Trump’s health

Here is a link to an article containing the full text of the letter by Trump’s personal physician Harold Bornstein M. D. -=-

Trump’s lipids could be better (total 232) and he is currently taking a lipid lowering agent (a statin). Aside from this, his labs are good (perfect in fact). He does take care of himself, and has annual physicals.

It isn’t clear why he had a transthoracic echocardiogram 2 years ago. Otherwise aside from that every test performed is pretty standard for a man his age.

Despite being overweight his blood pressure is excellent (particularly for man his size).

The indications for low dose aspirin aren’t stated, but yours truly has taken much more for decades based on a reading of the literature while in practice showing that doses of two adult aspirin a day reduced the recurrence rate of stroke by 33%.

So his main health problem is weight and mildly elevated lipids (even on medication).

His BMI (Body Mass Index) is stated to be 29.5. So it’s time for you to calculate your own — don’t worry that BMI is usually based on weight in kilograms and height in meters — the following site lets you put in your weight in pounds, and your height in inches — To get started, calculate your own BMI– A 6 footer would have to weigh 222 pounds to be obese (BMI over 30).

So is Trump’s BMI of 29.5 bad? Overweight is defined as a BMI over 25. So is a BMI over 25 bad? Not if you’re interested in mortality (death) as opposed to morbidity (things like heart attack and stroke). It turns out that the BMI with the lowest mortality at 70 is over 25 — e.g. 26. e.g. in the overweight range as currently defined. I don’t think there are good statistics on overall morbidity vs. BMI (there probably is for heart attack and stroke separately).

Now it gets interesting. That statistic cited above is based on the following data on 3 million people in 97 different studies [ J. Am. Med. Assoc. vol. 309 pp. 71 – 82 ’13 ].

At 6 feet 1+ (which I used to be) a weight of 190 puts me at 24.69. To be obese (BMI over 30) I’d need to weigh 228 (which I almost did 54 years ago).

When you plot BMI vs. probability of death you get a U shaped cure, with the very thin and the very fat showing increased risk of dying (mortality). The paper is interesting as it shows 6 curves for people at ages 20, 30, 40, 50, 60, 70. As one might expect, the curves for each age lie below the next oldest. All of them rise with BMIs under 20 and over 30, so there’s no argument about whether obesity (BMI over 30) is bad for longevity.

Well, if the curve is U shaped, it has a minimum. The excitement comes in because the healthiest weight (the minimum) is a BMI of just over 25 for those in their 60s and around 26 for those in their 70s. Also in ALL 6 age groups the curve is pretty flat between 25 and 30, rising on either side of the range.

Naturally people who’ve invested their research careers in telling everyone to diet and that weight is bad, don’t like this, and a symposium involving 200 unhappy people convened 20 February at the Harvard School of Public Health is described, along with a lot of the back and forth between the authoress of the study (Flegel) and Willett of Harvard who didn’t like it one bit. The best comment IMHO is from Robert Eckel “We’re scientists. We pay attention to data, we don’t try to unexplain them.” Read the article, it’s well written and there’s a lot more.

One final point, which might explain why the minima of the curves shift to higher BMIs at older age — which the article didn’t contain. People lose height as they age, yet the BMI is quite sensitive to it (remember the denominator has height squared). The great thing about BMI is that it’s easily measured, and doesn’t rely on what people remember about their weight or their height. Well as a high school basketball player my height was 6′ 1”+, now (at age 78) it’s 6’0″. So even with constant weight my BMI goes up.

Well it’s time to do the calculation to see what a fairly common shrinkage from 73.5 inches to 72 would to to the BMI (at a constant weight). Surprisingly it is not trivial — (72/73.5) * (72/73.5) = .9596. So the divisor is 4% less meaning the BMI is 4% more, which is almost exactly what the low point on the curve does with each passing decade after 50 ! ! ! This might even be an original observation, and it would explain a lot.

Well, that’s the take of this neurologist on Trump’s health —’s pretty good. I’m going to pass this post on to the very smart internist (whose comments about Hillary you can read in — for his take, as there really isn’t anything in the history suggest a neurologic problem. Unlike Hillary, he hasn’t fainted twice in the past 4 years, and hasn’t had a neurologic deficit persisting for a month.

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  • neil  On September 18, 2016 at 10:15 pm

    Genuine questions: If he hasn’t had a stroke then the role of an antiplatelet is marginal at best (no comment around history of MIs). Further, isnt most of the benefit derived in the short-term for ASA when used for secondary prevention. ASA short term then switch to dipyridamole for long term. Offsite but Amarenco NEJM 2016????? from memory

  • GCC  On September 21, 2016 at 12:22 pm

    I don’t have a strong opinion on this either way, but I know there has been some research suggesting that there were confounding factors in the studies that found that the BMI associated with lowest mortality is “overweight” (smoking being the main one, since smokers tend to weight less, but die younger than people that have never smoked).

    This newer research suggests the optimal BMI for longevity is in the middle or even at the low end of the “normal” range. I think these studies focused mostly on BMI measured in younger people though, so that’s a bit different from the study you mentioned here. Who knows… maybe it’s best to be relatively lean in your younger years and then gain a bit of weight as you get older, moving slightly into the “overweight” BMI range?

    Here’s a link to a summary of a couple of the studies:

  • GCC  On September 21, 2016 at 9:03 pm

    Just as a follow-up to my previous comment, a study published in Lancet about a month ago came to similar conclusions:

    “All-cause mortality was minimal at 20.0 – 25.0 kg/m2”
    (in groups of people selected to avoid potential confounders, such as smoking)

    Lancet. 2016 Aug 20;388(10046):776-86.

    Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

  • luysii  On September 21, 2016 at 10:50 pm

    GCC Thanks for the latest info (I stopped reading the Lancet and the BMJ and NEJM when I retired — I picked up the JAMA article because it was featured in Science or Nature. As noted by the 2013 study I cited, the BMI of lowest mortality increases with age. Figure 1 is particularly interesting at age 70 — because there is essentially no change in risk between BMIs of 25 and 27, and an increase of 15 – 20% in the next one which is 27.5 to 30, so the conclusion stands. Excellent that more and more data is being analyzed.

    What do you think of calling a biological value associated with the lowest mortality ‘overweight’?

    • GCC  On September 22, 2016 at 9:44 am

      Interesting stuff. And yes, we definitely need a better definition of “overweight”!

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