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Which Diets Are Heart Healthy?

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What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

heart attacksHeart disease is a big deal. According to the CDC, “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 33 seconds in the United States from cardiovascular disease. About 695,000 people in the United States died from heart disease in 2021 – that’s 1 in every 5 deaths”.

This doesn’t have to happen. According to the Cleveland Clinic, “90 percent of heart disease is preventable through healthier diet, regular exercise, and not smoking”. For this issue of “Health Tips From the Professor”, I will focus on the role of diet on heart health.

The problem is many Americans are confused. They don’t know what a heart-healthy diet is. There is so much conflicting information on the internet.

Fortunately, the American Heart Association has stepped in to clear up the confusion.

In 2021 they reviewed hundreds of clinical studies and published “Evidence-Based Dietary Guidance to Promote Cardiovascular Health”.

And recently they have published a comprehensive review (CD Gardner et al, Circulation, 147: 1715-1730, 2023) of how well popular diets align with their 2021 dietary guidelines.

I will cover both publications below. But first I want to address why Americans are so confused about which diets reduce heart disease risk.

Why Are Americans Confused About Diet And Heart Disease Risk?

I should start by addressing the “elephant in the room”.

  • As I discussed in last week’s “Health Tips From the Professor” article, Big Food Inc has seduced us. They have developed an unending supply of highly processed foods that are cheap, convenient, easy to prepare, and fulfill all our cravings. These foods are not heart-healthy, but they make up 73% of our food supply.

The Institute of Medicine, the scientific body that sets dietary standards, states that a wide range of macronutrient intakes are consistent with healthy diets. Specifically, they recommend carbohydrate intake at 45% to 65%, fat intake at 20% to 35%, and protein intake at 10% to 35% of total calories. (Of course, they are referring to healthy carbohydrates, fats, and proteins.)

The authors of this article pointed to several reasons why Americans have been misled about heart-healthy diets.

  • Many of the most popular diets fall outside of the “Acceptable Macronutrient Range”.
  • Many popular diets exclude heart-healthy food groups.

And, the words of the authors,

  • “Further contributing to consumer misunderstanding is the proliferation of diet books, [and] blogs [by] clinicians with limited understanding of what the dietary patterns entail and the evidence base for promoting cardiometabolic health.” I call these the Dr. Strangeloves of our world.

What Does A Heart Healthy Diet Look Like?

Let me start by sharing the American Heart Association’s 10 “Evidence-Based Dietary Guidelines to Promote Cardiovascular Health.

#1: Adjust energy intake and expenditure to achieve and maintain a healthy body weight
#2: Eat plenty of vegetables and fruits; choose a wide variety
#3: Choose foods made mostly with whole grains rather than refined grains
#4: Choose healthy sources of protein
Mostly from plants (beans, other legumes, and nuts)
Fish and seafood
Low-fat or fat-free dairy products instead of full-fat dairy products
If meat or poultry are desired, choose lean cuts and avoid processed forms
#5. Use liquid plant oils (olive, safflower, corn) rather than animal fats (butter and lard) and tropical oils (coconut and palm kernel)
#6. Use minimally processed foods instead of highly processed foods
#7: Minimize intake of beverages and foods with added sugars
#8: Choose and prepare foods with little or no salt
#9: If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
#10: Adhere to this guidance regardless of where food is prepared or consumed

Here are my comments on these guidelines:

  • If you have been reading my “Health Tips From the Professor” blog for a while, you probably realize that these aren’t just guidelines to promote heart health. These guidelines also reduce the risk of diabetes, cancer, inflammatory diseases, and much more.
  • If you have read my post on coconut oil, you will know that I have a minor disagreement with the AHA recommendation to avoid it. There is no long-term evidence that coconut oil is bad for the heart. But there is also no long-term evidence that it is good for the heart. My recommendation is to use it sparingly.
  • And you probably know there has been considerable discussion recently about whether full fat dairy is actually bad for the heart. In my most recent review of the topic, I concluded that if full fat dairy is heart healthy, it is only in the context of a primarily plant-based diet and may only be true for fermented dairy foods like unpasteurized yogurt and kefir.
  • Finally, guideline 10 may need some translation. Basically, this guideline is just asking how easy it is to follow the diet when you are away from home.

Which Diets Are Heart Healthy?

confusionIn evaluating how well diets adhered to the American Heart Association guidelines the authors ignored item 1 (energy intake) because most of the diets they evaluated did not provide any guidelines on how many calories should be consumed.

Each diet was given a score between 0 (Fail) and 1 (A+) for each of the other 9 guidelines by a panel of experts. The points for all 9 guidelines were added up, giving each diet a rating of 0 (worst) to 9 (best). Finally, a score of 9 was assigned 100%, so each diet could be given a percentage score for adherence to heart-healthy guidelines.

Here are the results:

Tier 1 diets (the most heart healthy diets) received scores of 86% to 100%. Going from highest (100%) to lowest (86%), these diets were:

  • DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • You will notice that these are all primarily plant-based diets.

Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics). They both received scores of 78%.

  • The Vegan diet received 0 points for category 10 (ease of following the diet when eating out). It was also downgraded in category 7 for not having clear guidance for the use of salt when preparing foods.
  • The other low-fat diets were downgraded in categories 7, 10, and 5 (use of tropical oils).

Tier 3 diets received scores of 64% to 72%. They included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).

  • They received 0 points for category 10 and were downgraded for eliminating heart-healthy food groups (liquid plant oils for the very low-fat diets, and fruits, vegetables, whole grains, and plant proteins for the low-carb diets).

Tier 4 diets (the least heart healthy diets) were the Paleo diet with a score of 53% and very low-carb diets (Atkins and Ketogenic) with a score of 31%.

  • The Paleo diet received 0 points for categories 10, 3 (choose whole grains), and 5 (using liquid plant oils rather than animal fats or tropical oils). It was also downgraded for lack of healthy plant-based protein sources.
  • The very low-carb diets were the least heart healthy. They received 0 points for categories 2 (eat plenty of fruits and vegetables), 3 (choose whole grains), 3 (healthy protein sources), 5 (use liquid plant oils instead of animal fats), 7 (minimize salt consumption), and 10 (ease of following the diet away from home).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family

The Bottom Line 

In 2021 the American Heart Association published 10 guidelines for evaluating heart-healthy diets. A recent study looked at how well popular diets adhered to those guidelines. The authors separated the diets into four categories (tiers) based on how heart-healthy they were. The results were not surprising:

  • Tier 1 diets (the most heart healthy diets) were DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics).
  • Tier 3 diets included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).
  • Tier 4 diets (the least heart healthy diets) were the Paleo diet and very low-carb diets (Atkins and Ketogenic).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family.

For more information on this study, 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.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Do Processed Foods Cause Cancer?

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How Can You Reduce Your Cancer Risk?

Author: Dr. Stephen Chaney 

We are facing a food crisis in this country. Big Food Inc is taking over our diet. Currently, 73% of our food supply is processed. And because these are manufactured foods, not real foods, they are 52% cheaper than the whole unprocessed foods we should be eating.

And Big Food Inc has seduced us. They know our weaknesses. The foods they make are convenient and easy to prepare. They also know our bodies were created with an ingrained craving for sweet, salty, and fatty foods. These cravings served us well in prehistoric times, but in today’s world Big Food Inc has weaponized them. Their foods are designed to satisfy every craving. They have done their best to make their processed foods irresistible!

The result is no surprise. In 2018 (LG Baraldi et al, BMJ Open, 2018, 8(3) e020574 60% of the calories the Average American consumes came from processed foods, and the percentage has only increased since then.

This is alarming because higher consumption of processed foods has been linked to increased risk of obesity, diabetes, and all-cause mortality.

Some studies have suggested that higher consumption of processed foods may also be linked to increased risk of cancer. The authors of the current study (K Chang, eClinicalMedicine 2023;56: 101840) set out to test this hypothesis.

How Are Processed Foods Defined In This Study?

Before I proceed with describing the findings of this study, I should probably contrast the common definition of processed foods with the current scientific definition of processed foods. The scientific community has recently developed something called “The NOVA food classification system” to describe the various levels of food processing.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

  1. Unprocessed or minimally processed foods.
    • This category includes foods like fruit, vegetables, milk, and meat.

2) Processed culinary ingredients.

    • This category includes foods you might find in restaurants or prepare yourself to which things like sugar, vegetable oils, butter, or cream were added in the preparation.

3) Processed foods.

    • This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

    • This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists call ultra-processed foods. Since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in describing the results of this study because it is more understandable to the average reader.

