Supplements and Health

Are Food Supplements Safe?

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Author: Dr. Stephen Chaney

 

are food supplements safeIf you saw the recent headlines proclaiming that dietary supplements were responsible for 23,000 emergency room visits and 2,100 hospitalizations every year, you are probably wondering are food supplements safe to use at all. The study behind these headlines (Geller et al, New England Journal of Medicine, 373: 1531-1540, 2015) was based on an extrapolation from 63 hospitals to every hospital in the United States.

Some experts consider this to be an overestimation since it is almost 8 times higher than the 3,200 cases/year in the official FDA’s Serious Adverse Event Reporting database. However, for the purposes of this article I will accept the 23,000 numbers.

Let me start by putting the 23,000 number into perspective.

  • It represents about 0.015% of the 150 million people in the US who use supplements.
  • It represents about 1% of the emergency room admissions caused by side effects of properly prescribed medications.

In short, the headlines are over-dramatizing the dangers of dietary supplements. Dietary supplements are actually quite safe. However, even one emergency room visit due to a dietary supplement is too many – especially if it were to happen to you or a loved one. Consequently, I will analyze the study in more detail so that I can show you how to recognize and avoid those few supplements that are truly dangerous.

Are Supplements Dangerous?

Here is a breakdown of the data:

  • 13% of the ER visits were due to allergic reactions. These were seldom serious enough to require hospitalization. This is also a type of problem that is probably unavoidable. Since many food supplements use natural ingredients, some degree of food allergies are to be expected.
  • 13% of the ER visits were due to swallowing problems, primarily in people over the age of 65. The preventative measure here is also pretty simple. If you or a loved one has difficulty swallowing, choose pills that are small and slick, chewable, powder or liquid supplements.
  • 20% of the ER visits were due to adverse effects caused by unsupervised ingestion of the supplements by children. The preventative measure here is pretty simple. Keep your supplements out of reach of small children – especially if they are chewable or have attractive colors. While the supplements may be perfectly safe when taken as recommended, the unsupervised ingestion of a whole bottle of almost any supplement by a small child is problematic.
  • 41% of the ER visits were due to weight loss products (25.5%), energy products (10%), sexual enhancement products (3.4%) and bodybuilding products (2.2%). The most common adverse effect for these products were heart palpitations, chest pain, and irregular heartbeat. These are the kinds of supplements you really need to be most careful about.

Why Are Dangerous Supplements Even On The Market?

are supplements dangerousLet’s start with the obvious question: Why are weight loss, energy, sexual enhancement and bodybuilding products the ones most likely to be dangerous? To quote Pogo (now I’m really dating myself): “We have met the enemy, and he is us”

  • Weight Loss Products: We can listen all day long to experts tell us that we need to make lifestyle changes, and we should aim for no more than one or two pounds of weight loss per week. However, for most of us that advice goes in one ear and out the other. We want to lose weight fast, and we want it to be easy.
  • Energy Products: Many of us are just plain exhausted because our diets are terrible; we are under stress; and we are burning the candle at both ends. We don’t want to eat better and change our lifestyle. We want high octane energy, and we want it now.
  • Body Building Products: The story is similar, especially for males in the 20-34 age range. We want big muscles, and we don’t want to wait for the years of workouts it will take to build that kind of physique naturally. We want it now.
  • Sexual Enhancement Products: ER admissions for sexual enhancement products were 100% male. What does that say about us guys? I won’t even go there.

Most supplement manufacturers are ethical and don’t make supplements that could harm us. However, there are a few unscrupulous sports supplements companies that misleadmanufacturers who are only too happy to exploit our human weaknesses if they can make a buck in the process. They will give us exactly what we want, even if it kills us in the process.

I’ve warned about these unscrupulous manufacturers in the past. The easiest way to create products that will burn off weight effortlessly, build muscle rapidly, and give you energy are to add chemically synthesized stimulants in the amphetamine family. For example, I’ve warned you about products containing stimulants such as DMAA and  DEPEA  in Are Dietary Supplements Safe and BMPEA in Are Sports Supplements Safe. They all work, but they also cause heart palpitations, chest pain, and irregular heartbeat. They can land you in the emergency room, and sometimes they can kill you.

In addition to stimulants, some weight loss products use diuretics, and some energy products use dangerous levels of caffeine, both of which can cause problems. Sexual enhancement products often use herbal ingredients like yohimbe bark that can be quite dangerous

Don’t Count On The FDA To Protect You

Unfortunately, you can’t count on the FDA to protect you. For example, in the case of the DMAA scandal, the FDA did not act until the day before a big expose was to air on 60 Minutes about the deaths caused by DMAA. They were shamed into taking strong action and removing DMAA from the shelves of retailers.

Case closed, you might think, but the truth is a bit scarier. That action was back in 2013. Since then, the FDA has ignored DMAA-containing products. The Human Performance Resource Center, an initiative of the Department of Defense, recently listed 39 products containing DMAA  that are readily available, either online or from retail stores. Even though the FDA has classified DMAA as an illegal ingredient, it is still readily available, and they don’t act.

This is just one of many examples I could cite. It’s not clear whether the FDA is unwilling to protect us, or if it is overwhelmed. However, it is clear that if we want to avoid dangerous supplements, it is up to us.

How Can You Protect Yourself From Dangerous Supplements?

protect yourself against dangerous supplementsIf the FDA isn’t going to protect you, what can you do to protect yourself from dangerous supplements? There are threesimple things that you can do to protect yourself;

#1: Use common sense.

  • Don’t even consider those weight loss supplements that promise you’ll lose 5-10 pounds/week, or that they will make the fat melt away effortlessly.
  • Walk away from those bodybuilding supplements that promise to make your muscles “explode” or give you “insane energy”.
  • Put those energy supplements that promise a jolt of energy back on the shelf.
  • As for sexual enhancement products, consult your doctor before you reach for a magic pill. Your problems in the bedroom may be caused by a treatable medical condition.

#2: Make the Commitment. A holistic lifestyle change that includes weight control, exercise, diet and supplementation may be more work, but it is so much safer and more beneficial in the long run.

#3: Choose wisely. Look for a supplement company with integrity.

  • A company that is committed to only making products that are both safe and effective.
  • A company that does clinical studies to make sure their products are safe and effective and publishes those studies in peer-reviewed scientific journals.

Are food supplements safe?

The Bottom Line

  • A recent study reported that 23,000 emergency visits and 2,100 hospital admissions each year were caused by dietary supplements. Some experts consider this to be an overestimate. It is an extrapolation from 63 hospitals to every hospital in the United States, and it is approximately 8-fold higher than the FDAs Adverse Events database.
  • While the headlines sound scary, when you put the data into perspective it is clear that dietary supplements are actually quite safe. Even if we accept the 23,000 ER visits/year as accurate, this represents:
  • 015% of the supplement users in the US.
  • Approximately 1% of the annual ER admissions due to side effects of properly prescribed medications.
  • The main value of this study is that it allows us to identify what the dangers are and what strategies can help us avoid those dangers.
  • 13% of the ER visits were due to allergic reactions. This is probably unavoidable. Since many food supplements use natural ingredients, some degree of food allergies are to be expected.
  • 13% of the ER visits were due to swallowing problems, primarily in people over the age of 65. If you or a loved one has difficulty swallowing, the solution is pretty simple. Choose pills that are small and slick, chewable, powder or liquid supplements.
  • 20% of the ER visits were due to adverse effects caused by unsupervised ingestion of the supplements by children. The preventative measure here is also pretty simple. Keep your supplements out of reach of small children.
  • 41% of the ER visits were due to weight loss products (25.5%), energy products (10%), sexual enhancement products (3.4%) and bodybuilding products (2.2%). These are the kinds of supplements you really need to be most careful about. Some supplements in this category are truly dangerous.
  • If we ask why these dangerous supplements exist, the answers are pretty simple.
  • Many Americans are looking for quick and easy solutions. They want a magic pill or powder.
  • A few unscrupulous supplement companies are only too happy to give them exactly what they want, even if it kills them in the process.
  • Unfortunately, the FDA is not doing a good enough job of protecting us from the truly dangerous supplements on the market, so we need to protect ourselves.
  • To protect ourselves from the dangerous supplements on the market we need to take 3 simple steps:
  • Use common sense. Don’t fall for the advertising hype promising quick and easy solutions.
  • Commit to true lifestyle change. Adopt a holistic lifestyle that includes weight control, diet, exercise, and supplementation.
  • Choose your supplement manufacturer wisely. Choose one with integrity – one that is committed to making supplements that are both safe and effective.

