Does The Green Coffee Bean Extract Work?

October 14, 2014 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Does the green coffee bean extract work? The claims sounded so appealing. You could just take this green coffee bean extract and the pounds would melt away. You didn’t need to exercise or change your diet.

Your first reaction when you heard those claims was probably “Right, when pigs fly. I’ve heard this kind of stuff before. It’s just too good to be true.”

But then you were given a pseudo-scientific explanation about how it was the chlorogenic acid in the green coffee bean extract that was responsible for its amazing properties (What they didn’t tell you was that chlorogenic acid is present in all roasted coffees). You were told that it was backed by a clinical study showing that people lost 17.7 pounds, 10.5% of their body weight and 16% of their body fat in 22 weeks without diet and exercise.

To top it all off you were told that it was endorsed by Dr. Oz on his TV show and provided with a video clip to prove it. After all of that you were probably tempted to say “Maybe…just maybe… these amazing claims might be true.” You may have even been tempted to try it.

Were the claims true? Is green coffee bean extract the miracle weight loss product that everyone has been looking for? Or was it just another bogus weight loss product?

Is Green Coffee Bean Extract Bogus?

Evidently the Federal Trade Commission did not consider the claims about green coffee bean extract to be true. The FTC sued one of the companies that manufactured and sold green coffee bean extract for promoting a “hopelessly flawed study” to support the weight loss claims for their product.

The FTC alleged that:

The study was too small, at 16 subjects, to provide convincing data.

The study contained a number of critical flaws in the design and results of the study. For example, the greatest weight loss actually occurred in the placebo group.

The lead investigator in India actually falsified the results.

The company knew or should have known that this botched study didn’t prove anything.”

The manufacturer eventually agreed to pay $3.5 million to the FTC to settle their complaint. Basically, the company agreed with the FTC that there was no evidence to back their weight loss claims.

How Did Dr. Oz Get It So Wrong?

What about Dr. Oz’s endorsement? In Dr. Oz’s 2012 show segment he called green coffee bean extract “the magic weight loss cure for any body type.” The most puzzling aspect of this whole saga is how Dr. Oz got it so wrong.

After all, he is a trained neurosurgeon. He is Vice Chair of the Department of Surgery at Columbia University. He understands the principles of evidence-based medicine. Evidence-based medicine simply means that it is a physician’s responsibility to check the scientific evidence before recommending a treatment to a patient. Yet he never even looked into the supposed “clinical study” backing green coffee bean extract’s weight loss claims.

In a Senate hearing this past June Dr. Oz apologized. He said: “For my colleagues at the FTC, I realize I have made their jobs more difficult.”

How Can You Protect Yourself Against Weight Loss Scams?

There are dozens, if not hundreds, of new weight loss products appearing on the market every year. The FTC is doing its best to police the claims that are being made, but they are clearly overwhelmed. And even when they have an airtight case, it can take years for them to force a company to stop making false claims.

So, how can you protect yourself against weight loss scams? How can you avoid wasting your money on products that don’t work, or may even harm your health? I advise a little healthy skepticism.

Be skeptical about the claims. The old adage “If it sounds too good to be true, it probably is [too good to be true]” is always good advice. In a previous “Health Tips From the Professor” I discussed the the FTC’s recommendation for “7 Easy Ways To Spot Fad Diets”. That one is probably worth printing out and keeping handy so that you can review it the next time a new diet program comes out.

Be skeptical about the studies. The bottom line is that not all clinical studies are reliable. I realize that it is extremely difficult for a non-scientist to evaluate the validity of clinical studies. My best advice is to go online and see what other experts are saying about the study and the claims. There are a number of “fact checker” blogs online that focus on careful scientific analysis of product claims and the “studies” that support them.

Be skeptical about the endorsements. Unfortunately, there are far too many examples of well known doctors who have endorsed bogus product claims on their TV shows or in their blogs. That makes it even more difficult for the layman to separate fact from fiction. My advice is to simply ask the question: “Does their blog or TV show feature something novel, something spectacular, and/or something sensational…every single week?”

My belief is that these experts all start out with good intentions. However, to develop a really big audience and keep them engaged they feel pressured to deliver novel and sensational health news every single week. The reality is that there are not advances every single week that are novel, sensational… and scientifically accurate. Eventually, they feel pressured to sacrifice accuracy for novelty.

That is why my blog is different. I don’t promise you spectacular and sensational news every week, but I do promise you accuracy. I will share the latest headlines, but I will tell you both their strengths and their weaknesses. Ultimately, it is your responsibility to protect yourself against weight loss scams and I tell you how below. Fortunately, what you can always count on from me is I will be honest with you.

So, does the green coffee been extract work?

The Bottom Line

According to the FTC the green coffee bean extracts that were so widely promoted a couple of years ago were yet another example of bogus weight loss products. The FTC sued one of the companies that markets and sells green coffee bean extract for promoting a “hopelessly flawed” clinical study to advertise their product, and the company has recently settled with the FTC for $3.4 million.
The only way that you can protect yourself from bogus weight loss products is to be skeptical. I discuss the questions you should ask in more detail above, but in short:
- Be skeptical of claims that sound too good to be true.

Be skeptical of the clinical studies the companies quote to support their claims.

Be skeptical of expert endorsements. This product was even endorsed by Dr. Oz on his TV show.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is Omega-3 Uptake Gender Specific?

September 30, 2014 by Dr. Steve Chaney

Do We Need To Reexamine Everything We Thought We Knew About Omega-3s?

Author: Dr. Stephen Chaney

Some of you may remember the book from a few years ago titled “Men are from Mars, Women are from Venus”. The book proposed that men and women communicate differently (Who would have guessed?), and understanding that fact would help husbands and wives communicate with each other more effectively. I know that some people complained that it was an overly simplistic viewpoint, but I know it sure helped me communicate more effectively with my wife.

I came across a very interesting article recently that suggested the omega-3 fatty acid EPA might be metabolized and utilized differently by men and women. You might say that the statement “Men are from Mars, Women are from Venus” applies to omega-3 utilization as well.

The Science Behind the Study

Now that I’ve captured your interest, perhaps I should fill in a few details. We have known for years that the long chain omega-3 fatty acids EPA and DHA appear to be beneficial at reducing the risk of heart disease. There are several mechanisms for that protective effect:

Omega-3s reduce the stickiness of platelets so that platelet aggregation, a fancy name for blood clotting, occurs less readily. Of course, we want our blood to clot when we cut ourselves, but we don’t want it to clot inside our arteries, because that is the very process that can lead to heart attacks and stroke.

Omega-3s lower triglycerides and reduce inflammation, two important risk factors for heart disease.

Omega-3s help keep the walls of our blood vessels elastic, which enhances blood flow and reduces the risk of hypertension.

However, for any of those things to occur, the omega-3 fatty acids must first be incorporated into our cell membranes. Thus, it is not just how much omega-3s we get in our diet that is important. We need to know how many of those omega-3s are actually incorporated into our membranes.

