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Does Protein Supplement Timing Matter?

Written by Dr. Steve Chaney on . Posted in Protein Supplement Timing

How Do You Gain Muscle Mass & Lose Fat Mass?

Author: Dr. Stephen Chaney

 

protein supplement timingMost of what you read about protein supplements on the internet is wrong. That is because most published studies on protein supplements:

  • Are very small
  • Are not double blinded.
    • Both the subjects and the investigators knew who got the protein supplement.
  • Are done by individual companies with their product.
    • You have no idea which ingredients are in their product are responsible for the effects they report.
    • You have no idea how their product compares with other protein products.
    • There is no standardization with respect to the amount or type of protein or the addition of non-protein ingredients.

Because of these limitations there is a lot of misleading information on the benefits of protein supplements timing and maximal benefit. Let’s start by looking at why people use protein supplements. Let’s also look at what is generally accepted as true with respect to the best supplement timing.

There are 4 major reasons people consume protein supplements:

  • Enhance the muscle gain associated with resistance training: In this case, protein supplements are customarily consumed concurrently with the workout.
  • Preserve muscle and accelerate fat loss while on a weight loss diet: In this case, protein supplements are customarily consumed with meals or as meal replacements.
  • Provide a healthier protein source. In this case, protein supplements are customarily consumed with meals in place of meat protein.
  • Prevent muscle loss associated with aging or illness. There is no customary pattern associated with this use of protein supplements.

How good are the data supporting the customary timing of protein supplementation? The answer is: Not very good. The timing is based on a collection of weak studies which do not always agree with each other.

The current study  (J.L. Hudson et al, Nutrition Reviews, 76: 461-468, 2018 ) was designed to fill this void in our knowledge. It is a meta-analysis that compares all reasonably good studies that have looked at the effect of protein supplement timing on weight gain or loss, lean muscle mass gain, fat loss, and the ratio of lean muscle mass to fat mass.

How Was The Study Done?

The authors started by doing a literature search of all studies that met the following criteria:

  • The study was a randomized control trial with parallel design. This means that study contained a control group. It does not mean that the investigators or subjects were blinded with respect to which subjects used a protein supplement and which did not.
  • The subjects were engaged in resistance training.
  • The study lasted 6 weeks or longer.
  • Reliable methods were used to measure body composition (lean muscle mass and fat mass).
  • The subjects were healthy and at least 19 years old.
  • There was no restriction on the food the subjects consumed.

The authors started with 2074 published studies and ended up with 34 that met all their criteria. They then separated the studies into two groups – those in which the protein supplements were used with meals and those in which the protein supplements were used between meals.

Both groups were diverse.

  • Group 1 included subjects who consumed their protein supplement with their meal and those who consumed their protein supplement as a meal replacement.
  • Group 2 included subjects who consumed their protein supplement concurrent with exercise (usually immediately after exercise) and those who consumed their protein supplement at a fixed time of day not associated with exercise.

Does Protein Supplement Timing Matter?

 

protein supplement timing workoutsBecause the individual studies were very diverse in the way they were designed, the authors could not calculate a reliable estimate of how much lean muscle mass was increased or fat mass was decreased. Instead, they calculated the percentage of studies showing an increase in lean muscle mass or a decrease in fat mass.

When the authors compared protein supplements consumed with meals versus protein supplements consumed between meals:

  • Weight gain was observed in 56% of the studies of protein supplementation with meals compared to 72% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • An increase in lean muscle mass was observed in 94% of the studies of protein supplementation with meals compared to 90% of the studies of protein supplementation between meals. In other words, timing of protein supplementation did not matter with respect to increase in muscle mass.
  • A loss of fat mass was observed in 87% of the studies of protein supplementation with meals compared to 59% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • An increase in the ratio of lean muscle mass to fat mass was observed in 100% of the studies of protein supplementation with meals compared to 87% of the studies of protein supplementation between meals. In short, protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean muscle mass to fat mass.

The following seem to suggest protein supplement timing matters:

The authors pointed out that their findings were consistent with previous studies showing that when protein supplements are consumed with a meal they displace some of the calories that otherwise would have been consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors stated that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

The others concluded: “Concurrently with resistance training, consuming protein supplements with meals, rather than between meals, may more effectively promote weight control and reduce fat mass without influencing improvements in lean [muscle] mass.”

What Are The Limitations Of The Study?

Meta-analyses such as this one, are only as good as the studies included in the meta-analysis. Unfortunately, most sports nutrition studies are very weak studies. Thus, this meta-analysis is a perfect example of the “Garbage In: Garbage Out (GI:GO)” phenomenon.

For example, let’s start by looking at what the term “protein supplement” meant.

  • Because the studies were done by individual companies with their product, the protein supplements in this meta-analysis:
    • Included whey, casein, soy, bovine colostrum, rice or combinations of protein sources.
    • Were isolates, concentrates, or hydrolysates.
    • Contained various additions like creatine, amino acids, and carbohydrate.
  • As I discuss in my book, Slaying the Food Myths, previous studies have shown that optimal protein and leucine levels are needed to maximize the increase in muscle mass and decrease in fat mass associated with resistance exercise. However, neither protein nor leucine levels were standardized in the protein supplements included in this meta-analysis.
  • Previous studies have shown that protein supplements that have little effect on blood sugar levels (have a low glycemic index) are more likely to curb appetite. However, glycemic index was not standardized for the protein supplements included in this meta-analysis.

protein supplement timing workout peopleIn short, the conclusions of this study might be true for some protein supplements, but not for others. We have no way of knowing.

We also need to consider the composition of the two groups.

  • Protein supplements used as meal replacements are more likely to decrease weight and fat mass than protein supplements consumed with meals. Yet, both were included in group 1.
  • Some studies suggest that protein supplements consumed concurrent with resistance exercise are more likely to increase muscle mass than protein supplements consumed another time of day. Yet, both are included in group 2. We also have no idea whether the meals with protein supplements in group 1 were consumed shortly after exercise or at an entirely different time of day.

This was the most glaring weakness of the study because it was completely avoidable. The authors could have grouped the studies into categories that made more sense.

In other words, there are multiple weaknesses that limit the predictive power of this study.

What Can We Learn From This Study?

Despite its many limitations, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, most of us are using protein supplements to lose weight or to increase our lean mass to fat mass ratio. Simply put, we are either trying to lean out (shape up) or lose weight. And, we want to lose that weight primarily by getting rid of excess fat. For us, calories do matter. With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

 

The Bottom Line:

 

A recent study looked at the optimal timing of protein supplements consumed by subjects who were engaged in resistance exercise. Specifically, the study compared protein supplements consumed with meals versus protein supplements consumed between meals on weight, lean muscle mass, fat mass, and the ratio of lean muscle mass to fat mass. The study reported:

  • Protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • Timing of protein supplementation did not matter with respect to increase in muscle mass.
  • Protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • Protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean mass to fat mass.

The authors pointed out that their findings were consistent with previous studies showing that when a protein supplement was consumed with a meal it displaces some of the calories that would have been otherwise consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors said that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

As discussed in the article above, the study has major weaknesses. However, despite its many weaknesses, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, for those of us who are using protein supplements to lose weight or to increase our lean mass to fat mass ratio, calories do matter.  With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

For more details, read the article above:

 

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.

Vitamin D and Cancer Risk?

Written by Dr. Steve Chaney on . Posted in Vitamin D and Cancer Risk

Does Vitamin D Reduce Cancer Risk?

Author: Dr. Stephen Chaney

 

vitamin d and cancer riskThe relationship between vitamin D and cancer risk is controversial. Some studies suggest that vitamin D reduces cancer risk. In those studies, the risk reduction was strongest for colon cancer, lung cancer, and breast cancer. However, other studies have found no association between vitamin D status and cancer risk.

Most previous studies have been conducted in European and American populations. Very few of the studies have been done in Asian populations. So, the authors of the current study (S. Budhathoki et al, BMJ 2018; 360:k671, doi: 10.1136/bmj.k671 ) focused their attention on the Japanese population.

How Was The Study Done?

vitamin d and cancer risk studyThe data for this study were drawn from the much larger Japanese Public Health Center (JPHC) Study. THE JPHC Study is an ongoing study investigating the role of lifestyle and other factors on the risk of cancer and other diseases. The study began in 1990 and enrolled 140, 420 participants aged 40-59.

All participants in the JPHC study filled out a detailed food frequency questionnaire at the time of entry into the study. A subset of participants also donated blood upon entry into the study for determination of 25-hydroxyvitamin D levels (the most reliable measurement of vitamin D status). It is this subset of participants who formed the basis of the current study.

There were 33,736 participants in this study. Based on plasma 25-hydroxyvitamin D levels at entry into the study, the participants were divided into four groups of around 1000 participants.

  • Group 1 had a median serum 25-hydroxyvitamin D level of 36.9 nmol/L.
  • Group 2 had a median serum 25-hydroxyvitamin D level 48.4 nmol/L.
  • Group 3 had a median serum 25-hydroxyvitamin D level of 56.9 nmol/L.
  • Group 4 had a median serum 25-hydroxyvitamin D level of 72.6 nmol/L.