How Was This Study Done?

clinical studyThe authors of this study started by using data from the UK Biobank study. The UK Biobank study is a long-term study in the United Kingdom that is investigating the contributions of genetics and environment to the contribution of disease.

The authors focused on 197,426 (54.6% women) participants in the study who completed up to five 24-hour dietary recalls between 2009 and 2012. The participants were age 58 (range 40 to 69) when they entered the study and were followed for an average of 9.8 years. None of the participants had been diagnosed with cancer at the time of their enrollment in the study.

The purpose of this study was to examine the correlation between percent of “processed food” in the participant’s diets and both the frequency of newly diagnosed cancer and the frequency of cancer deaths during the 9.8 years of follow-up.

More importantly, the size of this study allowed the authors to examine associations between processed food consumption and both the risk of cancer and cancer mortality for 34 site-specific cancers – something most previous studies were unable to do.

  • The percentage “processed food” in their diets was calculated from the 24-hour dietary recalls using the NOVA scoring system.
  • The frequency of newly diagnosed cancers and cancer deaths was obtained by linking the data in this study with the national cancer and mortality registries, provided by the National Health Service.

Do Processed Foods Cause Cancer?

CancerThe authors started by dividing participants into four equal quartiles based on their consumption of processed foods:

  • For quartile 1 processed foods made up between 0 and 13.4% of calories (average = 9.2%).
  • For quartile 2 processed foods made up between 13.5 and 20% of calories (average = 16.7%).
  • For quartile 3 processed foods made up between 20.1 and 29.4% of calories (average = 24.3%).
  • For quartile 4 processed foods made up between 29.5 and 100% of calories (average = 41.4%).

They started by looking at the risk of developing cancer during the 9.8-year follow-up period. A total of 15,921 participants developed cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 2% increase in overall cancer incidence…and…
  • A 19% increase in ovarian cancer incidence.

A total of 4,009 participants died from cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 6% increase in overall cancer mortality.
  • A 16% increase in breast cancer mortality.
  • A 30% increase in ovarian cancer mortality.

The authors concluded, “Our UK-based study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

How Can You Reduce Your Cancer Risk?

American Cancer SocietyLet’s start with the American Cancer Society recommendations to limit cancer risk:

1) Avoid tobacco use. 

2) Get to and stay at a healthy weight.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can reduce your risk of cancer and have other health benefits. It is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

4) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

5) It is best not to drink alcohol.

It is best not to drink alcohol. People who choose to drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women.

This study adds an exclamation point to the American Cancer Society’s recommendation to avoid or limit “processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products”.

You may be asking, “What is so harmful about processed foods?” The most obvious harm is that they are replacing healthier foods that reduce cancer risk, such as “a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains” that the American Cancer Society recommends for reducing cancer risk.

But there are other reasons as well. In the words of the authors:

  • “Evidence has been accumulating on the strong obesity and type-2 diabetes-promoting potential of [processed foods], both of which are risk factors for many cancers including those of the digestive tract and some hormone-related cancers in women.
  • Emerging research has suggested other common properties of [processed foods] that may contribute to adverse cancer outcomes, including the use of controversial food additives, contaminants such as acrylamide that form during [food processing], and toxic contaminants such as phthalates and bisphenol-F that migrate from food packaging [into the food].”

The Bottom Line 

You probably know that processed foods are bad for you. But do processed foods cause cancer? A very large study (197,426 people followed for 9.8 years) suggests the answer to that question appears to be yes.

When the authors of the study compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

And when they looked at cancer deaths and did the same comparison:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

The authors concluded, “Our study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

These results are alarming because the most recent study shows that 60% of calories in the American diet comes from processed foods, and the percentage is increasing each year. We need to reverse this trend!

For more information on this study, why processed foods increase your risk of cancer, and what the American Cancer Society recommends to reduce your risk of cancer, 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.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Is Whole Fat Dairy Healthy?

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Is It Dairy Or Diet?

Author: Dr. Stephen Chaney 

CheesesFor years we have been told to select low fat dairy foods. But recent headlines claim, “That’s nonsense. Whole fat dairy foods are healthy.” Are those headlines true?

In previous issues of “Health Tips From the Professor” I have kept you abreast of recent studies suggesting that whole fat dairy foods may not be as bad for us as we thought. I also cautioned you that the headlines may not have accurately represented the studies they described.

Headlines have to be simple. But truth is often more nuanced. If we believed the current headlines, we might be asking ourselves questions like, “Should we ditch the current health guidelines recommending low-fat dairy foods? Are foods like ice cream, sour cream, and cheddar cheese actually be good for us?

To answer these questions, I will look at the study (A Mente et al, European Heart Journal, 44, 2560-2579, 2023) behind the current headlines and put the study into perspective.

Spoiler alert: If I could summarize the study findings in two sentences, they would be, “Whole fat dairy can be part of a healthy diet. But can it be part of an unhealthy diet?”

Stay tuned. I will discuss the science behind that statement below.

How Was This Study Done?

clinical studyThis study started with data collected from the Prospective Urban Rural Epidemiology (PURE) study. The PURE study is an ongoing study correlating diet, lifestyle, and environmental effects on health outcomes. It has enrolled 166,762 individuals, age 35-70, from 21 low-, middle-, and high-income countries on 5 continents.

Habitual food intake was determined using country-specific food frequency questionnaires at the time participants joined the study. Participants (166,762) from the PURE study who had complete dietary information were included in this study and were followed for an average of 9.3 years.

Based on preliminary analysis of data from the PURE study, the authors developed their version of a healthy diet, which they call the PURE diet. Like most other healthy diets, the PURE diet emphasizes fruits, vegetables, legumes, nuts, and fish. However:

  • Based on studies suggesting that whole fat dairy foods can be part of a healthy diet, the PURE diet includes whole fat dairy foods.

This is different from most other healthy diet recommendations.

They went on to develop what they referred to as the PURE healthy diet score by:

  • Determining the median intake for each of the 6 food groups included in their PURE diet (fruits, vegetables, legumes, nuts, fish, and whole fat dairy).
  • Assigning each participant in the study a score of 0 or 1 depending on whether their intake for that food group was below or above the median intake.
  • Adding up the points. Since 6 food groups were included in the PURE diet, this means that each participant in the study was assigned a PURE diet score ranging from 0-6.

Once they had developed a PURE diet score, they expanded their data by including five additional large independent studies that included people from 70 countries. The combined data from all six studies amounted to 245,597 people from 80 countries. Of the people included in the data analysis:

  • 21% came from high income countries.
  • 60% came from middle income countries.
  • 19% came from low-income countries.

This is very similar to the global population distribution. This is a strength of this study because it allowed them to ask whether the PURE diet score worked as well in low-income countries as in high-income countries.

Finally, they correlated the PURE diet score with outcomes like all-cause mortality, heart attack, and stroke.

Is Whole Fat Dairy Healthy?

QuestionsThe authors of this study divided the participants of all 6 studies into quintiles based on their PURE diet score and compared those in the highest quintile (PURE score of ≥ 5) with those in the lowest quintile (PURE score of ≤ 1).

The people in the highest quintile were eating on average 5 servings/day of fruits and vegetables, 0.5 servings/day of legumes, 1.2 servings/day of nuts, 0.3 servings/day of fish, 2 servings/day of dairy (of which 1.4 servings/day was whole fat dairy), 0.5 servings/day of unprocessed red meat, and 0.3 servings/day of poultry.

 

The people in the lowest quintile ate significantly less fruits, vegetables, nuts, fish, and dairy; and slightly less legumes, unprocessed red meat, and poultry than those in the highest quintile.

However, they consumed significantly more refined wheat foods and white rice. This study did not track consumption of highly processed foods, but the high consumption of white flour leads me to suspect they ate a lot more highly processed food.

With that in mind, when the authors compared people with the highest PURE diet scores to those with the lowest PURE diet scores:

  • All-cause mortality was reduced by 30%.
  • Cardiovascular disease was reduced by 18%.
  • Heart attacks were reduced by 14%.
  • Strokes were reduced by 19%.
  • The PURE healthy eating score was slightly better at predicting health outcomes than the Mediterranean, DASH, and HEI (Healthy Eating Index) scores. But the differences were small. So, I still recommend choosing the healthy diet that best fits your preferred foods and your lifestyle.
  • The PURE healthy eating score was significantly better at predicting health outcomes than the Planetary diet score. I will discuss the nutritional inadequacy of “sustainable diets” like the Planetary diet in next week’s “Health Tips From the Professor” article.