What if the efficiency of omega-3 uptake into cellular membranes were different for men and women? That would change everything. It would affect the design of omega-3 clinical studies. It would affect omega-3 dietary recommendations for men and women. The implications of gender-specific uptake of omega-3s would be far reaching.

Is Omega-3 Uptake Gender Specific?

The authors of this week’s study (Pipingas et al., Nutrients, 6, 1956-1970, 2014) hypothesized that efficiency of omega-3 uptake might differ in men and women. They enrolled 160 participants in the study (47% male and 53& female) with an average age of 59 years. The study excluded anybody with pre-existing diabetes or heart disease and anybody who was significantly overweight. The study also excluded anyone taking drugs that might mask the effects of the omega-3 fatty acids and anybody who had previously consumed fish oil supplements or more than two servings of seafood per week.

This was a complex study. In this review I will focus only on the portion of the study relevant to the gender specificity of omega-3 uptake. For that portion of the study, both male and female participants were divided into three groups. The first group received 3 gm of fish oil (240 mg EPA and 240 mg DHA); the second group received 6 gm of fish oil (480 mg EPA and 480 mg of DHA); and the third group received sunflower seed oil as a placebo. The study lasted 16 weeks, and the incorporation of omega-3 fatty acids into red blood cell membranes was measured at the beginning of the study and at the end of 16 weeks.

When they looked at men and women combined, they found:

A dose specific increase in EPA incorporation into red cell membranes compared to placebo. That simply means the amount of EPA that ended up in the red blood cell membrane was greater when the participants consumed 6 gm of fish oil than when they consumed 3 gm of fish oil.

Very little incorporation of DHA into red blood cell membranes was seen at either dose. This was not unexpected. Previous studies have shown that EPA is preferentially incorporated into red cell membranes. Other tissues, such a neural tissue, preferentially incorporate DHA into their membranes.

When they looked at men and women separately, they found:

The efficiency of EPA incorporation into red cell membranes compared to placebo was greater for women than for men. In women increased EPA uptake into red cell membranes was seen with both 3 gm and 6 gm of fish oil. Whereas, with men increased EPA incorporation into red cell membranes was only seen at with 6 gm of fish oil.

What Is The Significance Of These Observations?

The authors concluded “This is an important area for future research because dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”

However, there are a number of weaknesses of this study:

It was a very small study. Obviously, this study needs to be repeated with a much larger cohort of men and women.

This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.

Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.

So what does this mean for you? Should men be getting more omega-3 fatty acids in their diet than women, as the authors suggested? That is an intriguing idea, but based on the weaknesses I described above, I think it’s premature to make this kind of recommendation until these results have been confirmed by larger studies.

The Bottom Line

A recent study has suggested that women may be more efficient at incorporating the omega-3 fatty acids EPA into their cellular membranes than men. The authors of the study concluded that “…dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”

However, the study has a number of weaknesses:

It was a very small study. Obviously, it needs to be repeated with a much larger cohort of men and women.

This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.

Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.

The idea that men and women may differ in their needs for omega-3 fatty acids is intriguing, but based on the weaknesses described above, it is premature to make this kind of recommendation until the results of the current study have been confirmed by larger studies.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do B Vitamins Slow Cognitive Decline?

September 2, 2014 by Dr. Steve Chaney

The B Vitamin Controversy

Author: Dr. Stephen Chaney

Do B Vitamins slow cognitive decline? Heart disease, cancer and strokes are all pretty scary. Even if we survive, our quality of life may never be the same. But, we can endure many physical afflictions if our mind stays sharp. For most of us the ultimate irony would be to spend a lifetime taking good care of our body, only to lose our mind.

Last week I told you about a study showing that a holistic approach, which to me includes healthy diet, weight control, exercise, supplementation, socialization and memory training, significantly reduces cognitive decline in the elderly (https://chaneyhealth.com/healthtips/hope-alzheimers/).

This week I’d like to focus on one aspect of that holistic approach, namely B vitamins. If you are like most people, you are probably confused about the role of B vitamins in preserving mental function. On the one hand you are seeing headlines proclaiming that B vitamins slow cognitive decline as we age. On the other hand you are being told “Don’t waste your money. B vitamins won’t slow cognitive aging.” What are you to believe?

Why Might Certain B Vitamins Slow Cognitive Decline?

To help you understand how B vitamins might slow cognitive decline I’m going to need to get a little biochemical. Don’t worry. I’ll be merciful.

#1: The story starts with a byproduct of amino acid metabolism called homocysteine.

Multiple studies have shown that elevated blood levels of homocysteine are associated with cognitive decline and Alzheimer’s. Elevated homocysteine levels are found in 5-10% of the overall population and elevated homocysteine levels double the risk of Alzheimer’s.

In our bodies homocysteine is converted to the amino acid methionine in a reaction involving folic acid and vitamin B12. Homocysteine is converted to the amino acid cysteine in a reaction involving vitamin B6. Thus, elevated homocysteine levels are most frequently associated with deficiencies of these three B vitamins caused by inadequate intake or increased need for those B vitamins.

#2: Many of us are deficient in the B vitamins that lower homocysteine levels.

There are many situations in which inadequate intake or increased need of those vitamins can occur. For example:

Vitamin B12:

The most frequent cause of B12 deficiency is the age related loss of the ability to absorb vitamin B12 in the upper intestine. This affects 10-30% of people over the age of 50.
Chronic use of acid-suppressing medications such as Prilosec, Nexium, Tagamet, Pepcid and Zantac also decreases B12 absorption and increases the risk of B12 deficiency. Millions of Americans use those drugs on a daily basis.
Finally, vegetarians can become B12 deficient because most naturally occurring B12 is found in meat and dairy products.
Overall, B12 deficiency has been estimated to affect about 40% of people over 60 years of age.

Folic Acid:

In the past, many Americans consumed diets that were low in folic acid. However, this has been minimized in recent years by the fortification of grain products with folic acid. Today, the primary concern is with factors that increase the need for folic acid.
For example, birth control pills along with some anti-inflammatory and anticonvulsant medications interfere with folic acid metabolism and increase the need for folic acid.
In addition, deficiency of the enzyme methylenetetrahydrofolate reductase (MTHFR) substantially increase the amount of folic acid needed to reduce homocysteine levels to normal. About 10% of the US population has this enzyme deficiency.

Vitamin B6:

Birth control pills along with some drugs used to treat high blood pressure and asthma interfere with vitamin B6 metabolism and increase the need for vitamin B6.
Vitamin B6 is found in reasonable amounts in meat, beans, green leafy vegetables, brown rice and whole grain flour. Unless you are consuming a balanced diet containing all of those foods your intake of B6 may be inadequate. About 25% of Americans have low blood levels of B6.

#3: Multiple studies have shown that supplementation with folic acid, B12 and B6 can lower homocysteine levels.

Based on this information it has been hypothesized that supplementation with folic acid, B12 and B6 would decrease the rate of cognitive decline in people with elevated homocysteine levels. It is a logical hypothesis, but is it correct?

