Author Archive

Are Multivitamins A Waste Of Money?

Written by Dr. Steve Chaney on . Posted in Supplements and Health

Don’t Throw Your Vitamins Away Yet

Author: Dr. Stephen Chaney

ProfessorThe Professor is annoyed. Two things really irritate me:

  • Charlatans who cherry pick studies to “prove” that their snake oil supplements will cure what ails you.
  • Doctors who proclaim that vitamins are a waste of money without understanding the science behind the studies they are quoting.

Are Multivitamins A Waste Of Money?

You’ve seen the headlines telling you that “the experts” have concluded that multivitamins are a waste of money. You might be wondering “What’s behind these headlines? Who are these experts, and what is their evidence?”

Let’s start at the beginning. The article (Gualler et al., Annals of Internal Medicine, 159: 850-851, 2013) that generated all of the headlines was an editorial, which means it is an opinion piece, not a scientific study. It represents the opinion of five very prominent doctors, but it is, at the end of the day, just their opinion. Many other well respected experts disagree with their opinion.

They based their editorial on three recently published studies:

  • The first study reported that vitamin and mineral supplements did not decrease the risk of heart disease and cancer in healthy individuals (Fortmann et al., Annals of Internal Medicine, 159, doi: 10.7326/003-4815-159-12-201312170-00729)
  • The second study reported that multivitamins did not affect cognitive function in healthy male physicians aged 65 and older (Gradstein et al, Annals of Internal Medicine, 159, 806-814, 2013)
  • The third study concluded that multivitamins did not reduce the risk of a second heart attack in patients who had previously had a heart attack and were receiving appropriate medical therapy.

These were all large, well designed studies, so it would be tempting to conclude that the headlines were right. Maybe vitamins are a waste of money.

But, what if the whole underlying premise of these studies was flawed? Let’s examine that possibility by examining the flawed premises behind these and other studies.

What’s Wrong With These Studies?

#1) These studies were too narrowly focused.

MultivitaminsMultivitamins and individual vitamins and minerals are not magic bullets. They are not drugs. They are meant to fill nutritional gaps in our diet – not prevent or cure disease. We should be asking whether holistic approaches can prevent or cure disease – not whether individual nutrients can do so.

One of the examples that I love to use, because it really made an impression on me as a young scientist, occurred at an International Cancer Symposium I attended more than 30 years ago. I attended a session in which an internally renowned expert was giving his talk on colon cancer. He said, “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B-vitamins, exercise and weight control. But I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they’re advising?” You’ve probably heard experts saying:

  • “Don’t worry about the fat content of your diet. It can’t be shown to increase the risk of colon cancer.”
  • “Don’t worry about calcium. It doesn’t decrease the risk of colon cancer”
  • “Don’t worry about B-vitamins. They don’t decrease the risk”
  • “Don’t worry about fiber. It can’t be shown to decrease the risk either”

But, is that the message that we should be giving people – that nothing matters? Shouldn’t we really be saying what that doctor said many years ago – that a lifestyle that includes all of those things significantly decreases the risk of colon cancer?

#2) These studies were destined to fail.

It’s almost impossible to prove that any single intervention prevents disease when you are starting with a healthy population (something we scientists refer to as a primary prevention study).

For example, in “Health Tips From the Professor” just a couple of weeks ago I shared with you that even when you combine all of the published studies with tens of thousands of patients, it is impossible to prove that stain drugs prevent heart attacks in healthy individuals.

If you can’t show that statins prevent heart disease in healthy people, why would you expect to be able to show that vitamins or minerals prevent heart attacks in healthy people?

I can’t resist pointing out that this perfectly illustrates the pro-drug, anti-supplement bias that is so prevalent among many of my medical colleagues. I haven’t seen a single editorial or headline suggesting that statin drugs might be a waste of money for healthy individuals.

#3) These studies simply asked the wrong questions.

For example, the third study described in the editorial was asking whether multivitamins reduced the risk of a second heart attack in patients who were receiving “appropriate medical therapy”. What does “appropriate medical therapy” mean, you might ask? It means that those patients were on 4 or 5 drugs, with all of their side effects.

In reality the study was not asking whether multivitamins reduced the risk of a second heart attack. The study asked whether multivitamins had any additional benefits for individuals who were taking 4 or 5 drugs to reduce their risk of a second heart attack. That’s a totally different question.