For reference, the NIH considers < 30 nmol/L to be deficient, 30 to < 50 nmol/L to be insufficient for bone and overall health, > 50 nmol/L to be sufficient, and > 150 nmol/L to be potentially associated with adverse effects. By these criteria, group 1 had insufficient serum levels of 25-hydroxyvitamin D, group 2 was borderline, and groups 3 and 4 had sufficient serum levels of 25-hydroxyvitamin D.

The participants were followed for a total of 19 years. During this time 3301 participants developed cancer. The cancer incidence in groups 2, 3 and 4 were compared to the cancer incidence in group 1 to determine the effect of vitamin D status on cancer risk.

 

Vitamin D and Cancer Risk

 

vitamin d and cancer risk study resultsThe results of the Vitamin D and cancer risk study were:

  • Vitamin D reduced total cancer risk by up to 25%.
  • Vitamin D reduced the risk of liver cancer by up to 55%.
  • Vitamin D reduced the risk of pre-menopausal breast cancer by up to 44%.
  • There was a trend towards reduction of colon, liver, and prostate cancer by vitamin D, but the results did not quite reach significance.
  • There were too few cases for most other cancers to assess whether vitamin D status had any effect.
  • Risk reduction was not linear. Except for liver cancer, risk reduction for group 4 (72.6 nmol/L) was not greater than the risk reduction for group 3 (56.9 nmol/L). The significance of this observation will be discussed below.

The authors concluded: “Our findings support the hypothesis that vitamin D may confer protection against cancer. Nevertheless, the lower risk associated with higher circulating vitamin D concentrations seemed to show a ceiling effect, which may suggest that although maintaining an optimal 25-hydroxyvitamin D concentration is important for prevention of cancer, having a concentration beyond this optimal level may provide no further benefit.”

 

Why Is The Association of Vitamin D And Cancer Risk So Confusing?

 

vitamin d and cancer risk confusionSo why do some studies demonstrate confusing data on Vitamin D and cancer risk?  The “ceiling effect” mentioned by the authors of this study may explain much of the variation in results from previous trials. As I say in my upcoming book, “Slaying The Supplement Myths” , supplementation is most likely to be effective when the subjects are deficient in that nutrient at the beginning of the study. If they are starting with adequate levels of the nutrient, supplementation is unlikely to provide additional benefit.

While that statement seems to be obvious, many previous studies have ignored the beginning nutritional status. Some have not measured 25-hydroxyvitamin D levels at the beginning of the study. Others have measured starting 25-hydroxyvitamin levels but have not considered the starting levels in interpretation of their data.

Group 1 in the current study clearly had inadequate 25-hydroxyvitamin D levels. That may be why the groups with sufficient 25-hydroxyvitamin D levels showed a reduction in risk. The low baseline 25-hydroxyvitamin D is logical because most of Japan lies north of the United States, so sun exposure is less. In addition, the authors stated that food fortification and supplementation with vitamin D is much less in Japan than the US. In contrast, the baseline 25-hydroxyvitamin D status in many US studies is significantly higher.

The authors did a thorough analysis of previous studies. In general, studies with a low baseline level of 25-hydroxyvitamin D showed a reduction in cancer risk by vitamin D. Studies with a higher baseline level of 25-hydroxyvitamin D showed no effect.

This analysis does not permit a definitive conclusion, but it clearly defines how future studies should be designed. Simply put, to reliably test whether vitamin D reduces cancer risk, the experiment must be designed in such a way that the baseline 25-hydroxyvitamin D level is in the inadequate range. Otherwise, there is no reason to expect that higher levels of 25-hydroxyvitamin D will confer any benefit.

 

The Bottom Line:

 

A recent study looked at the effect of vitamin D status (serum 25-hydroxyvitaminD levels) on cancer risk. The study reported:

  • Vitamin D reduced total cancer risk by up to 25%.
  • Vitamin D reduced the risk of liver cancer by up to 55%.
  • Vitamin D reduced the risk of pre-menopausal breast cancer by up to 44%.
  • There was a trend towards reduction of colon, liver, and prostate cancer by vitamin D, but the results did not quite reach significance.
  • There were too few cases for most other cancers to assess whether vitamin D status had any effect.
  • Risk reduction was not linear. Except for liver cancer, risk reduction for group 4 (72.6 nmol/L) was not greater than the risk reduction for group 3 (56.9 nmol/L).

The authors concluded: “Our findings support the hypothesis that vitamin D may confer protection against cancer. Nevertheless, the lower risk associated with higher circulating vitamin D concentrations seemed to show a ceiling effect, which may suggest that although maintaining an optimal 25-hydroxyvitamin D concentration is important for prevention of cancer, having a concentration beyond this optimal level may provide no further benefit.”

The “ceiling effect” mentioned by the authors of this study may explain much of the variation in results from previous trials.

For more details, read the article above:

 

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.

Protein and Heart Disease: Meat vs Plant-Based

Written by Dr. Steve Chaney on . Posted in Protein and Heart Disease

Does Meat Protein Increase Heart Disease Risk?

Author: Dr. Stephen Chaney

 

Is a plant-based diet better than eating meat when it comes to protein and heart disease?

protein and heart disease plant-basedThere are a multitude of studies showing the long-term health benefits of plant-based diets. Among the best of these studies are the Seventh-Day Adventist Studies. That’s because the Adventist church advocates a vegan diet but allows personal choice. This means Seventh-Day Adventists eat a more plant-based diet than most Americans. However, there is also significant variation in the diet of Adventists.

 

Not all Adventists are vegans. Significant numbers of Adventists choose lacto-ovo-vegetarian (dairy, eggs & vegetarian), pesco-vegetarian (fish & vegetarian), and semi-vegetarian (meat & vegetarian).

Because of this variation, Adventists provide a rich database for clinical studies. You can compare health outcomes of a vegetarian diet to the standard American diet by comparing Adventists to the non-Adventist population living in the same area. You can also use the Adventist population to compare the health outcomes of the various types of vegetarian diets.

I have described the Adventist Health Studies in detail in my new book, Slaying The Food Myths. Let me briefly summarize the results with an emphasis on heart disease risk:

  • Compared to the standard American Diet, vegetarian diets decrease cardiovascular deaths by 41% in men and 51% in women.
  • The reduction in cardiovascular death is greater for vegans than for lacto-ovo-vegetarians.
  • If we look at the average of multiple studies, the risk of heart disease, diabetes, and cancer is less for vegans than for lacto-ovo-vegetarians, which is less than the risk for pesco-vegetarians, which is less than the risk for semi-vegetarians, which is much less than the risk for people consuming the standard American diet.

There are multiple reasons why vegetarian diets decrease the risk of heart disease compared to the standard American diet. These will be discussed below. The current study was designed to look at the proteins found in vegetarian and non-vegetarian diets and ask what effect these proteins had on heart disease.  This was a good study of protein and heart disease.

How Was The Study Done?

protein and heart disease heart healthThis study (M. Tharrey et al, International Journal of Epidemiology, 2018, 1-10 doi: 10.1093/ije/dyy030 ) utilized a database of 81,337 men and women over age 25 who were enrolled in the Adventist Health Study-2 between 2002 and 2007.

At the time of enrollment, a very detailed food frequency questionnaire was administered. The participants were divided into groups based on the most prevalent protein source in their diet as follows:

  • Grains: This group averaged 44% of their protein intake from grains.
  • Processed foods: This category included protein from cheese, eggs, and milk. However, it also included processed plant proteins and protein from cold breakfast cereals.
  • Meats: The largest protein contributors to this category were red meat, processed meat, and poultry. Fish made only a minor contribution.
  • LFV (Legumes, fruits & vegetables): Legumes were the biggest protein contributors in this category.
  • Nuts and seeds: This included peanuts, tree nuts and seeds.

The participants in the study were followed for an average of 9.4 years during which there were 2276 cardiovascular deaths. The study then asked what effect protein intake from each of these food groups had on cardiovascular risk.

 

Meat Protein and Heart Disease?

 

protein and heart disease meatsSome of the findings from this study were expected, but some were surprising. When studying protein and heart disease for example:

  • When they compared people getting the most protein from meat with those getting the least (24% versus 1% of their protein intake from meat), the risk of cardiovascular death was increased by 61%. This is consistent with several previous studies suggesting that meat, particularly red meat, increases the risk of heart disease.
  • When they compared people getting the most protein from nuts and seeds with those getting the least (18% versus 2%), the risk of cardiovascular death was decreased by 40%. Again, this is consistent with previous studies suggesting that nuts and seeds reduce the risk of heart disease.
  • They found no significant effect of protein intake from grains on cardiovascular death. This could be considered as surprising because whole grains are an excellent source of fiber, which reduces the risk of heart disease. However, the difference in protein intake between the groups getting the most protein from grains versus the least was relatively small (34% versus 19%). In addition, the study did not differentiate between whole grains and refined grains.
  • There was a slight, but non-significant, increased risk of cardiovascular death for people getting the highest amount of protein from processed foods. This is also a bit surprising. It may be because the survey included both meat-based and vegetarian processed foods in the processed foods classification, and there are many processed foods that are marketed specifically to vegetarians.
  • There was also no significant effect of protein from legumes, fruits and vegetables on cardiovascular death. This is also surprising and will be discussed below.

The authors concluded “Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds.”