The Evidence That B Vitamins Don’t Slow Cognitive Decline

The recent headlines saying that B vitamins don’t slow cognitive decline came from a meta-analysis that included the results of 11 clinical trials with 22,000 individuals (Clarke et al, American Journal of Clinical Nutrition, 100: 657-666, 2014). That sounds pretty impressive! But to properly assess the conclusions of this study you need to understand the strengths and weaknesses of meta-analyses.

The strength of a meta-analysis is pretty obvious. By combining the results of many clinical trials and thousands of patients you greatly increase the statistical power of the study.

However, the strength of a meta-analysis is only as good as the studies it includes. It’s the old “GIGO” principle (Garbage In, Garbage Out). If the individual studies are poorly designed, the conclusions of the meta-analysis will be misleading.

Unfortunately, many of the studies in this meta-analysis were poorly designed. They fall into two groupings:

Problem #1: Many of the studies included in the meta-analysis were not designed to test the actual hypothesis.

Remember that the original hypothesis was that supplementation with folic acid, B12 and B6 would decrease the rate of cognitive decline in people who were deficient in those B vitamins and had elevated homocysteine levels. Nobody was predicting that B vitamin supplementation would make any difference for people who already had adequate B vitamin levels and low homocysteine levels.

Five of the studies were not designed to look at that hypothesis at all. They were very large studies designed to look at the hypothesis that B vitamins might reduce the risk heart attack and stroke in patients with cardiovascular disease. Some of those patients had elevated homocysteine levels, but many did not.

It’s no wonder they did not show any significant effect of B vitamins on cognitive decline. They weren’t designed for that purpose, but they contributed the vast majority of patients and most of the statistical weight to the conclusions of the meta-analysis.

Problem #2: Some of the studies were too short to draw any meaningful conclusions.

Three of the studies were well designed in that they specifically looked at patient populations with elevated homocysteine levels and documented B vitamin deficiency, but they only lasted for 3 to 6 months. There simply was not a large enough cognitive decline in the control group in such a short time span for one to see a statistically significant effect of B vitamin supplementation.

Do B Vitamins Slow Cognitive Decline?

That leaves three studies from the original meta-analysis, plus another clinical study published after the meta-analysis was complete, that were actually designed to test the hypothesis and were long enough to give meaningful results. Three of those four studies showed a positive effect of B vitamin supplementation on cognitive function.

Study #1: This study was a 3-year study in patients with elevated homocysteine levels, folic acid deficiency and normal B12 levels (Durga et al, The Lancet, 369: 208-216, 2007). They were given 800 ug/day of folic acid or a placebo. Folic acid levels increased 576% and homocysteine levels decreased by 25%. At the end of 3 years the change in memory, information processing speed and sensorimotor speed was significantly better in the folic acid group than the control group.

Study #2: This was a 2-year study in patients with elevated homocysteine levels (McMahon et al, New England Journal of Medicine, 354: 2764-2769, 2006). B vitamin deficiencies were not measured. The patients were given either 1000 ug 5-methyltetrahydrofolate, 500 ug of B12 and 10 mg of B6 or a placebo. Homocysteine levels decreased significantly, but there was no effect of B vitamins on cognitive function in this study.

Study #3: This study was a 2-year study in patients over 70 with mild cognitive decline (Smith et al, PLoS ONE 5(9): e12244. doi:10.1371/journal.pone.0012244, 2010). B vitamin deficiencies were not measured. The patients were given either 800 ug of folic acid, 500 ug of B12 and 20 mg of B6 or placebo. B vitamin supplementation increased folic acid levels by 270% and decreased homocysteine levels by 22%. Brain volume was measured by MRI. Overall, B vitamin supplementation decreased brain shrinkage by 30%. The rate of brain shrinkage in the placebo group and the protective effect of B vitamins were greatest in the patients with elevated homocysteine at entry into the trial.

Study #4: This was an expansion of the previous study (Douaud et al, Proceedings of the National Academy of Sciences, 110: 9523-9528, 2013). In this study the same investigators focused on the regions of the brain most vulnerable to cognitive decline and the Alzheimer’s disease process. They found that B vitamin supplementation reduced brain atrophy in those regions by 7-fold (a whopping 86% decrease in brain shrinkage) over a 2-year period. Once again, the rate of brain shrinkage in the placebo group and the protective effect of B vitamins were greatest in the patients with elevated homocysteine at entry into the trial.

Are B Vitamins Only Effective In People With Elevated Homocysteine Levels?

The published data certainly suggest that B vitamins may reduce cognitive decline in people with elevated homocsteine levels, but what about other people with B vitamin deficiencies? For reasons that are not entirely clear, not everyone with folic acid, B12 and/or B6 deficiencies has elevated homocsyteinine levels.

Other symptoms of folic acid, B12 and B6 deficiency are depression, pronounced fatigue, irritability, peripheral neuropathy (tingling and loss of feeling in extremities), and loss of fine motor coordination. If you have these symptoms and they are caused by B vitamin deficiency, B vitamin supplementation may relieve the symptoms.

B vitamin supplementation may also slow cognitive decline in individuals who are B vitamin deficient and have normal homocysteine levels, but that hypothesis has not been clinically tested.

The Bottom Line

1) Forget the headlines telling you that B vitamins don’t slow cognitive decline. Also ignore headlines implying that B vitamins will help everyone be an Einstein well into their 90’s. As usual, the truth is somewhere in between.

2) Supplementation works best for people with inadequate dietary intake and/or increased needs. That is just as true for B vitamins and brain health as it is for other health benefits of supplementation.

3) Many people with deficiencies of folic acid, B12 and/or B6 have elevated homocysteine levels. If you do have elevated homocysteine levels, the data are pretty convincing that supplementation with folic acid, B12 and B6 may reduce the risk of cognitive decline. Unfortunately, homocysteine is not something that is routinely measured in most physical exams, but perhaps it should be.

4) Not everyone with folic acid, B12 and/or B6 deficiencies has elevated homocsyteinine levels. Other symptoms of folic acid, B12 and B6 deficiency are depression, pronounced fatigue, irritability, peripheral neuropathy (tingling and loss of feeling in extremities), and loss of fine motor coordination. If you have these symptoms and the symptoms are caused by B vitamin deficiency, B vitamin supplementation might also slow cognitive decline. However, that hypothesis has never been clinically tested.

5) It has been recognized recently that deficiencies of methylenetetrahydrofolate reductase (MTHFR) interfere with folic acid metabolism and cause elevated homocysteine levels. Contrary to what you may have heard, 5 methyltetrahydrofolate is not essential for reducing homocysteine levels in people with MTHFR deficiency. High levels of folic acid work just as well for most MTHFR-deficient individuals. [It is also interesting to note that the only well designed clinical study that did not find B vitamins to be effective in reducing cognitive decline was the one that substituted 5-methyltetrahydrofolate for folic acid.]

6) B vitamin deficiency is common in the elderly due to impaired absorption and the use of multiple medications that interfere with B vitamin metabolism and can contribute to many of the symptoms commonly associated with aging. In this population, B vitamin supplementation is cheap and often effective.

