greater feelings of anger and irritability, and with lower pleasure. They found that these were significant findings, even after they accounted for the sex of the participant, the age — interestingly — of the participant, BMI, dietary behaviors, and something that they call trait anger. I guess that’s just baseline angry people.
Sure enough, they provide evidence that if you’re hungry maybe need to be more aware that you might also be more irritable.
Rick: They asked these individuals to complete the survey five times a day for 21 days and then they didn’t tell them the hypothesis. Again, they asked them questions: How hungry are you at the moment? How irritable do you feel? How angry are you? How pleasant is your current state? What is your level of arousal? Are you sleepy or highly aroused?
There was no preconceived idea. Otherwise, if you thought, “Gosh, I want to find out if you’re angry when you’re hungry,” most people would say, “Of course, I am.” They experienced these negative feelings not only if they were hungry that particular day, but even as their mean levels of hungriness over the previous 3 weeks affected their emotional state as well.
What’s the hypothesis behind that? It may be that low blood sugar triggers these. They didn’t actually measure that, so it’s hard to know. But the hypothesis is that even mild decreases in blood sugar, or increases or changes in insulin, or insulin-regulating hormones, may be the thing that affect our emotional state.
Elizabeth: Clearly, that’s where the hard data is going to come in order to really completely assess this. What I thought was really fascinating was the lack of association with age. I would have thought that as people got older they would have been less liable, I guess, to the impact of low blood sugar on their irritability.
Rick: You and I that are aging, now that we have been doing this podcast for 19 years, I just think we just get more irritable as we age. I don’t think it has anything to do with hunger. Sorry about that.
Elizabeth: Oh, well. You mean I can’t pin it on that, my chronic irritability?
Rick: No, but it has nothing related to our hunger. But I do think it does have to do with our aging process. Sorry to admit it.
Rick: With that, let me go ahead and encourage you to get something to eat for breakfast.
Elizabeth: Thank you very much. I know since we started so early in the morning I certainly have not had breakfast yet.
I do want to say this one thing, though, about eating behaviors. I’m not sure how this meshes with this notion of getting more irritable and angry when you’re hungry because only 58% of their participants stated that they usually had breakfast, 78% have lunch, and 84% had dinner. 48% snacked in between main meals. I’m just wondering how that all distributed and what people were actually eating. I would be interested in the individual-level data with regard to “hangriness,” if you will.
Rick: The other thing we didn’t mention is this was a study that was conducted in Europe; 80% of the participants were women as well. I would like to think that men don’t get hangry. We’re nearly perfect, but I think that actually it may have skewed the results in the opposite direction. Men may have been worse.
But as you mentioned, this is an interesting study. It’s fun to report on it. It’s a very limited study on a very limited number of individuals geographically and also gender-wise.
Elizabeth: I think the take-home is if you’re hungry and you’re feeling irritable, the only thing to really do about that is try to be aware of it.
Rick: Yep, I would say keep your mouth shut. But if you keep your mouth shut, you can’t eat anything, so that’s not going to solve the problem.
Elizabeth: On that note, 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.