What Does This Mean For You?

protein and heart disease nuts and seedsThis study does not fundamentally alter what we know about diet and heart disease risk. That is because this study focused solely on the protein and heart disease not on the foods and heart disease. The data were statistically corrected for every other beneficial and detrimental effect of those foods. For example:

  • The people in this study with the highest intake of processed foods were more likely to be overweight and physically inactive. They were also more likely to be smokers. These factors increase the risk of cardiovascular disease. However, the data were statistically adjusted to remove these considerations from the analysis.
  • The people in this study with the highest intake of whole grains, legumes, fruits and vegetables also had the highest intake of fiber, antioxidants, and B vitamins. These factors decrease the risk of heart disease. However, the data were statistically adjusted to remove these considerations from the analysis.

In short, processed foods are still probably bad for the heart, but that is not due to the protein component of processed foods. Similarly, whole grains, legumes, fruits, and vegetables are still good for the heart, but it is not the protein component of these foods that conveys the heart-healthy benefits.

Where the study breaks new ground and leaves some unanswered questions is with the effect of meat, nuts, and seeds on heart disease risk. For example:

  • The American Heart Association has recently released a Presidential Advisory statement warning that the saturated fat in meats increases heart disease risk. However, the data in the present study were statistically adjusted to remove the effect of saturated fat from the analysis. Thus, this study suggests that the protein in red meat also contributes to heart disease risk. If this is confirmed by subsequent studies, it is an important advance. It might mean, for example, that grass-fed beef is no healthier than conventionally raised beef.

However, it is unclear why meat protein increases heart disease risk. One recent study has suggested that meat-based diets favor a population of gut bacteria that metabolize a compound called carnitine, also found in meat, into a metabolite that increases heart disease risk. However, this mechanism has not yet been confirmed.

[Note: The effects of saturated fats and carnitine on heart disease risk are covered in detail in my new book “Slaying the Food Myths.” In my book I carefully analyze the arguments of saturated fat proponents as well as saturated fat opponents.]

  • Conventional wisdom has attributed the heart health benefits of nuts and seeds to their omega-3 fatty acids. However, the data in this study were statistically adjusted to remove the effect of omega-3 fatty acids from the analysis. Thus, this study suggests that the protein in nuts and seeds decreases heart disease risk.

Once again, the mechanism of this effect is unclear. The authors suggest it might be due to higher levels of the amino acids glutamate and arginine in seed and nut protein. However, these two amino acids are abundant in a variety of plant-based proteins. Their presence in nut and seed proteins would not appear to be sufficient to confer a special heart health benefit.

In short, this is the first study of this kind and the mechanisms of the effects described are unclear. Thus, one cannot yet definitively claim that meat protein is bad for the heart and nut and seed proteins are good for the heart.

Whether it is the protein component of these foods that affects heart health is relatively unimportant. It does not change what we know about diet and heart health. As discussed in “Slaying The Food Myths,” multiple studies show that meat-based diets increase heart disease risk and primarily plant-based diets decrease heart disease risk. Multiple studies also show that nuts and seeds decrease heart disease risk.

 

The Bottom Line:

 

A recent study looked at the effect of the protein content of various foods on heart disease risk. The study reported:

  • Meat protein increased the risk of cardiovascular deaths by 61%.
  • Proteins from nuts and seeds decreased the risk of heart disease deaths by 40%.
  • Proteins from processed foods, grains, legumes, fruits, and vegetables had no effect on cardiovascular deaths.

This study does not fundamentally alter what we know about diet and heart disease risk. That is because this study focused solely on the protein component of various foods rather than the foods themselves. The data were statistically corrected for every other beneficial and detrimental effect of those foods. Because of that:

  • Processed foods are still probably bad for the heart
  • Whole grains, legumes, fruits and vegetables are still good for the heart.
  • Meat, especially red meat, is probably bad for the heart, while nuts and seeds are good for the heart.

The major new information provided by this study is that:

  • The increased risk of heart disease associated with meats is not just due to their saturated fat content. Meat protein may also increase heart disease risk. If confirmed by subsequent studies, this is an important finding because it suggests that lean cuts of meat and grass-fed beef may not eliminate heart disease risk.
  • The decreased risk of heart disease associated with nuts and seeds is not just due to their omega-3 content. Nut and seed proteins may also decrease heart disease risk.

For more details, read the article above:

 

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.

The Economic Benefits of Plant-Based Diets

Written by Dr. Steve Chaney on . Posted in Benefits of Plant-Based Diets

Could Plant-Based Diets Cut Healthcare Costs?

Author: Dr. Stephen Chaney

 

Could saving the healthcare system be one of the economic benefits of plant-based diets?

economic benefits of plant-based diets healthcare system costsI don’t need to tell you that our healthcare system is in crisis. Costs are out of control. The Centers for Medicare and Medicaid Services (CMS) estimates that healthcare costs will account for 25% of the gross domestic product by 2025. They also predict that 47% of that spending will be financed by federal. State, and local governments. That is unsustainable.

Our politicians have no answer. Neither political party has a viable plan to cut costs. Perhaps it is time to take matters into our own hands. What if there were a way to improve our own health and the viability of our healthcare system? A recent study suggests there may be a way to accomplish both goals.

How Was The Study Done?

In a recent study (L. Annemans and J. Schepers, Nutrition, 48: 24-32, 2018 ) scientist at Ghent university in Belgium set out to investigate the effect on public health and healthcare costs if just 10% of the population of Belgium and England switched to a primarily plant-based diet. They started with two diets for which the health benefits have been well established by multiple studies. These diets are:

economic benefits of plant-based diets soy#1: A Soy-Containing Diet: This is defined as a diet in which soy protein foods were consumed in place of animal protein foods more than 5 times per week. The soy foods included in their study were soybeans, tofu, miso, soy protein drinks, and soy yoghurt.

The soy-containing diet was chosen because previous studies have shown it protects against obesity, heart disease, stroke, diabetes, and breast, colon, stomach, lung, and prostate cancer.  (Yes. In spite of the erroneous information you find on the internet, soy foods decrease cancer risk.)

#2: The Mediterranean Diet: This is defined as a diet rich in fruits, vegetables, whole grains, nuts, seeds and large amounts of olive oil. It includes a moderate to high consumption of fish and other seafood and a low intake of meat and dairy products.

economic benefits of plant-based diets mediterranean dietsThe Mediterranean diet was chosen because previous studies have shown it protects against heart disease, stroke, diabetes, and breast cancer. I have documented these health benefits in more detail in my book Slaying The Food Myths.”

This study did not look at the benefits of other plant-based diets. For example, as discussed in “Slaying The Food Myths,” the Seventh-Day Adventist studies have shown comparable health benefit for a variety of vegetarian diets.

This study looked at the prevalence of each of these diseases in Belgium and England and estimated what the effect would be if the prevalence of these diseases were reduced by the amounts reported in previous studies of soy-based and Mediterranean diets.

The study reported two outcomes: the increase in Quality of Life Years (QALYs) and the decrease in healthcare costs. Increased Quality of Life Years simply means the increase in disease-free years. That is the outcome most important to each of us personally. However, we should be equally interested in the decreased healthcare costs. The dollars our government spends on healthcare don’t grow on trees. They come out of our pockets.

 

Economic Benefits of Plant-Based Diets: Decreasing Healthcare Costs?

 

economic benefits of plant-based dietsWith that buildup, you are probably wondering what the outcome of the study was. The news was good:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

[Note: In case you were wondering, the authors said the reason why plant-based diets had less of an effect on Quality of Life Years in England than in Belgium is because public health interventions have already significantly decreased the incidence of heart attack and stroke in England. Conversely, the reason healthcare savings are higher in England is because healthcare costs are higher there.]

Finally, if one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

How Accurate Are These Estimates?

The benefits of soy-based and Mediterranean diets on which these estimates are based are very solid. The benefits are based on association studies, but the studies are very well done and are remarkably consistent.

The major weakness of these estimates is the benefits of these diets have been demonstrated in other parts of the world and are being extrapolated to a region of the world where neither of those diets are commonly followed. The authors tried very hard to control for all confounding variables, but the possibility remains that lifestyle differences unique to those geographic regions also contributed to the health benefits of soy-based and Mediterranean diets.

The authors acknowledged that some of the foods that are normally part of soy-based and Mediterranean diets were not as readily available in Belgium and England. They raised the possibility that something like the “New Nordic Diet”, which is also primarily plant-based but incorporates more familiar foods, might be equally effective. The equivalent diet in the US might be the DASH diet.

The economic benefits of plant-based diets may not depend so much on the diet, as long as it is plant-based and those foods are readily available.

 

The Bottom Line:

 

A recent study looked at the effect of a plant-based diet on Quality Of Life Years (disease free years) and healthcare costs in Belgium and England. The study estimated:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

If one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

For more details, read the article above:

 

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.

How to Choose the Right Pillow

Written by Dr. Steve Chaney on . Posted in Headaches, How to Choose the Right Pillow, Neck Pain

Wake Up Each Morning Pain Free

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

how to choose the right pillow without headachesThe way you sleep is often a key to discovering the cause of headaches and more. If you wake up with neck pain, a headache, or you suffer from ringing in your ears, dizziness, or ear pain, there is a good possibility that it may be caused by the way you are sleeping. Your pillow may be the culprit.  But if you need to know how to choose the right pillow for you, it’s easy.   It just takes a little “investigation.”