7) B12 deficiency is common in adults 60 and older. High doses of folic acid alone can mask B12 deficiency and lead to irreversible nerve damage. For that reason high doses of folic acid should be paired with high dose B12 and B12 nutritional status should be determined. [Contrary to what you may have heard, 5-methyltetrahydrofolate is just as likely to mask B12 deficiency as is folic acid.]

8) Finally, assuring an adequate intake of B vitamins is just one component of a holistic approach for maintaining brain function as long as possible. Other important lifestyle components for preserving cognitive function are healthy diet, weight control, exercise, supplementation, socialization and memory training. (https://chaneyhealth.com/healthtips/hope-alzheimers/).

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Nitric Oxide Benefits and Side Effects

August 19, 2014 by Dr. Steve Chaney

Reverse Heart Disease?

Author: Dr. Stephen Chaney

Nitric oxide has had a meteoric rise from obscurity to fame in just a few short years. It’s an amazing story. After all, nitric oxide is a colorless, odorless gas. Who could have known it was destined for greatness? In this article, we will discuss nitric oxide benefits and side effects.

Its rise to fame started in the 1980’s when scientists from several universities discovered that nitric oxide was an important regulator of numerous physiological processes. Just a few years later in 1992 Science magazine named it “Molecule of the Year”, a very prestigious honor. And, in 1998 three of its co-discoverers received the Nobel Prize for their ground-breaking research.

The Benefits of Nitric Oxide

Proven Benefits

Perhaps the most important benefit of nitric oxide is its role in maintaining the health of the endothelial cells that form the inner lining of our blood vessels. Nitric oxide reduces:

Platelet aggregation

Damage & inflammation of the endothelial cells

Oxidation of LDL cholesterol

Growth of smooth muscle cells.

This is important because these are the very physiological processes that, if left unchecked, can lead to atherosclerosis and disease of the cardiovascular system (Davignon and Ganz, Circulation, 109: 1127-1132, 2004; Tousoulis et al, Current Vascular Pharmacology, 10: 4-18, 2012).

However, the effect of nitric oxide that has gotten the most attention is its ability to relax the smooth muscle cells that surround our blood vessels. That leads to increased blood flow, which in turn decreases blood pressure, relieves angina, and even prevents erectile dysfunction (Davignon and Ganz, Circulation, 109: 1127-1132, 2004; Tousoulis et al, Current Vascular Pharmacology, 10: 4-18, 2012).

Possible Benefits

Many people with atherosclerosis, diabetes and hypertension (high blood pressure) have low nitric oxide levels. It’s not known whether this is a cause or a result of these diseases, but low nitric oxide levels certainly could contribute to the progression and health consequences of all three diseases. We already know that increasing nitric oxide levels can reduce high blood pressure. It is not yet known whether increasing nitric oxide levels could reduce or reverse heart disease and the effects of diabetes, but this is an area of active research.

Nitric oxide is a neurotransmitter and is thought to play a critical role in memory and learning. It also plays a critical role in immune function. In addition, it enhances the metabolic activity of mitochondria, which could enhance cellular metabolism. The physiological significance of these observations is unknown, but this is another area of active research

Finally, because nitric oxide stimulates blood flow, which should increase oxygen and nutrient delivery to active muscle, it has been suggested that nitric oxide supplements would improve sports performance. The results of clinical studies to test this hypothesis have been mixed. The latest research suggests that nitric oxide supplements may enhance performance in untrained or moderately trained subjects, but not in highly trained subjects (Bescoe et al, Sports Medicine, 42: 99-117, 2012). At last, a sports supplement for the common man!

Drugs That Affect Nitric Oxide Levels

Because nitric oxide has such powerful physiological effects, the pharmaceutical industry has been busy creating drugs that either increase nitric oxide levels or increase the biological effectiveness of nitric oxide. For example, these include drugs to treat angina, hypertension, pulmonary hypertension and erectile dysfunction.

These drugs are generally effective, but have some drawbacks, namely:

They have numerous side effects. For example, just listen to the Viagra or Cialis ads on TV.

Some of them lose their biological effectiveness over time, especially the angina medications.

Natural Approaches for Increasing Nitric Oxide Levels

There are two natural pathways for generating nitric oxide in the body.

1) The first pathway is an enzymatic process that oxidizes a nitrogen atom in the amino acid arginine to nitric oxide.

2) The second pathway is a non-enzymatic process in which naturally occurring nitrates and nitrites are reduced to nitric oxide either by bacteria in the mouth and intestine, or by naturally occurring antioxidants.

Arginine is found in proteins. The best protein sources of arginine are red meat, soy, crustaceans (crab, shrimp & lobster), nuts, spinach and lentils. In addition, you can find arginine supplements and arginine-enriched protein supplements.

The best natural sources of nitrates and nitrites are vegetables, especially spinach, beet root and arugula followed by green leafy vegetable and root vegetables in general. Vegetables provide about 80% of the nitrates and nitrites in the American diet.

Nitrates and nitrites do not appear to have the side effects of the nitic oxide producing drugs. This is probably because their effects on raising nitric oxide levels are slower and more modest, and they do not accumulate in the body.

Interestingly, conventionally grown vegetables are higher in nitrates than organically grown vegetables because of the use of inorganic, nitrate-containing fertilizers. However, that doesn’t mean that I recommend conventionally grown produce over organic produce. In last week’s “Health Tips From the Professor”, I reported that conventionally grown produce is 4-fold higher in pesticides.

Red meat and processed meats are also a minor source of nitrates and nitrites in the American diet because nitrates and nitrites are used as preservatives and coloring agents in those meats.

Are Nitrates and Nitrites Beneficial?

Until recently most of the focus has been on arginine as a natural source of nitric oxide. However, there are several lines of evidence suggesting that dietary sources of nitrates and nitrates can also provide the health benefits expected from nitric oxide.

For example, it has long been known that the DASH (Dietary Approaches to Stop Hypertension) diet is as effective as medications for lowering moderately elevated blood pressure. The DASH diet recommends 4-5 servings of vegetables per day, and recent studies have suggested that the nitrates found in those vegetables may play an important role in the blood pressure lowering effect of the DASH diet (Hord et al, American Journal of Clinical Nutrition, 90: 1-10, 2009; Lin et al, Journal of Nutrition and Metabolism, p 472396, 2012).

In addition, a recent meta-analysis of 16 clinical trials concluded that inorganic nitrate and beet root juice supplements lower blood pressure by modest amounts in healthy individuals (Siervo et al, Journal of Nutrition, 143: 818-826, 2013).

Are Nitrates and Nitrites Harmful?

There are two potential concerns around increasing dietary nitrate and nitrite intake.

1) The one you may have heard the most about is the concern that dietary nitrates and nitrites might increase cancer risk. That turns out to be mainly associated with the nitrates and nitrites added to meats because, in the intestine, nitrites can combine with amino acids to form cancer causing nitrosamines.

That does not appear to be a problem with vegetables because vitamin C and other naturally occurring antioxidants in the vegetables prevent nitrosamine formation. There is no cancer risk in consuming more vegetables.