There are lots of examples of this paradigm. For example, 17 years ago the Cambridge Heart Antioxidant Study showed that vitamin E significant decreased heart attack risk in patients with severe cardiovascular disease (Stephens et al, The Lancet, 347: 781-786, 1996). Patients in that study were taking one or two medications. However, in today’s world that would be considered unethical. The standard medical treatment for high risk heart disease patients today is 4 or 5 drugs, and when patients are receiving that many medications it is no longer possible to demonstrate a benefit of vitamin E. The story is similar for omega-3 fatty acids.

That poses a dilemma. What recent studies show is that individual nutrients don’t reduce the risk of a second heart attack in someone who is receiving “standard of care” medical treatment.

But that’s not the question I am interested in. I’d like to know whether natural approaches might be just as effective as the drugs or whether natural approaches might allow one to use fewer drugs or lower doses. I’d like to avoid all of the side effects of those drugs if I could.

What about you? What questions would you like answered? Do these studies answer those questions?

What Was Overlooked In Those Studies

The studies did show conclusively that there were no harmful effects from supplementing except for high dose beta-carotene in smokers. Somehow that information never made it into the headlines.

The Bottom Line

  • Don’t pay much attention to the reports that supplements don’t work and are a waste of money. Those studies are fundamentally flawed.
  • Don’t pay much attention to the reports claiming that vitamins will hurt you. Except for beta-carotene in smokers the latest studies showed no evidence of harm.
  • On the other hand, don’t expect miracles from your vitamins. If you spend your time sitting in front of the TV set eating pizza & drinking sodas, popping a vitamin pill won’t prevent much of anything.
  • Finally, holistic approaches are often as effective as drug therapy – without the side effects. Your vitamins can be an important part of a holistic approach to better health that includes weight control, a good diet and exercise.

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.

Belly Fat Increases Your Risk Of Dementia

Written by Dr. Steve Chaney on . Posted in Issues, Obesity

Does Belly Fat Make You Dumb?

Author: Dr. Stephen Chaney

Forgetful Old ManIn last week’s “Healh Tips From the Professor” I told you that abdominal obesity (otherwise known as “belly fat“) increases your risk of dying from both heart disease and cancer.

But you probably knew that already.

This week I’m going to tell you about a recent study that breaks new ground and should really grab your attention.

Belly Fat Increases Your Risk Of Dementia

This week’s study shows that abdominal obesity dramatically increases your risk of developing dementia as you age (RA Whitmer et al, Neurology, 71: 1057-1064, 2008).

This study involved 6,583 members of Kaiser Permanente of Northern California, ages 40 to 45, who had their abdominal obesity measured between 1964 and 1973. The investigators then pulled their medical records between 1994 and 2006 when they were between 73 and 87 years old and asked how many of them had dementia.

The results may shock you.

The participants were divided into five groups based on their abdominal circumference. Those with the largest abdominal circumference were nearly 3 times more likely to have developed dementia than those with the smallest abdominal circumference. And that was after the data were adjusted for age, sex, race, education, diabetes, hypertension, hyperlipidemia, stroke and heart disease – all factors that are known to affect the risk of dementia.

Belly Fat Is Worse Than Overall Obesity

Interestingly enough the abdominal circumference was a better predictor of dementia risk than was BMI, the most frequently used measure of obesity.

  • Those subjects who had high abdominal obesity and normal BMI had a 2-fold increased risk of developing dementia
  • Those subjects who were obese but had normal abdominal circumference had only an 80% increased risk of developing dementia.
  • Of course, those people who were both obese and had a large belly were the worst off – they had almost a 4-fold increased risk of developing dementia.

So where you store your fat is more important than the total amount of fat, but you probably knew that already.

You Can Reduce Your Risk Of Dementia

Now let’s get to the question that I’m sure that many of you are dying to ask me: “If I don’t like what I see when I look into the mirror, am I doomed to develop dementia when I get older?”

The answer is no. Most experts feel that the effects of abdominal obesity are reversible.

But the time to act is now!

If you wait until you get older, you might just forget that you ever read this article.

The Bottom Line

  • The bad news is that belly fat increases your risk of developing dementia as you get older by as much as 3-fold.
  • The good news is that dementia is not inevitable. You can reverse the increased risk of dementia by losing the belly fat

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 Do You Fight Insomnia?

