Author Archive

Are Heart Attacks Increasing in Young Women?

Written by Dr. Steve Chaney on . Posted in Heart Attacks in Women

Why Are Heart Attacks Increasing In Young Women?

Author: Dr. Stephen Chaney

 

are heart attacks increasing in young women age 32-54Heart disease is still the leading cause of death in the United States, but things seemed to be getting better. More people are following heart-healthy diets and the treatment of heart disease has improved. One recent study found that the overall rate of heart disease has decreased by 38% in the U.S. since 1990. Heart attack rates have also been inching down in recent years.

Are heart attacks increasing in young women?

That’s why the latest study was both surprising and concerning. If it is to be believed, heart attack rates are increasing in young Americans, especially young women. That is particularly shocking because young women are thought to be protected from heart disease by their estrogen. Until recently, heart attack rates have been lower for young women than for young men. It hasn’t been until after menopause that women caught up to men in terms of their risk for a heart attack.

Obviously, this study raises several questions:

  • Is it true?
  • Why are heart attacks increasing in young women?
  • What should young women be doing to prevent heart disease?

 

How Was The Study Done?

heart attacksThis study (S Arora et al, Circulation, 139: 1046-1056, 2019 was an offshoot of the Atherosclerosis Risk in Communities (ARIC) Surveillance Study. The ARIC study collected data on hospital admissions for acute myocardial infarction (or in layman terms, heart attacks) for patients aged 35-74 in four geographical areas in the U.S. (Forsyth County in North Carolina, Washington County, Maryland, Jackson, Mississippi, and the Northwest suburbs of Minneapolis, Minnesota).

During the time period of 1995 to 2014 28,732 people ages 35-74 were admitted to one of the participating hospitals for a heart attack. The results of the original study have been published previously (WD Rosamond et al, Circulation, 125: 1848-1857, 2012 ). For the population as a whole:

  • The annual rate of hospital admissions for a heart attack decreased by around 3.5% during this time period, and…
  • The annual rate of death following a heart attack decreased by around 3%.

However, the current study focuses on the younger people in the study (ages 35-54) and came to a surprisingly different conclusion. Contrary to the results obtained with the general population, the rate of heart attacks increased in younger people.

 

What Did The Study Show?

are heart attacks increasing in young women studyAlthough the article uses the terms “young adults” and “young women,” I realize that some of you may consider that misleading. My only comment is whether you consider the 35-54 age range to be “young” or not probably depends on which side of 35 you are on.

Having said that, when the authors compared younger people in the study (the 35-54 age group) with everyone in the 35-74 age group they found:

  • The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
  • The increase in heart attack rate was most dramatic for young women.
  • Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
  • Hospitalizations for heart attack increased from 21% to 31% for young women. This increase was highly significant.
  • This is a wake-up call. We now appear to be entering an era in which heart attack rates for young women (ages 35-54) equal those of young men. The protective effects of estrogen have disappeared.

 

Why Are Heart Attacks Increasing In Young Women?

 

are heart attacks increasing in young women obesityAs I said at the beginning, there are several questions we need to answer:

  • Is this study true? There are some limitations to this study, but it is a fairly robust study. A similar study in Canada came to the same conclusion, and several other studies have suggested a similar trend. More research is needed, but this is a very disturbing finding.
  • Why are heart attacks increasing in young women? The short answer to this question is that we don’t know. However, the study offers several hints.
  • Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.
  • Young women were less likely than young men to be receiving lipid-lowering medications and other medications to reduce heart disease risk at the time of admission for their first heart attack. This may reflect a perception among both patients and physicians that young women are less likely to develop heart disease than young men.
  • Young women may be less likely to seek medical advice about how to control obesity, high blood pressure and diabetes, and medical professionals may not treat these conditions as aggressively as they do for young men.
  • The current study suggests the perception that obesity, high blood pressure and diabetes are less likely to cause heart attacks in young women than in young men is no longer true, if it ever was.
  • The early symptoms of a heart attack are different for women than for men. For men heart attacks are associated with chest pain. For women early symptoms of an impending heart attack may be back pain, nausea, or dizziness. Both women and their doctors may not recognize these symptoms early enough to fend off a full-blown heart attack.
  • What should young women be doing to prevent heart disease? This is the topic of the next section.

What Should Every Woman Know About Heart Disease?

 

what every woman should know about heart diseaseThere are several simple lessons every woman should take from this and similar studies.

  • Heart disease is not a male disease. If that were ever true, it is definitely no longer true.
  • Don’t assume your risk is low until you reach menopause. This study suggests today’s young woman is just as likely to have a heart attack as a young man.
  • Obesity, high blood pressure, and diabetes are killers. The good news is that if you start while you are young, you can reverse these killers with diet and lifestyle changes.
  • A heart healthy diet and lifestyle is important at every age. Don’t fall for the diet fads. Despite what Dr. Strangelove’s health blog would have you believe, saturated fats increase your risk of heart disease. A whole-food, primarily plant-based diet is the only proven dietary approach for reducing heart disease risk long term. For more information on how you can protect your heart, read my books. “Slaying The Food Myths” and “Slaying The Supplement Myths”.
  • Get regular checkups. If you develop risk factors for heart disease, don’t ignore them. Treat them aggressively. This requires a partnership between you and your doctor. Your part of the partnership is to make the necessary lifestyle changes to reverse these risk factors. Your doctor’s role is to provide appropriate medications to control these risk factors if you are unable to control them with lifestyle changes alone.

 

The Bottom Line

 

While heart disease has been declining in the general population, a recent study has shown that heart attacks are on the increase for young adults.  In particularly, heart attacks are increasing in young women.

  • The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
  • The increase in heart attack rate was most dramatic for young women.
  • Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
  • Hospitalizations for heart attack increased from 21% to 31% young women. This increase was highly significant.
  • This is a significant and disturbing finding. We now appear to be entering an era in which heart attack rates for young women equal those of young men. The protective effects of estrogen have disappeared.
  • Note: The authors defined 35-54 years old as young. Whether you consider that young or not probably depends on which side of 35 you are on.
  • Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.

For more details and my recommendations for what every woman should know about heart disease 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.

What is the Flexitarian Diet?

Written by Dr. Steve Chaney on . Posted in Flexitarian Diet

Is The Flexitarian Diet Good For You And Good For The Planet?

Author: Dr. Stephen Chaney

 

flexitarian diet breaking newsIf you follow U.S News & World Reports, you may have noticed that the Flexitarian Diet was ranked #3, just slightly behind the Mediterranean and DASH diets. You may be scratching your head and wondering: “What is the Flexitarian Diet?” There are so many popular diets these days that it is hard to keep track. It is confusing. To paraphrase the old baseball quote: “You can’t tell the diets without a scorecard.”

Let me provide you with that scorecard. I will describe the Flexitarian Diet and answer two important questions:

  • Is the Flexitarian Diet good for you?
  • Is the Flexitarian Diet good for the planet?

 

What Is The Flexitarian Diet?

flexitarian diet to lose weightThe term “flexitarian” was coined 10 years ago by dietitian Dawn Jackson Blatner in her book, “The Flexitarian Diet: The Mostly Vegetarian Way To Lose Weight, Be Healthier, Prevent Disease and Add Years To Your Life.” Flexitarian is simply a contraction of the phrase “flexible vegetarian.”

Blatner’s premise was two-fold:

  • A vegan diet is very healthy. It is also very restrictive and hard for most people to follow.
  • Allowing small amounts of meat and other animal products in a primarily vegetarian diet would preserve most of the health benefits of a vegan diet. It would also be more flexible and easier to follow.

The Flexitarian Diet has no strict rules or calorie limits. It has no prohibited foods or food groups. It is neither low-carb nor low-fat. It focuses more on what to eat than on what not to eat. It is just based on a few general principles:

  • Eat mostly fruits, vegetables, legumes, and whole grains. In other words, it is a primarily plant-based diet.
  • Focus on protein from plants rather than from animals.
  • Be flexible and incorporate small amounts of meat and animal products in your diet. Flexibility reigns here. The diet recognizes that some people do better with more meat and animal products than others.
  • Eat the least processed, most natural form of foods.
  • Limit added sugars and sweets.

If you have read my book, “Slaying The Food Myths,” you know that this is essentially a semi-vegetarian diet. It is also very similar to the Mediterranean and DASH diets.

 

Is the Flexitarian Diet Good For You?

 

flexitarian diet good for youAs you may have guessed from the title of her book, Dawn Jackson Blatner claimed her diet would help you lose weight, get healthier, reduce your risk of diseases, and add years to your life. You might ask: “Is there any basis for her claims?”

The answer is “Yes,” but the evidence does not come from studies of the Flexitarian Diet. The evidence is based on similarities between the Flexitarian Diet and the semi-vegetarian diet, the Mediterranean diet, and the DASH diet.

I have covered the health benefits of these diets in detail in my book, “Slaying The Food Myths.” In summary, compared to people following the typical American diet or meat-based low-carb diets, people following these 3 diets:

  • Tend to weigh less.
  • Have a lower risk of diabetes and heart disease.
  • Have a lower risk of some forms of cancer.
  • Have lower blood pressure.
  • Have less inflammation.

In addition, a paper has recently been published entitled, “Flexitarian Diets and Health: A review of the Evidence-Based Literature” (EJ Derbyshire, Frontiers In Nutrition, 3: 1-7, 2017). The title is a bit misleading in that the review did not include any studies on Flexitarian Diets (There have been none). Instead, the study reviewed 25 studies of semi-vegetarian diets published between 2000 and 2016 and relied on the fact that the Flexitarian Diet and semi-vegetarian diets are virtually identical.

The study concluded that semi-vegetarian (Flexitarian) diets:

  • Resulted in weight loss.
  • Improved metabolic markers (cholesterol, triglycerides, blood sugar levels).
  • Lowered blood pressure.
  • Reduced the risk of type-2 diabetes.
  • May play a role in the management of Inflammatory bowel disease, such as Crohn’s disease.

In short, there is no direct evidence that the Flexitarian Diet is healthy. However, its similarity to semi-vegetarian, Mediterranean, and DASH diets makes it highly likely that the Flexitarian Diet is very good for you.

 

Is The Flexitarian Diet Good For The Planet?

 

flexitarian diet good for planetThe short answer is “Yes.” More importantly, it is critical for the health of our planet that we adopt a more plant-based diet. Our current diet is not environmentally sustainable.