2) The other concern is potential drug-nutrient interactions, especially drugs which also increase nitric oxide levels such as drugs for angina, hypertension, pulmonary hypertension and erectile dysfunction. This is because the combination of nitric oxide from nitrates in the diet and from the drugs has the potential to cause dangerously low blood pressure.

As a general precaution, if you are taking any medications I suggest consulting your doctor or pharmacist before increasing your dietary intake of nitrates and nitrites.

The Bottom Line

1) Nitric oxide plays an important role in keeping the endothelial lining of your blood vessels healthy, which is thought to reduce the risk of atherosclerosis.

2) Nitric oxide also relaxes the smooth muscle cells that surround our blood vessels. That increases blood flow and decreases blood pressure. The increased blood flow also decreases angina and erectile dysfunction.

3) Nitric oxide also may increase blood flow to active muscle cells. This has been reported to increase exercise efficiency and sports performance. This effect of nitric oxide appears to primarily affect untrained and moderately trained athletes, not highly trained athletes.

4) It has been suggested that nitric oxide may be useful for memory and learning, immune function, mitochondrial function and may reduce the risk of diabetes and heart disease. Research is currently going on to evaluate these hypotheses.

5) There are two natural sources of nitric oxide:

The amino acid arginine from proteins and supplements

Nitrates and nitrites from vegetables such as spinach, beet root and arugula and from supplements.

6) Foods (primarily vegetables) and supplements providing dietary nitrates have been shown to modestly lower blood pressure in healthy individuals. They are likely to provide the other benefits associated with nitric oxide as well, without the side effects associated with nitric oxide enhancing medications.

7) Nitrates and nitrites from vegetables are unlikely to increase cancer risk because vitamin C and other antioxidants from the vegetables prevent the conversion of nitrates and nitrites to nitrosamines.

8) If you are taking any medications, especially medications for angina, high blood pressure or erectile dysfunction, consult with your doctor or pharmacist before increasing your dietary nitrate intake.

9) High blood pressure is a silent killer. You should never substitute dietary nitrates for blood pressure medication. Always consult with your physician first. They may be willing to work with you to lower the amount of medication if appropriate. Finally, even if you don’t have high blood pressure, you should monitor your blood pressure on a regular basis. High blood pressure can sneak up on you without you realizing it.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Organic Foods Healthier?

August 12, 2014 by Dr. Steve Chaney

Organic Fruits & Vegetables

Author: Dr. Stephen Chaney

Are organic foods healthier for us than conventionally grown foods, specifically fruits and vegetables? The controversy about the benefits of organically raised produce continues. In fact, about the only thing that all sides agree on is that:

Organic foods have lower pesticide and herbicide residues and cause less environmental pollution.
Organic foods generally cost more.

But that is where all agreement ends.

Some experts argue that the pesticide levels on conventionally grown fruits and vegetables are within safe levels and that any risk from the pesticides is outweighed by the health benefits of the fruits and vegetables themselves.
Some studies have suggested that organic foods, fruits and vegetables, are healthier because they have higher antioxidant levels, while other studies have reported no nutritional differences between organic and conventionally grown fruits and vegetables.

Benefits of Organic Food?

The present study (Baranski et al, British Journal of Nutrition, doi: 10.1017/S0007114514001366) tried to overcome the shortcomings of many of the previously published reports.

To begin with this study was a meta-analysis that combined the results from 343 of the best designed previous studies to increase the statistical power of the analysis. In addition, the investigators utilized a type of statistical analysis that was superior to previously published studies. In short, it was a very good study. It does show some benefits of organic food.

The results were fairly clear cut:

Pesticide residues were four-fold lower in the organically raised produce than the conventionally raised produce. This result has been consistently seen in all of the previously published studies, and is probably the #1 reason that people choose organic produce. It is also one of the most agreed upon benefits of organic food.

Polyphenol antioxidant levels were significantly higher in the organically raised produce. The percent increase ranged from 19% to 69% depending on the polyphenolic compound tested. This increase has not been seen in all previously published studies, but would represent a side benefit if true.

Levels of the toxic metal cadmium were significantly less in the organically grown fruits and vegetables. The authors speculated that the cadmium found in conventionally grown produce came from the inorganic fertilizers that were used.

Should You Choose Organic Supplements?

If organic foods are better for you than conventionally grown foods, does that mean that you should also choose organic supplements? While that idea sounds logical, the reality is actually more complex.

While organic foods clearly have less pesticides and toxic metals than conventionally grown foods, the level of those contaminants is not zero – even in foods with organic certification. The problem is that our environment is so polluted that no farm is contaminant free. A farmer can use the best organic practices, but if their groundwater is contaminated or pesticides from neighboring farms blow on to their farm, some of those toxic residues will end up in their “organic” crops.

So with supplements, “Organic” certification is not an absolute guarantee of purity. Instead you should insist on getting your supplements from a company with a very rigorous quality control program and a policy of rejecting any raw materials that contain contaminants of any kind.

The Bottom Line

1) The latest study shows that pesticide residues are four-fold lower in the organically raised produce than the conventionally raised produce. This result has been consistently seen in all of the previously published studies, and is probably the #1 reason that people choose organic fruits and vegetables.

2) Polyphenol antioxidant levels were significantly higher in the organically raised produce. The percent increase ranged from 19% to 69% depending on the polyphenolic compound tested. This increase has not been seen in all previously published studies, but would represent a side benefit if true.

3) While one of the benefits of organic foods is they are less likely to be contaminated than conventionally grown foods, an organic certification is not a sufficient proof of purity when you are choosing supplements.You should insist on getting your supplements from a company with a very rigorous quality control program and a policy of rejecting any raw materials that contain contaminants of any kind.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

VTE

August 5, 2014 by Dr. Steve Chaney

Benefits of Omega-3

Author: Dr. Stephen Chaney

When a blood clot ends up in your lungs, it can be deadly. But that blood clot didn’t start out in your lungs. It initially formed in your veins where it is referred to as a thrombus. Then it broke off and migrated to your lungs – a process called venous thromboembolism or VTE. Venous thromboembolism is the third most common form of cardiovascular disease, killing around 100,000 Americans each year.

What if something as simple as adding more omega-3 fatty acids to your diet could dramatically decrease your risk of VTE? That’s exactly what a recent study (Hansen-Krone et al, J. Nutr., 144: 861-867, 2014) has suggested. It claims that one of the benefits of omega-3 in your diet may be to help prevent venous thromboembolism.

What Is Venous Thromboembolism or VTE?

As described above, venous thromboembolism starts when a blood clot (also called a thrombis) forms in a vein. About 2/3 of the time, the blood clot forms in the deep veins in the leg (called deep vein thrombosis or DVT) and stays there before eventually dissolving. The symptoms of deep vein thrombosis or DVT are generally leg pain and swelling.