 

How to Choose the Right Pillow if You Sleep On Your Side

Your head, neck, and spine need to always stay in a nice straight line, just as it is when you are standing up, but that takes a little thought and understanding of the way you sleep.  So, get comfy in your bed and then notice how your head is resting.

how to choose the right pillow to sleep painfreeIf you sleep on your side, your pillow needs to be just the right size, so your head doesn’t point down toward the mattress (your pillow is too soft) or up to the ceiling (your pillow is too thick). Either of these positions will make the muscles on the side of your neck stay in the contracted position for hours and pull your vertebrae in that direction, especially when you try to turn over to your other side.

Your SCM Muscle May Cause Serious Problems

You also need to notice if you turn your head a bit, especially if you are turning into your pillow or turning your head up toward away from your pillow. In either of these two cases you will be causing your sternocleidomastoid (SCM for short) to be held shortened for hours.

Your SCM originates on your collarbone and inserts into the bone behind your ear.  When it contracts you turn your head to the opposite side. However, if the muscle is tight (for example, when you’ve held your head turned toward one side for an extended period of time) and then you bring your head back so you are facing forward, the tight muscle will pull on the bone behind your ear and cause havoc.

The symptoms for a tight SCM are tinnitus (ringing in the ear), dizziness, loss of equilibrium, ear pain, headaches, pain in the eye and around the skull, pain at the top of the head, and even pain in the throat. Amazing! What’s even more amazing is that it’s rare that this muscle is considered when a medical professional is searching for the cause of your symptoms.

These are the things to know when considering how to choose the right pillow if you sleep on your side.

How To Choose The Right Pillow If You Sleep On Your Back

how to choose the right pillow for sleeping on your backIf you sleep on your back, your head should be on the mattress (not propped up with a pillow) and you should have a tiny support (like a folded washcloth) under your neck.  Or, you can have a wedge pillow that starts at your mid-back and gently raises your entire trunk and head up while still allowing your head and back to be in a straight line.

It’s always a challenge for people who toss and turn during the night, sometimes on their side and sometimes on their back.  The best thing I’ve found for this situation is to have the pillow below shoulder level so when you turn on your side your shoulder will automatically slide to the edge of the pillow while still supporting your head properly, and when you turn onto your back, the pillow will start at shoulder level so your head and neck are supported, but your head is being pushed in a way that causes your chin to move down to your chest.

hip pain causes and treatment pain freeIt’s tricky, but I can personally attest to the fact that it will work.  I can always tell when I’ve had my head tilted (I toss and turn during the night) because I will wake with a headache. When that happens I’m grateful that I know how to self-treat the muscles of my neck and shoulders so the headache is eliminated quickly.  If you already have Treat Yourself to Pain Free Living,  you can self-treat all your neck and shoulder muscles to release the tension.

How To Choose The Right Pillow If You Sleep On Your Stomach

If you sleep on your stomach, this is the one position that is so bad that it behooves you to force yourself to change your position. Your head is turned to the side and held still for hours, putting a severe strain on all your cervical and upper thoracic vertebrae. Not only will this cause headaches, tinnitus, and a list of other pains, but it can cause problems down your entire spine. It can also impinge on the nerves that pass through the vertebrae on their way to your organs.

If you do sleep that way, let me know and I’ll give you some suggestions that work to change your habit of sleeping. It takes time and energy, but the results are worth the effort.

In every case, the way you sleep may cause neck pain that won’t go away until the pillow situation is resolved.

Now you should know how to choose the right pillow for the way you sleep.

Wishing you well,

Julie Donnelly

About The Author

julie donnelly

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

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 Processed Food Cause Cancer?

Written by Dr. Steve Chaney on . Posted in Processed Food and Cancer

What Are Processed Foods Doing To Your Health?

Author: Dr. Stephen Chaney

 

does processed food cause cancerDoes processed food cause cancer?

We Americans have a love, hate relationship with processed foods. We love how they taste. We love the convenience. All our friends eat them, so it is the socially acceptable thing to do. But, we also worry about them. We know they aren’t good for us.

We know they increase our risk of becoming obese. We have been warned that they may increase our risk of heart disease, diabetes, and hypertension. But, what if they also increased our risk of cancer? A new study strongly suggests that ultra-processed foods significantly increase our cancer risk.

What Are Ultra-Processed Foods?

udoes processed food cause cancer ultra processed foodsUntil recently it had been very difficult to determine the effect of processed foods on our health because there was no uniform system for classifying the processed food content of our diet. With no consistent classification system, the outcomes varied from one study to the next. That changed around 2016 with the development of the NOVA food classification system. The NOVA system divides foods into four categories:

 

  • Ultra-processed foods.
    • These are foods most Americans would consider junk foods.

 

  • Commercially Processed foods.
    • These are commercially processed foods using natural ingredients like salt, sugar, and fats. For example, frozen peas would be considered a minimally processed food (category 4). Frozen peas with added salt or frozen creamed peas would be considered a commercially process food.

 

  • Restaurant Foods.
    • These are foods processed in a kitchen (either in people’s homes or a restaurant) using salt, sugar, and/or fats to produce a culinary masterpiece (As you might suspect from the emphasis on culinary masterpiece, this is a European classification system).

 

  • Unprocessed or minimally processed foods.
    • These are foods that most Americans would consider whole foods. They are either raw or minimally processed.

 

Intuitively, you have probably already guessed that foods in category 1 are likely to be bad for us and foods in category 4 are likely to be good for us. Categories 2 and 3 start with healthy foods but often end up with foods that are higher in salt, sugar, and/or fat than most experts would consider to be healthy.

With this classification system in mind, the next step was to classify every food in large food databases into one of these four categories. In this case the 3,300 item French NutriNet-Santé food composition database was used.

 

How Was The Study Performed?

does processed food cause cancer studyThis study (T. Fiolet et al, British Medical Journal, 2018;360:k322 doi: 10.1136/bmj.k322) was performed as part of the 8-year NutriNet-Santé web-based program launched in France in 2009 with the objective of studying the associations between nutrition and health. This study enrolled 104,980 participants who were 18 or older. The average age of participants was 42.8 years. There were 82% women and 18% men enrolled in the study.

Dietary intake was assessed using an online 24-hour dietary recall survey administered every 6 months over a two-year period. The survey was administered on random days so that every day of the week was covered in the survey. On average, participants completed 5 diet surveys during the study. The validity of these dietary surveys has been established in other studies that were part of this project.

Over an average 5-year follow-up, cancer incidence was assessed via a check-up questionnaire for health events that was administered every three months.  Participants were also encouraged to self-report health events at any time. Any time a cancer diagnosis was received, a physician from the study team contacted the participant and requested their medical records, which were provided in 80% of the cases. Finally, French death records were also screened to identify any study participants who died from cancer during the study.

In short, this was a very well-done study.

 

Does Processed Food Cause Cancer?

 

does processed food cause cancer junk foodsUsing the NOVA classification system, this question is concerning ultra-processed food.

Here is what the study showed:

  • Every 10% increase in the proportion of ultra-processed foods (junk foods) in the diet was associated with a 12% increase in overall cancer and a 11% increase in breast cancer.
  • No association was seen between commercially processed foods or restaurant foods in the diet and cancer.
  • Every 10% increase in the proportion of unprocessed foods in the diet was associated with a 9% decrease in overall cancer and a 58% decrease in breast cancer.

Just in case you might be tempted to say that a 12% increase in cancer risk is insignificant, remember it is the cancer risk associated with just a 10% increase in ultra-processed foods in the diet. Recent studies have suggested that ultra-processed foods contribute from 25% to 50% of the calories consumed by most Americans.

The authors concluded “[The] rapidly increasing consumption of ultra-processed foods may drive an increased burden of cancer and other non-communicable disease.”

 

What Does This Study Mean For You?

does processed food cause cancer unprocessed foodsBecause the NOVA classification system for identifying the processed food composition of the diet is a recent introduction, this is the first study of its kind. While it is a very good study, it needs to be confirmed by further studies in different population groups.

It would be tempting to ascribe the higher cancer incidence to secondary consequences of ultra-processed food consumption. For example, consumption of ultra-processed food is associated with:

  • Obesity which, in turn, is associated with increased cancer risk.
  • Increased intake of fat, saturated and trans fats, and sugar and decreased intake of fiber and essential nutrients. The effect of these dietary changes is uncertain but could be associated with higher cancer risk.
  • Decreased intake of fruits, vegetables, and whole grains which would result in increased cancer risk.
  • Increased intake of neoformed contaminants (a fancy term for contaminants formed during processing such as acrylamide, heterocyclic amines, and polyaromatic hydrocarbons). These are all carcinogenic compounds. They are usually present in very small amounts, so their effect on cancer risk is uncertain.
  • Increased consumption of food additives of uncertain safety.

While this is an interesting area for future research, it represents a danger and shows that we will try to “have our cake and eat it too.”  Let me explain what I mean by that.