That assessment is based on four factors; Greenhouse Gas Emissions, Land Use, Water Use, and Population Growth. Here are some fast facts to ponder:

  • Food production currently is responsible for:
    • 40% of global land, and land conversion for food products is the single most important driver of biodiversity loss.
    • Up to 30% of global greenhouse emissions.
    • 70% of freshwater use.
  • The population is expected to increase by 2.5 billion people between now and 2050. That raises two important issues:
    • How are we going to feed those people?
    • How are we going to do it in a sustainable manner?
  • Ruminant animals (cattle and sheep, for example) are the worst offenders when it comes to greenhouse gas emissions. That’s because they not only breathe out CO2, but they also release methane into the atmosphere from fermentation of the food they eat in their rumens. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO2. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb.

Two major studies have published recently that have evaluated the effect of food production on our planet.

The first study (L Aleksandrowicz et al, PLOS One, 11(11): e0165797, 2016) reviewed 63 studies that looked at the effect of dietary patterns on greenhouse gas emissions, land use, and water use. It concluded that moving from our current diet to a more plant-based diet would:

  • Reduce greenhouse gas emissions and land use for food production by 70-80%.
  • Reduce water use for food production by 50%.

The degree to which all these parameters could be reduced was generally proportional to the extent to which animal foods were replaced with plant foods (vegan > semi-vegetarian > Mediterranean).

The second study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission reviewed 356 published studies in preparing their report.

Based on an exhaustive evaluation of the literature on healthy diets and sustainable food production, the Commission recommended something they called the “Planetary Health Diet.” This science-based diet ended up being very close to the Flexitarian (semi-vegetarian) diet.

  • It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
  • It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).
  • It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
  • It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

In other words, it is a less flexible version of the Flexitarian diet. You could also consider it a restrictive version of the Mediterranean or DASH diets.

The Commission concluded:

  • “A diet that includes more plant-based foods and fewer animal source foods is healthy, sustainable, and good for both people and planet.”
  • “Shifting from unhealthy diets to the ‘planetary health diet’ can prevent 11 million premature adult deaths per year and drive the transition toward a sustainable global food system by 2050 that ensures healthy food for all within planetary boundaries.”

 

The Bottom Line

 

The Flexitarian Diet has been in the news lately. You might be asking 3 questions:

  • What is the Flexitarian Diet?
  • Is it good for me?
  • Is it good for the planet?

Here are the answers:

#1: The Flexitarian Diet is a contraction of the phrase “flexible vegetarian.” It is a vegetarian diet that allows small amounts of meat, dairy, and/or eggs. It is virtually identical to what has been called a semi-vegetarian diet for years and is very similar to the Mediterranean and DASH diets.

#2: There is no direct evidence that the Flexitarian diet is healthy. However, its close similarity to the semi-vegetarian, Mediterranean, and DASH diets makes it highly probable that the Flexitarian Diet is a healthy diet. It is likely to be good for you.

#3: When greenhouse gas emissions, land & water use, and population growth are all taken into account, experts have concluded that the only sustainable diet is a semi-vegetarian diet in which meat, dairy, and eggs are severely restricted (details in the article above). You can think of it as a less flexible version of the Flexitarian diet or a very restrictive form of the Mediterranean or DASH diets.

According to these experts, controlling carbon emissions from fossil fuels is not enough. We also must change what we eat if we wish to avoid catastrophic global warming.

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.

Biceps Pain Caused by a Tiny Muscle

Written by Dr. Steve Chaney on . Posted in Biceps Pain

An Unexpected Cause Of Biceps Pain

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

 

It’s Spring In Florida

spring flowersMarch is a beautiful time of year here in Florida, and it’s the beginning of Spring for our friends and relatives in the northern states.  I lived most of my life in New York, and I loved when the purple crocuses started peeping up through the snow.  Spring was on its way!

Of course, on March 17th there is also that fun holiday – St. Patrick’s Day.  The parade in New York City is the largest St. Patrick’s Day parade in the world, followed by Dublin. In fact, the first parade in New York was in 1762, a full 14 years before the signing of the Declaration of Independence.  It’s a huge party, a parade that lasts for hours officially, and then the party continues for many more hours unofficially.

Everyone is Irish on St. Patrick’s Day!  So, whether you are born Irish, or you’re just Irish for the day, I wish you this popular Irish blessing…

“May the road rise up to meet you

May the wind be always at your back

And may the sun shine be warm upon your face.”

 

A Tiny Muscle Can Cause Shoulder And Arm Pain

biceps pain subclavius muscleA tiny muscle that can cause biceps pain.

There is a pencil thin muscle that runs from the cartilage of your 1st rib to the end of your clavicle (collar bone). The name of the muscle is Subclavius.

The subclavius muscle lifts your first rib when you inhale so your lungs can expand, and it also stabilizes the joint between your clavicle and your sternum.  It’s a small muscle and most people aren’t aware of it, or how it helps us.

Normally this muscle is not repetitively strained, however during a time of rapid breathing it can go into spasm.  Perhaps you have a cough and you are doing sudden, rapid breaths. Or, maybe you are a runner and you’re breathing rapidly. Anything that makes you take deep breaths quickly can cause muscle spasms to form in your subclavius muscle.

As shown by the green shading on the chart, the referred pain for the subclavius goes across the entire length of the front of your shoulder, and then continues down biceps muscle on the front of your arm.  The darker shading demonstrates where the greatest pain is felt. While the pain is most frequently felt in the shoulder, biceps pain can also occur.

 

An Unexpected Cause Of Biceps Pain

biceps pain treatmentIf you have pain in your biceps muscle, you may not consider that a muscle spasm in the top/front of your chest is the source of the problem. If rubbing and stretching your biceps isn’t giving relief, you are stuck for a solution.  Yet, just putting direct pressure on the spasm, located at your sternum, just under your collarbone, will solve the problem.

Press your finger directly onto the spot.  If you don’t find a tender point, move ½” toward the outside and continue pressing until you find a tender point.  This is the spasm that is causing the pain pattern.

It’s as simple as that!

 

Wishing you well,

Julie Donnelly

 

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.

 

About The Author

julie donnellyJulie 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.

Check It Out!

If you would like easy to follow instructions on how to relieve joint pain and muscle tightness from head to toe click here  to check out Julie Donnelly’s Pain Relief System today. Whenever, I have pain and stiffness I use her techniques. They work!

Is Hemp Oil Good For You?

Written by Dr. Steve Chaney on . Posted in Hemp Oil or CBD

The Truth About Hemp Oil and CBD Products

Author: Dr. Stephen Chaney

 

is hemp oil good for you productsCBD products are hot. If you believe the hype, they cure just about anything that ails you. Plus, they are “natural,” and the public has an insatiable appetite for natural cures. If that weren’t enough, marijuana has had a long history as an illicit drug, which adds a little allure to CBD products. The CBD industry is exploding.

But, is hemp oil good for you?

Many of you have contacted me and asked for my opinion on CBD products. Up until now I have deferred because it was simply not an area of expertise for me, and I had not come across any good studies on the effects of CBD.

However, I recently came across a comprehensive review of the evidence behind CBD and cannabis by experts I trust. This was a report called “The Health Effects of Cannabis and Cannabinoids. The Current State of Evidence and Recommendations for Research” published by the National Academies of Sciences, Engineering, and Medicine (National Academies Press, Washington DC, 2017 ).

Before I describe the findings of the report, I need to define some terms for you.

 

What Are Cannabis And Cannabinoids

 

is hemp oil good for you plantsCannabis is a genus of flowering plants that originated in Central Asia. Cannabis plants contain a class of compounds called cannabinoids, of which the two most abundant are tetrahydrocannabinol (THC) and cannabidiol (CBD). It is THC that is responsible for the intoxicating effects of cannabis.

The term hemp refers to varieties of Cannabis that have been selected for non-drug use. Hemp is low in THC and high in CBD. Marijuana, on the other hand, is high in THC and low in CBD.

 

How Was The Report Prepared?

is hemp oil good for you scientists studyThe National Academy of Sciences selected 16 of the top experts in this area of research. These experts reviewed hundreds of published studies, met several times to discuss the studies, and wrote a comprehensive, 468-page report based on their evaluation of the data. This report was then sent to another group of 15 experts to be reviewed and edited before final publication.

The report evaluated the scientific basis for:

  • Claims for benefits of CBD and/or THC that have been proposed by their advocates.
  • Claims for risks of CBD and/or THC that have been proposed by their opponents.

The strength of the evidence behind these claims was classified as follows:

  • Conclusive Evidence: The claim was supported by many good-quality studies with no credible opposing findings.
  • Substantial Evidence: The claim was supported by several good-quality studies with few or no credible opposing findings.
  • Moderate Evidence: The claim was supported by several good- to fair-quality studies with few or no opposing findings.
  • Limited Evidence: The claim is supported by fair-quality studies or study results have been mixed, with more studies supporting the claim than refuting it.
  • Insufficient or No Evidence: The claim is supported by a single poor-quality study, study results have been mixed, or no studies have been done to either support or refute the claim.

 

Is Hemp Oil Good for You?

 

is hemp oil good for you pillsThe report lumped all claims for any form of cannabis or cannabinoids together. This includes the cannabis plant, CBD, THC, preparations containing both THC and CBD, and everything in between. I will help you sort out which approved claims were associated with which form of cannabis.

Benefits: The report stated that there was:

  • Conclusive evidence that a high potency pharmaceutical CBD drug helps prevent seizures in two rare and severe forms of epilepsy. (This is a patented drug formulation and is not found in commercially available CBD preparations.)
  • Conclusive evidence that THC or a combination of THC with CBD is effective for treating chemotherapy-induced nausea and vomiting. (These studies were not done with CBD by itself).
  • is hemp oil good for you the risksSubstantial evidence that THC or a combination of THC with CBD is effective for treating involuntary muscle contractions due to multiple sclerosis. (These studies were not done with CBD by itself).
  • Substantial evidence that THC or a combination of THC with CBD is effective for treating chronic pain. (These studies were not done with CBD by itself).
  • Moderate evidence that THC or a combination of THC with CBD may help with certain sleep problems. (These studies were not done with CBD by itself).
  • Limited, insufficient, or no evidence to support claims for CBD products by themselves.

 

The reviewers did not say that CBD products were worthless. They simply concluded that the existing studies were not strong enough to rate the evidence supporting CBD claims in the moderate to conclusive range.