Written by Dr. Steve Chaney on . Posted in Issues, Stress Management

Preventing Sleeplessness Without Medication

Author: Dr. Pierre DuBois

man-with-insomniaDo you struggle to fall asleep at night?  Do you find yourself wide awake at three in the morning staring up at the ceiling and wondering if you’ll fall back to sleep at all before your alarm goes off?

If you answered “yes”, you are not alone. Research has shown that up to 50 percent of the population suffers from insomnia with up to a third having struggled with it for at least a year.

 How Much Sleep Do You Need?

The average adult requires a little over 8 hours of sleep each day.  However, very few people are able to manage that with lives that are more hectic than ever. Jobs, children and other obligations require us to be up with the birds and to go to bed far later than we would if we were following our own biological rhythm. A disruption to our circadian rhythm, which governs our hormone production, body temperature and sleep, can lead to insomnia.

What Does Insomnia Do To Us?

We need adequate, restful sleep in order to perform at our best. Prolonged insomnia can cause mental fuzziness and interfere with how you perform your daily activities. It also increases your risk of depression, headaches, auto accidents, and can lead to substance abuse.

Of course, worrying about the lack of sleep you are getting rarely helps you get more sleep! Stress, anxiety, and widespread use of coffee and alcohol are some of the greatest contributors to insomnia.

How Do You Fight Insomnia?

Learning how to manage stress effectively is one of the best ways to increase your chances of getting a good night’s sleep, and making some changes to your lifestyle may make a difference in the number of hours of sleep you get. The following are the top 10 strategies you can use:

  • Get regular exercise before dinner, which can help put your body in a restful state by bedtime. Just be sure not to exercise too close to bedtime, as this will likely make you restless.
  • Try to get out in the late afternoon sun as often as possible to stimulate melatonin release, which will help get your circadian rhythm back on track.
  • Use stress reduction techniques such as yoga, meditation and Tai Chi, which are great ways to help teach your mind and body to relax.
  • Caffeine and smoking keep the body stimulated. Try to avoid them from mid-afternoon on, and keep your consumption of alcohol to a minimum.
  • Eat a small snack of protein with a complex carbohydrate just before bed, such as peanut butter on a whole-grain cracker. It can keep your blood sugar from dipping too low and waking you up in the night.
  • Keep to the same sleeping and waking schedule every day and don’t change it by more than an hour on weekends.
  • Avoid television or computer use at least an hour before bedtime, as it stimulates the brain, making it difficult to fall asleep.
  • Keep your bedroom dark, quiet and cool.
  • If you are lying awake for more than about 20 minutes, get up and go sit in another dimly lit room until you feel sleepy.

These strategies have proven useful for many people in getting them back to a regular sleeping rhythm. Give them a try — they may help you too!

 

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.

Abdominal Fat Shortens Your Lifespan

Written by Dr. Steve Chaney on . Posted in Issues, Obesity

Your Belly Fat Could Be Killing You

Author: Dr. Stephen Chaney

Belly FatYou’ve probably already heard about the dangers of abdominal obesity (otherwise known as “belly fat“). You’ve probably heard that it increases your risk of diabetes, heart disease, stroke and cancer.

But did you know that your belly fat could be killing you? And, the weirdest part is that your belly fat could be killing you even if you are at ideal body weight (more about that in a minute).

Abdominal Fat Shortens Your Lifespan

A group of scientists at the National Institutes of Health recently analyzed data collected from 44,000 women in the Nurses’ Health Study over a 16-year period and asked if abdominal obesity affected their death rates from heart disease and cancer (Zhang et al, Circulation, 117: 1658-1667, 2008).

The answer was a clear-cut yes!

The study showed that women with a waist circumference of 35 inches were 2X more likely to die from heart disease and cancer than women with a waist circumference of 28 inches – even if they were at ideal body weight.

Abdominal Fat Can Kill You Even If Your Weight Is In The Normal Range

You might be asking “How could those women be at ideal body weight and still have abdominal obesity?”

There is a natural tendency to lose muscle mass as we age. When we add in the inactivity associated with the American lifestyle that loss of muscle mass is accelerated and the muscle is replaced with fat. Thus, it is actually possible in today’s world to have both normal weight and abdominal obesity – and that is not a good thing!

Of course, the women who were both overweight and had abdominal obesity were even more likely to die from heart disease or cancer. So weight control is not just about looking good in your bathing suit – abdominal obesity is a killer!

However, the good news is that you can do something about abdominal obesity. With exercise and a controlled calorie, high protein diet you can replace that fat with muscle (See my previous article “Do High Protein Diets Reduce Fat And Preserve Muscle?).