Because of the size and design of this study, they were able to make three interesting observations.

  1. The PURE, Mediterranean, DASH, and HEI diet scores were predictive of health outcomes in every country across the globe. You no longer have to wonder if what works in the United States will work in low-income countries and in countries with very different food preferences. Previous studies have not been able to make that claim.

2) You don’t have to be perfect.

    • A 20% increase (one quintile) in PURE score was associated with a 6% lower risk of major cardiovascular events and an 8% lower risk of mortality. In other words, even small improvements in your diet may improve your health outcomes.
    • The health benefits of the PURE diet started to plateau at a score of 3 (with 6 being the highest score). The authors concluded that most of the health benefits were associated with a modestly higher consumption of healthy foods compared to little or no consumption of healthy foods.

Simply put, that means the health benefits gained by going from a moderately healthy diet to a very healthy diet are not as great as the health benefits gained by going from a poor diet to a moderately healthy diet.

[Note: There are still improvements in health outcomes when you go from a moderately healthy diet to a very healthy diet.  My recommendation: “You don’t need to achieve perfection, but you shouldn’t accept mediocrity”.]

3) The PURE diet score was more predictive of health outcomes in some countries than in others.

    • The PURE diet score was more predictive of health outcomes in low-income countries. The authors felt that was because low-income countries started with average PURE scores of 2.1, whereas higher-income countries started with average PURE scores of 3.5.

The authors felt this was another example getting more “bang for the buck” by going from a poor diet to a moderately healthy diet than from a moderately healthy diet to a very healthy diet. (Remember, the health benefits associated with improving PURE diet scores start to plateau at a PURE score of 3.

    • The difference in benefits for low-income countries compared to high-income countries was observed for the Mediterranean, DASH, and HEI diet scores. So, it is probably safe to say for any healthy diet you don’t need to be perfect. You just need to be better.

The authors concluded, “A diet composed of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole fat dairy is associated with a lower risk of cardiovascular disease and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.”

Is It Dairy Or Diet?

CheesesThe headlines are telling us that recommendations to choose low-fat dairy products are out of date. They say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. Let me provide perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context. What do I mean by that? Let’s dig a little deeper into this study.

  • Let’s start with a description of the PURE diet. It is a diet that emphasizes fruits, vegetables, legumes, nuts, and fish. In other words, it is a primarily plant-based diet.
  • Although the authors keep referring to the diet as one that includes whole fat dairy. It would be more accurate to say that it includes dairy, which was 30% low-fat and 70% whole fat.
  • The authors said that removal of any one food group from this combination reduced the predictive power of the PURE diet. In other words, the beneficial effect of 70% whole fat dairy is best seen in the context of a primarily plant-based diet.
  • The PURE diet was most effective at predicting health outcomes in low-income countries where a significant percent of the population consumes a primarily plant-based diet because meats are expensive.

So, a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

To answer that question let’s compare the potential effects of whole fat dairy on a primarily plant-based diet compared to the typical American or European diet.

  • Milk and other dairy foods are excellent sources of calcium, vitamin B12, and iodine and good sources of protein, vitamin D, choline, zinc, and selenium – nutrients that are often low or missing in plant-based diet. And this is true whether the dairy foods are low-fat or whole fat.
  • Primarily plant-based diets tend to be low in saturated fat, so the potential negative effects of adding a small amount of saturated fat to the diet may be outweighed by the beneficial effects of the nutrients dairy foods provide.

On the other hand,

  • The typical American or European diet provides plenty of protein and vitamin B12 and significantly more choline, vitamin D, iodine, and zinc than a plant-based diet. The added nutrients from adding dairy foods to this kind of diet is still beneficial, but the benefits are not as great as adding dairy foods to a primarily plant-based diet.
  • If you read the American Heart Association statement on saturated fats, it does not say that any amount of saturated fat is bad for you. In fact, small amounts of saturated fats play some beneficial roles in our bodies. The American Heart Association says, “Eating too much saturated fat can raise the level of LDL cholesterol in your blood…[which] increases your risk of heart disease and stroke.”
  • Here is where the problem lies. The typical American or European diet already contains too much saturated fat. Whole fat dairy just adds to that excess.

So, the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

The Bottom Line 

Once again, the headlines are telling us that recommendations to choose low-fat dairy products are out of date. The articles say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. In this post I looked at the study behind the most recent headlines and provided perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context.

When you consider diet context a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

When you consider that question the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

For more information on this study, and the science behind my summary of the study, 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.

_________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Treating Tension Headaches Naturally

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Which Muscles Cause Tension Headaches?

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

The snowbirds are long gone!  The plus is that it’s easier to get into restaurants, and the roads aren’t as crowded.  Of course, the minus is the weather. August is the hottest month of the year.

August is definitely a s-l-o-w month in Florida.  The temperature is in the mid-upper 90’s, which isn’t really too bad for a Floridian, but the humidity feels like it’s 120°!

You walk out of your cool house, and it hits you like a wet washcloth, immediately making you sweat from your hair to your toes.

So, it’s time to just relax, enjoy the beach and read a good book.   And thank heaven for air-conditioning!

Topic Of The Month – Tension Headaches

headacheLately a lot of people have been coming to my office complaining of headaches that have plagued them for a long time…in one case for years!

This woman has been everywhere and had every test that the medical world could offer.  Nothing showed why she had these terrible headaches.  At one point she told me the pain was a 10 on a scale of 1-10.  Imagine how terrible it was for her to suffer every day from such a crippling condition.  My heart went out to her!

Fortunately, her problem was caused by muscles, the one thing that most of the medical world doesn’t consider when looking for a solution to pain.

In fact, if you watched my TED talk: The Pain Question No One is Asking, you may have already heard me talk about this missing link. (If you haven’t heard my TED talk, go to YouTube and enter: Julie Donnelly, Pain and I’ll pop up.)

Let’s talk about muscles and why they will cause headaches (and a whole lot more!).

Which Muscles Cause Tension Headaches?

While there are many causes for headaches, such as stress, anxiety, depression, head injury, or anxiety, and life-threatening causes we won’t go into here, one type of headache that is caused by muscular tension is known as a muscle contraction tension headache.

As shown in the graphics above, muscle spasms (colored circles) will refer pain to your head, even when you don’t feel any discomfort where the spasm is actually occurring (as seen in the graphic on the bottom, the Sternocleidomastoid muscle).

(Please don’t get confused with the Posterior Deltoid showing in the right graphic, or the jaw muscles on the left graphic…I just didn’t know how to delete them from the graphic)

Muscles in the neck and scalp can become tense or contract in response to stress, depression, or anxiety, leading to tension headaches.  Fortunately, in many cases, simply pressing on the trigger points (the colored circles) will release the tension being felt in your head.

To prevent tension headaches, it is important to maintain good posture, practice relaxation techniques, and use a pillow that keeps your head, neck, and spine in a horizontal plane while you sleep.

Treating Tension Headaches Naturally

There are too many treatments for headaches to include all of them in this newsletter.  If you want to know them, I suggest you get one of my books, especially Pain-Free Living or The Pain-Free Athlete.

Meanwhile, I want to share an important Julstro self-treatment that you may find works well for tension headaches:

 

Place a ball such as the Perfect Ball (shown in picture) or a tennis ball, on the top of your shoulder.

 

 

 

Lean into the corner of a wall, as shown. headache relief shoulder muscle pressure using wall

 

Keep your head close to the wall to prevent the ball from slipping and landing on the floor.

 

Bend at your hips so your upper body goes up and down, causing the ball to roll along the top of your shoulder. This will treat both the levator scapulae and trapezius muscles – both are key muscles for tension headaches.

 

Be gentle with this treatment as it will cause pain to be felt in your head as you are doing the treatment.  Only use enough pressure that it “hurts so good.”

Do 5-6 passes on each side.  It can be repeated often during the day but give a little time between each session to allow the muscle to relax.

Drink a LOT of water so the acid that you’re pressing out of the muscle will get flushed out of your body.

This may look a bit confusing, but it’s simple when you follow the directions.  And the best part is, IT WORKS!

How to Learn the Other Treatments for Headaches

If you go to www.FlexibleAthlete.com you can read a lot more about muscles and pain.  You will also find my books and other self-treatment tools by pressing on Shop.

Have a Happy Summer!  Please remember to drink a lot of water to keep yourself hydrated.  😊

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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 Muscadine Polyphenols Reduce Skin Aging?

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What Does This Study Mean For You?