For example, the reviewers described a study reporting that 300 mg of CBD reduced anxiety for men giving a speech. It was a very small study, the data were inconsistent, and an effect of CBD on anxiety has not been supported by other studies. Thus, the reviewers concluded that the evidence supporting a claim that CBD reduces anxiety is insufficient. Of course, that may change as future studies are published.

In short, the reviewers felt that, while there may be benefits derived from CBD, more high-quality research is needed to either support or refute the claims that are currently being made for CBD products.

 

Risks: The report did not list any studies substantiating risks associated with CBD use.

is hemp oil good for you the risksThe reviewers did state that CBD blocks an enzyme that metabolizes many medicines, raising the possibility that CBD might affect the effectiveness of those medicines. They said that more research into these potential interactions was sorely needed. (Note: Many widely used herbal supplements block the same enzymes, so this effect is not unique to CBD products.)

The reviewers also noted two other concerns that CBD products have in common with many herbal supplements:

  • The amount of CBD used in clinical studies is generally 100 mg or more, while many CBD products provide 20 mg or less.
  • Quality control is spotty at best. One recent study (MO Bonn-Miller et al, JAMA, 318: 1708-1709, 2017 ) evaluated 84 CBD products and found that only 30% of them were accurately labeled. Some contained little to no CBD and about 20% had detectable levels of THC.

 

What Are The Benefits And Risks Of Marijuana or Hemp Oil?

Benefits: As described in the section above, there is:

  • Conclusive evidence that THC or THC + CBD:
    • is effective for treating chemotherapy-induced nausea and vomiting.
  • Substantial evidence that THC or THC + CBD:
    • is effective for treating involuntary muscle contractions due to multiple sclerosis.
    • is effective for treating chronic pain.
  • Moderate evidence that THC or THC + CBD:
    • may help with certain sleep problems.
  • Limited, insufficient, or no evidence to support the other claims for THC or THC + CBD.

 

Risks: The report stated that there was:

  • Substantial evidence for:
    • Cannabis smoking and more frequent bronchitis episodes.
    • Cannabis use and increased frequency of motor vehicle crashes.
    • Maternal cannabis smoking and lower birth weight of the offspring.
    • Cannabis use and the development of schizophrenia or other psychoses, with the highest risks among the most frequent users.
    • Progression to problem cannabis use. The risks are greatest for males, people who initiate cannabis use at an early age, and people who use cannabis frequently.
  • Moderate evidence for:
    • Cannabis use and the impairment of cognitive domains of learning, memory, and attention.
    • Cannabis use and the development of substance dependence and/or substance abuse disorder for substances including alcohol, tobacco, and other illicit drugs.

Once again, the committee concluded that more high-quality research was needed.

For a summary of the report’s evaluation of all claimed benefits and risks of CBD and/or marijuana use, click here . For details on individual studies reviewed by the committee, read the complete report at https://doi.org/10.17226/24625.

 

The Bottom Line

 

There is lots of excitement around CBD products and medical use of marijuana (THC). If you believe the proponents, they are a panacea for everything that ails us. If you believe the opponents, the risks far outweigh the benefits. Which of these claims are true and which are false?

Fortunately, the National Academy of Sciences appointed a committee of experts to evaluate the research supporting or refuting the claims. They issued a report in 2017 that evaluated the strength of scientific evidence supporting these claims.

In short:

  • They found no good evidence supporting the proposed benefits of CBD products. Nor did they find evidence for any risk of CBD products, properly used. They did not conclude that CBD products were worthless. They simply concluded that more high-quality research was needed to substantiate the claims.
  • They found conclusive evidence for some of the proposed benefits of medical marijuana. However, they also found substantial evidence supporting some of the proposed risks. Again, they concluded that more research was needed.

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 Much Omega-3s Do You Need?

Written by Dr. Steve Chaney on . Posted in Omega-3 Deficiency, Omega-3 Fish Oil Supplements, Omega-3 Supplementation, Omega-3s

Can You Get The Omega-3s You Need From Diet Alone?

Author: Dr. Stephen Chaney

how much omega-3s do you need prevent heart attackTwo recent studies have provided strong evidence that omega-3s reduce the risk of heart attacks. However, both studies used high doses of omega-3s and did not do a dose-response analysis. That leaves you with several unanswered questions:

  • How much omega-3s do you need to significantly reduce your risk of heart attack?
  • Will that amount of omega-3s provide other health benefits?
  • Can you get that amount of omega-3s from diet alone?
  • Can you get that amount of omega-3s from supplementation alone?

Fortunately, a recent study (KH Jackson et al, Prostaglandins, Leukotrienes and Essential Amino Acids, 142: 4-10, 2019) has answered those questions. But, before we consider that article, we should look at a biomarker called “Omega-3 Index.”

 

What Is Omega-3 Index And Why Is It Important?

how much omega-3s do you need fish oilThe Omega-3 Index is a measure of the ratio between the heart-healthy omega-3 fats (EPA + DHA) and all the other fats in red blood cell membranes. It is considered an excellent measure of our omega-3 status.

Dr. William S Harris, one of the top experts in the omega-3 field, first proposed the Omega-3 Index as a biomarker for cardiac health back in 2007. Based on multiple clinical and population studies, he proposed that an Omega 3 Index of 4% was associated with high heart attack risk, and an Omega-3 Index of 8% was associated with low heart attack risk. This has been supported by a recent meta-analysis of 10 clinical studies showing that an Omega-3 Index of 8% was associated with a 35% reduction in cardiovascular death compared to an Omega-3 Index of 4%.

Other studies suggest that an Omega-3 Index of 8% is associated with:

  • A slower rate of telomere shortening.
  • A lower risk of death from any cause.
  • Reduction in symptoms of depression.
  • Improved recovery from a heart attack.
  • Reduction in arthritis symptoms.
  • Reduced age-related brain shrinkage in B-vitamin treated subjects. (I have written about the synergistic relationship between omega-3s and B vitamins with respect to brain health in a previous issue  of “Health Tips From the Professor.”

(Note: You will find references to these studies in the paper I have cited.)

For reference, most Americans have an Omega-3 Index between 4 and 6%. In contrast, in Japan, where the incidence of heart disease is much lower, the Omega-3 Index ranges from 6.8% to 9%.

How Was The Study Designed?

how much omega-3s do you need studyThe data for this study were derived from 3458 individuals who 1) sent in a dried blood spot to a commercial laboratory for determination of Omega-3 Index between March 30, 2017 and January 15, 2018, 2) filled out a short questionnaire about fish intake and omega-3 supplement use, and 3) were older than 18.

With respect to fish intake, the possible responses were “none per week,” “every other week,” “every week,” “2 times per week,” and “3 or more times per week.”

With respect to omega-3 supplement use, those who reported taking an omega-3 supplement were asked what kind of omega-3 supplement they were taking. Those who said they were taking a flaxseed oil supplement were excluded from the analysis because flaxseed oil contains no EPA or DHA.

The characteristics of the population studied were as follows:

  • 84% came from the United States. The remaining 16% came from 27 other countries.
  • The average age was 51 years and 40% of the respondents were male.
  • 62% ate little or no fish. The exact breakdown of fish consumption was:
    • 5% ate no fish.
    • 9% ate fish every other week.
    • 6% ate fish weekly.
    • 2% ate fish twice a week.
    • 8% ate fish three or more times a week.
  • 52% took omega-3 supplements. Of those taking omega-3 supplements, 84% were taking fish oil supplements.

 

How Much Omega-3s Do You Need?

how much omega-3s do you need supplementsThe correlation between omega-3 intake and Omega-3 Index in these individuals was:

  • No fish = 4.5%.
    • No fish + supplementation = 6.6%.
  • Bi-weekly = 4.8%
    • Bi-weekly + supplementation = 6.9%
  • Weekly = 5.1%
    • Weekly + supplementation = 7.3%
  • Twice weekly = 5.7%
    • Twice weekly + supplementation = 7.8%
  • 3+ times per week = 6.5%
    • 3+ times per week + supplementation = 8.6%

The authors said: “We found that those with the best chance of achieving a desirable Omega-3 Index were reporting the consumption of at least 3 fish meals per week and were taking an EPA + DHA-containing omega-3 supplement.”

The authors further concluded that an EPA + DHA intake of around 835 mg per day or higher would be required to achieve an average Omega-3 Index of 8%. This was based on two assumptions:

  • A 4 once serving of oily fish provides around 1,200 mg of EPA + DHA.
  • The average omega-3 supplement provides around 300 mg of EPA + DHA.

 

What Are The Limitations Of The Study?

The two biggest limitations of the study are the assumptions that a serving of fish provides 1,200 mg of EPA + DHA and a fish oil supplement provides 300 mg of EPA + DHA.

  • Their dietary survey did not ask what kind of fish the respondents were consuming. Some fish provide much less than 1,200 mg of EPA + DHA per serving. This could have caused the authors to overestimate the contribution that fish intake made to the Omega-3 Index in their study.
  • Some omega-3 supplements provide more than 300 mg EPA + DHA, and some people take more than the recommended number of omega-3 capsules. This could have caused the authors to underestimate the contribution of omega-3 supplements to the Omega-3 Index in their study.

The major implication of these limitations comes when we look at the standard deviation of the correlations between omega-3 intake and Omega-3 Index.

  • Some people consuming 3 or more servings of fish per week had an Omega-3 Index of well above 8%. This suggests that diet alone can allow you to reach an optimal Omega-3 Index. This conclusion is also supported by dietary studies in Japan (see below).
  • Some people taking omega-3 supplements had an omega-3 index of above 8% even in the group consuming no fish. This suggests that supplementation alone can allow you to reach an optimal Omega-3 Index as long as your total EPA + DHA intake is 835 mg/day or greater.

These limitations may also affect the calculation of how much EPA + DHA we need to reach an optimal Omega-3 Index. For example, the most widely used omega-3 calculator estimates that you would need 950 mg of EPA + DHA to increase your Omega-3 Index from 4% to 8%.