 

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 and ADHD in Children

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Author: Dr. Stephen Chaney

 

Sometimes I write articles pointing out the fallacies in the headlines you’ve been reading. Other times I write articles because major studies have provided a definitive test of a current paradigm. And sometimes I write articles about small studies that have the potential to change existing omgega-3 and adhd in childrenparadigms. This week’s article falls in the latter category. This week’s article is on omega-3 and ADHD in children.  More precisely,  I’m going to review a study looking at the role of the omega-3s DHA and EPA in reducing ADHD symptoms.

Amid growing concern about the side effects and overuse of the stimulant medications used to treat ADHD symptoms in children, many parents have been looking for natural approaches for controlling ADHD symptoms. One of the most popular natural approaches has been omega-3 supplements, primarily the long chain omega-3s, DHA and EPA.

However, not everyone agrees that DHA and EPA are effective for reducing ADHD symptoms. Here is a brief summary of what we know:

  • Children with ADHD and learning difficulties generally have lower tissue levels of DHA and EPA than children without those deficits.
  • Animal studies show that DHA-deficient diets decrease neuron size and are associated with hyperactive and compulsive behavior.
  • Some clinical studies have reported a significant decrease in ADHD symptoms when children were given omega-3 supplements, while other studies found no effect of omega-3 supplementation on ADHD symptoms. This has led to considerable confusion as to the value of omega-3 supplementation in children with ADHD.

However, recent studies have led to a certain amount of clarity about omega-3 and ADHD in children. In particular:

  • Two recent meta-analyses of all high quality published studies have concluded that omega-3 supplements have a beneficial effect on ADHD symptoms, but the effect is relatively small (Bloch and Qawasmi, Journal of the American Academy of Child and Adolescent Psychiatry, 50: omega-3s991-1000, 2011; Sonuga-Burke et al. American Journal of Psychiatry, 170: 275-289, 2013).
  • One recent study showed that when omega-3 supplementation was combined with a stimulant medication, it improved the effectiveness of the medication, which allowed physicians to decrease the amount of medication they prescribed (Barragan et al, Journal of Attention Disorders, doi: 1177/1087054713518239, 2014).
  • Previous studies have shown that omega-3 supplementation is most effective in the children who are the most deficient in DHA and EPA at the beginning of the study. This is no surprise.

However,what you may not know is that many otherwise healthy children in this country have at least some degree of DHA and EPA deficiency. That’s because major food sources of EPA and DHA, such as salmon and sardines, are not most kid’s favorite foods.

Do Omega-3s Improve Attention Span In Children?

The most recent study (Bos et al, Neuropsychopharmacolgy, 40: 2298-2306, 2015) was a double blind, placebo controlled study looking at the effectiveness of omega-3 supplementation in reducing ADHD symptoms in boys between 8 and 14 years old. It differed significantly from most previous studies in that:

  • It included a matched group of boys who had not been diagnosed with ADHD.
  • It used a 1:1 ratio of DHA to EPA, which resulted in a greater intake of DHA than in many of the previous studies.

The study included 40 boys, aged 8-14, who had been diagnosed with ADHD and 39 matched controls who did not have ADHD. Both groups were either given margarine containing 650 mg/day of both DHA and EPA or a placebo margarine containing an equal amount of monounsaturated fatty acids for 16 weeks. Compliance with the study was measured in terms of the amount of margarine consumed and the levels of DHA and EPA found in cells obtained by a cheek swab. ADHD symptoms (particularly attention span, rule-breaking behavior and aggression) were assessed on the basis of standardized parent-rated child behavior assessments. The results of the study were:

  • At the start of the study, the children with ADHD scored higher on all measures of ADHD symptoms. No surprise here.
  • can foods cause adhd in kidsThe children with the lowest omega-3 levels at the beginning of the study scored highest on all measures of ADHD symptoms. This is also not surprising given the results of previous studies.
  • Omega-3 supplementation increased attention span in boys with ADHD, and the improvement in attention span correlated with an increase in omega-3 status. No improvement was seen in other symptoms of ADHD (rule-breaking behavior and aggression).

Since different studies tend to use different symptom assessments to measure the severity of ADHD, this may explain why some of the previous studies on omega-3s and ADHD symptoms have come up empty. The authors also suggested that some previous studies may have come up empty because the omega-3 supplements they used were low in DHA.

What Is The Significance Of This Study?

Because this study included a control group of boys without ADHD, it offers a whole new perspective on the importance of omega-3s for children. For example, this study showed:

  • Omega-3 supplementation improved attention span equally well in boys with and without ADHD. This is perhaps not surprising. If you have ever had a child in the 8 to 14 year old range, you know their attention span could stand a bit of improvement.

However, when you think about it, this study represents a potential paradigm shift in how we think about omega-3s and childhood behavior. The real significance of this studyis that it suggests that omega-3 supplementation may be beneficial for any child with poor attention span, not just for children with ADHD. This interpretation would be fully consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

 

The Bottom Line

  • Previous studies have suggested that the long chain omega-3 fatty acids DHA and EPA are modestly effective at improving ADHD symptoms in children, and that they are most effective in children with the lowest omega-3 status at the beginning of the studies.
  • The current study showed that supplementation with DHA and EPA improved attention span in boys aged 8-14 with ADHD, but did not improve other ADHD symptoms such a rule-breaking behavior and aggression.

What does this mean to you if you have a child with ADHD?

  • If the ADHD symptoms are mild and mostly relate to attention span or learning skills, omega-3 supplementation alone may be enough to make a difference. Based on this study you might want to choose an omega-3 supplement that is rich in DHA.
  • If the ADHD symptoms are severe, you will probably need to include omega-3 supplementation as part of a more holistic natural approach for controlling the symptoms.
  • Finally, if a holistic natural approach is just too difficult to manage, the good news is that recent studies suggest that omega-3 supplementation makes ADHD medications more effective, which means your child’s physician may be able to reduce the dose of medication if you include omega-3 supplementation along with the medication.

This study was unique in that it also included a control group of 8-14 year old boys without ADHD and found that omega-3 supplementation was equally effective at improving attention span in children without ADHD.

  • This is a single study, but if it is replicated by future studies it suggests that we may need to change our paradigm. What we have been thinking about omega-3 supplementation for children may be all wrong. Perhaps we should stop thinking of it as a supplement that might help with ADHD symptoms and start thinking of it as a supplement that might help children improve their attention span and mental focus whether they have been diagnosed with ADHD or not. This would certainly be consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

One final thought:

  • This study was performed with boys because they are more prone to ADHD symptoms than girls. However, based on numerous previous studies it is safe to assume that it is likely to apply equally well to girls with and without ADHD.

 

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.

Magnesium Supplements Benefits | Reduce Diabetes Risk?

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Author: Dr. Stephen Chaney

 

reduce diabetes riskI came across an article the other day suggesting that one of the magnesium supplements benefits might be  improved blood sugar control in pre-diabetics with low blood levels of magnesium (Guerrero-Romero et al, Diabetes & Metabolism, 41: 202-207, 2015). Considering that…

  • A 2014 CDC report stated that 1/3 of adult Americans are pre-diabetic, and…
  • Most people with pre-diabetes will go on to develop type 2 diabetes in 10 years or less, and…
  • Diabetes is the 7th leading cause of death in this country, and…
  • 60% of Americans don’t get enough magnesium in their diets…

…this could be a really big deal! Because of this I scrutinized the paper very carefully and reviewed the literature on magnesium intake and the incidence of type 2 diabetes.

 

Do Magnesium Supplements Improve Blood Sugar Control?

This was a relatively small study (116 adults, age 30-65), but it was well designed. All of the subjects had mild impairments in blood sugar control (i.e. were pre-diabetic), and all of them had low blood magnesium levels (≤1.8 mg/dL). This is a significant improvement over most previous studies of magnesium supplementation and blood sugar control because blood magnesium levels were not determined in many of those studies.

magnesium supplements benefitsThe study was double-blind, placebo controlled.Subjects received either 382 mg of magnesium or a placebo each day for 16 weeks, at which time blood sugar control and blood magnesium levels were re-measured. All subjects were put on a weight maintenance diet consisting of 55% healthy carbohydrates, 25% healthy fats, and 20% healthy proteins and told to exercise for at least 30 minutes three times per week.

Adherence to the diet and exercise regimen was 91% in both the supplement and placebo groups. Adherence to magnesium supplementation was 85% as measured by an increase in blood magnesium levels.

At the end of 16 weeks:

  • Improvement in blood sugar control was observed in 50% of the people in the magnesium group compared to 7% in the placebo group. This was significantly different.
  • Triglyceride levels were significantly decreased while HDL and blood magnesium levels were significantly increased in the magnesium group compared to the placebo group.
  • Side effects of magnesium supplementation were mild abdominal pain (7.6%) and diarrhea (6.0%).