Author: Dr. Stephen Chaney 

Red WineNormally, I don’t discuss results from pilot studies. I wait until larger studies have been published in peer reviewed journals. But I thought this study might be of interest to you.

Polyphenols from muscadine grapes and muscadine wine have been reported to reduce cellular aging. So, scientists from the University of Florida decided to do a pilot study asking whether muscadine polyphenols in the diet might improve signs of an aging skin. They reported their results in a poster (L Christman and L Gu, Dealcoholized Muscadine Wine Improved Skin Health, Reduced Oxidative Stress, and Inflammation in Women in a Randomized Controlled Trial, July 24, 2023) presented at the American Society for Nutrition’s NUTRITION 2023 meeting.

They enrolled 17 healthy women ages 40-67 to participate in a randomized, single-blinded, placebo controlled, cross-over study. Simply put, that means:

  • The study started with a 7-day “run-in period” in which their diet was standardized.
  • Then they were asked to drink 10 ounces/day of dealcoholized muscadine wine or a placebo drink for 6 weeks. Since participants did not know which beverage they were given, this is the “single-blind” part of the experimental design.
  • This was followed by a 21-day “wash-out” period to allow muscadine polyphenols to be flushed out of their system.
  • They then were switched to the opposite beverage for an additional 6 weeks. This was the “cross-over” portion of the experimental design.

Their skin conditions and blood markers of inflammation and oxidative stress were measured at the start (baseline) and end of each 6-week portion of the study.

When compared to both baseline and placebo, the dealcoholized muscadine wine significantly improved:

  • Skin elasticity, which prevents the skin from sagging as it ages.
  • Retention of moisture at the skin surface, which indicates the skin is providing a more effective barrier against aging.
  • Skin smoothness.
  • Blood glutathione peroxidase activity, a measure of antioxidant protection.

The authors concluded, “This randomized controlled trial demonstrated that consumption of polyphenol-rich dealcoholized muscadine wine improved skin conditions associated with aging. This is likely due to decreases in inflammation and oxidative stress.”

What Does This Study Mean For You?

Questioning WomanAs for what this study means for you, I have two words, “Stay tuned”.

On the plus side, while muscadine polyphenols have been shown to reduce markers of skin aging when applied to the skin, this is the first study to suggest those same benefits may be seen from the inside out – i.e., from dietary muscadine polyphenols.

On the minus side, this is a pilot study. Pilot studies are meant to test hypotheses to see whether there is enough evidence to justify larger studies. In the words of the authors, “…repeating this study with a larger and more diverse group of people would help to confirm and strengthen the findings going forward.”

So, stay tuned. When the results of larger studies have been published in peer-reviewed scientific journals, I will give you an update.

The Bottom Line 

Scientists at the University of Florida recently did a pilot study to see whether muscadine polyphenols in the diet might improve signs of an aging skin. When compared to a placebo, dealcoholized muscadine wine significantly improved skin elasticity, moisture retention, and smoothness. It also increased blood glutathione peroxidase activity, a measure of antioxidant protection.

The authors concluded, “This randomized controlled trial demonstrated that consumption of polyphenol-rich dealcoholized muscadine wine improved skin conditions associated with aging. This is likely due to decreases in inflammation and oxidative stress.”

On the plus side, while muscadine polyphenols have been shown to reduce markers of skin aging when applied to the skin, this is the first study to suggest those same benefits may be seen from the inside out – i.e., from dietary muscadine polyphenols.

On the minus side, this is a pilot study. Pilot studies are meant to test hypotheses to see whether there is enough evidence to justify larger studies. In the words of the authors, “…repeating this study with a larger and more diverse group of people would help to confirm and strengthen the findings going forward.”

So, stay tuned. When the results of larger studies have been published in peer-reviewed scientific journals, I will give you an update.

For more information on this study 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.

 ___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Are All Carbs Bad?

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Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

Author: Dr. Stephen Chaney 

Low carb enthusiasts have been on the warpath against carbohydrates for years.

Almost everyone agrees that sugar-sweetened sodas and highly processed, refined foods with added sugar are bad for us. But low carb enthusiasts claim that we should also avoid fruits, grains, and starchy vegetables. Have they gone too far?

Several recent studies suggest they have. For example, both association studies and randomized controlled studies suggest that total carbohydrate intake is neither harmful nor beneficial for heart health.

In addition, recent studies suggest that free sugar intake is associated with both elevated triglyceride levels and an increase in heart disease risk.

But those studies have mostly looked at free sugar intake from sugar-sweetened sodas. The authors of this study (RK Kelley et al, BMC Medicine, 21:34, 2023) decided to look more carefully at the effect of all free sugars and other types of carbohydrates on triglyceride levels and heart disease risk.

How Was This Study Done?

clinical studyThe 110,497 people chosen for this study were a subgroup of participants in the UK Biobank Study, a large, long-term study looking at the contributions of genetic predisposition and environmental exposure (including diet) to the development of disease in England, Scotland, and Wales.

The participants in this study were aged between 37 and 73 (average age = 56) on enrollment and were followed for an average of 9.4 years. None of them had a history of heart disease or diabetes or were taking diabetic medications at the time of enrollment.

During the 9.4-year follow-up, five 24-hour dietary recalls were performed, so that usual dietary intake could be measured rather than dietary intake at a single time point. The people in this study participated in an average of 2.9 diet surveys, and none of them had less than two diet surveys.

The averaged data from the dietary recalls were analyzed for the amount and kinds of carbohydrate in the diet. With respect to the types of carbohydrate, the following definitions would be useful.

  • The term free sugars includes all monosaccharides and disaccharides added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit juices.
  • The term non-free sugars includes all sugars not in the free sugar category, mostly sugars naturally occurring in fruits, vegetables, and dairy products.
  • The term refined grains includes white bread, white pasta, white rice, most crackers and cereals, pizza, and grain dishes with added fat.
  • The term whole grains includes wholegrain bread, wholegrain pasta, brown rice, bran cereal, wholegrain cereals, oat cereal, and muesli.

Finally, the study looked at the association of total carbohydrate and each class of carbohydrate defined above with all heart disease, heart attacks, stroke, and triglyceride levels.

Are All Carbs Bad?

Question MarkThe study looked at total carbohydrate intake, free sugar intake, and fiber intake. In each case, the study divided the participants into quartiles and compared those in the highest quartile with those in the lowest quartile.

Using this criterion:

  • Total carbohydrate intake was not associated with any cardiovascular outcome measured (total heart disease risk, heart attack risk, and stroke risk).
  • Free sugar intake was positively associated with all cardiovascular outcomes measured. Each 5% increase in caloric intake from free sugars was associated with a:
    • 7% increase in total heart disease risk.
    • 6% increase in heart attack risk.
    • 10% increase in stroke risk.
    • 3% increase in triglyceride levels.
  • Fiber intake was inversely associated with total heart disease risk. Specifically, each 5 gram/day increase in fiber was associated with a:
    • 4% decrease in total heart disease risk.

The investigators also looked at the effect of replacing less healthy carbohydrates with healthier carbohydrates. They found that:

  • Replacing 5% of caloric intake from refined grains with whole grains reduced both total heart disease risk and stroke risk by 6%.
  • Replacing 5% of caloric intake from free sugars (mostly sugar-sweetened beverages, fruit juices, and processed foods with added sugar) with non-free sugars (mostly fruits, vegetables, and dairy products) reduced total heart disease risk by 5% and stroke risk by 9%.

Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

With these data in mind let’s look at the claims of the low-carb enthusiasts.

Claim #1: Carbohydrates raise triglyceride levels. This study shows:

  • This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake (fruits, vegetables, and whole grains. This study did not measure intake of beans, nuts, and seeds, but they would likely be in the same category).
  • However, this claim is true with respect to foods high in free sugars (sugar-sweetened beverages, fruit juices, and processed foods with added sugar).

Claim #2: Carbohydrates increase heart disease risk. This study shows:

  • That claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.
  • However, this claim is true with respect to foods high in free sugars.

Claim #3: Carbohydrates cause weight gain [Note: Low carb enthusiasts usually word it differently. Their claim is that eliminating carbohydrates will help you lose weight. But that claim doesn’t make sense unless you believed eating carbohydrates caused you to gain weight.] This study shows:

  • This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.
  • Once again, this claim is true with respect to foods high in free sugars.

The data with high fiber carbohydrates was particularly interesting. When the authors compared the group with the highest fiber intake to the group with the lowest fiber intake, the high-fiber group:

  • Consumed 33% more calories per day.
  • But had lower BMI and waste circumference (measures of obesity) than the low-carbohydrate group.