 

What Does This Study Mean For You?

how much omega-3s do you needAt the beginning of this article I said that this study answered 4 questions:

  • How much omega-3s do you need to significantly reduce your risk of heart attack?
    • This study estimated that around 835 mg/day of EPA + DHA is needed to reach an Omega-3 Index of 8%, which previous studies have shown to be associated with low heart disease risk.
    • This is similar to the 950 mg/day estimate from a widely used omega-3 calculator.
    • There is considerable individual variability, but 835 – 950 mg/day is a good target for most people. If in doubt, I recommend that you get your Omega-3 Index tested.
  • Will that amount of omega-3s provide other health benefits?
    • The evidence is strongest for heart health, but this paper lists other studies suggesting that a high Omega-3 Index is associated with reduced risk of depression, arthritis, age-related brain shrinkage & cognitive decline, and death from all causes.
  • Can you get that amount of omega-3s from diet alone?
    • In this study an optimal Omega-3 Index was achieved only in the group that consumed 3 or more servings of fish per week and took an omega-3 supplement. However, not all those fish were rich in EPA + DHA.
    • Previous studies have shown that Japanese who consume 3 or more servings per week of oily fish, rich in EPA + DHA, have an Omega-3 Index of 6.8% to 9%. This shows us it is possible to reach an optimal Omega-3 Index from diet alone.
  • Can you get that amount of omega-3s from supplementation alone?
    • Here the answer is clearly yes. Based on this and other studies, it would require in the range of 835-950 mg/day from supplementation to reach an optimal Omega-3 Index for most people.

 

Here are some other conclusions from the authors of the study:

  • “The average Omega3 Index in Japan ranges from 6.8 to 9.0%…So, yes, an Omega-3 Index of >8% is achievable by diet alone. But Japan is fairly unique…The average Omega-3 Index for Americans ranges from 4 to 6%. So, short of adopting the Japanese diet for a lifetime, it appears that taking an EPA + DHA supplement could be an important strategy for achieving a cardioprotective Omega-3 Index.”
  • They consider current recommendations for omega-3 intake to be inadequate. Their recommended intake of 835 mg of EPA + DHA per day is:
    • “>3 times the EPA + DHA recommended by the Dietary Guidelines for Americans (250 mg/day).”
    • “1.7 times the amount recommended by the Academy of Nutrition and Dietetics (500 mg/day).”
    • “8 times higher than the typical EPA + DHA intake in the US (~100 mg/day).”
  • The American Heart Association currently recommends the consumption of 1-2 seafood meals per week.
  • The authors commented: “We do recognize that public health recommendations must balance what is ideal vs. what is practical for the public and must also take into consideration…potentially hazardous components of fish (mercury, PCBs) and the sustainability of the world’s fish supply.”
  • However, they considered the recommendation of the American Heart Association to be woefully inadequate. Based on their data, they concluded: “To achieve an Omega-3 Index of >8%, either adding an EPA + DHA supplement or increasing to 4-5 servings of fish/week would be necessary.”

Because of the high level of contamination of the world’s fish supply, my personal preference would be to add a high purity omega-3 supplement to my diet rather than consuming fish multiple times a week. I love salmon, but I try to limit myself to a salmon dinner no more than once a month.

 

The Bottom Line

 

A recent study looked at how much EPA + DHA you would need to achieve an optimal omega-3 status. The investigators used a measurement called Omega-3 Index, which has been shown to be an excellent measurement of omega-3 status. They asked how much EPA + DHA from diet plus supplementation was required to achieve an Omega-3 Index of 8%, which is associated with a low risk for heart disease. The key findings from this study were:

  • Around 835 mg/day of EPA + DHA is needed to reach an Omega-3 Index of 8%.
  • This is similar to the 950 mg/day estimate from a widely used omega-3 calculator.
  • There is considerable individual variability, but 835 – 950 mg/day is a good target for most people. If in doubt, I recommend that you get your Omega-3 Index tested.
  • The Japanese eat EPA + DHA-rich fish 3 or more times per week and have an Omega-3 Index of 6.9 to 9.0%, so it is clearly possible to achieve an optimal Omega-3 Index from diet alone. However, the American diet is so different from the Japanese diet that the authors concluded: “Short of adopting the Japanese diet for a lifetime, it appears that taking an EPA + DHA supplement could be an important strategy for achieving a cardioprotective Omega-3 Index.”
  • The American Heart Association currently recommends the consumption of 1-2 seafood meals/week. The authors consider this recommendation to be woefully inadequate. They said: “To achieve an Omega-3 Index of >8%, either adding an EPA + DHA supplement or increasing to 4-5 servings of fish/week would be necessary.”

Because of the high level of contamination of the world’s fish supply, my personal preference is to add a high purity omega-3 supplement to my diet rather than consuming fish multiple times a week. I love salmon, but I try to limit myself to a salmon dinner no more than once a month.

 

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.

Side Stitch Pain Relief and Intercostal Muscles

Written by Dr. Steve Chaney on . Posted in Side Stitch Pain

You Don’t Need To Suffer Pain In The Side After A Bout With The Flu

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Happy Valentine’s Day

 

valentine's dayWhile February is the shortest month of the year, to our northern family and friends it is the longest, seemingly endless, month.  Where I live in Sarasota, Florida, winter brings us near-perfect days and cooler nights.  It’s my favorite time of year.  And of course, we all celebrate the holiday of love – Valentine’s Day!

Just a bit of trivia: In 1868, Richard Cadbury released the first Valentine’s Day box of chocolates, followed in 1902 with the first conversation hearts from the New England Confectionery Company. In the 1840s Esther A. Howland created the first commercial Valentine’s Day cards in the United States. Hallmark first offered Valentine’s Day cards in 1913 and began producing them in 1916.  (Thanks to Wikipedia for all this interesting info).

February Is Also Flu Season –

A Tough Month For Colds & Coughs

How do you get side stitch pain releif?  Have you ever had a cough that just lingers on and on?  Sometimes you may cough so hard, and so much, that your side hurts. Some people call it a “side-stitch” because it feels like a sewing needle is being jammed in between your ribs.  First it only hurts when you have a coughing fit, but eventually it could hurt just from breathing.  Fortunately, it’s a simple thing to explain, and even easier to treat. It is caused by spasms in our intercostal muscles.

 

What Are Intercostal Muscles & What Do They Do?

 

side stitch painThe intercostal muscles are between each rib, and like every other muscle they contract (shorten) and expand (lengthen).  Visualize muscles going up and down between each rib, connecting one rib to the next rib.

When you breathe in the intercostal muscles must lengthen to allow your ribs to separate so your lungs can expand and absorb oxygen.

In order to breath out, the muscles must contract and pull your ribs together. This puts pressure on your lungs so you can expel carbon dioxide from your body.

 

Coughing Causes Tiny Spasms In The Intercostal Muscles

 

side stitch pain coughWhen you cough your ribs open and close suddenly. This isn’t a problem if you cough once or twice, but if you have a condition such as a cold, the flu or pneumonia, you may have severe and repeated coughing spells. This causes a repetitive strain injury to the intercostal muscles as you are coughing repeatedly.

The tiny intercostal muscles are rapidly contracting and expanding, without a chance to relax.  Eventually tiny muscle spasms are created in the muscles, each one shortening the muscle fibers. The spasms cause a strain to be put onto the attachment at the rib, laying the groundwork for a side-stitch. The strained muscle fibers prevent your ribs from opening properly as you take in a breath. As you gasp for air during your coughing attack, you are forcing your ribs to part, and the tight muscle is putting a strain on the bone. The strain feels like a needle or the point of a knife is being pushed into your side.

 

How To Release Muscle Spasms In The Intercostal Muscles

Using your opposite hand press your fingertip(s) into the exact point where you feel the pain.  These spasms are specific, and they hurt exactly where you are feeling the pain.

Hold the pressure on the spasm for about one minute. You’ll feel the pain lessen as the spasm releases. Continue pressing on the point while you take in a slow, deep breath.  Your goal is to open your rib cage as much as possible.

As you are pressing on the spasm and opening your rib cage so your lungs can fill with air, you are also stretching the intercostal muscle that was in spasm.  Do this several times until the point no longer is painful.  Press around your entire rib cage, as far as you can reach, and see if you find any other spasms between your ribs.  If you do, treat each one the same way.

Fortunately, it is simple to self-treat spasms that cause pain. This is the case whether you are treating spasms that cause headaches, shoulder pain, low back pain, hip, knee, leg or foot pain. In fact, I resolved debilitating carpal tunnel syndrome by treating the muscles that impact the median nerve &/or my wrist and hand.  For more information, visit www.JulstroMethod.com.

 

Wishing you well,

 

Julie Donnelly

 

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.

 

About The Author

julie donnellyJulie 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.

Can You Believe Clinical Studies

Written by Dr. Steve Chaney on . Posted in Believe Clinical Studies

The “Secret” About Clinical Studies Nobody Is Telling You

Author: Dr. Stephen Chaney

 

can you believe clinical studiesIt is so confusing. You get lots of advice in today’s world.

  • Your friend shares a new diet they read about and tells you how well it worked for her.
  • Your trainer puts you on a diet his sports guru recommended.
  • You read Dr. Strangelove’s health blog and decide you need to throw out all the foods in your refrigerator.
  • Your doctor tells you what you should eat and whether you should take supplements.
  • You decide to follow the recommendations of the American Heart Association or American Diabetes Association because they are the experts.

The problem is you are told all this advice is based on clinical studies – AND – most of the advice is conflicting. You don’t know who to believe, and, even worse, you are starting to wonder whether you can believe clinical studies.

I have covered the source of much of this confusion in my two books “Slaying The Food Myths”  and “Slaying The Supplement Myths.”  The Cliff Notes summary from these books is:

  • The placebo effect approaches 50% for things like feeling good, energy and mood.
  • Reputable scientists ignore testimonials and look for clinical proof.
  • What works for your friend or trainer may not work for you.
  • Any extreme diet that eliminates foods and food groups from your diet will cause short-term weight loss and improvements in health parameters like cholesterol, blood sugar, and blood pressure.
  • Reputable scientists look for studies documenting the long-term health outcomes of those diets. Some diets that look healthy short-term are unhealthy long-term.
  • Advocates of these fad diets emphasize short-term successes of their favorite diet and don’t even look for studies on long-term health outcomes.

Every clinical study has its flaws.

  • can you believe clinical studies doctorReputable scientists recognize this and don’t base their recommendations on individual studies. Instead, they base their recommendation on the preponderance of evidence from multiple studies.
  • Strangelove and other bloggers don’t understand that. They select studies that support their viewpoint and ignore the rest.
  • Some clinical studies are better than others. In fact, some really bad clinical studies get published.
  • Reputable scientists know how to distinguish between good studies and bad studies. They ignore bad studies and base their recommendations on good studies.
  • Strangelove, other bloggers, and the news media aren’t scientists. They don’t know how to distinguish between good and bad studies. They simply report the studies that support their viewpoint.
  • Strangelove, other bloggers, and the new media prefer audience over accuracy. They measure success by the number of readers rather than the accuracy of their articles.
  • “Man bites dog” stories gather the most readers. Dr. Strangelove and the media focus on studies that challenge the advice you have been getting from the health and nutrition establishment. The studies may not be accurate, but they attract a lot of readers.
  • Responsible scientists will give you the boring truth, even if it doesn’t attract many readers.