The authors concluded:

  • “Our present results demonstrate the efficacy and safety of magnesium supplementation in the reduction of plasma glucose levels and in the improvement of glycemic status [blood sugar control] of pre-diabetic individuals who have low serum magnesium levels.”
  • “Our results support the hypothesis that, as a complement to lifestyle intervention programs, people with pre-diabetes and low blood levels of magnesium also should take magnesium supplements to decrease plasma glucose levels and potentially decrease the transition rate from pre-diabetes to diabetes.”

Magnesium and Blood Sugar Control

reduce blood sugarWhile the results of the recent study were impressive, it was a single, relatively small study, so I did a thorough review of the literature to put this study in perspective. This is what I found:

  • A major study that followed 2,582 participants enrolled in the Framingham Heart Study for 7 years (Hruby et al., Diabetes Care, 37: 419-427, 2014) concluded that those who consumed the most magnesium (400 mg/day) had a 50% reduction in the risk of developing type 2 diabetes compared to those who consumed the least (240 mg/day).

Several other studies comparing magnesium intake to diabetes risk have come to similar conclusions.

  • A meta-analysis of 13 studies with 536,318 people (Dong et al, Diabetes Care, 34: 2116-2122, 2011) concluded that the risk of diabetes was decreased by 14% for every 100 mg of magnesium consumed.
  • Most, but not all, intervention studies like the one described above have shown that magnesium supplementation reduced blood glucose levels and improved blood sugar control.

However, most of these studies did not measure blood magnesium levels. This is a significant drawback because if the majority of subjects in a particular study had adequate blood magnesium levels at the beginning of the study, one would not expect additional magnesium to improve blood sugar control.

  • A study of 4257 participants in the 1999-2000 National Health and Nutrition Examination Survey (Ford &Mokdad, Journal of Nutrition, 133: 2879-2882, 2003) concluded that around 60% of the adult US population was getting sub-optimal levels of magnesium from their diet.

The RDAs for magnesium range from 310-420 mg/day depending on age and gender, while intakes of magnesium ranged from 144-326 mg/day depending on age, gender and ethnicity. Those taking supplements had significantly greater magnesium intake than non-supplement users.

However, dietary recall studies almost always overestimate the percentage of the population that is deficient in any particular nutrient. Blood nutrient levels are usually considered a better indicator of nutrient deficiency, and some experts estimate that 20-30% of the US population may have blood levels of magnesium that are less than optimal.

Unfortunately, in the case of magnesium it is unclear whether even blood levels are an adequate indicator of nutrient status. That’s because only 1% of your body’s magnesium is found in the blood. The rest is locked up in your tissues where it is much more difficult to determine whether your magnesium status is adequate or not.

 

The Bottom Line

  • A recent study showed that magnesium supplementation improves blood sugar control in pre-diabetics with low blood magnesium levels. The authors concluded that magnesium supplementation along with lifestyle change may be effective in slowing the progression from pre-diabetes to type 2 diabetes.
  • This study is consistent with a number of previous studies suggesting that increased magnesium intake is associated with decreased risk of developing type 2 diabetes.
  • This study is also consistent with the principle that supplementation works best in situations where there is a demonstrated need for a particular nutrient, in this case magnesium (the study participants were selected in part on the basis of low blood levels of magnesium).
  • Other studies have shown that around 60% of the population is getting inadequate magnesium from their diet.Dietary recall studies probably overestimate the percentage of the population that is magnesium deficient, but most experts agree that a significant percentage of the US population likely have less than optimal magnesium status.
  • You probably don’t need mega-doses of magnesium to support good blood sugar control. The clinical study described above used 382 mg/day of magnesium, but most dietary recall studies suggest that dietary intake of magnesium in this country is only 100-200 mg/day below RDA recommendations.
  • Assuring an adequate intake of magnesium is only one component of a holistic approach for reducing the risk of developing type 2 diabetes. Other important components are weight control, exercise, and a healthy diet that restricts sugars and starches.
  • Good dietary sources of magnesium include leafy green vegetables (5-6 servings = RDA), nuts (5-6 servings = RDA), orwhole wheat bread or brown rice (8-9 servings = RDA).
  • Supplementation with ≥300 mg of magnesium can cause gas, bloating and diarrhea in sensitive individuals. If you are supplementing with magnesium, I recommend a sustained release supplement.

 

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

Is Vitamin E Deficiency Common in the US

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 Does Vitamin E Matter?

Author: Dr. Stephen Chaney

are Americans vitamin E deficientA headline claiming “Over 90% of Twentysomethings Have Suboptimal Vitamin E Status” caught my eye the other day, so I decided to investigate further. If you have been following all of the information and misinformation about vitamin E in the online media, you are probably confused – and this headline just adds to the confusion. There are probably three basic questions you want answered:

  • Is the latest study valid? Are most Americans vitamin E deficient?
  • Does it matter? Vitamin E has been described as “a vitamin in search of a disease”. If there are no diseases associated with vitamin E deficiency, should we even be concerned if most Americans are vitamin E deficient?
  • Is there any value to vitamin E supplementation? You will see claims that vitamin E supplementation has been proven not to work. Are these claims valid?

Let me guide you through the maze. I will start by analyzing the study behind the current headlines.

Are Americans Vitamin E Deficient?

is vitamin e deficiency common in the usThe best food sources of vitamin E are nuts, seeds and unrefined vegetable oils, followed by green leafy vegetables. Since these foods are not abundant in the American diet, it is no surprise that previous studies have shown that 83% of US children and 91% of US adults do not consume the recommended 12 mg/day of vitamin E. Consequently, the 2015 Dietary Guidelines Advisory Committee identified vitamin E as a “shortfall nutrient”.

This study (McBurney et al, PLoS One 10(8): e0135510 doi: 10.1371/journal.pone.0135510) took the next logical step by asking whether the inadequate intake of vitamin E lead to inadequate blood levels of the vitamin. The authors analyzed data from 7,922 participants who had their blood levels of alpha-tocopherol (the most abundant form of vitamin E) determined in the 2003-2006 National Health and Nutrition Examination Survey (NHANES).

They subdivided participants into those who used no supplements (4049) and those who used supplements (3873). (Note: The supplement users were not necessarily using vitamin E supplements, but many were using a multivitamin supplement containing vitamin E). The authors compared the study participant’s blood levels of vitamin E with the Institute of Medicine standard for vitamin E deficiency (12 umol/L) and with a standard they set for adequate vitamin E levels (30 umol/L). Here are the results of their analysis:

  • People who did not use supplements had lower blood levels of vitamin E (24.9 umol/L) than those who used supplements (33.7 umol/L). No surprise here.
  • Only 0.6% of Americans were clinically deficient in vitamin E (blood levels < 12 umol/L). The prevalence of vitamin E deficiency did not vary significantly with age, gender or ethnicity.
  • When they looked at the people not using supplements, the percentage with suboptimal vitamin E status (blood levels < 30 umol/L) varied significantly by age, but was not significantly affected by gender or ethnicity. In this analysis the percentage with suboptimal vitamin E status was:
  • 7% for ages 20-30.
  • 8% for ages 31-50
  • 2 % for ages 51 and above

Were The Headlines Correct?

newspaper heallinesTechnically speaking the headlines were correct. 92.7% of Americans aged 20-30 who used no supplements had suboptimal blood levels of vitamin E as defined in this study. When you combined both supplement users and non-users, the percentage with suboptimal blood levels of vitamin E was only slightly less (87.4%). However, there are a couple of important caveats:

  • There is no internationally recognized standard for adequate blood levels of vitamin E. The authors had a reasonable rationale for choosing 30 umol/L as their standard for adequate blood levels, but they also acknowledged that the Estimated Average Requirement of vitamin E from food (12 mg/day) would result in a blood level of 27.9 umol/L, so their standard may be a bit high.
  • The average blood level of vitamin E for non-supplement users was 24.9 umol/L. While that is less than adequate, it is only slightly low – especially if the lower standard of 27.9 umol/L is used.

I think it would be more accurate to say that a large percentage of Americans have blood levels of vitamin E that are slightly below what is considered adequate but are far above what could be considered clinically deficient. The question then becomes “Does it matter?”

Does Vitamin E Matter?

Let me start with a little perspective. In the United States diseases like scurvy, pellagra and beriberi are things of the past. We simply don’t see deficiency diseases anymore. What we do see are intakes of essential nutrients that are slightly below optimal. Vitamin E is no different.

If we focus on suboptimal nutrient intake by itself, the answer would probably be that it doesn’t matter. Suboptimal nutrition is seldom enough to cause poor health by itself.