  • does processed food cause cancer restaurant foodWe love our junk foods. Food manufacturers will be only too happy to provide us with “healthier junk foods” by removing salt, sugar, and/or fat and replacing them with a chemical smorgasbord of artificial ingredients. They will reduce calories (again by adding artificial ingredients) so they can claim their junk foods won’t make us fat. They can reduce neoformed contaminants like acrylamide and claim their junk foods are now healthy. But, are they really any healthier? Not necessarily, according to this study.
  • The investigators performed a very sophisticated statistical analysis. The 12% increase in cancer they reported had already been adjusted for differences in age, sex, BMI (a measure of obesity), physical activity, smoking habits, alcohol intake, family history of cancer, and educational level. They also adjusted for fat, salt, and sugar content of the diet.
  • Some supplement companies may tell you that it’s OK to eat junk foods as long as you take the supplements they are trying to sell you. I have head dietitians say it’s OK to eat junk foods as long as you “balance” your diet with lots of fruits and vegetables. The results of this study suggest those approaches won’t be much help either.
  • Further analysis of their data by the investigators showed that the 12% increase in cancer risk was independent of overall fruit and vegetable consumption and supplement use.

The only variables left were increased intake of food additives and neoformed contaminants, and it is unlikely that those would have been sufficient to cause a 12% increase in cancer.

So, does processed food cause cancer?

Once again it appears to be the foods we eat rather than the individual components in those foods that are either good for us or bad for us. The inescapable conclusion from this study is that we are more likely to be healthy if we eat fewer processed foods and more unprocessed foods. Who would have guessed?

 

The Bottom Line:

 

A recent study looked at the effect of ultra-processed foods (otherwise known as junk foods) on cancer  risk. This was a very well-designed study, and it showed.

  • Every 10% increase in the proportion of ultra-processed foods in the diet was associated with a 12% increase in overall cancer and a 11% increase in breast cancer.
  • Every 10% increase in the proportion of unprocessed foods in the diet was associated with a 9% decrease in overall cancer and a 58% decrease in breast cancer.

Just in case you might be tempted to say that a 12% increase in cancer risk is insignificant, remember it is the cancer risk associated with just a 10% increase in ultra-processed foods in the diet. Recent studies have suggested that ultra-processed foods contribute from 25% to 50% of the calories consumed by most Americans.

This is the first study of its kind. While it is a very good study, it needs to be confirmed by further studies in different population groups.

When you look at the details of this study it appears to be the foods we eat rather than the individual components in those foods that are either good for us or bad for us. The inescapable conclusion from this study is that we are more likely to be healthy if we eat fewer processed foods and more unprocessed foods. Who would have guessed?

For more details, read the article above:

 

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 a Holistic Approach to Diabetes Reduce Risk?

Written by Dr. Steve Chaney on . Posted in Holistic Approach to Diabetes

The Role of Supplementation In Reducing Diabetes Risk

Author: Dr. Stephen Chaney

 

holistic approach diabetes doctors recommendDoctors usually discuss a holistic approach to diabetes with their patients.  But, that often isn’t the case for other diseases. Why do doctors recommend drugs rather than natural approaches for controlling and treating other diseases? In part, it’s because so many Americans would rather take a pill than change their diet or lifestyle. Many of our doctors have become so conditioned to that expectation from their patients they don’t even suggest diet and lifestyle changes.

That is our fault. We need to take responsibility for our health. Rather than just accepting whatever treatment our doctors suggest, we should partner with our doctors in designing the best treatment plan for us.

The other reason doctors often recommend drugs is that they are trained to base their decisions on evidence-based medicine. The Gold Standard for evidence-based medicine is, of course, a double blind, placebo controlled clinical trial. In those studies, a single component is compared to the placebo. That is easy to do when you are comparing a drug to a placebo. The drug either works better than the placebo, or it doesn’t.

 

Do Natural Remedies for Diabetes Work?

 

Of course, many of you are more interested in knowing whether holistic, natural approaches also work. That is a much more difficult question to answer.

Double blind, placebo controlled clinical studies are much more difficult to perform when you are looking at foods or nutrients. That’s because foods and nutrients are seldom effective by themselves. They interact with each other. It is the whole, rather than the individual components, that reduce the risk of diabetes and other diseases. Even worse, when you want to test the effectiveness of a holistic change in diet and lifestyle, how do you design a placebo?

holistic approach diabetes talkIt reminds me of an international cancer symposium I attended over 30 years ago as a young Assistant Professor. A world-renowned cancer expert gave a talk from main stage and concluded by saying “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B vitamins, omega-3 fatty acids, exercise, and weight control. But, I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they are advising?” You’ve heard experts saying: “Don’t worry about the fat.” “Don’t worry about calcium.” “Don’t worry about B vitamins.” “Don’t worry about fiber.” “None of them can be shown to decrease the risk of colon cancer.”

Is that the message we should be giving people? Or should we really be saying what that doctor said many years ago – that a lifestyle that includes all those things significantly decreases the risk of colon cancer?

The problem is the negative studies you hear about, and your doctor hears about, are usually studies done with individual foods or individual nutrients. Those studies leave the impression that natural approaches don’t work. However, when you look at a holistic approach to diabetes, the answers are often much different.

 

Can a Holistic Approach to Diabetes Reduce Risk?

holistic approach diabetes reduceI created the diagram on the left for my book “Slaying the Food Myths” to represent holistic approaches to health. Simply put, diet, weight control, exercise, and supplementation all play a role in improving our health. It is that sweet spot in the middle of the diagram where we receive the optimal benefit. Finally, both diet and supplementation should also be holistic. No one food or nutrient will be effective by itself.

This is perfectly illustrated by a recent study (S.M. Kimball et al, Journal of Clinical & Translational Endocrinology, doi: 10.1016/j.jcte.2017.11.002 eCollection Dec 2017 ). If you just read the headlines, you would conclude the study was just about the effect of supplementation on the risk of developing diabetes. However, when you read the publication, you realized the study involves a lot more than supplementation.

The study was conducted by a non-profit wellness organization called Pure North S’Energy Foundation located in Calgary, Canada. They enrolled 188 middle-aged adults (ages 25-54 years) in the studies. Based on BMI measurements the participants were overweight, but not obese. They were followed for a two-year period.

Each of the participants met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

In addition, the subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D/drop. The dosage they received was individualized so that each subject received enough vitamin D to bring their blood levels of 25-hydroxy-vitamin D to an optimal level of >100 nmole/L.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin. In addition to the nutrients found in most multivitamins, their formulation contained carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

[Note: This supplement is not commercially available. However, I would not recommend it if it were. There appears to be little scientific rationale for the amounts of some ingredients.]

In short, all the subjects were put on a holistic diet and lifestyle program ( a holistic approach to diabetes ). Groupe 2 also received what I would consider a holistic supplement. Here were the results of the study.

  • Neither group had significant weight loss or weight gain.
  • Serum 25-hydroxyvitamin D increased significantly in both groups (the vitamin D supplementation was effective).
  • HbA1c levels (a measure of blood sugar control) worsened slightly in Group 1 and improved slightly in Group 2.

However, those were average values. Individual subjects had much more significant changes in HbA1c. In fact, based on changes in HbA1c levels:

  • 16% of Group 1 participants and only 8% of Group 2 participants progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

The authors of the study concluded: “The results suggest that nutrient supplementation may provide a safe, economical, and effective means for lowering diabetes risk. Further examination of this potential via randomized controlled trials is warranted.”

 

The Role of Supplementation In Reducing Diabetes Risk

holistic approach to diabetes supplementationThis is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we can conclude that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle changes did not affect diabetes risk in this study was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

 

The Bottom Line:

 

A recent study looked at the effect of a holistic diet, lifestyle and supplementation intervention on diabetes risk.

All participants in the study met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

The subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin containing carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

Over a two-year period:

  • 16% of Group 1 participants and only 8% of Group 2 progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

This is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we know that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle change did not affect diabetes risk was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

For more details, read the article above:

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 Omega-3s Reduce Heart Disease Risk

Written by Dr. Steve Chaney on . Posted in Omega-3s and Heart Disease

Omega-3 Confusion

Author: Dr. Stephen Chaney

 

do omega 3s reduce heart disease risk confusionDo omega-3s reduce heart disease risk?

Perhaps there is nothing more controversial in nutrition today than omega-3 fatty acids and heart disease risk. It is so confusing. One day you are told they reduce heart disease risk. The next day you are told they are worthless.

The controversy around omega-3s and heart disease risk is part of the larger controversy around supplementation. It is omega-3 supplements that are controversial, not omega-3-rich fish. Of course, that completely ignores the fact that many omega-3-rich fish are contaminated with PCBs and/or heavy metals.

Why is omega-3 supplementation so controversial? The problem is that proponents of omega-3 supplementation often seize on a single study as “proof” that everyone should supplement with omega-3s.  Opponents of omega-3 supplementation take the opposite approach. They pick studies showing that not everyone benefits from omega-3 supplementation as “proof” that nobody benefits. As usual, the truth is in between.

I have a section in my book, “Slaying The Food Myths,”  called “None of Us Are Average.” In that section I point out that clinical studies report the average results of everyone in the study, but nobody in the study was average.

For example, let’s say the study reported that (on average) there was no heart health benefit from omega-3 supplementation. That is what makes the headlines. That is what opponents of omega-3 supplementation cite as “proof” omega-3 supplementation doesn’t work.

However, some of the people in the study may have benefited from omega-3 supplementation, while others did not. Thus, the important question is not “Does everyone benefit from omega-3 supplementation?” It is “Who benefits from omega-3 supplementation?” and “Why do the results vary so much from study to study?”