The Bottom Line

  • Belly Fat may double the risk of dying from heart disease and cancer in women. The statistics are likely to be similar in men.
  • Because both inactivity and the normal aging process cause us to lose muscle and replace it with fat, many of us have excess belly fat even when we are not overweight.
  • Combining a calorie controlled, high protein diet with exercise can help reverse the process and replace that excess fat with muscle.

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.

Trigger Point Therapy

Written by Dr. Steve Chaney on . Posted in Issues, Muscle Therapy and Health

Five Tips For Releasing Trigger Points

Author: Julie Donnelly

Neck PainHave you ever had a pain in one area, rubbed another place on your body, and felt the pain melt away?  If so, you’ve experienced the result of “trigger point therapy.”

A trigger point is technically an area of hyperirritability in a muscle that may refer pain &/or numbness to another area.  In other words, it is a “knot” in the muscle fibers and it prevents muscle fibers from lengthening to their longest length.  The shortened fibers are therefore pulling on the insertion, limiting range of motion, and weakening the entire muscle because these fibers are basically out of commission.

Trigger Points and Stretching

A muscle originates on a bone, crosses over a joint, and inserts onto a bone that will move when the muscle contracts.  This is the way the body moves, and it functions perfectly until a trigger point forms in the muscle.  As the muscle shortens it is pulling on the insertion point and you feel stiff, inflexible.

You may decide to stretch, however, people sometimes complain about feeling worse after stretching than they did before doing the stretch.  To stretch a muscle, while it still has an active trigger point, could cause tiny tears to occur in the fibers, and could cause even more pain.

Consider this analogy.  If you tied a rope onto a strong tree and then went straight across and tied the other end of the rope onto a flexible tree, the smaller tree would continue to stand straight.  If you then tugged on the rope the flexible tree would bend.  However, if you tied a knot, or two, or three, into the rope, the flexible tree would be leaning over.  If you then pushed the bent tree so it was again standing up straight, you would only cause the knot in the rope to tighten, and you would be overstretching the fibers on either side of the knot.

This is exactly what happens when you try to stretch a muscle that is shortened by knots in the fibers, without first releasing the trigger points.

Five Tips For Releasing Trigger Points

As the trigger points caused knots to form in the muscle, the shortening of the fibers put a strain on the insertion point on the other side of the joint.  You can reverse this situation by doing the following steps:

  1. Treat. Hold the pressure on each trigger point.  In order to effectively stretch a muscle you need to first press on each trigger point, holding the pressure for 30-60 seconds.
  1. Understand the Muscle Movement.  Look at the muscle that you will be treating.  To best treat and stretch a trigger point, you need to know what movement the muscle makes.  For example, the muscles in the back of your neck will pull your head back so you can look up at the ceiling, and the muscle on your shoulder blade raises your arm.  To stretch, you need to go in exactly the opposite direction as the movement of the muscle.
  1. Stretch.  Move so the muscle needs to stretch. For example, the trapezius muscle will raise your shoulder, so to stretch it you want to move your head away from your shoulder.  You can accomplish this by dropping your head in the opposite direction while pulling your shoulder down toward the floor.
  1. Press and Stretch for Optimal Benefit.  To optimize the treatment, whenever possible, continue the pressure on the deactivated trigger point and then move your body so the muscle is forced to lengthen.
  1. Slowly Move the Joint in a Smooth Circle.  Slowly rotate your shoulder in a circle, move your leg so your hip joint loosens, curl and open your fingers fully, circle your neck, and arch your back like a cat.  Finally, stop pressing on the trigger points but continue the slow, relaxed movement of your joints.

The more often you limber up your joints, the more flexible you will feel.  Always go only to the point of “this feels great,” never trying to overstretch or make a movement that is beyond your comfort level.  Stretching feels great when you have untied the knots that have held you bound!

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.

Omega-3 Fatty Acids And Brain Health

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues

Is it How Much You Eat, or How Much You Keep?

Author: Dr. Stephen Chaney

 

Brain HealthWhy do some studies conclude that omega-3 fatty acids are essential for a strong mind, a strong heart and will wipe out inflammation – while other studies suggest that they are ineffective? The simple answer is that nobody really knows.

However, in the process of reviewing two recent studies on omega-3 fatty acids and brain health I made an interesting observation that offers a possible explanation for the discrepancies between studies. And if my hypothesis is correct, it suggests that the design of many of the previous studies with omega-3 fatty acids is faulty.