This suggests that you don’t need to starve yourself to lose weight. You just need to eat healthier foods.

And, in case you were wondering, the high fiber group ate:

  • 5 more servings of fruits and vegetables and…
  • 2 more servings of whole grain foods than the low fiber group.

This is consistent with several previous studies showing that diets containing a lot of fruits, vegetables, and whole grains are associated with a healthier weight.

The authors concluded, “Higher free sugar intake was associated with higher cardiovascular disease incidence and higher triglyceride concentrations…Higher fiber intake and replacement of refined grain starch and free sugars with wholegrain starch and non-free sugars, respectively, may be protective for incident heart disease.”

In short, with respect to heart disease, the type, not the amount of dietary carbohydrate is the important risk factor.

What Does This Mean For You?

Questioning WomanForget the low carb “mumbo jumbo”.

  • Carbohydrates aren’t the problem. The wrong kind of carbohydrates are the problem. Fruit juice, sugar-sweetened sodas, and processed foods with added sugar:
    • Increase triglyceride levels.
    • Are associated with weight gain.
    • Increase the risk for heart disease.
  • In other words, they are the villains. They are responsible for the bad effects that low carb enthusiasts ascribe to all carbohydrates.
  • Don’t fear whole fruits, vegetables, dairy, and whole grain foods. They are the good guys.
    • They have minimal effect on triglyceride levels.
    • They are associated with healthier weight.
    • They are associated with a lower risk of heart disease and diabetes.

So, the bottom line for you is simple. Not all carbs are created equal.

  • Your mother was right. Eat your fruits, vegetables, and whole grains.
  • Avoid fruit juice, sodas and other sugar-sweetened beverages, and processed foods with added sugar. [Note: Artificially sweetened beverages are no better than sugar-sweetened beverages, but that’s another story for another day.]

And, if you were wondering why low carb diets appear to work for weight loss, it’s because any restrictive diet works short term. As I have noted previously, keto and vegan diets work equally well for short-term weight loss.

The Bottom Line 

Low carb enthusiasts have been telling us for years to avoid all carbohydrates (including fruits, starchy vegetables, and whole grains) because carbohydrates:

  • Increase triglyceride levels.
  • Cause weight gain.
  • Increase our risk for heart disease.

A recent study has shown that these claims are only true for some carbohydrates, namely fruit juices, sodas and other sugar-sweetened beverages, and processed foods with added sugar.

Whole fruits, vegetables, and whole grain foods have the opposite effect. They:

  • Have a minimal effect on triglyceride levels.
  • Are associated with a healthier weight.
  • Are associated with a lower risk of heart disease and diabetes.

So, forget the low carb “mumbo jumbo” and be sure to eat your fruits, vegetables, and whole grains.

For more information on this study and what it means for you, read the article above.

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

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Should Athletes Be Taking Omega-3s?

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Can Omega-3s Protect Your Brain?

Author: Dr. Stephen Chaney 

Contact sports like football and soccer can be an athlete’s ticket to fame and fortune. That is a powerful motivator. But many elite athletes in contact sports pay a terrible price after their playing days are over.

Repeated head trauma can lead to a condition called Chronic Trauma Encephalopathy or CTE. In CTE, a protein called Tau forms clumps that spread through the brain, killing brain cells. Eventually, this can lead to irrational behavior and/or early-onset Alzheimer’s, which is, indeed, a terrible price to pay for their brief moment in the spotlight.

The NCAA is aware of the damaging effects of repeated head trauma and are experimenting with rule changes and improvements to protective head gear to reduce it. But, given the pressures of college teams to win at all costs, it will be impossible to completely eliminate head trauma from contact sports.

So, it is important to ask, “What else we can do?” Several studies have suggested that omega-3s may mitigate the damaging effect of repeated head trauma. For example:

  • The omega-3s DHA and EPA are metabolized to molecules called resolvins and protectins, which protect brain tissue from oxidative stress and help restore damaged brain tissue.
  • DHA and EPA also reduce the inflammation associated with brain injury, so the brain can heal faster.
  • DHA and EPA boost the level of a protein called BDNF in the brain. It helps trigger the production of new brain cells, which also aids in the recovery from brain injury.
  • Finally, some medical clinics have reported that high dose omega-3s help speed the recovery from severe head trauma.
  • This is concerning because omega-3s are largely missing from the diet of college athletes.

This raises the question, “Should athletes be taking omega-3s?”omega 3 supplements

The kinds of studies mentioned above suggest that DHA and EPA might help protect athletes from the damaging effects of repeated head trauma, but it is difficult to prove:

  • If a patient comes into a clinic with severe brain trauma, the symptoms are obvious. And if omega-3s speed recovery it will become apparent in weeks or months. This effect is easy to measure.
  • On the other hand, the effects of repeated, minor head trauma on a highly trained athlete are often not apparent until decades later. Therefore, any protective effects of omega-3s would also not become apparent for decades. Clinical studies don’t last that long.

Because of this, current research focuses on markers of brain damage such as neurofilament light chain or Nf-L. Nf-L is a neuronal protein that is released into the bloodstream by dying neurons. It is widely considered to be an early marker for neurodegenerative diseases such as those seen in former college football players. Previous studies have shown:

  • Nf-L blood levels increase during the season for NCAA-level college football players.
  • College football players have a very low omega-3 index, a measure of omega-3 status.
  • DHA supplementation reduces Nf-L levels in college football players.

With this in mind, the authors of this study (JL Heileson et al, Journal of the International Society of Sports Nutrition 18:65, 2021) looked at the effect of a high-dose, comprehensive omega-3 supplement on Nf-L levels in the blood of NCAA football players during the playing season.

How Was This Study Done?

clinical studyVolunteers from two geographically distinct NCAA football teams were recruited for this study. One team (n=31) was given a daily high-dose omega-3 supplement providing 2,000 mg of DHA, 560 mg of EPA, and 320 mg of DPA starting during pre-season (fall) practices and continuing through the entire season. Compliance with the supplement regimen was 93%.

Volunteers from the other team (n=35) received no supplements and served as a control.

Participants from both teams were advised which foods were high in omega-3s and were asked to limit servings to no more than 2 per week for the duration of the study.

Players were excluded from the study if they:

  • Were on long-term (>20 days) anti-inflammatory therapy.
  • Were using fish oil supplements.
  • Ate more than two servings of fish per week.
  • Were on medications to control blood pressure or blood lipid levels.

Blood samples were drawn 7 days before pre-season practice, at the end of pre-season practice, 3 times during the season, and at the end of the season (a total of 6 blood draws).

The blood samples were analyzed for Nf-L, a marker of brain injury, and Omega-3 Index, a measure of omega-3 status.

Should Athletes Be Taking Omega-3s?

As I stated above, compliance with the supplementation regimen was excellent (93%) and this was reflected in the blood levels of long-chain omega-3s. Between the first and last blood sample drawn:

  • DHA and EPA levels increased 2-fold.
  • DPA levels, on the other hand, decreased slightly.
    • This suggests that the beneficial effects of omega-3 supplementation were primarily due to DHA and EPA. I will discuss the implications of this below.
  • The omega-3 index increased from 4.3%, which is considered poor, to 7.4%, which is considered near optimal.

The effect of omega-3 supplementation on Nf-L levels was striking:

  • In the control team (no supplementation) Nf-L levels increased 1.5-fold during the pre-season practices and remained elevated throughout the regular season.
  • In the team receiving omega-3 supplementation there was no significant increase in Nf-L levels.

The authors of the study concluded, “These findings suggest a…neuroprotective effect of combined EPA+DPA+DHA omega-3 fatty acid supplementation in American-style football athletes.”

The authors went on to say, “Similar elevations of Nf-L have been reported with RHI [repeated head injuries] in other contact sport athletes. These data suggest that those other contact sports athletes may also benefit from omega-3 supplementation…”

So, let’s return to the original question, “Should athletes be taking omega-3s?” Here is my take on the study:

  • The conclusions of the authors are appropriately cautious. This study shows that omega-3 supplementation reduces an indicator of possible brain damage (Nf-L), but the actual symptoms of brain damage don’t appear for decades.
    • Therefore, this study suggests, but doesn’t prove, that omega-3 supplementation may reduce Chronic Trauma Encephalopathy (CTE) for athletes who competed in contact sports during their college years.
  • This study used an omega-3 supplement containing EPA, DHA, and DPA. It resulted in an increase in EPA and DHA levels, but not DPA levels. Thus, there is no evidence that the DPA portion of the supplement was needed. I recommend a supplement with a 4:1 ratio of DHA to EPA for brain health.
  • This study did not establish an optimal dose of omega-3s. Until more information is available, I would recommend around 2,000 mg of DHA and 500 mg of EPA for athletes in contact sports, but the optimal dose may be lower or higher.