However, we also need to take into account individual differences that affect the need for essential nutrients. Poor health is much more likely to arise when suboptimal intake of one or more essential nutrients is coupled with increased needs due to genetic predisposition, risk factors that predispose to disease, and/or pre-existing disease.

With this perspective in mind, we are ready to ask whether suboptimal intake of vitamin E or any other essential nutrient matters. The answer is pretty simple. It doesn’t matter for everyone, but it matters very much for those individuals with increased needs.

If we had a good way of assessing individual nutritional needs, it would be easy to say who needed supplements and who didn’t. The problem is that we currently have no good way of assessing individual needs for essential nutrients. We simply cannot predict who will and who won’t be affected by suboptimal nutrient intake. That is why millions of Americans take supplements on a daily basis.

Is There Any Value To Vitamin E Supplementation?

vitamin e supplementationThat brings us to the final question. Is vitamin E supplementation a waste of money? You’ve probably already heard that most studies have failed to show any benefit from vitamin E supplementation, but you may be asking “How can that be when we also know that most Americans are getting suboptimal levels of vitamin E in their diet?”

With the perspective I described above in mind, the answer is pretty simple. Those studies have been asking the wrong question. They have been asking whether vitamin E supplements benefit everyone. They haven’t asked whether vitamin E supplements benefit people with increased needs.

When you ask that question the answer is very different. Let me give you three examples – one representing each of the kinds of increased need I described above:

  • In the Women’s Health Study (JAMA, 294: 56-65, 2005) vitamin E supplementation had no effect on heart attack or stroke in the general population. But when they looked at women over 65 (those at highest risk for heart disease), vitamin E supplementation reduced heart attack and stroke by 25% and cardiovascular deaths by 49%
  • In the Heart Outcome Prevention Evaluation Study (Diabetes Care, 27: 2767, 2004; Atherosclerosis, Thrombosis & Vascular Biology, 24: 136, 2008) vitamin E supplementation had no effect overall on heart attacks or cardiovascular deaths. But when they looked at a population who had a haptoglobin genotype that significantly increases the risk of heart disease, vitamin E supplementation significantly decreased the risk of both heart attacks and cardiovascular deaths.

 

The Bottom Line

  • Recent headlines saying that over 90% of young Americans have suboptimal vitamin E status are technically correct, but a bit overstated. It probably would have been more accurate to say that most Americans have slightly suboptimal vitamin E status.
  • The important question then becomes “Do marginal nutritional deficiencies matter?” The answer is pretty simple. Marginal nutritional deficiencies do not matter for everyone. However, they matter very much for those people who have increased needs for that nutrient due to genetic predisposition, risk factors for disease or pre-existing disease.
  • If we had a good way of assessing individual nutritional needs, it would be easy to say who needed supplements and who didn’t. However, we don’t have a good way of assessing increased needs for most nutrients, which is why many Americans use supplements on a daily basis.
  • As for all of those studies saying that vitamin E supplementation has no benefit, they are a bit misleading because they are asking the wrong question. They are asking whether vitamin E supplementation benefits everyone. They are not asking whether vitamin E supplementation benefits people with increased needs. When you ask that question the answer is very different (see examples in 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.

Are Supplements Worth It?

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A Cost, Benefit Analysis of Supplementation

Author: Dr. Stephen Chaney

 

are supplements worth itAre supplements worth it?  There is no question that supplements add to the family budget. As families juggle their budgets it is natural to wonder whether the supplements they are buying are worth the cost.

It is only natural to ask questions like: “What is the cost, benefit ratio of supplementation?” “Is there any evidence that supplementation today will save us money in health care costs down the road?”

If a recent study is accurate, the answer to that last question may be a resounding yes!

How the Study Was Designed

A number of studies in the past have suggested that supplementation reduces health care costs, but they have suffered from a variety of methodological pitfalls so their conclusions could not be considered definitive.

In a time of skyrocketing health care costs coupled with governments tightening their budgets worldwide, it has become increasingly important for those governments to determine what the most cost effective public health interventions are. Thus, the question of whether supplementation can decrease health care costs has become paramount.

Therefore, an international group of scientists decided to do a systematic review and meta-analysis of the cost effectiveness of supplementation (Elia et al, Clinical Nutrition, doi: 10.1016/j.clnu.2015.07.012). They included only the highest quality previous studies in their analysis. After screening 16,598 published studies they excluded all but 19 in their final evaluation. The studies that they included had the following characteristics.

  • The subjects were supplementing with a commercially available multi-nutrient supplement that also contained protein and calories (i.e. a meal replacement supplement). Subjects consuming disease-specific supplements or immune-enhancing supplements were excluded from the study.
  • Subjects were studied in a wide variety of settings, including both free living individuals in the community and those in care homes
  • In some cases the supplementation was begun while they were in the hospital and continued when they went home. In other cases supplementation was begun while they were at home and continued after admission to the hospital.
  • Subjects were of all ages.

Are Supplements Worth It — The Money?

are supplements worth the moneyFrom a public health perspective the conclusion from this study was clear. Supplementation with a basic meal replacement supplement saves money. It is an effective public health intervention.

  • Overall, supplementation decreased health care costs by 8.1%.
  • For studies lasting less than 3 months, supplementation reduced health care costs by 9.2%. These were most often short-term pre- and/or post-operative supplementation studies. The cost savings ranged from $300-$530 per patient.
  • For studies lasting more than 3 months, supplementation reduced health care costs by 5%. These were mostly long-term community studies.
  • Overall, the costs savings attributable to supplementation were most apparent in short term studies involving a hospital component and in those studies involving younger patients.

The first observation was expected, but the second was a bit of a surprise. The general assumption is that elderly patients are more likely to suffer from malnutrition and benefit from supplementation. These data suggest that suboptimal nutrition may be more prevalent in younger adults than generally anticipated.

The reduction in health care costs was primarily due to:

  • Significant (16.5%) reduction in hospital admissions.
  • Decreased length of stay in the hospital.
  • Decreased infections.
  • Reduced post-operative complications.
  • Reduced falls and functional limitations in the elderly.

Although, it did not factor into the cost analysis, those subjects using the meal replacement supplement reported greater quality of life as well.  Are supplements worth it?  For some, a greater quality of life would help answer that question.

Strengths and Weaknesses of the Study

This was an excellent study, but it does have some important limitations.

  • While the systematic review and meta-analysis was very well done, it is limited by the quality of the studies that were included in the analysis, and most of those studies had one or more limitations. The authors acknowledged the need for future large scale, prospective studies, that are designed specifically to measure the cost effectiveness of supplementation.
  • The authors focused almost entirely on the cost benefit analysis. No information was provided on:
  • The health of these subjects
  • Why they were using a meal replacement supplement
  • Whether they decided to use the meal replacement supplement on their own or whether it was recommended by their doctor.

Thus, it is a bit difficult to extrapolate these data from a public health perspective to an individual perspective – the question of whether supplementation reduces health care costs sufficiently to be cost effective for you and me.

  • This study showed that even a basic meal replacement supplement has a significant effect on reducing health care costs in a variety of settings. However, it provides no information on whether individuals would obtain even greater benefit if they included other supplements in their program.

The Bottom Line

  1. A recent study has shown that even a simple meal replacement supplement can be an effective public health intervention because it significantly reduces health care costs and improves quality of life.
  2. The most significant reductions in health care costs came from:
    • A significant (16.5%) reduction in hospital admissions.
    • Decreased length of stay in the hospital.
    • Decreased infections.
    • Reduced post-operative complications.
    • Reduced falls and functional limitations in the elderly.
  3. The cost savings were most significant when the meal replacement supplement was used just prior to or following hospital admission for a surgical procedure. This argues strongly for a basic program of nutrition supplementation whenever you are preparing for surgery.However, as the saying goes “Stuff happens”. We don’t always know the precise date and time of our next hospital admission. This may be one case where an ounce of prevention is definitely worth a pound of cure.
  4. The study did include some long term studies of free living individuals in the community, but it is difficult to directly extrapolate from this study to the question of how much a basic meal replacement supplement might reduce health care costs for healthy individuals like you and me.However, many of the things we do to improve our health – buy organic, go on a diet program, purchase a gym membership, or go on a supplement program, for example – cost us money. It is studies like this that suggest at least a portion of those costs may be offset by reduced health care costs down the road.
  5. Finally, this study only looked at the cost effectiveness of a basic meal replacement supplement. It does not provide any information on whether addition of other supplements might provide even greater health care savings.There are studies suggesting that a holistic approach to supplementation may reduce disease burden long term (for example; Nutr J. 2007 Oct 24; 6:30). A detailed cost effectiveness analysis has not been performed on those studies, so we cannot say how much money they might save in reduced health care costs over the long term. However, if a holistic program of diet, exercise and supplementation keeps me out of the doctor’s office and out of the hospital, I’m happy.