About 1/3 of the time, the clot breaks loose and travels to the lung where it blocks blood flow to a portion of the lung (a process called pulmonary embolism). The symptoms of pulmonary embolism are severe shortness of breath, chest pain when breathing or coughing, and death! While the first two symptoms are pretty frightening, it’s the last symptom (death) that we’d really like to avoid.

Why Might Omega-3s Prevent Venous Thromboembolism or VTE?

One of the benefits of Omega-3s is they have been shown to reduce inflammation and platelet aggregation, two of the most important risk factors for venous thromboembolism. So it is logical to think that omega-3s might help reduce the risk. However, good scientists don’t rely on logic alone. They test their hypotheses by doing clinical studies.

Unfortunately, the results of previous clinical studies have been mixed. One study showed a protective effect of omega-3s, but two other studies found no correlation between omega-3 fatty acid intake and VTE. However, these studies had some significant limitations:

They were all performed with populations in the United States where fish consumption is relatively low and many of the fish have low omega-3 content. As a consequence omega-3 fatty acid intake was low and there wasn’t much of a range in intake.

Some of the studies did not ask about the use of omega-3 supplements. In a country where 37% of the population takes fish oil supplements, that is a huge omission.

They did not measure omega-3 fatty acid levels in the blood to verify that their dietary surveys were accurate.

Do Omega-3s Prevent Venous Blood Clots or DVT?

The current study (Hansen-Krone et al, J. Nutr., 144: 861-867, 2014) followed 23,631 people aged 25-97 from Tromso, Norway for 16 years.

The participants filled out a comprehensive dietary survey at the time of enrollment where they indicated the number of times per week they ate fish and how often they used fish oil supplements.

The scientists in charge of the study verified the estimated omega-3 intake from the dietary analysis in a subgroup of the population by measuring omega-3 fatty acid levels in their blood.

Finally, they utilized Norway’s excellent health records to determine how many of the people in their trial experienced a venous thromboembolism – either fatal or non-fatal.

The results were pretty impressive:

Blood level measurements of omega-3 fatty acids verified the omega-3 intake estimates from the dietary survey. There was a direct correlation between estimated intake and blood levels of the omega-3 fatty acids.

Those participants who ate fish most often (≥3 times/week) were 22% less likely to experience a VTE than those who ate fish least often (1-2 times/week). That difference was borderline significant.

Those participants who ate fish most often and took fish oil supplements were 48% less likely to experience a venous thromboembolism than those who ate fish least often and took no fish oil supplements. That difference was highly significant.

Strengths & Weaknesses of the Study

Since not all of the previous clinical studies have reached the same conclusion, it is important to look at the strengths and weaknesses of the study compared to the previous studies.

Strengths of the Study:

Tromso is located on the northeast coast of Norway, so fish consumption is high and most of the local fish are excellent sources of omega-3 fatty acids. Consequently, omega-3 intake was relatively high, which significantly increases the chance of seeing an effect if one exists. Fish consumption in the US is generally lower and not all of the fish consumed are good sources of omega-3s.

The study also took into account the use of omega-3 supplements. Some of the US studies did not.

The estimates of omega-3 intake from the dietary survey were verified by blood analysis of omega-3 fatty acids.

Weaknesses of the Study:

The amount of omega-3 fatty acids in the supplements was not recorded, so it is unclear what level of omega-3 fatty acid intake was required to see a significant decrease in VTE risk. This will make it difficult for future investigators to repeat the study.

They did not measure other nutrients that might affect the venous thromboembolism risk.

The Bottom Line

1) VTE is a serious condition with a high rate of mortality.

2) A recent study suggests that a combination of high fish consumption and fish oil supplement use may significantly decrease the risk of venous thromboembolism.

3) It is interesting to note that even three servings/week of omega-3 rich fish was not enough to cause a significant decrease in venous thromboembolism risk. It required additional omega-3s from fish oil supplements before the decreased risk was significant.

4) Not all previous studies have come to the same conclusion. So while the most recent study had several improvements in design compared to previous studies, the case can’t be considered closed. More studies are clearly needed.

5) This study suggests that omega-3 fatty acids may help prevent VTE from occurring. You should not consider them to be a treatment for the condition. If you are experiencing symptoms of venous thromboembolism (leg pain and swelling for deep vein thrombosis (DVT) or shortness of breath and pain when breathing for pulmonary embolism), don’t reach for your fish oil capsules. Call your doctor right away.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Calcium Supplements Increase Heart Attack Risk?

July 15, 2014 by Dr. Steve Chaney

Calcium Confusion

Author: Dr. Stephen Chaney

Should you avoid calcium supplements? Do calcium supplements increase heart disease risk? If you’ve been reading some of the recent headlines in magazines, newspapers and current health articles, that’s exactly what you might think.

And, after years of telling us that calcium supplements may be important for bone health, even some doctors are now recommending that their patients avoid calcium supplements. So what’s the truth? What should you believe?

Are The Benefits Of Resveratrol A Myth?

June 10, 2014 by Dr. Steve Chaney

Is Resveratrol Dead?

Author: Dr. Stephen Chaney

It seems like just a few years ago that the headlines were proclaiming that resveratrol, a polyphenol found in red wines, grapes and chocolate, was the latest “super nutrient”. It was going to make you younger, smarter and healthier. You probably knew that all of the claims being made at the time could not be true.

But the latest headlines are claiming that resveratrol health benefits are all a myth. Has the resveratrol bubble burst? Was it all just hype?

Before you decide that resveratrol supplements are just a waste of money, let me take you behind the scenes and evaluate the latest study objectively. Let’s talk about what it showed, and didn’t show. But, before we look at the study, let’s review the history of resveratrol.

How Did The Resveratrol Story Get Started?

The resveratrol story started in the 1990’s when Dr. Serge Renaud at Bordeaux University coined the term “French Paradox” to describe the fact that cardiovascular disease incidence was relatively low in the French population despite the fact that they consumed diets high in saturated fat and cholesterol.

People immediately started asking what could possibly explain this discrepancy between the US and French populations? In other words, what could be protecting the French population from their high fat diet? One obviously difference between the French and Americans is that the French consume a lot more red wine – or at least they did before the “French Paradox” publicity turned red wine into a health food. Based on that difference, Dr. Renaud proposed that the French Paradox was due to the high red wine consumption in France.

But, red wine is an alcoholic beverage and overconsumption of alcoholic beverages is a major health problem for many people. And, while alcohol does have some cardiovascular benefits, alcohol consumption was pretty constant across countries.

So the next logical question was what other ingredients in red wine might explain their supposed health benefits. Polyphenols appear to have numerous health benefits, and resveratrol is the major polyphenol in red wine. So resveratrol became the “poster child” for the health benefits of red wine.

Even so, for years resveratrol was a “niche” supplement. It had a loyal following, but it wasn’t a big player in the nutritional supplement market. All that changed in 2009. Dr. David Sinclair at Harvard University had been studying genes that slow the aging process. He had screened thousands of naturally occurring small molecules in hopes of finding some that could turn on those anti-aging genes.

He announced that resveratrol and a few related polyphenols were the most potent activators of those anti-aging genes, and he went on to publish studies showing that resveratrol could help obese mice live longer and lean mice be healthier. All of a sudden resveratrol became a superstar.