Omega-3 Fatty Acids And Brain Health

The first study (J.K. Virtanen et al, J Am Heart Assoc, 2013, 2:e000305 doi: 10.1161/JAHA.113.000305) looked at the effect of omega-3 fatty acids on brain function in older adults (>65 years old). It concluded that high omega-3 levels were associated with better white matter grade and a 40% reduction in subclinical infarcts (Sorry for the technical jargon – but both of those are good things in terms of brain function for those of us who are getting a bit older).

The second study (C. M. Milte et al, J of Attention Disorders, 2013, doi: 10.1177/1087054713510562) looked at the effect of omega-3 fatty acids on children (ages 6-13) with ADHD. It concluded that high omega-3 levels were associated with improved spelling and attention and reduced oppositional behavior, hyperactivity, cognitive problems and inattention.

What Is The Common Thread In These Studies?

Why, you might ask, am I comparing a study in the elderly, where the concern is retention of cognitive skills, with a study on ADHD in children?

That’s because there is a very important common thread in those two studies. It wasn’t the amount of omega-3 fatty acids in their diet that counted. It was the levels of omega-3 fatty acids in their blood that made the difference.

The first study included a detailed dietary history to estimate the habitual intake of omega-3 fatty acids in the participants.

  • There was no correlation between estimated dietary intake of omega-3 fatty acids and any measure of brain function in those older adults.
  • However, there was a strong correlation between blood levels of omega-3s and brain health in that population group.

The second study was actually a placebo controlled intervention study in which the children were given 1 gm/day of either omega-3 fatty acids or omega-6 fatty acids.

  • Once again, there was no correlation between dietary intake of omega-3 or omega-6 fatty acids and any outcome related to ADHD.
  • However, there was a strong correlation between blood levels of omega-3 fatty acids or omega-3/omega-6 ratio and improvement in multiple measures of ADHD.

How Could The Effect of Dietary Intake And Blood Levels Of Omega-3s Be So Different?

Fish OilBoth studies were relatively small and suffered from some technical limitations, but the most likely explanations are:

  • Inaccurate recall of the participants as to what they eat on a habitual basis. (study 1)
  • Individual differences in the ability of participants to convert short chain omega-3 fatty acids (found in foods such as canola oil, flaxseed oil and walnuts) to the beneficial long chain fatty acids (found in cold water fish). (study 1)
  • Poor compliance in taking the supplements. (study 2)

Why Are These Studies Important?

The most important insight to come out of both of these studies is that it is essential to actually measure blood levels of omega-3 fatty acids and not just rely on dietary intake or supplementation for a valid clinical trial.

That’s a concern because blood measurements of omega-3 fatty acids are expensive and have not been a part of many of the clinical studies that have been performed to date. Even the largest, best designed clinical study is worthless if the dietary recalls aren’t accurate or people don’t take their capsules.

We need to go back and reevaluate many of the clinical studies that have been published.

We need to ask:

  • Are their conclusions valid?
  • Did some studies fail to show that omega-3s were effective simply because they only measured dietary intake and not how much of the omega-3s actually accumulated in the blood?

The Bottom Line

  • High blood levels of omega-3s in the blood correlated with improved brain health in the elderly and reduced ADHD symptoms in children
  • These studies were small, but they are consistent with a number of other studies that have come to similar conclusions.
  • Blood levels of omega-3s are better predictors than dietary intake for evaluating the health benefits of omega-3 fatty acids.
  • Many previous studies that failed to find an effect of omega-3 fatty acids on brain health, heart health or inflammation did not actually measure blood levels of the omega-3 fatty acids. These studies should be reevaluated.

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 Cell Phone Use Lead to Brain Cancer?

Written by Dr. Steve Chaney on . Posted in Environment and Health, Issues

Author: Dr. Pierre DuBois

Does Cell Phone Use Lead To CancerThere are currently close to 6 billion cell phone subscriptions worldwide, and increased usage of cell phones has understandably led to a greater level of interest in how safe they are.

The main concern for our health is that mobile phones emit and receive electromagnetic radiation as a result of their need to communicate with relay towers, and some of this radiation is absorbed by the head when the phone is held up to the ear.

Whether or not the radiation (both the amount and the frequency) that a typical mobile phone user is likely to receive is potentially damaging to their health has been the subject of debate for some time.

Does Cell Phone Use Lead to Brain Cancer?