In my books I help you navigate through the world of conflicting clinical studies, so you can base your decisions on the very best clinical studies. However, there is one more “secret” you need to know. It is one that every scientist knows, but the public almost never hears about.

However, before I tell you the secret, let me set up this discussion by talking about glycemic index and use one food, the lowly banana, as an example.

 

Glycemic Index – How Sweet It Is

can you believe clinical studies glycemic indexIf you are a diabetic or are following one of the many low-carb diets, you probably know all about glycemic index. You probably have a glycemic index list in your kitchen or on your phone. You probably consult that list often to determine which foods you can eat and which you can’t. (If you aren’t familiar with the term, it is simply a measure of how big a blood sugar increase each food causes).

What if I were to tell you the glycemic index list you are relying on may not apply to you?

Then there is the lowly banana. You have probably heard from your trainer or favorite nutrition blog that you should avoid bananas because they are too high in sugar. However, if you were to consult a nutrition expert, they would tell you that bananas are a great choice. Bananas are nutrient powerhouses. In addition, a ripe banana has a glycemic index of 51 and anything under 55 is considered low-glycemic.

What if I were to tell you that the advice about bananas that both your trainer and nutrition experts give you is correct for some people? You just need to find out which advice applies to you.

 

The Secret About Clinical Studies Nobody Is Telling You

 

can you believe clinical studies secretNow, you are ready to learn the secret. It is this: Clinical studies are based on averages, and none of us are average. Because of that, even the very best clinical study results may not apply to you.

In a way, this reminds me of “The Wizard Of Oz.” You remember the story. If you were sitting in front of the curtain, the wizard was impressive. He was all powerful. He was making learned pronouncements about the way things should be. But, behind the curtain, the reality was quite different.

The authors of most clinical studies and most nutrition gurus make learned pronouncements about the life changes you should make based on the results of their study. They seldom let you peak behind the curtain to see how much the results vary from one individual to the next.

One exception is a recent study that reported individual variation in blood sugar responses to various foods. There are lots of examples from that study I could share with you, but I will use bananas versus sugar cookies as an example.

When they reported average values, bananas had a glycemic index of 51 and sugar cookies had a glycemic index of around 59. Both of those values are very close to what you find in most glycemic index lists.

The glycemic index of a banana is only 13% less than the glycemic index of sugar cookies. However, since the cut-off between high and low glycemic indices is 55, bananas are classified as low-glycemic and sugar cookies are classified as high-glycemic. According to conventional wisdom, bananas are good for you and sugar cookies are bad for you. But, what about individual variation? Does that wisdom really apply to you?

can you believe clinical studies blood sugarBased on the range of blood-sugar responses reported in the paper, I have created the scatter plot on the left to help you visualize the range of individual responses. The horizontal line represents the average glycemic index for sugar cookies and bananas. The dots represent the glycemic response of individuals in the study. For some people in the study the glycemic response to bananas was greater than the average glycemic response to sugar cookies. For other individuals the glycemic response to sugar cookies was less than the average glycemic response to bananas.

You can see the extent of individual variability even more clearly in the figure on the right, which was reproduced from one of the figures in the paper. The authors reported that for some individuals, bananas caused no increase in blood sugar while sugar cookies caused a big spike in blood sugar (the response most people would expect). However, for other individuals, sugar cookies caused no increase in blood sugar while bananas caused a big spike in blood sugar.

can you believe clinical studies glycemic loadNow you understand why I told you the glycemic list you are relying on may not apply to you. You also understand why I said the advice you have been given about bananas might not apply to you.

Lest you think this just applies to bananas, the same study reported that individual blood sugar responses varied by:

  • 4-fold for sugar-sweetened soft drinks, grapes, and apples.
  • 5-fold for rice.
  • 6-fold for bread and potatoes.
  • 7-fold for ice cream and dates.

 

Can You Believe Clinical Studies?

 

can you believe clinical studies provenI used glycemic index as an example. The same principle is true for almost any clinical study.

Let’s consider clinical studies looking at the effect of diet on health outcomes such as heart disease.

  • The headlines may say that a particular diet significantly decreases your risk of heart disease.
  • When you read the paper behind the headlines, you discover that the diet decreases heart disease by 15%. That result may be statistically significant, but it is hardly life changing.
  • If you could peak behind the curtain you might discover that the diet cut heart disease risk in half for some individuals and had no effect on heart disease risk for others.

Clinical studies looking at weight loss are another example.

  • You might be told “Clinical studies show people who follow diet X lose 12 pounds in 6 weeks”.
  • That’s an average value. If you could peak behind the curtain, you would discover that nobody lost exactly 12 pounds. Some lost more. Some lost less. Some may have actually gained weight.

I am not saying that well-designed clinical studies are useless. They are a good foundation for general nutrition guidelines. What I am saying is that not every nutritional guideline applies to you.

What Does This Study Mean For You?

Some of you may be saying: “What does this mean for me?” When you carry the concept of individual variability through to its ultimate conclusion, the bottom line message is:

  • Conclusions from clinical trial results are based on averages – none of us are average.
  • Daily Values (DV) are based on averages – none of us are average.
  • Nutritional recommendations for optimal health are based on averages – none of us are average.
  • The identified risk factors for developing diseases are based on averages – none of us are average.
  • Glycemic index lists are based on averages. None of us are average.

That means lots of the advice you may be getting about your risk of developing disease X, the best diet to prevent disease X, the best foods to keep your blood sugar under control, or the role of supplementation in preventing disease X may be generally true – but it might not be true for you.

So, my advice is not to blindly accept the advice of others about what is right for your body. Just because some health guru recommends it, doesn’t mean it is right for you. Just because it worked for your buddy, doesn’t mean it will work for you. Learn to listen to your body. Learn what foods work best for you. Learn what exercises just feel right for you. Learn what supplementation does for you.

Don’t ignore your doctor’s recommendations, but don’t be afraid to take on some of the responsibility for your own health. You are a unique individual, and nobody else knows what it is like to be you.

 

Final Thought: Glycemic Index Versus Glycemic Load

Since I used glycemic index as an example in this discussion, I feel obligated to discuss the difference between glycemic index and glycemic load. Glycemic index is based on the blood sugar response to 50 gm of carbohydrate in various foods. Glycemic load is based on the blood sugar response to a serving of that food. In some cases, that’s a big difference.

Glycemic index can sometimes be deceiving. Let me give you two examples. Carrots and watermelon are often found on lists of high glycemic foods. If that sounds a bit weird to you, it is.

One serving (one medium carrot) of carrots has 6 grams of carbohydrate (of which, only 2.9 grams is sugar). To get 50 grams of carbohydrate, you would need to eat 8 carrots. Watermelon is, not surprisingly, mostly water. One serving (a 1-inch thick sliced wedge or one cup) of watermelon contains 11 grams of carbohydrate (of which, 9 grams of sugar). To get 50 grams of sugar, you would need to eat 4.5 cups of watermelon. For both carrots and watermelon, their glycemic load is a more accurate measure of their effect on your blood sugar than is their glycemic index.

Leaving individual variation out of consideration, here is a simple guide for choosing low-glycemic foods if you are trying to control your blood sugar levels.

  • Foods with a low glycemic index are generally a good choice.
  • Many foods with a high glycemic index also have a high glycemic load.
  • If you are uncertain about some foods on the high glycemic index list, also check their glycemic load.

 

The Bottom Line

Clinical studies are the bedrock on which we build recommendations for diet, exercise, and supplementation. In the article above I discuss how to distinguish between good and bad clinical studies. I also discuss how individual variability influences the interpretation of clinical studies.

 

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.

Does Magnesium Optimize Vitamin D Levels?

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

The Case For Holistic Supplementation

Author: Dr. Stephen Chaney

 

Does magnesium optimize vitamin D levels?

magnesium optimize vitamin dOne of the great mysteries about vitamin D is the lack of correlation between vitamin D intake and blood levels of its active metabolite, 25-hydroxyvitamin D. Many people who consume RDA levels of vitamin D from foods and/or supplements end up with low blood levels of 25-hydroxyvitamin D. The reason(s) for this discrepancy between intake of vitamin D and blood levels of its active metabolite are not currently understood.

Another great mystery is why it has been so difficult to demonstrate benefits of vitamin D supplementation. Association studies show a strong correlation between optimal 25-hydroxyvitamin D levels and reduced risk of heart disease, cancer, and other diseases. However, placebo-controlled clinical trials of vitamin D supplementation have often come up empty. Until recently, many of those studies did not measure 25-hydroxyvitamin D levels. Could it be that optimal levels of 25-hydroxyvitamin D were not achieved?

The authors of the current study hypothesized that optimal magnesium status might be required for vitamin D conversion to its active form. You are probably wondering why magnesium would influence vitamin D metabolism. I had the same question.

The authors pointed out that:

  • Magnesium status affects the activities of enzymes involved in both the synthesis and degradation of 25-hydroxyvitamin D.
  • Some clinical studies have suggested that magnesium intake interacts with vitamin D intake in affecting health outcomes.
  • If the author’s hypothesis is correct, it is a concern because magnesium deficiency is prevalent in this country. In their “Fact Sheet For Health Professionals,” the NIH states that “…a majority of Americans of all ages ingest less magnesium from food than their respective EARs [Estimated Average Requirement]; adult men aged 71 years and older and adolescent females are most likely to have low intakes.” Other sources have indicated that magnesium deficiency may approach 70-80% for adults over 70.

If the author’s hypothesis that magnesium is required for vitamin D activation is correct and most Americans are deficient in magnesium, this raises some troubling questions.

  • Most vitamin D supplements do not contain magnesium. If people aren’t getting supplemental magnesium from another source, they may not be optimally utilizing the vitamin D in the supplements.
  • Most clinical studies involving vitamin D do not also include magnesium. If most of the study participants are deficient in magnesium, it might explain why it has been so difficult to show benefits from vitamin D supplementation.