But, does resveratrol also work in humans? There are many clinical studies that suggest it does. That’s why I was surprised by the recent headlines proclaiming that the supposed health benefits of resveratrol were myths. So once again, let’s look at the study behind the headlines.

Are The Benefits Of Resveratrol a Myth?

The study behind the headlines (Semba et al, JAMA Internal Medicine, doi: 10.1001/jamainternalmed.2014.1582) followed 783 men and women aged 65 years or older from the Chianti region of Italy for 9 years. None of the participants were taking resveratrol supplements. The investigators estimated resveratrol intake by measuring the concentrations of resveratrol metabolites in the urine.

The investigators measured all cause mortality and the prevalence of heart disease and cancer over the 9 year period and found no correlation between those outcomes and urinary resveratrol metabolites. From those data the authors concluded that “Resveratrol levels achieved with a Western diet did not have a substantial influence on health status or mortality risk of the population in this study.”

The Strengths And Weaknesses of The Study

There are really two important questions – what are the strengths and weaknesses of the study and what does the study actually show?

What are the strengths and weaknesses of the study?

A major strength of the study was the measurement of urinary resveratrol metabolites rather than relying on the less accurate dietary recall – although it should be noted that the assays used are relatively new and could benefit from further validation.

The main weakness is that it was a relatively small study in a relatively homogeneous population. Most of the resveratrol consumed by this population came from red wine and even the group with the lowest resveratrol intake was drinking 2-3 glasses of red wine per week (You don’t find many teetotalers in the wine growing regions of Italy).

What does the study actually show?

The level of resveratrol metabolites in this population directly correlated with alcohol consumption. And, the authors of the study concluded that since the study was done in the Chianti region of Italy, most of the resveratrol came from red wine. So the study actually suggests that red wine consumption has no effect on heart disease, cancer or longevity – in direct contradiction to Renaud’s French Hypothesis.

The conclusion that the amount of resveratrol one can obtain from diet alone is unlikely to provide health benefits needs to be replicated in a much larger population group with a wider range of resveratrol intakes from a wider variety of foods before it can be considered definitive.

Even if the amount of resveratrol in food does offer no significant health benefits, that information provides little or no guidance when we consider resveratrol supplements, which generally provide much higher levels of resveratrol.

The Bottom Line:

1) Don’t pay too much attention to the headlines saying that the health benefits of resveratrol are a myth. The study behind the headlines was a small study in a relatively homogeneous population. If anything, it debunked the hypothesis that red wine consumption is responsible for the French Paradox.

2) The study did suggest that the amount of resveratrol one can obtain from diet alone is unlikely to provide significant health benefits. While that may be true, it is irrelevant when considering resveratrol supplements because they provide much higher amounts of resveratrol.

3) The clinical studies on resveratrol supplements are very encouraging, but not yet definitive (see, for example, my “Health Tips From the Professor” article on resveratrol and blood sugar control. That’s to be expected at this stage. It generally takes decades of studies before the scientific community reaches consensus on anything. In the meantime you will continue to see alternating headlines proclaiming the miracles and the myths of resveratrol.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Resveratrol Improve Blood Sugar Control?

May 27, 2014 by Dr. Steve Chaney

Is The Promise of Resveratrol True?

Author: Dr. Stephen Chaney

It was just a few years ago that resveratrol was the latest “miracle nutrient”. It was featured on Dr. Oz and on 60 Minutes. It was hot! Today you see dueling headlines. The headlines one week proclaim the benefits of resveratrol. Next week’s headlines say that it’s all hype. What’s a person to believe?

Let me take you behind the headlines to look at the actual studies and answer some important questions.

1) What do we actually know about the benefits of resveratrol?

2) Is the evidence for beneficial effects of resveratrol where it should be considering the number of clinical studies that have been published?

3) What additional studies need to be done before we can be sure that resveratrol is beneficial?

4) Should you wait until we are absolutely certain resveratrol is beneficial, before you start using it? This is perhaps the most important question of all.

To answer those questions, let’s examine the study behind one of the latest headlines, namely: “Resveratrol Improves Blood Sugar Control in Diabetics”. One of the promises of resveratrol has been that it might help diabetics and pre-diabetics who struggle with blood sugar control. However, this promise was based on animal studies. The study that generated the headlines in question was a meta-analysis of recently published human clinical trials in this area (Liu et al, Am. J. Clin. Nut., 2014, doi: 10.3945/ajcn.113.082024).

Does Resveratrol Improve Blood Sugar Control?

The meta-analysis included 11 published placebo controlled double blind clinical studies looking at the effects of resveratrol supplementation on fasting blood sugar levels, insulin levels, hemoglobin A1c (a measure of blood sugar control) and insulin resistance (a measure closely associated with type 2 diabetes).

A strength of this meta-analysis is the fact that it included 11 clinical studies. However, a weakness of this analysis is that these studies utilized a wide variety of resveratrol doses (10 mg/day to 1 gram/day), a wide variety of end points and both diabetic and non-diabetic patients. That means that there were only a few studies with common population groups, resveratrol doses, and end points.

The conclusions of the study (and the headlines you may have seen) were that:

• Resveratrol appeared to improve blood sugar control (based on improvements in fasting blood sugar levels, insulin levels, hemoglobin A1c and insulin resistance) in diabetics.

• No consistent effect of resveratrol on blood sugar control was seen in non-diabetics.

How Good Are These Studies?

While these studies are very promising, they are bot definitive. There were only 3 published clinical studies in diabetics. While all 3 of the studies showed a positive effect of resveratrol supplementation:

• The doses used were different in each study (ranging from 10 mg/day to 1 gram/day)

• Each study measured different end points (one measured blood glucose, insulin levels, hemoglobin A1c and insulin resistance, one measured blood glucose and hemoglobin A1c and the third measured insulin resistance).

As a research scientist I would like to see more studies done at comparable doses and measuring the same end points – we scientists always want more studies.

Similarly, there was not enough consistency in the studies with non-diabetics to draw a firm conclusion. (3 were with obese patients, 3 were with patients with cardiovascular disease, 1 was with patients with metabolic syndrome and 1 was with perfectly healthy subjects.)

If you really wanted to see if something like resveratrol helps non-diabetics with blood sugar control, you would want to start with people who are already experiencing some difficulties with blood sugar control (pre-diabetics or patients with metabolic syndrome) and follow them for a couple of years to see if resveratrol reduces the number of them who become diabetic.

Are The Headlines Just Hype?

Does that mean that the blood sugar benefits of resveratrol are just hype? The answer is no. There is a difference between “very promising, but not yet definitive” and “hype”. We shouldn’t be surprised that human studies on the health benefits of resveratrol are not yet definitive. Science moves slowly. It often takes decades of scientific research before promising concepts are widely accepted by the scientific community.