 

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.

Leucine And Muscle Gain

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Should Your Post-Workout Protein Shake Contain Added Leucine?

Author: Dr. Stephen Chaney

 

If you are an athlete – or just someone who is exercising to create a lean and healthy body, you are probably interested in increasing your lean muscle mass following each workout. You may leucinealready use leucine.  Of course, if you read any of the “muscle magazines”, you’ve seen the ads. “Explode Your Muscles.” “Double Your Gains.” They all claim to have the perfect post-workout protein shake, backed by science. They all sound so tempting, but you know that some of them have to be scams.

I told you about some of the sports supplements to avoid in previous “Health Tips From the Professor”. In this issue, I’m going to ask “What does the perfect post-workout protein shake look like?”

For years athletes have been using protein beverages containing branched chain amino acids after their workouts to maximize muscle gain and recovery. There was some science behind that practice, but the major questions were unanswered. Nobody really knew:

  • How much protein is optimal?
  • What kind of protein is optimal?
  • What amount of branched chain amino acids is optimal?
  • Are some branched chain amino acids more important than others?
  • Does the optimal amount of branched chain amino acids depend on the amount of protein?

As a consequence, after workout protein supplements were all over the map in terms of protein source, protein amount, branched amino acid amount and type of branched chain amino acids. Fortunately, recent research has clarified many of these questions.

How Much Protein Do You Need and What Kind?

  • Recent research has shown that the optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young adults (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older adults (Symons et al, Am J Clin Nutr 86: 451-456, 2007).
  • More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young adults and 30 gm for older adults (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).
  • Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, pea, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

Leucine: The Only Branched Chain Amino Acid To Stimulate Muscle Protein

  • branched chain amino acidIt turns out that leucine is the only branched chain amino acid that actually stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.
  • Recent research has shown that 2-3 gm of leucine (2 gm for young adults; 3 gm for older adults) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

Unanswered Questions About Optimizing Muscle Gain Post-Workout

  • Do the other branched chain amino acids play a supporting role, or is leucine alone sufficient to drive post-workout muscle gain?
  • Can leucine still help maximize post-workout muscle gain if protein intake is inadequate? If so, how much leucine is needed?

Does Leucine Enhancement Improve Low Protein Shakes?

A recent study (Churchward-Venne et al, Am J Clin Nutr, 99: 276-286, 2014) seems to answer those two questions. The authors compared the effect of 5 protein-amino acid combinations on best post workout shakemuscle protein synthesis in 40 young men (~21 years old) following unilateral knee-extensor resistance exercise. The protein shakes contained:

  • 25 gm of whey protein, which naturally contains 3 gm of leucine (high protein)
  • 6.25 gm of whey protein, which naturally contains 0.76 gm of leucine (low protein)
  • 6.25 gm of whey protein with 3 gm of leucine (low protein, low leucine)
  • 6.25 gm of whey protein with 5 gm of leucine (low protein, high leucine)
  • 6.25 gm of whey protein with 5 gm of leucine + added isoleucine and valine (the other branched chain amino acids). (low protein, branched chain amino acids).

The results were clear cut:

  • The high protein shake (25 gm of protein) was far superior to the low protein shake (6.25 gm of protein) at enhancing post workout protein synthesis. This is consistent with numerous other published clinical reports.
  • Adding 3 gm of leucine to the low protein shake had no effect on post-workout protein synthesis, but 5 gm of added leucine made the low protein shake just as effective as the high protein shake at supporting post-workout protein synthesis.

In short, leucine can improve the effectiveness of a low protein shake, but you need more leucine than if you chose the high protein shake to begin with.

  • Adding extra branched chain amino acids actually suppressed the effectiveness of leucine at enhancing post-workout protein synthesis. These data suggest:
    • Leucine probably is the major amino acid responsible for the muscle gain reported in many of the previous studies with branched chain amino acids.
    • If the other branched chain amino acids play a supporting role in the muscle gain, the quantities that occur naturally in the protein are probably enough. Adding more may actually reduce the effectiveness of leucine at stimulating muscle gain.

While this is a single study, it is consistent with numerous other recent clinical studies. It simply helps clarify whether leucine can increase the effectiveness of a low protein supplement. It also clarifies the role of branched chain amino acids.

Also, while this study focused on protein synthesis, numerous other studies have shown that optimizing post-workout protein and leucine intake results in greater muscle gain (for example, Westcott et al., Fitness Management, May 2008)

 

The Bottom Line

Research on post-workout nutrition to optimize muscle gain from the workouts has come a long way in recent years. It is now actually possible to make rational choices about the best protein supplements and foods to support your workouts.

  • If you are a young adult (17-30), you should aim for 15-20 gm of protein and about 2 gm of leucine after your workout.
  • If you are an older adult (50+), you should aim for 20-25 gm of protein and 3 gm of leucine after your workout.
  • If you are in between you are on your own. Studies haven’t yet been done in your age group, but it’s reasonable to assume that you should aim for somewhere between the extremes.
  • If you are getting the recommended amounts of whey protein, the leucine level may also be optimal. If you are using other protein sources you may want to choose ones with added leucine.
  • The research cited above shows that you can make a low protein supplement effective by adding lots of leucine, but that’s going to require artificial flavors and sweeteners to cover up the taste of that much leucine. I would recommend choosing one that provided adequate protein to begin with.
  • While the research in this area is still somewhat fluid, I would avoid protein supplements with added branched chain amino acids other than leucine. If the paper I cited above is correct, you probably get all of the other branched chain amino acids you need from your protein and adding more may actually interfere with the effect of leucine on muscle gain.
  • I’d pretty much forget all the other “magic ingredients” in post-workout supplements. If you’re a novice there is some evidence that arginine and HMB may be of benefit, but if you have been working out for more than 6 months, the evidence is mixed at best. As for the rest, the clinical studies are all over the map. There’s no convincing evidence that they work.
  • Whey protein is the best choice for enhancing muscle gain immediately after your workout. Soy, pea, and casein are better choices for sustaining muscle gain over the next few hours. If you’re looking at meat protein, chicken is a particularly good choice. Four ounces of chicken will provide the protein and leucine you need to sustain muscle gain for several hours.

Even if you are not working out, recent research on dietary protein and leucine has important implications for your health. In a recent “Health Tips From the Professor” High Protein Diets and Weight Loss, I shared research showing that optimizing protein and leucine intake helps to increase muscle retention and maximize fat loss when you are losing weight.

 

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.

Alternatives To Statins

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How Do Stanols And Sterols Lower Cholesterol?

Author: Dr. Stephen Chaney

 

alternatives to statins%BLOG_TITLE%Are there alternatives to statins?  If you have been looking for natural approaches for lowering your cholesterol and protecting your heart, you’ve probably been hearing a lot about plant stanols and sterols lately.

What Are Stanols and Sterols & What Do They Do?

Just what are plant stanols and sterols and why does the National Institutes of Health (NIH) recommend them as a natural approach for lowering cholesterol?

Stanols and sterols are natural substances found in plants that have a structural resemblance to cholesterol. Because they look a lot like cholesterol, they compete with cholesterol for absorption from the intestine into the mucosal cells lining the intestine. However, once they get into the intestinal mucosal cells they are recognized as foreign and are immediately pumped back into the intestine so that they never get into the bloodstream.

lower cholesterolLet me give you an analogy. Let’s think of the intestinal mucosal cells as a nightclub. The doorman doesn’t check IDs. He lets everyone into the club. Pretty soon the word gets around and stanols and sterols start lining up at the door. If a cholesterol molecule comes along, he gets discouraged by the line and doesn’t even try to get in. What the stanols and sterols don’t know is that there is a bouncer inside the club who does check IDs throws everyone who doesn’t belong there out the back door.

When you think about it, this is the best of all possible worlds. Cholesterol molecules don’t get into the bloodstream and neither do the stanols and sterols.

 

Alternatives to Statins:  How Do Stanols and Sterols Lower Cholesterol?

stanols and sterols lower cholesterolAs part of their Therapeutic Lifestyle Change Program the NIH recommends that people with elevated cholesterol consume 2 grams of plant stanols and sterols a day because over 80 clinical studies have proven that they work.

Two grams a day of stanols and sterols is sufficient to lower LDL cholesterol (the bad kind) by 9 to 13%. And many other clinical studies have shown that lowering LDL cholesterol by that much will lower your risk of a heart attack by 18-26%.

No wonder the NIH is so bullish on stanols and sterols!

 

Answers To The Questions You Didn’t Think To Ask

Here are answers to some questions that you haven’t even thought of yet:

#1: If 2 grams a day is good, would more be better?