Can Omega-3s Protect Your Brain?

If you are not a college athlete competing in contact sports (which would include most of us), you are probably wondering what this means for you. Here are my thoughts.

As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.”

  • You never know when you may suffer unexpected head trauma. It could be a car accident. It could be a fall. You might be playing a friendly game of softball and get hit in the head by a foul ball. You get the point.
  • And the best time to make sure you have enough omega-3s (specifically DHA + EPA) in your brain is before the trauma occurs.

But how much DHA + EPA is enough? This is where it gets confusing.

  • Recommendations range from 500 mg/day to 3,000 mg/day depending on whether the goal is to reduce death from heart disease, lower blood pressure, or lower triglycerides.
  • This study used 2,500 mg/day to reduce a marker of brain damage in college athletes, but we don’t know whether that is optimal.
  • Finally, these numbers are averages, and none of us are average. We all utilize omega-3s from supplements with different efficiencies.

My recommendation is to use the Omega-3 Index as a gauge. It tells us how much DHA + EPA we have actually accumulated in our tissues.

  • An Omega-3 Index of 8% is considered optimal for heart health, and this study suggests it might be optimal for brain health as well.
  • So, my recommendation is to get your Omega-3 Index measured at 6-month intervals until you have determined the amount of supplemental DHA + EPA you need to attain and maintain an 8% Omega-3 Index.
  • Based on this study, I would recommend a high-purity supplement with an ~4:1 ratio of DHA to EPA if your primary goal is brain health. But other studies suggest that an EPA to DHA ratio of 3:2 may be optimal for heart health.

In short:

  • While the evidence is not definitive, this study suggests that it might be prudent to have accumulated enough DHA and EPA in your neural tissue to help reduce the complications of unexpected brain trauma.
  • This study also suggests that you may wish to aim for an Omega-3 Index of 8%.
    • An Omega-3 Index of 8% likely has side benefits. There is also evidence that it may reduce the rate of cognitive decline as you age, help protect your heart, and reduce inflammation.
  • The ratio of DHA to EPA in the supplement you choose may be different for brain health and heart health. If you are equally interested in brain and heart health, just be sure your supplement provides both DHA and EPA.

The Bottom Line 

Repeated head injuries are a major concern for NCAA football players and college athletes in other contact sports. That’s because repeated head injuries during their playing years are associated with a degenerative brain condition called Chronic Trauma Encephalopathy or CTE, which can lead to irrational behavior and/or early-onset Alzheimer’s.

A recent study looked at the effect of a high-dose, comprehensive omega-3 supplement on Nf-L, a marker of brain injury, in NCAA football players during the playing season. Two teams were selected.

  • In the team receiving no omega-3s, Nf-L increased 1.5-fold during preseason practice and remained elevated throughout the playing season.
  • In the team receiving omega-3 supplementation there was no significant increase in Nf-L levels.

The authors of the study concluded, “These findings suggest a…neuroprotective effect of… omega-3 fatty acid supplementation in American-style football athletes.”

The authors went on to say, “Similar elevations of Nf-L have been reported with RHI [repeated head injuries] in other contact sport athletes. These data suggest that those other contact sports athletes may also benefit from omega-3 supplementation…”

For more information on this study and what it means for all of us who are not college athletes, 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.

 ____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Treating Restless Leg Syndrome

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What Is Restless Leg Syndrome?

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

HotJuly is here and Florida is hot! The “Snowbirds” have gone north to the cooler weather (a goal of mine!) and life is moving in the slow lane.

Before I get started talking about our topic for the day, I want to give a big shout-out to one of my clients: Camilla Massa.  Camilla is an incredible athlete in a sport called Hyrox.  Hyrox isn’t well-known in the USA yet, but it’s very big in Europe.  You can think of it as CrossFit on steroids – pure strength and endurance events on an extreme level.

Camilla has grown through the sport and just a few weeks ago she was ranked #15 in the world. Then she went to a Worldwide competition this past week and she came in 1st place!  I don’t know where that puts her on the roster, but when you consider she was competing against the best in the sport, she has a lot to be proud of.  I’m looking forward to her returning to Sarasota, and to my office for a post-competition therapy session.  I want to hear all about the event!

What Is Restless Leg Syndrome?

QuestionsHopefully you aren’t suffering from restless leg syndrome (RLS), but maybe you know someone who is, and if so, this newsletter may be of some help.

It sounds so mild, but clients have told me it’s a really uncomfortable condition that affects the nervous system and muscles. The primary symptom is an unpleasant sensation in the legs that makes a person have an uncontrollable urge to move their legs. Often the legs just jump by themselves, which can make sleeping difficult.

Sufferers report sensations such as itching, tingling, burning, or overall aching. These symptoms are blamed for the overwhelming urge to move their legs.

The sensations associated with RLS are distinct from normal sensations experienced by those who don’t have the disorder, which makes them difficult to characterize. While research hasn’t been able to find any abnormalities in the brain, nerves, or muscles, it is logical that the muscles play a major role in the problem as they are the primary drivers of movement.

The interaction between the muscles and the central nervous system (CNS) is essential for voluntary and involuntary movements. Research suggests that dysfunction in this interaction can contribute to the development of RLS symptoms.

It has been observed that certain muscle-related factors, such as muscle fatigue or excessive tension, can trigger or exacerbate RLS symptoms. Prolonged periods of inactivity, such as sitting for extended periods, can lead to muscle stiffness and reduced blood flow, increasing the likelihood of RLS symptoms occurring.

Treating Restless Leg Syndrome

There are medical treatments that use medications to help relieve the symptoms, but for those solutions I suggest you see your medical practitioner.

I’d like to suggest treating the muscles from your hips to your feet to release any pressure that is being placed on the nerves as they pass through or beside the muscle fibers. I have had success in helping people release the tight muscles in their hips.

Before I share a self-treatment for your hips, I also want to suggest that anyone suffering from RLS also go to a good myofascial release (MFR) massage therapist. MFR will release tension in the fascia, the strong substance that surrounds every muscle fiber in the body.

On to a Julstro self-treatment:


You can treat all the muscles of your hip by placing a ball, such as the Perfect Ball that is on my website, or a tennis ball, on the very outside of your hip.

 

Lean into a wall and slowly move around until you find a “hot spot.” I call it that because you suddenly come to a point where it really hurts.

Hold pressure on the spot for 15-30 seconds. If you want, you can move back and forth just a little bit to press the acid (H+) out of the muscle.

Then move around until you find another hot spot and repeat the treatment.

Go all the way around your pelvis, along the length of your sacrum, around the top of your thigh bone, and along the crease where your leg meets your trunk.

Go slowly as the muscle takes some time to release the acid from the fibers, which then draws blood into the area and promotes healing in the muscle fibers.

I suggest you also use the heel of your hands and press down on your thigh muscles, sliding from the very top of your leg, like you’re trying to lengthen the muscles toward your knees. If you feel a bump that is painful, that’s a spasm that is putting pressure on your knee and hips. Just do your best to rub it out.

I wish I could say that these will heal the situation, but if it can give you some relief, then that’s a good thing.

If you have any treatments that have worked for you, please let me know so I can share them with others.

Next Month’s Treatment – Headaches

There are many causes of headaches, some life threatening and others that are the end result of tension or other causes that can be resolved. I’ll be sharing a few helpful techniques that have helped a lot of my clients.

Treat Yourself To Pain-Free Living

Pain-Free Living BookYou can locate the source of your pain, and then see how to do the Julstro self-treatments that can stop the pain FAST!

Treat Yourself to Pain-Free Living has 21 colorful charts that show you where to treat to relieve pain that you are experiencing, and over 200 clear photos that explain how to do each self-treatment.

You don’t need to live with pain – you can STOP PAIN FAST!

 Treat Yourself to Pain-Free Living

 

 

 

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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 Vegan Breast Milk Sufficient?

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What Can Vegan Moms Do?

Author: Dr. Stephen Chaney 

breastfeedingA whole food vegan diet is incredibly healthy:

  • Vegans are less likely to be overweight than the general population.
  • Vegans have a lower risk of diabetes, heart disease, cancer, hypertension, and several other diseases than the general population.
  • Whole food vegan diets are anti-inflammatory, so they lower the risk of autoimmune diseases and the “itis” diseases.