Thus the authors devised a study (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018 ) to directly test their hypothesis.

 

How Was The Study Designed?

magnesium optimize vitamin d studyThe authors recruited 180 volunteers, aged 40-85, from an ongoing study on the prevention of colon cancer being conducted at Vanderbilt University. The duration of the study was 12 weeks. Blood was drawn at the beginning of the study to measure baseline 25-hydroxyvitamin D levels. Three additional blood draws to determine 25-hydroxyvitamin D levels were performed at weeks 1, 6, and 12.

Because high blood calcium levels increase excretion of magnesium, the authors individualized magnesium intake based on “optimizing” the calcium to magnesium ratio in the diet rather than giving everyone the same amount of magnesium. The dietary calcium to magnesium ratio for most Americans is 2.6 to 1 or higher. Based on their previous work, they considered an “ideal” calcium to magnesium ratio to be 2.3 to 1. The mean daily dose of magnesium supplementation in this study was 205 mg, with a range from 77 to 390 mg to achieve the “ideal” calcium to magnesium ratio. The placebo was an identical gel capsule containing microcrystalline cellulose.

Two 24-hour dietary recalls were conducted at baseline to determine baseline dietary intake of calcium and magnesium. Four additional 24-hour dietary recalls were performed during the 12-week study to assure that calcium intake was unchanged and the calcium to magnesium ratio of 2.3 to 1 was achieved.

In short this was a small study, but it was very well designed to test the author’s hypothesis.

 

Does Magnesium Optimize Vitamin D Levels?

 

does magnesium optimize vitamin d levelsThis was a very complex study, so I am simplifying it for this discussion. For full details, I refer you to the journal article (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018).

The most significant finding was that magnesium supplementation did affect blood levels of 25-hydroxyvitamin D. However, the effect of magnesium supplementation varied depending on the baseline 25-hydroxyvitamin D level at the beginning of the study.

  • When the baseline 25-hydroxyvitamin D was 20 ng/ml or less (which the NIH considers inadequate), magnesium supplementation had no effect on 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D was 20-30 ng/ml (which the NIH considers the lower end of the adequate range), magnesium supplementation increased 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D level approached 50 ng/ml (which the NIH says may be “associated with adverse effects”), magnesium supplementation lowered 25-hydroxyvitamin D levels.

The simplest interpretation of these results is:

  • When vitamin D intake is inadequate, magnesium cannot magically create 25-hydroxyvitamin D from thin air.
  • When vitamin D intake is adequate, magnesium can enhance the conversion of vitamin D to 25-hydroxyvitamin D.
  • When vitamin D intake is too high, magnesium can help protect you by lowering 25-hydroxyvitamin D levels.

The authors concluded: “Our findings suggest that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. Further dosing studies are warranted…”

 

What Does This Study Mean For You?

magnesium optimize vitamin d for youThis was a groundbreaking study that has provided novel and interesting results.

  • It provides the first evidence that optimal magnesium status may be required for optimizing the conversion of vitamin D to 25-hydroxyvitamin D.
  • It suggests that optimal magnesium status can help normalize 25-hydroxyvitamin D levels by increasing low levels and decreasing high levels.

However, this was a small study and, like any groundbreaking study, has significant limitations. For a complete discussion of the limitations and strengths of this study I refer you to the editorial (S Lin and Q Liu, American Journal of Clinical Nutrition, 108: 1159-1161, 2018) that accompanied the study.

In summary, this study needs to be replicated by larger clinical studies with a more diverse study population. In order to provide meaningful results, those studies would need to carefully control and monitor calcium, magnesium, and vitamin D intake. There is also a need for mechanistic studies to better understand how magnesium can both increase low 25-hydroxyvitamin D levels and decrease high 25-hydroxyvitamin D levels.

However, assuming the conclusions of this study to be true, it has some interesting implications:

  • If you are taking a vitamin D supplement, you should probably make sure that you are also getting the DV (400 mg) of magnesium from diet plus supplementation.
  • If you are taking a calcium supplement, you should check that it also provides a significant amount of magnesium. If not, change supplements or make sure that you get the DV for magnesium elsewhere.
  • I am suggesting that you shoot for the DV (400 mg) of magnesium rather than reading every label and calculating the calcium to magnesium ratio. The “ideal” ratio of 2.3 to 1 is hypothetical at this point. A supplement providing the DV of both calcium and magnesium would have a calcium to magnesium ratio of 2.5, and I would not fault any manufacturer for providing you with the DV of both nutrients.
  • If you are taking high amounts of calcium, I would recommend a supplement that has a calcium to magnesium ratio of 2.5 or less.
  • If you are considering a magnesium supplement to optimize your magnesium status, you should be aware that magnesium can cause gas, bloating, and diarrhea. I would recommend a sustained release magnesium supplement.
  • Finally, whole grains and legumes are among your best dietary sources of magnesium. Forget those diets that tell you to eliminate whole food groups. They are likely to leave you magnesium-deficient.

Even if the conclusions of this study are not confirmed by subsequent studies, we need to remember that magnesium is an essential nutrient with many health benefits and that most Americans do not get enough magnesium in their diet. The recommendations I have made for optimizing magnesium status are common-sense recommendations that apply to all of us.

 

The Case For Holistic Supplementation

 

magnesium optimize vitamin d case for holistic supplementationThis study is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No”. Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are they didn’t also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal.

That’s because most doctors and nutrition experts still think of nutrients as “magic bullets.” I cover holistic supplementation in detail in my book “Slaying The Supplement Myths.”  Other examples that make a case for holistic supplementation that I cover in my book include:

  • A study showing that omega-3 fatty acids and B vitamins may work together to prevent cognitive decline. Unfortunately, most studies looking at the effect of B vitamins on cognitive decline have not considered omega-3 status and vice versa. No wonder those studies have produced inconsistent results.
  • Studies looking at the effect of calcium supplementation on loss of bone density in the elderly have often failed to include vitamin D, magnesium, and other nutrients that are needed for building healthy bone. They have also failed to include exercise, which is essential for building healthy bone. No wonder some of those studies have failed to find an effect of calcium supplementation on bone density.
  • A study reported that selenium and vitamin E by themselves might increase prostate cancer risk. Those were the headlines you might have seen. The same study showed Vitamin E and selenium together did not increase prostate cancer risk. Somehow that part of the study was never mentioned.
  • A study reported that high levels of individual B vitamins increased mortality slightly. Those were the headlines you might have seen. The same study showed that when the same B vitamins were combined in a B complex supplement, mortality decreased. Somehow that observation never made the headlines.
  • A 20-year study reported that a holistic approach to supplementation produced significantly better health outcomes.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. When we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to our diet. I mentioned earlier that whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies of nutrients, phytonutrients, specific types of fiber, and the healthy gut bacteria that use that fiber as their preferred food source.

The Bottom Line

 

A recent study suggests that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. This is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No.”  Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are he or she did not also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal. That may be why so many of those studies have failed to find any benefit of vitamin D supplementation.

I cover holistic supplementation in detail in my book “Slaying The Supplement Myths” and provide several other examples where a holistic approach to supplementation is superior to taking individual supplements.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. Whenever we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to what we eat. For example, whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies.

For more details about the current study and what it means to you 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.

Soy And Breast Cancer Survivors

Written by Dr. Steve Chaney on . Posted in Soy and Breast Cancer, Soy and Cancer

Do Soy & Cruciferous Vegetables Reduce Breast Cancer Treatment-Related Symptoms?

Author: Dr. Stephen Chaney

 

soy and breast cancer survivorsThe topic of soy and breast cancer has been a controversial subject for years. If you read Dr. Strangelove’s nutrition blogs, you would be led to believe that soy causes breast cancer and shortens the lifespan of breast cancer survivors.

This is one of the many myths I have debunked in my book “Slaying The Supplement Myths.” Multiple clinical studies have proven that soy reduces the likelihood of developing breast cancer. Several clinical studies have shown it also decreases recurrence of breast cancer and enhances survival following breast cancer treatment. Other clinical studies have found no effect of soy on recurrence or longevity in breast cancer survivors. Zero studies have found any detrimental effects of soy in breast cancer survivors.

So, is there a true relationship between soy and breast cancer survivors?  These studies have all shown that soy is part of a healthy diet and should not be feared by women who have survived breast cancer.

Breast cancer survivors suffer from several treatment-related side effects. These include menopausal symptoms, fatigue, joint problems, hair thinning, and memory loss.

The most recent headlines claim that soy and cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts, kale and related vegetables) decrease menopause and other treatment-related symptoms in breast cancer survivors. If you have seen those headlines, you are probably wondering:

  • Are they true?
  • Should I increase soy consumption following breast cancer treatment?

How Was The Study Designed?

soy and breast cancer survivors studyThis study (SJO Nomura et al, Breast Cancer Research and Treatment, 168: 467-479) enrolled 192 Chinese-American and 173 non-Hispanic White women in the San Francisco Bay area between 2006 and 2012. The average age of the women was 57. They were all breast cancer survivors who had been treated 1-5 years previously. Most had been treated at least 2 years previously.

The participants were recruited by mail and filled out questionnaires which provided demographic data, health information, and information on treatment-related symptoms. They also filled out a food frequency questionnaire designed to estimate intake of soy foods and cruciferous vegetables.

In terms of food consumption, the range was:

  • 0 to 24 gram/day for soy.
  • <33 grams/day to >71 grams/day for cruciferous vegetables. For reference, one serving (1/2 cup) of cooked broccoli weighs 78 grams.

 

Soy And Breast Cancer Survivors?

 

soy and breast cancer survivors dietIn looking at the effect of soy and cruciferous vegetables on treatment-related symptoms, it is important to understand that the two groups of women had different baseline characteristics.

  • The Chinese-American women had a higher average intake of both soy and cruciferous vegetables.
  • The Non-Hispanic White women were more likely to experience treatment-related worsening of menopausal symptoms.
  • The Chinese-American women were more likely to experience fatigue, joint problems, hair thinning, and memory loss.

With that in mind, here are the results of the study:

Soy intake:

  • soy and breast cancer survivors cruciferous vegetablesWhen all women in the study were grouped together, high (>24 grams/day) versus low (0 grams/day) soy intake was associated with a 57% reduction in fatigue.
  • For Non-Hispanic White women high versus low soy intake was associated with a 71% reduction in menopause symptoms and a 75% reduction in fatigue.
  • The effect of soy on treatment-related symptoms was non-significant for Chinese-American women, perhaps because the baseline intake of soy was greater for this group.