No. Studies clearly show that 2 grams/day is optimal. Higher intakes do not lead to a significantly greater reduction in LDL cholesterol.

#2: Are there any side effects from consuming plant stanols & sterols on a daily basis?

No. That’s the great thing. Plant sterols and stanols are natural substances that we consume every day – and clinical studies have shown that they have no side effects.

#3: Is there some magical stanol/sterol combination that is more effective than others (as some supplement manufacturers would have you believe)?

fruits and vegetables lower cholesterol naturallyNo. Numerous studies have shown that stanols and sterols from many different sources have exactly the same effect and that it doesn’t matter whether they are esterified or not.

#4: Can I get 2 grams a day of stanols and sterols from my diet?

It’s unlikely. Even the best natural sources (usually fruits and vegetables) only have 5 to 40 mg per serving. If you are a vegetarian you can expect to get around 700 mg from your diet. If you consume a typical American diet you get around 250 mg and if you eat a lot of fast food you are probably getting less than 100 mg.

#5: I’ve noticed that food manufactures have started fortifying foods with stanols and/or sterols. Is this a good choice for me?

Not necessarily. You need to remember that Big Food Inc is not always your friend. To get 2 grams of stanols from Benecol you would need to consume 280 calories, 4 grams of saturated fat and 1.2 grams of trans fat. Two grams of stanols from Promise activ Super-Shot only costs you 70 calories, but it comes with artificial colors and 8 grams of sugar plus sucralose.

#6: When should I consume stanols and sterols if I want to maximize my LDL cholesterol reduction?

Any time from 30 minutes prior to your meal to with your meal is ideal – but the plant sterols and stanols will exert their beneficial effects for several hours so the time that you take the stanols & sterols is not critical.

#7: Are plant sterols and stanols a source of dietary fiber?

No. Plant stanols & sterols and dietary fiber work by different mechanisms – but they do complement each other in lowering LDL cholesterol. As a matter of fact, the NIH Therapeutic Lifestyle Program recommends 10-25 grams/day of soluble fiber along with the 2 grams/day of stanols and sterols. You should consider stanols/sterols and dietary fiber as a powerful one-two punch in your battle to lower your LDL cholesterol naturally.

#8: I’m already taking a statin drug. Is it OK to take plant stanols & sterols as well?

Absolutely. The NIH recommends that people using statin drugs also follow their Therapeutic Lifestyle Change Program – which includes 2 grams of plant stanols and sterols a day. In fact, because the effects of statins and plant sterols & stanols are additive, you may be able to reduce your dosage of statins or eliminate them entirely – which means less cost and less risk of side effects to you. [Note: You should partner with your physician in determining the dosage of statins to take.]

What I do not recommend is that you go off your statin drug and switch to a supplement containing stanols and sterols without consulting your doctor. Stanols and sterols have a more modest cholesterol lowering effect (and fewer side effects) than statin drugs. So if you were to just go off your statin and switch to a stanol/sterol supplement, your cholesterol levels might actually go up.

#9: Should I ask my doctor before taking plant stanols & sterols?

I always recommend that you keep your doctor informed about what you are doing. However, because the NIH recommends plant sterols and stanols for people with elevated cholesterol, your doctor is very likely to approve.

 

The Bottom Line

 

  • Plant stanols and sterols can be an important part of a holistic approach to lowering cholesterol naturally. In fact, the NIH recommends 2 grams/day of plant stanols and sterols as part of its Therapeutic Lifestyle Change Program  for lowering cholesterol.
  • 2 grams/day of plant stanols and sterols lowers LDL cholesterol (the bad kind) by an average of 9 to 13%, which is sufficient to decrease your heart attack risk by 18-26%.
  • Here are the answers to the most common questions I receive about stanols and sterols (for the full response read the article above)
  • 2 grams of stanols & sterols a day is optimal. More is not better.
  • There are no side effects to adding stanols & sterols to your diet.
  • There is no “magical” sterol/stanol formulation. They all work about the same.
  • It is very unlikely that you can get 2 grams/day of stanols & sterols from your diet.
  • It is best to consume stanols & sterols before or with a meal, but the exact timing isn’t crucial.
  • Stanols & sterols are not the same as dietary fiber, but stanols/sterols and dietary fiber complement each other as part of a holistic approach to lower cholesterol.
  • It is OK to take stanols & sterols along with a statin drug. In fact, this is part of the approach recommended by the NIH Therapeutic Lifestyle Change Program. However, I do not recommend going off of a statin drug and substituting stanols & sterols without the permission of your doctor.

 

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

Do Statins Cause Memory Loss?

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Is the Cure Worse Than the Disease?

Author: Dr. Steve Chaney

 

statins and diabetesDo statins cause memory loss?  They are at it again. The medical profession is telling us that yet another study shows that statins are safe, so almost everyone should be taking a statin drug. There is only one problem. That’s not what the study really showed.

Let’s start at the beginning. For people who have already had a heart attack it is pretty clear that statin drugs save lives. If stain drugs were only prescribed for people who have had a heart attack or were at high risk of having a heart attack, I would be a proponent of their use.

However, the guidelines developed by the pharmaceutical and medical industry recommend statin use for millions of Americans who have never had a heart attack and who are at low to moderate risk of ever having a heart attack. That is problematic.

As I documented in a recent “Health Tips From the Professor”  the benefits of statins are marginal at best in healthy people who have not yet had a heart attack.

In addition, statins have some significant side effects. For example, up to 5% of people taking statins develop muscle pain and weakness. For most people the muscle pain is merely an inconvenience, but in a small percentage of cases it can lead to serious complications.

More concerning are the required label warnings that statins can lead to memory loss, mental confusion, high blood sugar and type 2 diabetes. In fact, a recent study described in “Health Tips From the Professor” suggests that statins may increase diabetes risk by as much as 46%.

In other words, statins may not kill you, but they sure can make life miserable. For many people, the most troubling aspect of statin use is memory loss. One of the most terrifying aspects of aging is the thought that you might be able to keep your body healthy but lose your mind.

However, recent headlines have proclaimed that we can “forget” about statins causing memory loss (Pardon the pun. I couldn’t resist it). They claim that a recent study has shown that statins don’t actually cause memory loss. The problem is that is not exactly what the study showed. It is only the medical profession’s interpretation of what the study showed.

Why Might Statins Cause Memory Loss?

iron and brain developmentStatin drugs block cholesterol synthesis, and cholesterol is an integral part of the myelin sheath that coats our neurons. You can think of myelin as being like the plastic coating on an electrical wire. It is that plastic coating that allows the electrical current to travel from one end of the wire to the other without shorting out. Myelin plays essentially the same role for our neurons.

Because of the importance of cholesterol in maintaining the integrity of myelin, there was concern from the earliest days of statin development that it might adversely affect memory. Thus, multiple clinical studies have been performed to determine whether statin use adversely affects memory.

Unfortunately, the previous clinical studies have been inclusive. Some suggested that statins cause memory loss. Others found no correlation between statin use and memory loss. A few actually suggested that statins improved memory. There are a number of reasons why the previous studies came to different conclusions including use of different statin drugs, different duration of the studies, and differences in how memory was measured.

Do Statins Cause Memory Loss?

blood pressure medicationsThis study (Strom et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.2092) differed from previous studies in that:

  • It focused on short term memory loss, and
  • It also included a group of patients who were using non-statin cholesterol lowering drugs.

The study drew on patient data from the online Health Improvement Network database collected from general practitioners offices throughout England between July 7, 2013 and January 15, 2015. The study compared 482,543 statin users with 482,543 matched controls using no cholesterol lowering medication and 26,484 patients using non-statin cholesterol lowering medications. The average age of the participants in this study was 63. Memory loss within the first 30 days after initiation of drug therapy was assessed by scanning the medical records in the database for codes related to memory loss.

The results were stunning!

  • Stain drug users were 4-fold more likely to experience short term memory loss within the first 30 days than non-users, and the likelihood of memory loss was dose dependent.
  • The users of non-statin cholesterol lowering drugs were also 4-fold more likely to experience short term memory loss within the first 30 days than non-users.
  • As you might expect there was no significant difference in memory loss between users of the statin and non-statin cholesterol lowering drugs.

How Were The Results Interpreted?

The results seemed to be pretty clear cut, but it was a somewhat misleading interpretation of the results that was widely publicized. The authors of the article correctly pointed out that there are two possible interpretations of these results. Either…

  • All cholesterol lowering drugs cause acute memory loss….or
  • The association of memory loss with cholesterol lowering drugs is the result of something called “detection bias”.

Let me explain. Some memory loss is fairly common for people in their 60s and beyond. The term “detection bias” simply means that the patients might have been more acutely aware of memory loss because they were monitoring themselves for side effects to the drug they just started taking.