But vegan diets leave out meat, dairy, and eggs. Vegetarians without proper dietary advice are at high risk of inadequate intake of vitamin B12, vitamin D, iron, iodine, calcium, and DHA. And, of course, the risk of inadequate intake is even greater for vegans than it is for vegetarians, who may include some dairy and eggs in their diet.

So, it is legitimate to ask whether a vegetarian or vegan diet is sufficient for pregnancy and lactation. The short answer is that they can be if they are properly designed and properly supplemented.

But that is not an easy task, as evidenced by a recent study (N Ureta-Velasco et al., Nutrients 15:1855, 2023) comparing the breast milk of omnivore moms with the breast milk of vegetarian and vegan moms.

How Was This Study Done?

clinical studyThis study was done with 92 omnivore moms, 9 vegetarian moms (5-ovo-vegetarian and 4 lacto-ovo-vegetarians) and 11 vegan moms between August 2017 and February 2020 at the Regional Human Milk Bank at the “12 de Octubre” University Hospital in Madrid, Spain. The vegetarian and vegan moms were grouped together for data analysis.

On Day 0 of the study, participants went to the regional milk bank for blood and urine samples to determine nutritional status, a screening to determine health and socioeconomic status, and for food frequency questionnaire to characterize their habitual diet.

On days 1-5, they returned to the regional milk bank with a 24-hour diet recall of the previous day and to express 25 ml of breast milk to determine its nutrient content. On day 6, they returned to express a larger sample of breast milk to determine its lipid content (including EPA and DHA).

Note: Both the food frequency questionnaire and the 24-hour dietary recalls included nutrients derived from supplements.

What Did The Study Show About Dietary Intake of Key Nutrients?

Questioning WomanThis was a comprehensive study, so I will just cover the highlights here:

Birth Weight: Compared to the children of omnivore moms, the children of vegetarian/vegan moms were more likely to:

  • Have less weight gain during pregnancy (2 pounds less on average).
  • Be underweight at birth (60% of babies born to vegetarian/vegan moms were in the underweight category of birth weights versus 25% for babies born to omnivore moms).

This is probably because vegetarian/vegan moms:

  • Consumed slightly fewer calories per day (2146 versus 2319).
  • Consumed significantly less protein (67 g/d versus 96 g/d).
  • Were 10 times more likely to be underweight prior to pregnancy (10% versus 1%).

This is a concern because low birth weight increases the risk of physical and mental health issues later in life.

Supplement Use: The nutrients of greatest concern in a vegetarian/vegan diet are vitamin B12, vitamin D, iron, iodine, calcium, and DHA. For all these nutrients except DHA, this message appears to have gotten out to most vegetarian/vegan mothers because they were compensating for these potential deficiencies through supplementation.

For example, when they looked at average daily intake of these key nutrients from supplements, they found:

Nutrient Vegetarian/Vegan Moms Omnivore Moms
Vitamin D 1,080 IU (27mcg) 240 IU (6 mcg)
Folic acid 400 mcg 280 mcg
Vitamin B12 312 mcg 2 mcg
Calcium 566 mg 164 mg
Iron 40 mg 29 mg
DHA 100 mg 180 mg

However, that doesn’t tell the whole story, because not all vegetarian/vegan moms took supplements. When the investigators looked at the percent taking supplements, this is what they found.

Nutrient Vegetarian/Vegan Moms Omnivore Moms
Vitamin D 50% 50%
Folic acid 35% 61%
Vitamin B12 85% 60%
Calcium 15% 37%
Iron 25% 43%
DHA 10% 16%

Dietary Intake (Food + Supplements): The extra supplementation clearly played an important role because when the investigators looked at the overall intake from food and supplements, they found:

Nutrient Vegetarian/Vegan Moms Omnivore Moms
Vitamin D 224 IU (5.6 mcg) 432 IU (10.8 mcg)
Folate + Folic acid 668 mcg 473 mcg
Vitamin B12 258 mcg 6.9 mcg
Calcium 910 mg 1148 mg
Iron 31 mg 25 mg
DHA 110 mg 380 mg

Again, this doesn’t tell the whole story. Some women didn’t supplement. When the investigators looked at the percentage of women getting an inadequate intake of key nutrients from food plus supplements they found:

Nutrient Vegetarian/Vegan Moms Omnivore Moms
Vitamin D 75% 88%
Folate + Folic acid 0% 39%
Vitamin B12 25% 0%
Calcium 45% 40%
Iron Not reported Not reported
DHA Not reported Not reported

These results clearly show the need for supplementation. While the average intake from food plus supplements looked good, there were a significant percentage of women who weren’t getting adequate intake of key nutrients because they didn’t supplement.

The exceptions were folate + folic acid for vegetarian/vegans because their diet is rich in folate-containing foods and vitamin B12 for omnivores because their diet is rich in foods containing B12.

Is Vegan Breast Milk Sufficient?

Of course, the proof is in the pudding. When the investigators looked at the nutrient content of breast milk, this is what they found:

Nutrient Vegetarian/Vegan

Moms

 Omnivore

Moms

 Reference

Value*
Vitamin D3 1.1 mcg/L 3.4 mcg/L 0.25-2 mcg/L
Folate + Folic acid 19 mcg/L 20 mcg/l 80 mcg/L
Vitamin B12 0.74 mcg/L 0.65 mcg/L 0.5 mcg/L
Calcium 83 mg/L 99 mg/L 200-300 mg/L
Iron Not reported Not reported
DHA 0.15 g/100 g fat 0.33 g/100 g fat 0.35 g/100 g fat

*Reference values established by WHO

  • The chief difference between breast milk from vegetarian/vegan moms was in DHA levels.
  • That’s because the diet of vegetarians and vegans contains very little DHA, and very few vegetarian/vegan women in this study supplemented with DHA.
  • This study also found that breast milk from both vegetarian/vegan moms and omnivore moms was low in folate + folic acid, calcium, nicotinamide, and selenium. They said that requires follow-up in future studies.

The authors concluded, “The most important contribution of this study is the detailed and comprehensive description of micronutrients and lipids in human milk from omnivore milk donors and vegetarian/vegan women…Of particular concern is the lower DHA content in the milk of our vegetarian/vegan group. However, raising awareness and administering proper supplementation could bridge the gap, as has been the case with vitamin B12.”

What Can Vegan Moms Do?

This study emphasizes the importance of careful planning and supplementation during pregnancy and lactation if you are a vegetarian or vegan mom.

For example, the vegetarian/vegan women in this study were more likely to have low birthweight babies, and low birthweight infants are at risk for health issues later in life. That means:

  • Careful planning is required to select calorie- and protein-rich plant foods.
  • A high-quality plant protein supplement can be a great help.

Supplementation is particularly important during lactation to assure your breast milk adequately nourishes your newborn baby. For example, in this study:

  • The vitamin B12 level in the breast milk from vegetarian/vegan moms was adequate because 85% of them supplemented with vitamin B12.
  • The DHA level in the breast milk from vegetarian/vegan moms was inadequate because only 10% of them supplemented with DHA.
  • The authors of this study recommended that vegetarian and vegan moms consume at least 200 mg of DHA from algal sources while they are breastfeeding.

However, finding a prenatal supplement that provides all the nutrients you need prior to pregnancy, during pregnancy, and while breastfeeding is challenging. I gave you 7 tips for choosing the best prenatal supplements in a previous “Health Tips From the Professor” article.

The Bottom Line 

A recent study asked whether the breast milk of vegetarian and vegan moms was sufficient for the needs of their newborn babies. The study found that:

  • Folate levels in their breast milk were sufficient because the diets of vegetarians and vegans contain many folate-rich foods.
  • Vitamin B12 levels in their breast milk were sufficient because 85% of the vegetarian and vegan women in this study supplemented with vitamin B12.
  • DHA levels in their breast milk were insufficient because the diets of vegetarian and vegan women are very low in DHA, and only 10% of the women in this study supplemented with DHA.
  • The authors of this study recommended that vegetarian and vegan moms consume at least 200 mg of DHA from algal sources while they are breastfeeding.

This study reinforces the need for supplementation during lactation to assure your breast milk adequately nourishes your newborn baby.

However, finding a prenatal supplement that provides all the nutrients you need prior to pregnancy, during pregnancy, and while breastfeeding is challenging. I gave you 7 tips for choosing the best prenatal supplement in a previous “Health Tips From the Professor” article.

For more information on this study 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.

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Is HDL Good For Your Heart?