Omega-3 Confusion

do omega 3s reduce heart disease risk rolesI have a chapter in my book called “What Role Does Supplementation Play?” which helps put this omega-3 controversy into perspective. I created the graphic on the left to answer the question “Who needs supplementation?”

The concept is simple. Poor diet, increased need, genetic predisposition, and pre-existing disease all increase the likelihood that supplementation will be beneficial. However, the benefit will be most obvious in the center of the diagram where two or more of these factors overlap.

Let’s take this concept and apply it to studies of omega-3 fatty acids and heart disease risk.  In particular, let’s use this concept to understand what I call “omega-3 confusion” – why some studies give negative results and others give positive results:

Poor Diet: Again, the concept is simple. You are most likely to see a benefit of omega-3 supplementation when the dietary intake of omega-3 fatty acids is low. Put another way, if the subjects in a study are already getting plenty of omega-3s from their diet, supplementing with omega-3s is unlikely to provide any benefit.

Until recently, dietary surveys were the standard method for assessing dietary omega-3 intake. However, dietary surveys can be inaccurate. The best of recent studies, measure the omega-3 levels in cellular membranes. The omega-3 levels at the beginning of the study reflect your diet. The omega-3 levels at the end of the study reflect how effective supplementation was at improving your omega-3 status. In short, this is the gold standard for omega-3 clinical studies. Subjects can lie about how many omega-3-rich foods they eat and whether they take their supplements, but the omega-3 levels in their cell membranes reveal the truth.

When you read the methods section, it turns out that most negative studies did not ask how much omega-3s their subjects were getting from their diet. Almost none of the negative studies measured omega-3 levels in cell membranes.

Increased Need: In terms of heart disease, we can think increased need as the presence of risk factors for heart disease such as:

  • Age
  • Obesity
  • Inactivity
  • Elevated cholesterol or triglycerides
  • Dietary factors like saturated fats and/or sugar and refined carbohydrates
  • Smoking

What does this mean in terms of clinical studies?

  • Studies in which most of the subjects have a poor diet, are over 65, and have multiple risk factors for heart disease are more likely to show a beneficial effect of omega-3s on heart disease risk.
  • Studies in which most of the subjects are young and healthy are unlikely to show a measurable benefit of omega-3s on heart disease risk. You would need to follow this population group 20, 30, or 40 years to demonstrate a benefit.

Genetic Predisposition: There is a lot we don’t know about genetic predisposition for heart disease. The only exception is family history. If you do omega 3s reduce heart disease risk geneticshave a family history of early heart disease, you can be pretty certain you are at high risk for heart disease. As you might suspect:

  • Studies focused on populations with genetic predisposition to heart disease are more likely to show a benefit of omega-3 supplementation.
  • Studies that just look at the general population without consideration of genetic predisposition to heart disease are less likely to show a benefit of omega-3 supplementation.

Disease: Diseases like diabetes and high blood pressure increase heart disease risk. And, of course, pre-existing heart disease, especially a recent heart attack, dramatically increase the risk of a subsequent heart attack or stroke. Studies focusing on subjects with diabetes have been inconsistent. However, studies focusing on patients with pre-existing heart disease are more clear-cut:

  • Studies focused on populations with pre-existing heart disease and/or a recent heart attack are more likely to show a benefit of omega-3 supplementation.
  • Studies that just look at the general population without consideration of genetic predisposition to heart disease are less likely to show a benefit of omega-3 supplementation.

Interestingly, the situation is very similar with statin drugs. As I reported in a recent issue  of “Health Tips From the Professor” on cholesterol lowering drugs, studies done with patients who had recently had a heart attack show a clear benefit of statin drugs, while studies with the general population show little or no benefit of statin drugs.

One More Factor: There is one more confounding factor that is somewhat unique to the omega-3-heart disease studies and, therefore, not included in the figure at the beginning of this section. Ethical considerations dictate that the placebo group in a double-blind, placebo controlled clinical study receive the “standard of care” for that disease. In the case of heart disease, the standard of care is 4-5 drugs which provide most of the same benefits as omega-3 fatty acids (although with many more side effects).

Thus, these studies are no longer asking whether omega-3s reduce heart disease risk. They are asking whether omega-3s have any additional benefits for heart disease patients already on 4-5 drugs. I have discussed this in more detail in a previous issue of “Health Tips From the Professor” on omega-3 and heart disease.

do omega 3s reduce heart disease risk conflicting studiesWhy Are Omega-3 Studies Conflicting? In summary, the likelihood that clinical studies show a beneficial effect of omega-3 fatty acids on heart disease risk is highly dependent on study design and the population group included in the study. Many of the studies currently in the scientific literature are flawed in one way or another. Once you understand that, it is obvious why there are so many conflicting studies in the literature.

Unfortunately, meta-analyses that combine data from many studies are no better than the individual studies they include in the analysis. It is the old “Garbage in – garbage out” principle.

What Does An Ideal Study Look Like? In my opinion, an ideal study to evaluate the effect of omega-3s on heart disease risk should (at minimum):

  • Determine omega-3 levels in cellular membranes as a measure of omega-3 status (dietary intake of omega-3s plus their utilization by the body). The percentage of omega-3 fatty acids in cell membranes is referred to as Omega-3 Index. Based on previous studies (W.S. Harris et al, Atherosclerosis, 262: 51-54, 2017, most experts consider an Omega-3 Index of 4% to be low and an Omega-3 Index of 8% to be optimal.
  • Focus on a population group at high risk for heart disease or include enough subjects in the study so that you can determine the effect of omega-3s on high risk subgroups.
  • Measure cardiovascular outcomes (heart attack, stroke, cardiovascular deaths, etc.).
  • Perform the study long enough so that you can accumulate a significant number of cardiovascular events.
  • Include enough subjects for a statistically significant conclusion.

 

Do Omega-3s Reduce Heart Disease Risk?

do omega 3s reduce heart disease riskMost of you have probably heard of the Framingham Heart Study. It was started in 1941 with a large group of residents of Framingham Massachusetts and surrounding areas. The data from this study over the years has shaped much of what we know about cardiovascular risk factors. The original participants have passed on, but the study has continued with their offspring, now in their 60s.

A recent study (W. H. Harris et al, Journal of Clinical Lipidology, doi: 10.1016/j.jacl.2018.02.010 ) with 2500 subjects in the Offspring Cohort of the Framingham Heart Study incorporates many of characteristics of a good omega-3 clinical study.

  • The average age of the subjects was 66. While none of the subjects enrolled in the study had been diagnosed with heart disease at the time the study began, this is a high-risk population. At this age a significant percentage of them would be expected to develop heart disease over the next few years.
  • The subjects did have other risk factors for heart disease. 13% of them had diabetes, 44% had high blood pressure, and 40% of them were on cholesterol medication. However, those risk factors were corrected for in the data analysis, so they did not influence the results.
  • The Omega-3 Index was measured in their red blood cell membranes at the beginning of the study.
  • The study was long enough (7.3 years) for cardiovascular disease to develop.

When they compared subjects with the highest Omega-3 Index (>6.8%) with those with the those with the lowest Omega-3 Index (<4.2%):

  • Death from all causes was reduced by 34%
  • Incident cardiovascular disease was reduced by 39% (Remember that none of the subjects had been diagnosed with heart disease at the beginning of the study. This terminology simply means that they received a new diagnosis of heart disease during the study.)
  • Cardiovascular events (primarily heart attacks) were reduced by 42%
  • Strokes were reduced by 55%.

There were two other interesting observations from the study:

  • There was no correlation between serum cholesterol levels and heart disease in this study.
  • The authors estimated that it would require an extra 1300 mg of omega-3s/day, either from a serving of salmon or from fish oil supplements, to bring the membrane Omega-3 Index from the lowest level in this study to an optimal level.

The authors cited three other recent studies performed in a similar manner that have come to essentially the same conclusion. These studies are not perfect. They are all association studies, so they do not prove cause and effect.

However, the authors concluded that Omega-3 Index should be measured routinely as a risk factor for heart disease and should be corrected if it is low.

 

The Bottom Line:

Perhaps there is nothing more controversial in nutrition today than omega-3 fatty acids and heart disease risk. It is so confusing. One day you are told they reduce heart disease risk. The next day you are told they are worthless.  I have discussed the reasons for the conflicting results and the resulting omega-3 confusion in the article above.

I shared a recent study that escapes many of the pitfalls of previous studies because it measures the Omega-3 Index of red blood cells as an indication of omega-3 status.

When the study compared subjects with the highest Omega-3 Index (>6.8%) with those with the those with the lowest Omega-3 Index (<4.2%):

  • Death from all causes was reduced by 34%
  • Incident cardiovascular disease was reduced by 39% (Remember that none of the subjects had been diagnosed with heart disease at the beginning of the study. This terminology simply means that they received a new diagnosis of heart disease during the study.)
  • Cardiovascular events (primarily heart attacks) were reduced by 42%
  • Strokes were reduced by 55%.

There were two other interesting observations from the study:

  • There was no correlation between serum cholesterol levels and heart disease in this study.
  • The authors estimated that it would require an extra 1300 mg of omega-3s/day, either from a serving of salmon or from fish oil supplements, to bring the membrane Omega-3 Index from the lowest level in this study to an optimal level.

The authors concluded that Omega-3 Index should be measured routinely as a risk factor for heart disease and should be corrected if it is low.