When a research area is as young as this one, we sometimes need to go beyond the clinical studies and look at the totality of evidence. In this case:

• In mice resveratrol exerts its beneficial effects by turning on a specific anti-aging gene called SIRT1 (Cell Metabolism, 15: 675-690, 2012). In humans, resveratrol appears to activate the same genetic pathways as in mice (Journal of Clinical Endocrinology & Metabolism, 96: 1409-1414, 2011).

• In obese mice resveratrol improves markers of blood sugar control (Nature, 444: 337-342, 2006). Published clinical studies in diabetic humans also show improvements in blood sugar control (Journal of Clinical Nutrition, 2014, doi: 10.3945/ajcn.113.082024).

So while more and better clinical studies are needed to be absolutely certain that resveratrol helps improve blood sugar control, the evidence supporting that effect is substantial.

What Should You Do?

The ONLY important question for each of you is probably: “Should I wait a decade or two until we are absolutely sure about the health benefits of resveratrol before I take a resveratrol supplement?” That question is ultimately yours to answer. It’s all about benefits and risk.

Benefits – In animal studies resveratrol clearly improves blood sugar control. The human clinical studies published to date are consistent with the animal studies.

Risk – Current data suggest that resveratrol appears to be safe, even at high doses. For example, one recent study indicated that up to 5 gm/day is safe (Cancer Epidemiology BioMarkers & Prevention, volume 16:1246-1262, 2007), but I wouldn’t personally recommend exceeding 100-200 mg/day.

The Bottom Line:

1) Don’t get too excited about the headlines suggesting that resveratrol might help improve blood sugar control in diabetics. The few human clinical studies that have been published to date are consistent with previous animal studies. That is very promising, but more studies are needed before we can be absolutely confident that resveratrol supplementation is beneficial for diabetics.

2) Similarly, don’t be discouraged by the headlines suggesting that resveratrol does not help with blood sugar control in non-diabetics. Those results are preliminary as well.

3) That doesn’t mean that the headlines are just hype. It takes decades to accumulate definitive proof that any kind of food or nutrient offers proven benefits, and the bulk of human clinical research on reveratrol has occurred in the last couple of years. We are exactly where we should expect to be at this point in time.

4) With something as promising as resveratrol, the real question becomes whether you can afford to wait a decade or two until you know whether the potential benefits have been definitely proven. That question is up to you. On the plus side, current data suggest that resveratrol is highly promising for blood sugar control. In addition, resveratrol appears to be safe, even at high doses, but I wouldn’t personally recommend exceeding 100-200 mg/day.

5) We already know that weight control, exercise and a healthy diet improve blood sugar control. You should think of resveratrol as something you may wish to add to a healthy lifestyle, not as a substitute for a healthy lifestyle.

6) If you are diabetic and decide to try a resveratrol supplement, be sure to work with your physician so they can modify your dose of insulin or blood sugar medication as necessary.

7) Finally, you may be asking whether resveratrol supplements are even necessary. Can’t you just get all the resveratrol you need from a glass or two of red wine? Stay tuned. I’ll have the answer to that question in a couple of weeks.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Can Fish Oil Make Children Smarter?

May 20, 2014 by Dr. Steve Chaney

When Do Omega-3 Supplements Make Sense?

Author: Dr. Stephen Chaney

We know that the omega-3 fatty acids found in fish oil are critically important for brain development. But will they really help our kids learn better? Some studies suggest that they do, while other studies have come up empty. Why is this? More importantly, what does it mean for your children? Will fish oil supplements help or not?

I’ve selected today’s study (Portillo-Reyes et al, Research in Developmental Disabilities, 35: 861-870, 2014) because it sheds some light on those important questions.

Can Fish Oil Make Children Smarter?

This study looked at the effect of supplementation for 3 months with 360 mg of EPA + DHA on cognitive function of malnourished Mexican children, ages 8-12 years old. The children came from poor neighborhoods where foods rich in omega-3 fatty acids were seldom available. Low intake of omega-3 fatty acids was confirmed by a food frequency survey.

Cognition was assessed based on a battery of 16 standardized cognition tests at the beginning of the study and again 3 months later.

The results were fairly clear cut. The children receiving the fish oil supplements showed significant gains in mental processing speed, visual-motor coordination, perceptual integration, attention span and executive function compared to children receiving a placebo. In case you were wondering, the first three most strongly affect a child’s ability to learn and last two affect their tendency to display ADHD symptoms.

What Is the Significance of This Study?

There are a lot of things not to like about the study:

It was a small study (59 children total)
Blood levels of omega-3 fatty acids were not determined.
It was a short term study (12 months would have been better).
Measuring the ability to learn is difficult. Experts in the field differ about which cognitive tests are best. I’m not taking a position on the adequacy of the tests they were using because that is not my area of expertise.
Because it was done in a poor region of Mexico, one could argue that its applicability to children in this country is uncertain.

So why even mention this study? That’s because it illustrates an important principle – one that is often ignored in the design and interpretation of clinical studies.

Simply put, the principle is that not everyone will benefit equally from supplementation. It is the malnourished and the sick who will benefit most. When you focus your clinical studies on those groups you are most likely to observe a benefit of supplementation. When you focus your study on well nourished, healthy individuals it will be much more difficult to observe any benefit. And if you perform a meta-analysis of all studies, without evaluating the studies on the basis of need – nutrition status and health status – benefits will also be much more difficult to demonstrate.

This study is just one example of that principle. In an earlier “Health Tips From the Professor” (Can DHA Help Johnny Read?) I reported on a study looking at the effect of DHA supplementation on reading ability of English schoolchildren. In that study, it was the children who were most deficient in DHA and started with the lowest reading skills who benefitted most from DHA supplementation.

What does all of this mean to you?

If you are a parent, you may be asking if a study done with Mexican children eating poor diets has any relevance for your kids. In today’s world of pop tarts and pizza it just might. Most children don’t order sardines on their pizza. As a consequence, many American children don’t get enough omega-3 fatty acids in their diet.

Should your children be getting more omega-3s in their diet? A recent study concluded that most American children only get 20-40 mg/day of DHA from their diet. So if your child’s food preferences don’t include salmon, sardines and the like – and if your child is experiencing learning issues or problems with ADHD, you might consider adding fish oil supplements to their diet. There’s no need to megadose. The international standard is around 200 mg/day of DHA for children 7 or older.

If you are one of those people who is confused by conflicting headlines about the benefits of supplementation, you may want to look at the studies behind those headlines and ask if supplementation would have been likely to provide any benefit in the subjects studied.

The Bottom Line:

1) A recent study reported that supplementation with fish oil significantly improved learning skills in children consuming a diet that was deficient in omega-3 fatty acids.

2) If your children are not consuming foods rich in omega-3 fatty acids such as coldwater fish, you might wish to make sure that they are getting adequate levels of omega-3 fatty acids in their diet. Most experts recommend around 200 mg/day for children over 7.

3) This study also illustrates the principle that supplementation is most likely to be of demonstrable benefit to those who have the worst diets and the greatest need. That doesn’t mean that supplementation won’t benefit everyone, but it does mean that it may be difficult to prove the value of supplementation in healthy people consuming a good diet.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.