Anecdotal evidence that high mobile phone use can potentially lead to brain cancer is not hard to find. Newspapers and other media sources are only too ready to run such stories.

However, given that there are so many people using mobile communication so regularly, the chances are that someone is going to have a brain tumor at some point, whether or not there is any link with the amount of time they spend on their phone.

The obvious question is whether or not there is good reason to be concerned over how and how much you use your phone.

The Evidence Against Cell Phone Usage Leading To Brain Cancer

The most recent assessment of the scientific evidence of mobile phone safety was carried out by the European Commission Scientific Committee on Emerging And Newly Identified Health Risks (SCENIHR). They concluded that mobile phone usage was unlikely to increase the risk of developing brain tumors.

The most recent results from a long-term study by researchers from the Institute of Cancer Epidemiology at the Danish Cancer Society in Denmark also failed to find any link between mobile phone usage and the development of brain tumors or any other cancers of the nervous system.

This study was particularly significant in that it used most of the Danish population to determine if there was any difference in the incidence of brain cancer between mobile phone users and non-mobile phone users. Unsurprisingly, this work has been quoted frequently, especially by cell phone companies, as evidence that their products have now been given a completely clean bill of health.

The Evidence For Cell Phone Usage Leading To Brain Cancer

In contrast to the previous results, the conclusion of a 2010 paper published in the International Journal of Epidemiology on the subject suggested that while no overall link was found between two kinds of brain tumor and mobile phone usage, the data did point to a possible increase in the development of glioma-type tumors in the most intensive users

The authors also pointed out that since the new generations of smart phones are being used for even greater periods of time, especially by younger people, further and ongoing studies in this area are definitely merited.

In 2011, the World Health Organization (WHO) classified mobile phone radiation as “potentially carcinogenic to humans.” Following from this, many countries have adopted a precautionary approach and suggested moderation in cell phone usage. Using a hands-free kit to avoid holding a phone next to your head has also been advised.

While the available evidence suggests that low and normal usage of a mobile phone does not increase your risk of developing a brain tumor, it is probably wise to reduce your exposure to electromagnetic radiation as much as you can, and certainly to avoid spending long periods of the day with a phone next to your ear.

The Bottom Line:

  • The link between cell phone use and brain cancer is inconclusive at present. Most studies find no overall link, but suggest that certain types of brain cancers could be associated with cell phone use.
  • Experts recommend not holding cell phones next to your head for long periods of time.

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

Are Cholesterol Lowering Drugs Right For You?

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Issues

Do Statins Really Work?

Author: Dr. Stephen Chaney

Do statins really work?Statins – those ubiquitous drugs used to lower cholesterol levels – are big business!

Over 20 million Americans are currently being treated with statin drugs at a cost that runs into billions of dollars every year. And cardiologists have just recommended that another 20 million Americans consider using cholesterol lowering drugs. 44% of the men and 22% of the women in this country are now being told that they should be using statin drugs.

Some of my cardiologist friends are so convinced that statin drugs prevent death from heart attacks that they have said, only half-joking, that we should just add statins to the water supply.

Are Cholesterol-Lowering Drugs Right For You?

Is the faith of doctors in the power of statin drugs to prevent death from heart disease justified? To answer that question in full we need to look at people who have already survived a heart attack and people who have never had a heart attack separately.

If you’ve already had a heart attack the evidence is clear cut.

  • If you have had a heart attack, there is good evidence that statins will reduce your risk of dying from a second heart attack.
  • In the technical jargon of the scientific world that is referred to as secondary prevention.

But what about those millions of Americans who are being prescribed statin drugs who have never had a heart attack? This is something we scientists refer to as primary prevention.

What Do The Studies Actually Say About Statins And Primary Prevention?

Here the evidence is not clear at all. Two major reports have cast doubt on the assumption that statins actually do prevent heart attacks in people who have not already had a first heart attack.

In the first study, Dr. Kausik Ray and colleagues from Cambridge University in England performed a meta-analyis of 11 clinical studies involving over 65,000 participants (Ray et al, Arch. Int. Med., 170: 1024-1031, 2010). They focused on those participants in the studies who had not previously had a heart attack (primary prevention).

  • They found that the use of statins over an average of 3.7 years had no statistically significant effect on mortality. In short, statins had no effect on the risk of dying from heart disease or any other cause.
  • Dr. Sreenivasa Sechasai, one of the doctors involved in the study, said “We didn’t find a significant reduction in death despite having such a huge sample size. This is the totality of evidence in primary prevention. So if we can’t show a reduction with this data, it is unlikely to be there.”