 

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.

Hip Pain Causes and Treatment

Written by Dr. Steve Chaney on . Posted in Hip Pain, Hip Pain Causes, Hip Pain Treatment

How To Find and Treat The Muscles That Cause Hip Pain

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

This article will help you discover hip pain causes and treatment.  We’ll first uncover hip pain causes and then we will teach you how to administer self treatment.

Hip Pain Is Commonly Caused By Tight Muscles

hip pain causes and treatmentHip pain is commonly caused by one or several muscles putting pressure on the insertion points surrounding your hip. The body is amazing!  Consider the number of muscles that enable us to move in countless directions, and you’ll really appreciate your body.

However, when the muscles shorten from either repetitive or static movements, they pull on the bones. Tight muscles pull on the bone and cause hip pain. You can think of it as being like your head hurting because you were pulling your hair.

Muscles That Cause Hip Pain

hip pain causes and treatment lateralYour hip has approximately 17 different muscles originating on your pelvis and inserting into your thigh bone.  Each muscle causes your leg to move in a different direction.

On the outside of your hip, you have muscles that lift your leg out to the side and stabilize your knee joint. Your gluteal muscles , including the large gluteus maximus (butt) muscle, and tensor fascia lata muscle may cause lateral hip pain.

Deep inside your hip joint are multiple muscles that move your thigh to the front, back, and toward midline.

Muscles like the adductors  and hamstrings  are major muscles that move your thigh midline, or toward the back.

hip pain causes and treatment rotatorAnd the six deep lateral rotator muscles  can cause hip pain, including sciatica, deep inside the joint.

Deep inside the curve of your pelvis is your iliacus muscle. The iliacus muscle lifts your thigh up, so you can sit down or take a step.

Your quadratus lumborum muscle lifts your hip up, so you can take a step. It also is responsible for allowing you to bend to your side.

There are other muscles that put pressure on your hip to allow you to move. With so many muscles it is impossible to do just one self-treatment to get total relief of hip pain.

Hopefully, the above has given you a better understanding of what causes hip pain.  But, we promised to show hip pain causes and treatment.  Now, we will demonstrate some hip pain treatment.

An Effective Self-Treatment For Hip Pain

hip pain causes and treatment self treatmentTake a ball and place it on the muscle that is between your hip and thigh bones. You are on your tensor fascia lata muscle. Then lie down on the floor as shown in this picture.

You can also do this treatment standing up and leaning into a wall.

Move around your pelvis by turning your body forward and backward.  You’ll be able to feel your pelvis as you move. Try to stay along the edge of the bone, and then move the ball further down toward your butt.

End the treatment by pressing the ball along the top of your thigh bone.  You have found a spasm each time you get to a tender point. Press into the tender point and hold it for 30 seconds. Then let up the pressure for 5 seconds before repeating it again.  You’ll find that each time it will hurt a little less.

It hurts less because you are forcing out the H+ acid that is causing the pain. As the acid/blood ratio changes, the pain diminishes and the spasm releases.

Solutions For Hip Pain And More

hip pain causes and treatment pain free athleteThere are many other self-treatments that will eliminate pain throughout your body. You can find solutions to pain in my books:

The Pain-Free Athlete  is a book written specifically for active adults. Whether you like to run, bike, walk, swim, or play any sport, you’ll find solutions to common aches and pains.

Included in this book are two chapters by guest authors that are important to active adults.

Steve Chaney, PhD, authored Sports Nutrition which is great information even for non-athletes.

Greg Matis and Mike Young, PhD, authored a detailed Exercise Routine chapter that is excellent for the serious athlete.

hip pain causes and treatment pain freeTreat Yourself to Pain-Free Living  is my most popular book. It has been totally updated with new self-treatments for the entire body.

Self-treatments that are effective for sinus headaches are included in this book.  Plus, you’ll discover how to help someone who suffers from sinus pain.

Now, you should understand hip pain causes and treatment.

You don’t need to suffer from hip pain!  Learn effective self-treatments that will eliminate aches and pains before they become debilitating by checking out my book.

Wishing you well,

Julie Donnelly

julie donnelly

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

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 Genetics Predict Which Diet is Best For You?

Written by Dr. Steve Chaney on . Posted in Genetics and Diet

Author: Dr. Stephen Chaney

 

genetix and dietIt is so confusing. The weight loss claims for popular diets sound so convincing, but they can’t all be true.

The low carb proponents give impressive metabolic arguments for why their diet works best. (Of course, you aren’t a biochemist. You have no idea whether they are speaking the truth or just trying to pull the wool over your eyes.) They quote clinical studies and offer testimonials that “prove” their diet works.

Other “experts” tell you that is nonsense. Your diet needs to be individualized to fit your genetic and metabolic profile. Who do you believe? Do low-carb or low-fat diets work better? Are individualized diet plans the solution?

Fortunately for you a recent study (CD Gardner et al, JAMA, 319: 667-679, 2018 ) has answered your questions. Let me start with some background to put this study in perspective. Then I will describe how the study was done, the study results, and what this study means for you.

 

What Did We Already Know About Diets?

The studies that low-carb proponents quote to “prove” the success of their diet approach are misleading because:

  • Most of the studies are short-term. This is misleading because low-carb diets lead to an initial loss of water weight that is not seen with low-fat diets.
  • Most of the comparisons are done with the typical American diet (which is high in sugar, refined carbohydrates, and junk food) rather than a healthy low-fat diet.
  • Note: This is the short version. I cover this in more detail in my new “Slaying The Food Myths” book.

In contrast, there have been numerous studies comparing the effectiveness of low-carb versus low-fat diets long term (12 months or more). These studies have not found a dimes worth of difference between the two diets. Weight loss was virtually identical.

genetix and diet bestThat has led some weight loss experts to point out that any “one size fits all” diet fails to account for individual variability. They point out that while average weight loss on a particular diet might be 12-15 pounds, some people will have lost 45 pounds and others gained 5 pounds. That has led to research efforts to discover biomarkers that could predict which diet will work best for you. Let me share the two most promising approaches.

A DNA testing approach measures genetic variation in the PPARG, ADRB2, AND FABP2 genes [Don’t worry. There won’t be a quiz.] These are genes involved in fat and energy metabolism. Animal studies have suggested that genetic variation in these genes might be useful in predicting whether individuals respond better to a low-fat or low-carb diet. One preliminary clinical study has suggested it may work for humans as well.

An insulin sensitivity approach measures insulin levels 30 minutes after a glucose challenge (a measurement called INS-30). Some small clinical studies have suggested this approach might also have value in predicting the success of low-carb versus low-fat diets for weight loss.

Unfortunately, some companies are already promoting individualized diet plans based on DNA testing and insulin sensitivity measurement – even though the clinical support for the predictive power of those tests is very preliminary at present.

The current study was designed to compare the effectiveness of healthy low-carb and low-fat diets on weight loss. In addition, it evaluated whether either DNA testing or insulin sensitivity measurements could effectively predict whether individuals lost weight better on low-fat or low-carb diets.

How Was This Study Done? 

genetix and diet studyThis was an excellent study. In fact, it is one of the best studies comparing weight loss diets I have seen in recent years. It enrolled 609 middle-aged (average age = 40), overweight (average BMI = 33) adults from the San Francisco Bay area in a 12-month weight loss study. Here was the breakdown of participants:

  • 57% were women, 43% were men.
  • 40% had a DNA pattern considered favorable for a low-fat diet, 30% had a DNA pattern considered favorable for a low-carb diet (30% had an intermediate DNA pattern that did not predict either low-carb or low-fat).
  • 67% had insulin sensitivity values considered favorable for low-carb diets, 33% had insulin sensitivity considered favorable for a low-fat diet.

The study participants were randomly assigned to either the low-carb diet group or low-fat diet group by a computerized protocol that assured DNA patterns and insulin sensitivity were equally distributed across the two groups.

In contrast to many earlier studies, both groups followed a relatively healthy diet. They were instructed to:

  • Maximize vegetable intake.
  • Minimize intake of added sugars, refined flours, and trans-fats.
  • Focus on whole foods that were minimally processed, nutrient dense, and prepared at home whenever possible.

The participants were not advised to restrict their calories. However, they were given an extraordinary degree of support. They were further divided into groups of 17 that met a total of 22 times over the 12 months with a registered dietitian who provided instruction, support and encouragement. That level of support assured that the participants stuck with their diet for the full 12-month period.

 

Can Genetics Predict Which Diet Works Best?

genetix and diet works best Participants in the study lost an average of 12 pounds. That is not a huge amount of weight, but it is enough weight loss to make a difference, and it is consistent with the results of most long-term studies. When the results were broken down further:

  • There was no significant difference in weight loss between the low-carb group and low-fat group at 12 months. This is consistent with multiple previous studies.
  • Both diets were equally effective at improving lipid profiles and lowering blood pressure, insulin, and blood sugar levels. This is the dirty little secret that many low-carb enthusiasts don’t tell you. The improvements seen in health parameters such as lipids, blood pressure, insulin, and blood glucose are due to the weight loss, not whether the diet is low-carb or low-fat.
  • Neither the DNA pattern or insulin sensitivity offered any predictive value as to whether a low-carb or low-fat diet was more effective for weight loss.