Cruciferous vegetable intake:

  • When all women in the study were grouped together, high (>71 grams/day) versus low (<33 grams/day) cruciferous vegetable intake was associated with a 50% reduction in menopause symptoms.
  • For Chinese-American women, high versus low intake of cruciferous vegetables was associated with a 39% reduction in memory loss.
  • The effect of cruciferous vegetables on treatment-related symptoms was non-significant for Non-Hispanic White women.

The authors concluded: “In this population of breast cancer survivors, higher soy and cruciferous vegetable intake was associated with less treatment-related menopausal symptoms and fatigue. To confirm study findings, additional research is needed that explores the relationship between diet and breast cancer treatment-related symptoms…in a larger, diverse study population.”

What Does This Study Mean For You?

soy and breast cancer survivors meaning for youThis is a small, preliminary study that needs to be repeated before any definitive recommendations can be made. Here are my take-home points from this study.

  • Soy is an excellent source of high-quality plant protein. We already know there is no reason to avoid soy following breast cancer treatment. This study provides another reason to include soy as part of a healthy, plant-based diet following treatment. This study also provides a rationale for including cruciferous vegetables as part of a healthy, plant-based diet following treatment.
  • However, 24 grams of soy represents a single serving of many soy foods. This study does not provide a rationale to increase soy consumption beyond a single serving.
  • The danger after studies like this are publicized is that breast cancer survivors will just focus on soy and cruciferous vegetables in their diet. This study looked at the effects of soy and cruciferous vegetables based on their potential effects on menopausal symptoms. However, they are just two components of a healthy, plant-based diet, and we know that primarily plant-based diets are associated with a decreased risk of breast cancer.

In my opinion, we need to focus less on “magic bullet” approaches (single nutrients and single foods) and focus more on holistic approaches. We should be asking how holistic, healthy diets influence recovery from breast cancer and reduction of treatment-related symptoms. We should be encouraging breast cancer survivors to focus on all aspects of a healthy diet, not just soy and cruciferous vegetables.

 

The Bottom Line

 

The topic of soy and breast cancer has been a controversial subject for years. If you read Dr. Strangelove’s nutrition blogs, you would be led to believe that soy causes breast cancer and shortens the lifespan of breast cancer survivors.

This is one of the many myths I have debunked in my book “Slaying The Supplement Myths.” Multiple clinical studies have shown that soy is part of a healthy diet and should not be feared by women who have survived breast cancer.

The most recent headlines claim that soy and cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts, kale and related vegetables) decrease menopause symptoms and fatigue in breast cancer survivors.

These headlines are based on a small, preliminary study that needs to be repeated before any definitive recommendations can be made. Here are my take-home points from this study.

  • Soy is an excellent source of high-quality plant protein. We already know there is no reason to avoid soy following breast cancer treatment. This study provides another reason to include soy as part of a healthy, plant-based diet following treatment. This study also provides a rationale for including cruciferous vegetables as part of a healthy, plant-based diet following treatment.
  • However, 24 grams of soy represents a single serving of many soy foods. This study does not provide a rationale for increasing soy consumption beyond a single serving.
  • This study focused on soy and cruciferous vegetables based on their potential effects on menopausal symptoms. However, they are just two components of a healthy, plant-based diet, and we know that primarily plant-based diets are associated with a decreased risk of breast cancer. In my opinion, we need to focus less on “magic bullet” approaches (single nutrients and single foods) and focus more on holistic approaches. We should be asking how healthy diets influence recovery from breast cancer and reduction of treatment-related symptoms.

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.

Dairy Products and Heart Disease

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

Will Eating Cheese Help You Live Longer?

Author: Dr. Stephen Chaney

 

dairy products and heart diseaseA recent study is generating lots of headlines. Here are some examples:

  • Eating Dairy Foods Can Help Reduce Heart Disease Risk.
  • Fermented Dairy-Products May Protect Against Heart Attack.
  • Full-Fat Dairy May Actually Benefit Heart Health.
  • Eating Cheese Might Help You Live Longer.
  • Eating Cheese and Butter Every Day Linked To Living Longer.

My favorite headlines were the ones about cheese and longevity. For example, one headline read: “New Study Finds People That Eat Cheese Live Longer.” The article opened by saying “Sprinkle on another handful of mozzarella on your pizza, add an extra slice of American cheese on your burger, or grab a bite of sharp cheddar with your crackers. A new study published in The Lancet claims that eating cheese reduces your risk of stroke and cardiovascular disease. Now that’s something we like to hear.”

A lot of people must like to hear good news about cheese. The headlines about cheese making you live longer outnumbered all the other headlines by about 3 to 1.

In summary, the claims ranged from dairy foods in general to milk & fermented dairy foods, full-fat dairy foods, cheese, and cheese & butter. Let’s look at the study behind the claims to see which of these claims about dairy products and heart disease are true and which are wishful thinking.

 

How Was The Study Designed?

dairy products and heart disease relationshipThe study behind the headlines (M. Dehghan et al. The Lancet, 392: 2288-2297, 2018 ) was a very ambitious study called PURE (Prospective Urban Rural Epidemiology study). It was a large multinational study of 136,384 individuals aged 35-70 from 21 countries in five continents.

At the beginning of the study participants filled out a country-specific food frequency questionnaire. The data from this survey were broken down into total dairy foods, milk, yogurt, cheese, and butter. The data were also subdivided into low-fat and full-fat dairy foods.

The participants were followed for an average of 9.1 years. The outcomes measured at the end of the study were overall mortality, cardiovascular mortality, cardiovascular disease, heart attack, stroke and heart failure. The way these outcomes were measured was also country specific because the way these data are collected varies from country to country. [Note: There were some other outcomes measured, but for the sake of simplicity I have not included them in the discussion. Their omission does not change the discussion.]

Finally, in case you were wondering, this research was not funded by money from the dairy industry.

 

Dairy Products and Heart Disease Risk?

dairy products and heart disease milkThe results were interesting:

  • Higher intake of total dairy foods (>2 servings/day compared with no intake) was associated with a lower risk of overall mortality (17% less), cardiovascular mortality (23% less), cardiovascular disease (22% less) and stroke (34% less). No association of dairy consumption with heart attack or heart failure was seen.
  • Higher intake of milk (>1 serving per day compared with <0.5 servings/day) was associated with a lower risk cardiovascular disease (18% less).
  • Higher intake of yogurt (>1 serving/day compared with <0.5 servings/day) was associated with a lower risk of overall mortality (17% less) and cardiovascular disease (10% less).
  • No significant effect of cheese was observed for any of the outcomes measured.
  • Butter intake was low and was not associated with any of the outcomes measured.

The authors concluded: “We observed that higher dairy consumption was associated with lower risks of mortality and cardiovascular disease, particularly stroke. Our study suggests that consumption of dairy products should not be discouraged and perhaps should even be encouraged in low-income and middle-income countries where dairy consumption is less.”

 

Will Eating Cheese Help You Live Longer?

  • dairy products and heart disease cheeseThe claims you have been seeing about consumption of dairy foods in general, milk, and yoghurt reducing heart attack risk are supported by this study and several other recent studies.
  • I hate to disappoint you, but the claims about cheese and butter consumption reducing cardiovascular disease and extending lifespan are clearly wishful thinking. They are not supported by this study.

The discussion of full-fat versus low-fat dairy products is more complicated. You are undoubtedly aware that most current dietary guidelines recommend avoiding full-fat dairy foods in favor of low-fat alternatives. Studies like this have led some to question whether these dietary guidelines should be changed.

Interestingly, the authors of the PURE study did not make any claims about the benefits of full-fat dairy foods in their discussion of the results. These claims have all come from internet blogs and articles. Why were the authors of the study reluctant to make that claim? To answer that question I turned to reviews of the study published in the Science Media Center by experts in that field of study. Here were some of their comments:

  • Because dietary guidelines recommending the consumption of low-fat dairy foods exist primarily in western countries (specifically, the US, Canada & Europe) the distribution of low-fat dairy and full-fat dairy was not evenly divided between counties. Most of the low-fat dairy consumption occurred in western countries. In contrast, most of the full-fat dairy consumption occurred in developing countries. That introduces a couple of confounding variables that are unique to this study. For example:
    • In developing countries, diets are often primarily plant-based and tend to be low in sugar and highly processed foods, while in western countries, diets are often primarily meat-based and are high in sugar and highly processed foods. The addition of full-fat dairy to a plant-based diet may not have the same effect as adding it to a pizza or hamburger.
  • In developing countries, people with higher incomes, a healthier lifestyle, and better access to health care are often the ones who consume more dairy products. In other words, the PURE study can’t tell us whether consumption of full-fat dairy lead to better health outcomes in those countries or whether wealthier and healthier people in those countries had the means to consume more dairy.
  • In many developing countries, a large segment of the population is lactose intolerant. Increased full-fat dairy consumption by these people would be largely yogurt and other fermented dairy foods which have health benefits of their own.

In short, confounding variables unique to this study make it difficult to say with confidence that full-fat dairy foods were just as beneficial as low-fat dairy foods.

In western countries the results of previous studies are mixed. Some suggest that full-fat dairy foods are just as effective as low-fat dairy foods at reducing heart disease risk. Others report that the primary heart-health benefits come from low-fat dairy foods.

 

Dairy Products and Heart Disease:  Diet Context Matters

dairy products and heart disease dietWhy so much confusion? Some recent studies suggest that diet context matters. Simply put, that means the effect of the overall diet is more important than single food groups (dairy). To illustrate this point, let’s look at two other studies.

The first study (M Chen et al, The American Journal of Clinical Nutrition 104: 1209-1217, 2016 ) was published two years ago by investigators at the Harvard Chan School of Public Health. That study included data from 43,000 men in the Health Professionals Follow-Up Study, 87,000 women in the Nurses’ Health Study, and 90,000 women in the Nurses’ Healthy Study II. All these study participants were from the United States. This study put dairy fat consumption into the context of the overall diet. The main findings were:

  • Full-fat dairy foods did not increase heart disease risk compared to a diet that contains high amounts of refined carbohydrates and sugar (the typical American diet).
  • However, when dairy fat was replaced with the same number of calories from:
    • vegetable fat, the risk of heart disease decreased by 10%.
    • polyunsaturated fat, the risk of heart disease decreased by 24%.
    • healthy carbohydrates (fruits, vegetables, and whole grains), the risk of heart disease decreased by 28%.