The second study was a Cochrane Systemic Review of statins published January 19th, 2011.  It stated that there was not enough scientific evidence to recommend the use of statins in people with no previous history of heart disease with some caveats (see below).

To help you understand the significance of that conclusion, let me give you a bit of background:

  • First you need to understand that the Cochrane Collaboration is an independent, non-profit organization that carefully reviews the scientific evidence behind medical treatments and proposed medical treatments.
  • Cochrane Reviews are considered the “Holy Grail” of evidence-based medicine (ie. medicine based on the best scientific evidence rather than what the pharmaceutical companies would have you believe).
  • So when a Cochrane Review concludes that there isn’t enough evidence to recommend use of statins in patients with no prior history of heart disease that is pretty big news in the medical world.

How Should These Studies Be Interpreted?

Please don’t misinterpret what I am saying. The Cochrane Review said that statin drugs are overprescribed, but it did not say that everyone who has not had a heart attack will not benefit from statins. It said that there are a number of risk factors that need to be considered in evaluating individual patients for statin use.

  • Simply put, that means that it is not as simple as saying that everyone with no previous history of heart disease should not be on statin drugs.
  • If you are currently taking statin drugs and you have no previous history of heart disease, you may want to discuss with your physician whether the Cochrane Review of statin drugs changes their opinion of whether se of those drugs is still warranted for you.
  • But the bottom line is that only your physician is trained to take into account all of the factors that increase your risk of heart disease and the best therapeutic approach for reducing your risk of heart attack.

There Is A Double Standard In The Medical Community

More importantly, these studies highlight the difficulty in showing that anything works when you start out with a healthy group of adults with no prior evidence of disease (primary prevention).

And, the way that doctors have responded to primary prevention studies shows that there is a double standard in how primary prevention trials are interpreted in the medical community. For example:

  • There is no good evidence that statins prevent fatal heart attacks in healthy people.
  • However, because statins do work in high risk patients, most doctors recommend their use by millions of Americans who have never had a heart attack.
  • There is also no good evidence that nutrients like vitamin E and omega-3 fatty acids prevent fatal heart attacks in healthy people.
  • However, there is evidence that both vitamin E and omega-3 fatty acids prevent heart attacks in high risk patients, yet most doctors will tell you they are a waste of money.

It is food for thought.

The Bottom Line

1)    Statin drugs clearly save lives when used by people who have already had a heart attack.

2)    On the other hand, there is no proof that statin drugs prevent heart attacks in people who have not previously had a heart attack

3)    Statin drugs do have side effects. Increased risk of diabetes, liver damage, muscle damage and kidney failure are the best documented, although memory loss has also been reported.

4)    I am not recommending that you stop using statin drugs without consulting your doctor. I am suggesting that you discuss the benefits and risks of statin drug use with your doctor.

5)    Perhaps the most important poin tto come out of these studies is that it almost impossible to prove the benefit of any intervention in a primary prevention trial. If you can’t prove that statins work in healthy people, it is not surprising that it is difficult to prove that other interventions work.

6)   Finally, the way that these studies have been interpreted shows that there is a clear double standard in how the medical community evaluates primary intervention trials.

  • Statin drugs don’t show any benefit in a primary prevention setting, yet most doctors still recommend them.
  • Vitamin E and omega-3 fatty acids don’t show any benefit in a primary prevention setting, and most doctors recommend against them.

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.

Healthy Thanksgiving

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues

Author: Dr. Stephen Chaney

Healthy ThanksgivingWhile “Healthy Thanksgiving” doesn’t quite have the appeal of the more familiar “Happy Thanksgiving” greeting, I used it here to make the point that Thanksgiving dinner (and many other holiday meals) doesn’t have to be an unhealthy affair.

After all, there is a lot to like about the ingredients in Thanksgiving dinner.  Turkey can be a healthy, low- fat meat, if prepared correctly.  Sweet potatoes, yams, winter squash and pumpkin are all loaded with vitamin A and other important nutrients.  And cranberries are a nutrition powerhouse.

Healthy Thanksgiving

Here are some tips to make your Thanksgiving meal one that contributes to your health:

1) Skip the basting.  Choose a plain bird and cook in a bag to seal in the moisture.  Remove the skin before serving.