That does not mean that DNA testing is of no value. It simply means that the human genome is far more complex than the companies offering DNA tests have assumed. There will be a day when we know enough to individualize diets based on DNA testing. That day is not now.

What Does This Mean For You?

Forget the weight loss claims of the low-carb enthusiasts. Ignore companies that promise they can select the best diet approach for you based on some simple DNA tests and/or measurements of insulin sensitivity.

This study does not provide definitive answers, but it hints at the weight loss tips that really matter:

  • Ditch the sodas, sweets, fast and processed foods. Instead focus on whole foods, primarily fruits and vegetables, whole grains, and legumes.
  • If you wish to follow a low-carb diet, choose one that is primarily plant-based  rather than meat-based.
  • Focus on what you are eating rather than on calories.
  • Find a group to provide support and encouragement. It doesn’t need to be some expensive diet program. It could just be a group of friends who agree to provide each other with support, encouragement, and accountability.

I cover this topic in much more detail in my new book “Slaying The Food Myths”.

 

The Bottom Line:

 

A recent study compared the effectiveness of healthy low-carb and low-fat diets on weight loss over a 12-month period. In addition, it evaluated whether DNA testing or insulin sensitivity measurements could effectively predict whether individuals lost weight better on low-fat or low-carb diets.

  • There was no significant difference in weight loss between the low-carb and low-fat groups at 12 months. This is consistent with multiple previous studies.
  • Both diets were equally effective at improving lipid profiles and lowering blood pressure, insulin, and blood sugar levels. This is the dirty little secret that many low-carb enthusiasts don’t tell you. The improvements seen in health parameters such as lipids, blood pressure, insulin, and blood glucose are due to the weight loss, not whether the diet is low-carb or low-fat.
  • Neither the DNA pattern or insulin sensitivity offered any predictive value as to whether a low-carb or low-fat diet was more effective for weight loss.

That means you can forget the weight loss claims of the low-carb enthusiasts. You should also ignore companies that promise they can select the best diet approach for you based on some simple DNA tests and/or measurements of insulin sensitivity.

As for what works and why, I cover that in detail in my new book “Slaying The Food Myths

 

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.

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Does Protein Supplement Timing Matter?

Posted May 15, 2018 by Dr. Steve Chaney

How Do You Gain Muscle Mass & Lose Fat Mass?

Author: Dr. Stephen Chaney

 

protein supplement timingMost of what you read about protein supplements on the internet is wrong. That is because most published studies on protein supplements:

  • Are very small
  • Are not double blinded.
    • Both the subjects and the investigators knew who got the protein supplement.
  • Are done by individual companies with their product.
    • You have no idea which ingredients are in their product are responsible for the effects they report.
    • You have no idea how their product compares with other protein products.
    • There is no standardization with respect to the amount or type of protein or the addition of non-protein ingredients.

Because of these limitations there is a lot of misleading information on the benefits of protein supplements timing and maximal benefit. Let’s start by looking at why people use protein supplements. Let’s also look at what is generally accepted as true with respect to the best supplement timing.

There are 4 major reasons people consume protein supplements:

  • Enhance the muscle gain associated with resistance training: In this case, protein supplements are customarily consumed concurrently with the workout.
  • Preserve muscle and accelerate fat loss while on a weight loss diet: In this case, protein supplements are customarily consumed with meals or as meal replacements.
  • Provide a healthier protein source. In this case, protein supplements are customarily consumed with meals in place of meat protein.
  • Prevent muscle loss associated with aging or illness. There is no customary pattern associated with this use of protein supplements.

How good are the data supporting the customary timing of protein supplementation? The answer is: Not very good. The timing is based on a collection of weak studies which do not always agree with each other.

The current study  (J.L. Hudson et al, Nutrition Reviews, 76: 461-468, 2018 ) was designed to fill this void in our knowledge. It is a meta-analysis that compares all reasonably good studies that have looked at the effect of protein supplement timing on weight gain or loss, lean muscle mass gain, fat loss, and the ratio of lean muscle mass to fat mass.

How Was The Study Done?

The authors started by doing a literature search of all studies that met the following criteria:

  • The study was a randomized control trial with parallel design. This means that study contained a control group. It does not mean that the investigators or subjects were blinded with respect to which subjects used a protein supplement and which did not.
  • The subjects were engaged in resistance training.
  • The study lasted 6 weeks or longer.
  • Reliable methods were used to measure body composition (lean muscle mass and fat mass).
  • The subjects were healthy and at least 19 years old.
  • There was no restriction on the food the subjects consumed.

The authors started with 2074 published studies and ended up with 34 that met all their criteria. They then separated the studies into two groups – those in which the protein supplements were used with meals and those in which the protein supplements were used between meals.

Both groups were diverse.

  • Group 1 included subjects who consumed their protein supplement with their meal and those who consumed their protein supplement as a meal replacement.
  • Group 2 included subjects who consumed their protein supplement concurrent with exercise (usually immediately after exercise) and those who consumed their protein supplement at a fixed time of day not associated with exercise.

Does Protein Supplement Timing Matter?

 

protein supplement timing workoutsBecause the individual studies were very diverse in the way they were designed, the authors could not calculate a reliable estimate of how much lean muscle mass was increased or fat mass was decreased. Instead, they calculated the percentage of studies showing an increase in lean muscle mass or a decrease in fat mass.

When the authors compared protein supplements consumed with meals versus protein supplements consumed between meals:

  • Weight gain was observed in 56% of the studies of protein supplementation with meals compared to 72% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • An increase in lean muscle mass was observed in 94% of the studies of protein supplementation with meals compared to 90% of the studies of protein supplementation between meals. In other words, timing of protein supplementation did not matter with respect to increase in muscle mass.
  • A loss of fat mass was observed in 87% of the studies of protein supplementation with meals compared to 59% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • An increase in the ratio of lean muscle mass to fat mass was observed in 100% of the studies of protein supplementation with meals compared to 87% of the studies of protein supplementation between meals. In short, protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean muscle mass to fat mass.

The following seem to suggest protein supplement timing matters:

The authors pointed out that their findings were consistent with previous studies showing that when protein supplements are consumed with a meal they displace some of the calories that otherwise would have been consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors stated that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

The others concluded: “Concurrently with resistance training, consuming protein supplements with meals, rather than between meals, may more effectively promote weight control and reduce fat mass without influencing improvements in lean [muscle] mass.”

What Are The Limitations Of The Study?

Meta-analyses such as this one, are only as good as the studies included in the meta-analysis. Unfortunately, most sports nutrition studies are very weak studies. Thus, this meta-analysis is a perfect example of the “Garbage In: Garbage Out (GI:GO)” phenomenon.

For example, let’s start by looking at what the term “protein supplement” meant.

  • Because the studies were done by individual companies with their product, the protein supplements in this meta-analysis:
    • Included whey, casein, soy, bovine colostrum, rice or combinations of protein sources.
    • Were isolates, concentrates, or hydrolysates.
    • Contained various additions like creatine, amino acids, and carbohydrate.
  • As I discuss in my book, Slaying the Food Myths, previous studies have shown that optimal protein and leucine levels are needed to maximize the increase in muscle mass and decrease in fat mass associated with resistance exercise. However, neither protein nor leucine levels were standardized in the protein supplements included in this meta-analysis.
  • Previous studies have shown that protein supplements that have little effect on blood sugar levels (have a low glycemic index) are more likely to curb appetite. However, glycemic index was not standardized for the protein supplements included in this meta-analysis.

protein supplement timing workout peopleIn short, the conclusions of this study might be true for some protein supplements, but not for others. We have no way of knowing.

We also need to consider the composition of the two groups.

  • Protein supplements used as meal replacements are more likely to decrease weight and fat mass than protein supplements consumed with meals. Yet, both were included in group 1.
  • Some studies suggest that protein supplements consumed concurrent with resistance exercise are more likely to increase muscle mass than protein supplements consumed another time of day. Yet, both are included in group 2. We also have no idea whether the meals with protein supplements in group 1 were consumed shortly after exercise or at an entirely different time of day.

This was the most glaring weakness of the study because it was completely avoidable. The authors could have grouped the studies into categories that made more sense.

In other words, there are multiple weaknesses that limit the predictive power of this study.

What Can We Learn From This Study?

Despite its many limitations, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, most of us are using protein supplements to lose weight or to increase our lean mass to fat mass ratio. Simply put, we are either trying to lean out (shape up) or lose weight. And, we want to lose that weight primarily by getting rid of excess fat. For us, calories do matter. With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

 

The Bottom Line:

 

A recent study looked at the optimal timing of protein supplements consumed by subjects who were engaged in resistance exercise. Specifically, the study compared protein supplements consumed with meals versus protein supplements consumed between meals on weight, lean muscle mass, fat mass, and the ratio of lean muscle mass to fat mass. The study reported:

  • Protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • Timing of protein supplementation did not matter with respect to increase in muscle mass.
  • Protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • Protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean mass to fat mass.

The authors pointed out that their findings were consistent with previous studies showing that when a protein supplement was consumed with a meal it displaces some of the calories that would have been otherwise consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors said that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

As discussed in the article above, the study has major weaknesses. However, despite its many weaknesses, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, for those of us who are using protein supplements to lose weight or to increase our lean mass to fat mass ratio, calories do matter.  With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

For more details, read the article above:

 

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.

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