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Is Everything You Knew About HDL Wrong?

Author: Dr. Stephen Chaney 

HDL CHolesterolIn last week’s “Health Tips From the Professor” I talked about one of the greatest strengths of the scientific method – namely that investigators constantly challenge, and occasionally disprove, existing paradigms. That allows us to discard old models of how things work and replace them with better ones.

Last week I shared a study that disproved the paradigm that low to moderate alcohol consumption is healthier than total abstinence. This week I share several studies that challenge the belief that HDL cholesterol is good for your heart.

The belief that HDL is good for your heart has all the hallmarks of a classic paradigm.

  • It is supported by multiple clinical studies.
  • Elaborate metabolic explanations have been proposed to support the paradigm.
  • It is the official position of most medical societies, scientific organizations, and health information sites on the web.
  • It is the recommendation of most health professionals.
  • It has been repeated so often by so many trusted sources that everyone assumes it must be true.

Once we accept the HDL/heart health paradigm as true, we can construct other hypotheses on that foundation. For example:

  • Raising your HDL levels naturally takes effort. Pharmaceutical companies have been pursuing the “magic pill” that raises HDL levels without any effort on your part.
  • Low carb diets like the Keto and Paleo diets are high in saturated fat. The low carb enthusiasts claim this is a good thing because saturated fat raises HDL levels, and HDL is good for your heart.

But what if the underlying HDL/heart health paradigm weren’t true? These hypotheses would be like the parable of a house built on a foundation of sand. The paradigm will be washed away as soon as it is critically tested.

So, let’s look at experiments that have challenged the HDL/heart health paradigm.

Do Drugs That Increase HDL Levels Work?

The first hint that the HDL/heart health paradigm might be faulty happened when a pharmaceutical company developed a drug that selectively increased HDL levels.

The drug company thought they had found the goose that laid golden eggs. Just imagine. People wouldn’t have to lose weight, exercise, or change their diet. They could simply take a pill and dramatically decrease their heart disease risk. A drug like that would be worth $billions.

The problem was that when they tested their drug (torcetrapib) in clinical trials, it had absolutely no effect on heart disease outcomes (AR Tall et al, Atherosclerosis, Thrombosis, and Vascular Biology 27:257-260, 2007).

The pharmaceutical company couldn’t believe it. Raising HDL levels just had to reduce heart disease risk. They concluded they didn’t have the right drug, and they continued to work on developing new drugs.

That was 16 years ago, and no HDL-increasing drug has made it to market. Have they just not found the right drug, or does this mean the HDL/heart health paradigm is incorrect?

Does Saturated Fat Decrease Heart Disease Risk?

Now let’s turn to two claims of low carb enthusiasts.

#1: Saturated fats decrease your risk of heart disease in the context of a low carb diet. I have debunked that claim in several previous issues of “Health Tips From The Professor”. But let me refer you to two articles here – one on saturated fat and heart disease risk and one on low-carb diets.

#2: Saturated fats decrease heart disease risk because they raise HDL levels. This is the one I will address today.

The idea that saturated fats decrease heart disease risk because they raise HDL levels is based on a simplistic concept of HDL particles. The reality is more complex. Several clinical studies have shown:

  • The type of fat determines the property of the HDL particles.
    • When polyunsaturated fats predominate, the HDL particles have an anti-inflammatory effect. When saturated fats predominate, the HDL particles have a pro-inflammatory effect.
  • Anti-inflammatory HDL particles relax the endothelial cells lining our blood vessels. That makes the lining of our blood vessels more pliable, which improves blood flow and reduces blood pressure.
    • Anti-inflammatory HDL particles also help reduce inflammation of the endothelial lining. This is important because an inflamed endothelial lining is more likely to accumulate fatty plaques and to trigger blood clot formation that can lead to heart attacks and strokes.

So, the question becomes, “What good is it to raise HDL levels if you are producing an unhealthy, pro-inflammatory HDL particle that may increase the risk of high blood pressure, heart attacks, and strokes?”

In short, these studies suggest it isn’t enough to just focus on HDL levels. You need to ask what kind of HDL particles you are creating.

Is HDL Good For Your Heart?

strong heartOnce the studies were published showing that…

  • Drug-induced increase of HDL levels without any change in health habits is not sufficient to decrease heart attack risk, and…
  • Not all HDL particles are healthy. There are anti-inflammatory or pro-inflammatory HDL particles, which likely have opposite effects on heart attack risk…

…some people started to question the HDL/heart health paradigm. And one group came up with the perfect study to test the paradigm.

But before I describe the study, I need to review the term “confounding variables”. I described the term and how it affects clinical studies in last week’s article. Here is a brief synopsis:

  • The studies supporting the HDL/heart health paradigm are association studies. Association studies measure the association between a single variable (in this case, increase in HDL levels) and an outcome (in this case, heart disease events, heart disease deaths, and total deaths).
  • Associations need to be corrected for other variables known to affect the same outcome (things like age, gender, smoking, and diabetes would be examples in this case).
  • Confounding variables are variables that also affect the outcome but are unknown or ignored. Thus, they are not used to correct the associations, which can bias the results.

The authors of this study (M Briel et al, BMJ 2009:338.b92) observed that most interventions that increase HDL levels also lower LDL levels. Lowering LDL is known to decrease the risk of heart disease deaths. But this effect had been ignored in most studies looking at the association between HDL and heart disease deaths.

They hypothesized that the change in LDL levels was a confounding variable that had been ignored in previous studies and may have biased the results.Heart Disease Study

To test this hypothesis the authors searched the literature and identified 108 studies with 299,310 participants that:

  • Compared the effect of drugs, omega-3 fatty acids, or diet with either a placebo or usual care.
  • Measured both HDL and LDL levels.
  • Measured reduction in cardiovascular risk.
  • Had a randomized control design.
  • Lasted at least 6 months.

They found that every 10 mg/dl decrease in LDL levels in these studies was responsible for a:

  • 7.1% reduction in heart disease events (both heart disease deaths and non-fatal heart attacks).
  • 7.2% reduction in heart disease deaths.
  • 4.4% reduction in total deaths.

After correcting for the effect of decreased LDL levels on these heart disease outcomes, the increase in HDL levels had no statistically significant effect on any of the outcomes.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

Is Everything You Knew About HDL Wrong?

Peek Behind The CurtainDoes that mean that everything you knew about HDL is wrong? Not exactly. It just means that you need to change your perspective.

Don’t focus on HDL levels. Peek behind the curtain and focus on what’s behind the HDL levels. For example:

  • Losing weight when overweight increases HDL levels. But the decrease in heart disease outcomes is more likely due to weight loss than to the increase in HDL levels.
  • Exercise increases HDL levels. But the decrease in heart disease outcomes is more likely due to exercise than to the increase in HDL levels.
  • Reversing pre-diabetes or type 2 diabetes increases HDL levels. But the decrease in heart disease outcomes is more likely due to the reversal of diabetes than to the increase in HDL levels.
  • High-dose omega-3 fatty acids increase HDL levels. But the decrease in heart disease outcomes is more likely due to the omega-3 fatty acids than to the increase in HDL levels.
  • The Mediterranean diet increases HDL levels. But the decrease in heart disease outcomes is more likely due to the diet than to the increase in HDL levels.

And if you want to go the drug route:

  • Statins and some other heart drugs increase HDL levels, but the reduction in heart disease outcomes is probably due to their effect on LDL levels rather than their effect on HDL levels.

On the other hand:

  • Saturated fats increase HDL levels. But saturated fats increase heart disease risk and create pro-inflammatory HDL particles. So, in this case the increase in HDL levels is not a good omen for your heart.
  • Drugs have been discovered that selectively increase HDL levels. However, there is nothing of value behind this increase in HDL levels, so the drugs have no effect on heart disease outcomes.

The Bottom Line 

In this article I discuss several studies that have challenged the HDL/heart health paradigm – the belief that HDL is good for your heart.

For example, one group of investigators analyzed the studies underlying the HDL/heart health paradigm. They hypothesized that these studies were inaccurate because they failed to account for the effects of LDL levels on heart disease outcomes.

After correcting for the effect of decreased LDL levels on heart disease outcomes in the previous studies, the authors showed that increases in HDL levels had no significant effect on any heart disease outcome.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

Does that mean that everything you knew about HDL is wrong? Not exactly. It just means that you need to change your perspective. Don’t focus on HDL levels. Focus on what’s behind the HDL levels. For more information on that, read the article above.

For more information on this study, and what it means for you, read the article above.

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

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Health Tips From The Professor