2) Refrigerate the turkey juices and skim off the hardened fat before making gravy and use a gravy cup that pours from the bottom to minimize fat.

3) Use ingredients like whole wheat bread, vegetables, fruits (cranberries, raisins, dates or apples), nuts and your favorite spices for the stuffing and bake it in the oven rather than in the turkey.

4) Serve your sweet potatoes or yams baked rather than candied and let your guests add butter to taste.

5) Use skim milk or buttermilk rather than whole milk and skip the butter for your mashed potatoes.

6) Give your meal gourmet appeal by cooking your green vegetables with garlic, nuts and herbs rather than creamy or fat-laden sauces.

7) Don’t serve the meal on your largest plates. By using smaller plates you ensure smaller portion size and even that second helping isn’t quite so damaging.

8) Use the Shaklee 180 meal replacement products for one or more meals the day before and/or after Thanksgiving so that your total caloric intake over the three day period is not excessive.

By now you have the idea.  There are lots of little things that you can do to make your Thanksgiving dinner one that your waist and your heart will thank you for. Bon Appetit and have a Happy, Healthy Thanksgiving!

The Bottom Line

  • If you make healthy food choices and choose your portion sizes wisely, you can make this a healthy Thanksgiving as well as a Happy Thanksgiving.

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

The Benefits of Sprint Interval Training

Written by Dr. Steve Chaney on . Posted in Exercise, Fitness and Health, Issues, Uncategorized

Are You Still Doing Cardio?

Author: Kai Fusser, MS

Sprint Interval TrainingLast month I told you about functional fitness training and why I think it is superior to workouts on the machines that fill most gyms and sports clubs. This month my topic is sprint interval training, and why it beats the traditional cardiovascular or aerobic exercises.

Walk into any gym and the first thing you see is people straddling treadmills, ellipticals or bikes for 45 minutes or more trying to burn calories and improving their aerobic fitness.

It is not an easy task for me to explain in a short fitness tip why we should stay away from the typical low to moderate-intensity continuous training (“CARDIO”) and instead do sprint interval training (SIT, or burst training), but here are the key points.

The Problem With Cardio Exercise

 

Slow cardio:

  • is very time intensive (the number one reason people skip their workouts)
  • only works on your aerobic fitness (and that fairly inefficient)
  • burns some calories during the activity but has no impact on your overall metabolism
  • stresses your joints due to repetitive impact (especially if you are running for your cardio)
  • increases inflammation

 

The Benefits of Sprint Interval Training

 

Now here is a solution for you. SIT (sprint interval training) training:

  • will only take about 4-8 minutes 3 days a week
  • works your aerobic and anaerobic system at the same time
  • will raise your metabolism for several hours after you have completed the exercise
  • is very effective for fat loss
  • will build “fast muscles”
  • reduces impact on your joints and helps reduce inflammation

Sprint training can burn the same calories as slow cardio in 1/15th of the time! In addition, slow cardio exercise produces a lot of stress hormones (cortisol) while sprint training stimulates growth hormone (have you ever compared the physique of a sprinter to a marathon runner? It’s your choice).

It is the intensity, not duration that effects the adaptation to exercise.

 

Making Sprint Interval Training Work For You

 

There are different ways to implement SIT training:

It can be done on equipment like a:

  • treadmill (using a steep incline rather than high speed)
  • stationary bike
  • upper body ergo meter
  • or a X-iser

Or it can be done with no equipment at all, like

  •  sprinting (athletes only)
  • running up a flight of stairs
  • running up a hill
  • or with full body calisthenics like a Turkish Getup.

I recommend that you start with 4 min workouts (add 2-3 min of warm up before) with a sprint to rest ratio of 1-3, say 10 sec sprint with 30 sec rest (slow pace). As you feel more comfortable you should work your way down to a ratio of 1-1 like 20 sec sprint with 20 sec rest. The maximum total time you would want to do is 8 min. (more is not better in this case).

Please remember that the sprints should be “high intensity” which is of course relative to your fitness level. The intensity will be different for a fully trained athlete than for a de-conditioned couch hugger.

 

The Bottom Line:

 

Sprint interval training (SIT) is a quick and efficient way to burn calories and get the cardiovascular exercise your body needs.

You will be surprised how quickly your:

  • body will adapt to the new and positive exercise stress
  •  energy level will increase
  • performance will improve,
  • metabolism will pick up

You will save time and wear on your joints. Most of all, it can be fun !

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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