Of course, the medical profession is so confident in the benefits of statins that they focused on the second interpretation, and that is the one that you heard about in all of the press releases about this study. If you believe that the self-reported memory loss in this study was entirely due to detection bias, then the most logical interpretation of the study is that statin drugs really don’t cause memory loss.

However, I consider the first interpretation to be the most likely of the two. If use of cholesterol lowering drugs were associated with a 25% or 50% increase in memory loss, detection bias could have been a credible interpretation of the data. However, a 4-fold increase in memory loss is hard to ascribe to detection bias alone.

Furthermore, the first explanation is fully consistent with what we know about myelin. Because of the importance of cholesterol in maintaining the integrity of the myelin sheath, it is logical that any drug that dramatically lowers cholesterol levels could have an adverse effect on cognitive function.

Are There Other Options Besides Statin Drugs?

Because of the marginal benefits in healthy people and the multiple side effects, some experts are starting to step up and say that statins may be overprescribed. For example, Dr. Roger Blumenthal, MD, a professor and director of the Ciccarone Preventive Cardiology Center at Johns Hopkins recently said: “Statin therapy should not be approached like diet and exercise as a broadly based solution for preventing coronary heart disease. These are lifelong medications with potential, although rare, side effects, and physicians should only consider their use for those patients at greatest risk…”

So, what are the alternatives?

#1: Lower Cholesterol Naturally With Some TLC

healthy livingsThe National Heart Lung & Blood Institute recommends that something called Therapeutic Lifestyle Change or TLC should always be tried first for patients with elevated cholesterol, and that statins only be used if the lifestyle approach fails – a message that seems to have gotten lost in the translation in many doctor’s offices. The TLC recommendations are:

  • Add 2 grams per day of plant stanols and sterols to your diet. In most cases some that will require some degree of supplementation.
  • Eat less than 7 percent of your daily calories from saturated fat
  • Eat less than 200 mg a day of cholesterol
  • Make sure that you get 10-25 grams per day of soluble fiber.
  • Get only 25–35 percent of daily calories from total fat (this includes saturated fat calories)
  • Consume only enough calories to reach or maintain a healthy weight
  • In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week.

There is ample evidence that implementation of these lifestyle changes will reduce cholesterol levels and reduce the risk of heart attack and stroke without any side effects. The reduction in cholesterol levels is more modest than what can be achieved with cholesterol lowering medications, but perhaps that is the point. Perhaps the medical profession is being too aggressive in reducing cholesterol levels with drug therapy.

If you are a bit overwhelmed by the TLC recommendations, there is good news. Even one or two of the lifestyle changes mentioned above can substantially reduce your risk of heart attack or stroke. For example, in a previous “Health Tips From the Professor,” apple a day keeps statins away, I reported on a study claiming that simply eating one apple a day would be just as effective as statins at reducing cardiovascular deaths.

#2: Reduce Other Risk Factors Associated with Heart Disease

Elevated cholesterol is not the only risk factor associated with heart disease. In fact, many experts feel that it isn’t even the most important risk factor. High blood pressure, high triglycerides, inflammation and damage to the endothelial lining of our arteries are other important risk factors for heart disease. If you are leery about using statins to reduce your cholesterol levels, you might want to explore other natural approaches to reducing heart disease risk. For example:

  • Nitrate from foods such as beetroot and spinach reduce blood pressure and improve endothelial health. This is also a topic I have covered in a previous “Health Tips From the Professor” Nitric Oxide Benefits Side Effects.
  • Resveratrol and related polyphenols reduce inflammation and improve endothelial health.

I could go on, but you get the point. There are other natural approaches for reducing heart attack risk. Statins and other cholesterol lowering drugs are not the only game in town.

     Red Yeast Rice Yeast Rice Side Effects?

red yeast rice side effectsHowever, just because a supplement is natural doesn’t necessarily mean that it is either safe or effective. Red yeast rice is a perfect example. Many people think of red yeast rice as a natural way to reduce cholesterol levels. They believe red yeast rice side effects are non-existent. Nothing could be further from the truth!

The active ingredients in red yeast rice are a class of compounds called monacolins, which are close analogs of the statin drugs. In fact, the most abundant monacolin, monacolin K, is identical to the statin drug lovastatin.

That destroys one myth. If a red yeast rice product contains as much monacolin K as a lovastatin pill, it would have the same benefits and the same side effects.

It only gets worse! In fact, you have no way of knowing how much monacolin K is in your red yeast rice supplement. Because lovastatin is a drug the manufacturers are caught in a Catch-22 situation. If the manufacturers were to actually standardize or disclose the levels of monacolin K in their product, the FDA would consider it an unapproved drug.

When manufacturers don’t standardize their active ingredients bad things happen. How bad, you might ask? A recent study analyzed the concentration of active ingredients in 12 commercially available red yeast rice supplements (R. Y. Gordon et al, Archives of Internal Medicine, 170: 1722-1727, 2015). The results were appalling:

  • Total monacolins in the supplements ranged from 0.31 to 11.15 mg/capsule.
  • Monacolin K (lovastatin) ranged from 0.10 to 10.09 mg/capsule.
  • To put that into perspective therapeutic doses of lovastatin range from 10 to 80 mg/day.

It gets even worse! The study also measured levels of a toxin called citrinin that is produced by a fungus and is potentially toxic to the kidneys. This is not a toxin that you would find in a pharmaceutical product like lovastatin, but it was present in high levels in one third of the red yeast rice formulations tested.

To sum it all up, if you were to go out and purchase a red yeast rice supplement.

  • You might get a batch with no active ingredients. It wouldn’t have any of the side effects of a statin drug, but it wouldn’t have any efficacy either.
  • You might get a batch that would have the same efficacy and the same side effects as a low dose statin drug.
  • You would have a 33% chance of getting a batch that was contaminated with a toxin that you would never find in a statin drug.

I don’t know about you, but after reading that study I have no desire to ever try a red yeast rice supplement.

Do statins cause memory loss?

 

 

The Bottom Line

  • For people who have already had a heart attack statin drugs are clearly beneficial. They save lives.
  • If you haven’t already had a heart attack and your doctor prescribes a statin, you may want to have a serious discussion with your doctor about alternative approaches for reducing heart attack risk. You may even want to seek a second opinion from a doctor with a more holistic orientation. Recent research suggests that statin drugs:
  • Are of marginal efficacy in low to moderate risk individuals who have not suffered a heart attack.
  • Can cause muscle pain and weakness, which can lead to serious illness in a small percentage of the cases.
  • May increase the risk of developing type 2 diabetes by up to 46%.
  • May cause memory loss and mental confusion.
  • A recent study showed that both statin and non-statin cholesterol lowering drugs caused 4-fold greater short term memory loss in older adults compared to matched patients who were not taking statin medications.
  • The medical profession has chosen to interpret this study as showing that statin drugs don’t cause short term memory loss, and that is the interpretation that has been widely reported in the press. I feel that the more logical interpretation of the data is that both statin and non-statin cholesterol lowering drugs cause short term memory loss.
  • Fortunately, there are natural approaches for reducing cholesterol levels and heart disease risk without any side effects. For example, the National Heart Lung and Blood Institute recommends a natural approach called Therapeutic Lifestyle Change or TLC .
  • There are also natural approaches for reducing other risk factors for heart disease such as high blood pressure, high triglycerides, and inflammation. These include things like omega-3 fatty acids, nitrate from vegetables like beetroots and spinach, and polyphenols like resveratrol just to name a few.
  • However, natural is not always better. Red yeast rice, for example, is neither safe nor effective. 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.

Iron and Brain Development

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Iron and the Teen Brain
Author: Dr. Steve Chaney

 

iron and brain development in teensFor those of you with teenagers – or who have had teenagers in the past – you may suspect that there’s nothing between their ears. But actually there is a lot going on between their ears, and some of the neural contacts laid down in the brain during the teen years influence the health of their brain during their adult life.  Let’s look at the association between iron and brain development.

And – no surprise here – what they eat can affect the health of their brain as well.

Which brings me to a study published in the Proceedings of the National Academy of Sciences January 9, 2012 (doi: 10.1073/pnas.1105543109) that looks at the adequacy of dietary iron intake during the teenage years and their brain health as adults.

Basics of Iron Metabolism

Before I describe the study perhaps a little bit of what I call Biochemistry 101 is in order.

Free iron is toxic to living cells. For that reason, our body produces multiple proteins to bind and transport the iron. The protein that binds and transports iron through the bloodstream is called transferrin. Under normal conditions 2/3 of the transferrin in our bloodstream has iron bound to it and 1/3 does not. And that is the ideal ratio of bound and unbound transferrin for delivery of iron to brain cells and other cells in our body.

