A Low Carb Diet and Weight Loss

Written by Dr. Steve Chaney on . Posted in low carb diet, Weight Loss

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

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

Choosing the Best Weight Loss Diet

Written by Dr. Steve Chaney on . Posted in Diets, Weight Loss

Calories Rule

Author: Dr. Stephen Chaney

 

weight loss dietChoosing a weight loss diet?

Next week you’ll be making your annual New Year’s resolution that this will be the year that you finally lose those extra pounds and keep them off!

The good news is that you will have lots of choices for losing that weight. The bad news is that most of those choices are bogus!

You see each diet book and Internet marketer will have a “magic formula.”

  • Sometimes it will be a “magic” diet composition – low fat diets, low carb diets, high protein diets – or don’t eat protein and carbohydrates together.
  • Sometimes it will be a “magic” food – grapefruit, cabbage soup, acai berries or chocolate.
  • Sometimes it will be a villainous food or food group to avoid – sugar, grains, or dairy.

All these diets are hyped with a lot of scientific sounding mumbo jumbo and many of them have short term studies that seem to show that they work. But whenever well designed scientific studies have been performed that compare these diets at equal calorie levels and look at weight loss over two years or more, there is not a dime’s worth of difference between them.

With Weight Loss Diets, Calories Rule

weight loss diet calories ruleDespite all the hype that you will hear, weight loss is dependent on the difference between calories in and calories out.

Don’t misunderstand me, I recognize that the calorie equation is not identical for everyone. For example, in a recent issue, “Does Genetics Determine Weight,”  of “Health Tips From The Professor” I talked about a study that put all of the subjects in a metabolic ward where every aspect of calorie intake and calorie expenditure were controlled. They then restricted calories by the same percent for everyone for 6 weeks. The subjects with “thrifty genes” lost 5% of their body weight. Subjects with “spendthrift genes” lost 12% of their body weight.

  • The good news is that everyone lost weight. Calories rule!
  • The bad news is that some people lost weight more slowly than others. Life isn’t fair.

The problem, of course, is that we don’t live in a metabolic ward. We have trouble keeping track of the calories we eat and overestimate the calories we burn. That’s why fad diets are so popular. They promise you won’t have to track calories. You don’t have to watch what you eat. You won’t need to exercise. All you need to do is eat the foods they tell you are OK and avoid the foods they tell you are bad.  This is not how to choose a weight loss diet.

I have a news bulletin: There is no “magic diet formula,” no “magic diet composition” and no “magic diet food.”  Did you really think that someone had repealed the laws of thermodynamics?

Once you understand and accept that the difference between calories in and calories out is the most important determinant of successful weight loss, you can start to understand the key principles of successful weight loss.

 

Choosing The Best Weight Loss Diet

 

choosing best weight loss dietHere is a quick guide to choosing the best diet:

Principle #1: The diet doesn’t have to be weird to be successful.

In fact, the diet is most likely to succeed if it includes foods that are familiar to you.

If you’re a “meat and potatoes” guy, a vegetarian diet is not likely to be successful for you (Some of my friends refer to that kind of diet as “rabbit food”). If you are a vegetarian, a meat-based low-carb diet is not likely to be appealing.

More importantly, we are all different. Some of us will lose weight successfully on one diet. Other people will be more successful on a different diet. That means that the diet that worked so well for your friend might not work at all for you. You will need to experiment a bit to find the best diet for you.

And, before you ask me, your body type or blood type has absolutely nothing to do with which diet is going to work best for you.

Of course, you will need to make some changes to your diet. You will want to drop unhealthy foods from your diet and include some foods that are new to you. The first foods to go should be sodas (both sugar-sweetened and diet), junk foods, and fast foods. In their place add water or herbal tea, fruits, vegetables, and whole grains. That change alone can be worth at least 2-5 pounds in your first month.