In other words, the effect of dairy fat on heart disease depends on the overall diet. If you add dairy fat to an already bad, heart-unhealthy diet, it does not further increase heart disease risk. (This finding may explain why several recent studies of western populations have found no difference between full-fat and low-fat dairy consumption.) However, this study also shows that addition of full-fat dairy to a heart-healthy diet is likely to increase heart disease risk.

The lead author of that study was quoted as saying: “These results suggest that dairy fat is not an optimal type of fat in our diets. Although one can enjoy moderate amounts of full-fat dairy such as cheese, a healthy diet pattern tends to be low in saturated fat. These results strongly support existing recommendations to choose mainly unsaturated fats from vegetable oils, nuts, seeds, avocados, and some oily fish for a heart-healthy diet.”

The second major study is the 7th-Day Adventist study, which I have described in detail in my book “Slaying The Food Myths.”  This study showed that a lacto-ovo vegetarian diet was less heart healthy than a vegan diet but is far heart-healthier than the typical American diet.

 

What Does This Study Mean For You?

dairy products and heart disease questionsDairy foods are good for you: Increased consumption of dairy foods, milk, and yogurt are associated with decreased risk of heart disease. As I have said before, we have 5 food groups for a reason. Dairy foods are an essential part of a healthy diet.

  • If you are lactose-intolerant I have good news for you. Yogurt and other fermented dairy foods are probably even better for you than non-fermented dairy foods.
  • If you are avoiding dairy for other reasons, be sure to get your calcium, magnesium, and vitamin D from other sources. There may be other important nutrients in dairy that are heart-healthy, but these are the ones we are sure of.

The jury is still out on full-fat dairy products: It is best to follow current dietary guidelines and consume primarily low-fat dairy products.

If you are a cheese lover, it is probably OK to consume moderate amounts of cheese or other full-fat dairy foods on occasion as part of a heart-healthy, primarily plant-based diet. In short, it is probably better to add a little cheese to a green salad than it is to add it to pizza or a hamburger. It is probably better to pair your cheddar with an apple than with crackers.

Hopefully, this gives you a better understanding of the relationship between dairy products and heart disease.

 

The Bottom Line 

A recent study looked at the consumption of dairy products and heart disease risk, and overall mortality risk in a study with 134,000 participants from 21 countries on five continents. The media response to this study has been overwhelming. Some of the recent headlines are:

  • Eating Dairy Foods Can Help Reduce Heart Disease Risk.
  • Fermented Dairy-Products May Protect Against Heart Attack.
  • Full-Fat Dairy May Actually Benefit Heart Health.
  • Eating Cheese Might Help You Live Longer.
  • Eating Cheese and Butter Every Day Linked To Living Longer.

The first two claims were supported by the study results. The claims about cheese and butter were wishful thinking. They were not supported by the study results. The claim about full-fat dairy was supported by the data, but the authors of the study did not make that claim because of study limitations.

Another recent study of 220,000 participants in the United States provides a better estimate of the effect of full-fat dairy foods on heart health. The main findings of this study were:

  • Full-fat dairy foods did not increase heart disease risk compared to a diet that contains high amounts of refined carbohydrates and sugar (the typical American diet).
  • However, when dairy fat was replaced with the same number of calories from:
    • vegetable fat, the risk of heart disease decreased by 10%.
    • polyunsaturated fat, the risk of heart disease decreased by 24%.
    • healthy carbohydrates (fruits, vegetables, and whole grains), the risk of heart disease decreased by 28%.

In other words, the effect of dairy fat on heart disease depends on the overall diet. If you add full-fat dairy to an already bad heart-unhealthy diet, it does not further increase heart disease risk. However, if you add full-fat dairy to a heart-healthy diet, it is likely to increase heart disease risk.

For more details and a thorough discussion of the full-fat versus low-fat controversy 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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Can Supplements Help You Live Longer?

Posted June 11, 2019 by Dr. Steve Chaney

Are Supplements The Fountain Of Youth?

Author: Dr. Stephen Chaney

 

It is buyer beware in the supplement industry. I have discussed the dark side of the supplement industry in the first half of my book “Slaying The Supplement Myths.”

I called that section of my book “The Lies of the Charlatans.”  In it, I detailed many of the false claims that some manufacturers make for their supplements. There are claims that their supplements will…

  • Cure what ails you (Just fill in the disease of your choice. Some company will try to tell you they have the cure).
  • Make the pounds melt away.
  • Make you smarter.
  • Make you stronger.
  • Improve your sex life.

Can supplements help you live longer?

The list seems endless…Except for one! I don’t know of any supplement company claiming their supplements make you live longer. Nobody is claiming their supplements are the “Fountain of Youth.”

However, many of you have been asking me about headlines claiming that a recent study showed that supplements don’t extend lives. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

In this issue of “Health Tips From The Professor” I will analyze the study and answer two questions:

  • Is it true?
  • Is it important?

How Was The Study Done?

Every few years the National Center for Health Statistics (a division of the CDC) conducts a massive survey of factors affecting the health of the American population. This survey is called the National Health and Nutrition Examination Survey (NHANES). The NHANES survey includes interviews and examinations of thousands of people across the country.

The interview includes dietary, health-related, demographic, and socioeconomic questions. The examination component includes laboratory tests plus medical, dental, and physiological measurements. The NHANES database is used for many studies such as this one.

The current study (F Chen et al, Annals of Internal Medicine, doi:10.7326/M18-2478, published April 9, 2019) used data from 30,899 US adults aged 20 years or more who participated in 6 cycles of the NHANES survey from 1999 to 2010. The dietary portion of the survey taken by these participants contained questions on the dietary supplements they had used in the 30 days prior to the survey.

The NHANES data were linked to the National Death Index mortality data so that the effect of nutrient intake and supplement use on mortality could be assessed. The median follow-up for the participants in the study was 6.1 years. During that time, 3613 deaths occurred, 945 from heart disease and 805 from cancer.

Of the participants:

  • 71% were white, 11% were non-Hispanic black, and 13% were Hispanic.
  • 9% were female, 49.1% were male.
  • 2 % of the participants reported supplement use in the 30 days preceding the survey.
  • Among the supplement users, the major supplements reported were:
    • Multivitamin/multimineral (74.8%).
    • Vitamin C (40.3%).
    • Calcium (38.6%).
    • Vitamin D (37.6%).
    • Zinc (34.5%).
    • Magnesium (33.3%).

When they compared supplement users with non-supplement users, the supplement users were:

  • More likely to be female and non-Hispanic white.
  • Have higher levels of family education and income.
  • Eat a healthier diet and be more physically active.
  • Less likely to be current smokers, heavy drinkers, or obese.

These are all factors that favor a longer lifespan.  However, the supplement users were also:

  • Older (average age = 50.7 versus 42.8 for non-supplement users).
  • Sicker (They were more likely to have cancer, heart disease, diabetes, high blood pressure, and high cholesterol levels).

These are factors that favor a shorter lifespan.

These are what statisticians refer to as confounding variables. They can influence the results of a study in unexpected ways.

 

Can Supplements Help You Live Longer?

When they looked at the raw data, supplemental use of most-individual nutrients was associated with a lower risk for all-cause death. In simple terms, supplementation appeared to increase lifespan.

However, when the data were statistically adjusted for all of the confounding variables (age, sex, race/ethnicity, education, physical activity, smoking, alcohol intake, diet quality, BMI [a measure of obesity], and diseases the participants had when they entered the study), the effect of supplementation on lifespan became non-significant.

The authors concluded: “Use of dietary supplements was not associated with mortality benefits among a nationally representative sample of U.S adults.”  Those are the headlines you saw from your favorite news source.

What Does This Study Mean For You?

Let’s go back to the two questions I posed about the study at the beginning of this article.

  • Is it true? Can supplements help you live longer?  The study had many weaknesses, which the authors identified in their discussion. Of course, the people writing the headlines never bothered to read the paper, so they were unaware of its weaknesses. Here are some of the major weaknesses reported by the authors:
  • The NHANES questionnaire only asked about supplement use over the preceding 30 days. We have no idea how long the participants had been using those supplements. It could have been years, or it could have been a month. In the words of the authors: “Dietary supplement use was assessed in the previous 30 days, which may not reflect habitual use or capture changes in use [before or] after the baseline assessment.”
  • The supplement users were more likely to have been diagnosed with health conditions such as cancer, heart disease, diabetes, and high blood pressure. It is well documented that diagnosed health conditions motivate some people to initiate supplement use.
  • Finally, there were multiple confounding variables in this study. The conclusion of the study rested on a statistical adjustment of the data to correct for those confounding variables. In the words of the authors: “Residual confounding may still be present.”

That last point reminds me of the famous Mark Twain quote: “There are lies. There are damn lies. And then there are statistics.” Don’t misunderstand me. I am not accusing the study authors of lying. They are some of the top scientists in the field. What Mark Twain and I are saying is that when you rely on statistics, sometimes bad things happen. You can come to erroneous conclusions.

  • Is it important? Even if the conclusion of this study is true, we should ask if it is important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth.

By the way, the situation is similar for diets. There have been a few claims in the past that healthy diets will help you live longer. However, when those claims have been rigorously evaluated, there is very little effect of diet on lifespan. There have been some studies that have reported a decrease in premature death due to heart disease or cancer. However, death from all causes usually remains unchanged. Once again, the fountain of youth has eluded us.

You may be asking, if supplements don’t increase lifespan, what good are they? The answer is simple. They increase healthspan. Simply put, that means you spend a greater portion of your lifespan in good health.

Of course, now you are probably really confused. You’ve read all those headlines saying that supplements don’t have any effect on your health. The problem is that the studies generating those headlines are flawed. They aren’t asking the right questions. When you look at populations with poor diets, increased needs, genetic predisposition, and/or pre-existing disease, supplementation is often beneficial. I cover this in the second half of my book, “Slaying the Supplement Myths.”  That section is called “The Myths Of The Naysayers.”

 

The Bottom Line

 

A recent study reported that supplements do not reduce mortality. They won’t make you live longer. In this article I provide a detailed analysis of that article. The two important take-aways are:

  • There are several weaknesses in the study. The conclusion may not be accurate.
  • Even if it is accurate, it may not be important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

The real benefit of supplementation isn’t in increasing your lifespan. It is increasing your healthspan. I cover that in my book, “Slaying The Supplement Myths.”

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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