When our diet is iron deficient (or we have excessive blood loss) the percent iron saturation of transferring decreases. The body tries to compensate by producing more transferrin, but this doesn’t really help since the problem was inadequate iron supply, not inadequate transferrin supply. As a consequence elevated transferrin levels are generally indicative of an iron-deficient diet.

Iron and Brain Development in Teens

iron and brain developmentThe study was led by Dr. Paul Thompson of the UCLA Department of Neurology. He and his team performed brain scans on 631 healthy young adults with an average age of 23. The brain scans were of a type that measured strength and integrity of the connections between the nerves in the brain – in other words, the brain’s wiring. They then went back and looked at the amount of iron available to each subject’s brain during adolescence by looking at their blood transferrin levels from routine physical exams performed at ages 12, 14 and 16 (blood transferrin levels are often measured as part of routine physical exams).

The results were pretty clear cut. Elevated transferrin levels during the teenage years were associated with reduced brain-fiber integrity in regions of the brain that are known to be vulnerable to neurodegeneration. These individuals did not show any cognitive impairments as young adults, but the concern is that they might be more likely to develop cognitive impairments as they age.

Dr. Thompson summarized his team’s findings by saying that “Poor iron levels in childhood erode your brain reserves which you need later in life to protect against aging and Alzheimer’s. This is remarkable, as we were not studying iron deficient people, just around 600 normal healthy people. It underscores the need for a balanced diet in the teenage years, when your brain command center is still actively maturing.”

Questions Every Parent Should Ask

If you have teenagers you might want to ask yourself questions like:

  • What is your teenager’s diet like?
  • Is it balanced?
  • Are you sure that it meets their nutritional needs?
  • Should you consider supplementation to make sure that they are getting all of the nutrients that they need?

 

The Bottom Line

  • A recent study suggested that inadequate iron intake in the teenage years may affect how our brains are wired in our adult years. The authors of the study interpreted the study as suggesting that an inadequate diet during the teen years could predispose us to cognitive decline and Alzheimer’s as adults.
  • This study only looked at structural differences in the brain circuitry. We can’t conclude from this study alone that inadequate iron intake as a teenager will doom somebody to cognitive impairment and increased Alzheimer’s risk as they age. But we can conclude that adequate iron intake during adolescence is required for normal brain development.
  • And it’s probably not just iron. This study focused on iron status because transferrin levels are routinely measured during physical exams so it was easy to go back and determine what each subject’s iron status was during their teenage years. Many other important nutrients are required for normal brain development, but we don’t have an easy way of going back and determining what someone’s nutritional status was for those nutrients in their teen years. What was shown to be true for iron in this study is likely to be true for other nutrients as well.
  • These were normal teens eating a normal American diet. They weren’t from a third world country and there was nothing weird about what they were eating. But, clearly some of the subjects in the study weren’t getting the iron that they needed from diet alone.
  • The teen years are a time of rapid growth and maturation. It’s not just the brain that needs the proper balance of nutrients during the teen years. All of their tissues require proper nutrition.

 

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

Do Omega-3s Prevent Age-Related Muscle Loss?

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Does Fish Oil Build Muscle?

Author: Dr. Stephen Chaney

 

omega-3Omega-3-rich fish oil supplements have attracted their share of controversy in recent years, but there appear to be lots of reasons to make sure that you get enough omega-3s from your diet.

There is actually pretty good evidence that omega-3s offer a natural approach for people who wish to lower their blood pressure (https://chaneyhealth.com/healthtips/do-omega-3s-lower-blood-pressure/) or heart attack risk (https://chaneyhealth.com/healthtips/fish-oil-really-snake-oil/). There is also some evidence that omega-3s may be important for brain development in infants (J Protzko et al, Perspectives on Psychological Science, 8: 25-40, 2013), for mental performance in children (https://chaneyhealth.com/healthtips/omega-3s-improve-reading-skills/) and for preventing cognitive decline in the elderly (https://chaneyhealth.com/healthtips/omega-3s-slow-cognitive-decline/).

If the latest headlines are to be believed, we can add preventing age-related muscle loss to the benefits of an omega-3-rich diet.

Why Is Age-Related Loss of Muscle Mass a Problem?

The term for age-related muscle loss is sarcopenia, and it is a big problem for older adults. After age 50 we lose 1-2% of our muscle mass each year. As you might expect, our strength declines as well. Each 1% loss of muscle mass translates into about 1.5% loss in strength. That means after age 50 we lose 1.5% of our muscle strength each year, and once we hit 60 the rate of loss increases to around 3% per year.

That may not sound like much on an annual basis, but it adds up over time. With a little bit of higher math you can calculate that you could easily have lost 45% of your muscle strength by the age of 70 and a whopping 75% by the age of 80. At that point even the simplest physical activities – lifting a grandchild or a bag of groceries – can become challenging. That loss of strength also contributes to a loss of balance that can lead to debilitating falls.

The most effective way of preventing age-related muscle loss is regular resistance training, especially when coupled with adequate intake of protein and leucine (https://chaneyhealth.com/healthtips/protein-needs-for-older-adults/). However, resistance training is hard work, so many older adults gravitate to quick fixes like testosterone, growth hormone, or DHEA – even though each of those treatment regimens have significant side effects and risks.

That’s why the recent headlines suggesting that a risk-free approach like omega-3 supplementation might increase muscle mass and strength in older adults is so enticing.

Do Omega-3s Prevent Age-Related Muscle Loss?

A previous study had suggested that omega-3 supplementation enhanced the effect of strength training in elderly women (Rodacki et al, AJCN, 95: 428-436, 2012). Although the mechanism of that effect is unclear, the authors of this study decided to go one step further. They asked if omega-3 fatty acids might prevent loss of muscle mass even in the elderly in the absence of a structured exercise program (Smith et al, AJCN, doi: 10.3945/ajcn.114.105833, 2015).

age-related muscle lossThe study consisted of 44 men and women age 60-85 (average age 69) who were not exercising on a regular basis. They were given either 4 gm of fish oil (containing 1.86 gm of EPA and 1.5 gm of DHA) or a placebo containing corn oil each day for 6 months. Muscle mass and four measures of muscle strength were performed at the beginning of the study and again at 6 months. The measures used were thigh muscle volume (a measure of muscle mass), hand grip strength, overall muscle strength (the maximum weight that the subject could lift in a single repetition for leg press, chest press, knee extension, and knee flexion) and isokinetic power (the power attained in knee extension and flexion exercises). The results were pretty impressive for the omega-3 group compared with the control group:

  • Thigh muscle volume (muscle mass) increased by 3.6%
  • Handgrip strength increased by 6%.
  • Overall muscle strength increased by 4%.
  • Isokinetic power increased by 5.6%.
  • Other than complaints about fishy breath, there were no adverse effects in the omega-3 group.
  • The authors calculated that the increase in muscle mass and strength during 6 months of omega-3 supplementation was sufficient to offset 2-3 years of normal age-related muscle loss and strength loss.
  • The increase in muscle mass and strength associated with omega-3 supplementation was less than can be attained from regular resistance exercise coupled with adequate protein intake. However, it was the same or greater than could be obtained from testosterone, growth hormone or DHEA – and didn’t have the risks associated with those treatments.

For example, a recent study has concluded that testosterone injections are associated with a significant risk of stroke, acute coronary syndromes, hospitalization and death (Layton et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.1573).

The authors concluded ”Fish oil-derived omega-3 therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.”

Limitations of the Study

Before you all run out and stock up on fish oil supplements, I should point out that this study has several limitations.

  • It is a very small study. It needs to be replicated by future studies.
  • It used a very high dose of fish oil (4 gm/day). High doses are often used in an initial study like this one just to establish whether there is an effect worth further study. However, this study needs to be repeated at lower doses to see if this benefit of omega-3 supplementation is also seen at more physiological doses (500 – 1,000 mg) of omega-3s.

Because of these limitations, I am not yet ready to agree with the authors that omega-3 supplementation “…should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.” This is an interesting finding that holds the promise of an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives.

 

The Bottom Line

  • A recent study has suggested that omega-3 supplementation may prevent age-related loss of muscle mass and strength. The study was performed in both men and women age 60-85 who were not exercising on a regular basis.
  • Omega-3 supplementation was less effective than regular resistance exercise coupled with adequate protein intake, but equal to or greater in effectiveness than testosterone, growth hormone, or DHEA treatment.
  • This was a very small study and it used a very high dose of omega-3s. It is a promising finding because it represents an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.
  • There are many good reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength. Resistance training combined with adequate protein is a proven intervention. Omega-3 supplementation is not.
  • However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives. It might just work, and it is a lot less risky.

 

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.

Health Tips From The Professor