You will want to think about what you are eating and make conscious choices about which foods are helping you fulfill your goals of losing weight and which are not.

Principle #2: The diet should be one that is healthy in the long run.

I’m particularly talking about the popular high fat, low carbohydrate diets here. It is clear diets high in meat and fat – particularly saturated and trans fats – are associated with increased risk of heart disease, diabetes, cancer and inflammatory diseases.

Plus, high fat diets just don’t work well for long term weight control. Fat has more calories than carbohydrate. This is not rocket science!

Just in case you don’t believe me, you just need to consult the National Weight Control Registry. The National Weight Control Registry was established in 1994 and has tracked the weight loss strategies of over 5000 people who have been successful at keeping their weight off long term.

While those people lost weight using every diet in the books, the vast majority of them who were successful at keeping their weight off long term followed a low calorie, low-fat diet to maintain their weight loss. Of course, I am not referring to a low-fat that contains a lot of sugar and refined carbohydrates. That kind of diet is part of the problem. I am referring to a plant-based low-fat diet with lots of fruits, vegetables, legumes and whole grains.

Principle #3. Don’t forget the other part of the calorie equation. That’s right, I’m talking about exercise.

While you burn some calories every time you exercise, the real value of exercise is that it increases lean muscle mass – and lean muscle mass burns more calories than fat.

Again, if you consult the National Weight Control Registry, you will find that virtually everyone who has been successful at keeping the weight off exercises on an almost daily basis.

Helpful hint: The handy exercise monitors on your Fit Bit, smart phone, and exercise machines overestimate energy expenditure by as much as 50%. Decrease those numbers accordingly when you are estimating your calorie balance for the day.

Principle #4: Don’t start if you don’t intend to finish. Once again, the National Weight Control Registry puts that in perfect perspective.

Almost everyone who was successful at keeping the weight off long term had stopped thinking of it as a diet. It had become a way of life. It was how they ate. It was the exercise that they liked to do on a daily basis. It no longer required any conscious effort. It no longer required any will power.

This is perhaps the most important weight control principle of all:

When you make your resolutions this New Year, don’t make a resolution to change your weight. Make a resolution to change your life.

 

The Bottom Line

 

Forget the hype. There is no “magic diet formula”, no “magic diet composition” and no “magic diet food.” While the calorie equation is different for each of us (see article above for details), weight loss always requires that calories out be greater than calories in. Calories rule!

Here are four simple principles to keep in mind when selecting the best diet to lose weight next year.

#1: The diet doesn’t have to be weird to be successful.

#2: The diet should be one that is healthy in the long run.

#3: Don’t forget the other part of the calorie equation, i.e. exercise.

#4: Don’t start if you don’t intend to finish.

For more details, read the article above.

 

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

3 Weight Loss Scams To Avoid

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Lose Weight, Weight Loss

Weight Loss, Wealth Loss, Or Health Loss?

Author: Dr. Stephen Chaney

 

weight loss scamsP.T. Barnum once said “There’s a sucker born every minute”.  Those words were never truer than in the weight loss industry and weight loss scams.

You’ve seen the ads: “Lose 4 pounds/week of belly fat”; “Lose 40 pounds in two weeks”; “burns off fat effortlessly”; “The pounds just melt away”. It’s hard to believe that people actually fall for those ads. Yet they do.

The problem is that weight loss is hard. You have to change your lifestyle – eat healthier, exercise more, give up some of your favorite foods. Even worse you can’t just make those changes for a few weeks or a few months. Those lifestyle changes need to be permanent if you wish to achieve lasting weight loss.

That just doesn’t fit with the American psyche. After all, our doctors and the TV ads promise us a “pill for every ill”. If you think that way, it is only logical that there should be a pill for weight loss.

 

Unfortunately, the unscrupulous supplement manufacturers are only too happy to fill that expectation. They don’t care whether their products actually work or whether they may actually kill you. They just want to make a quick buck.

 

Here are the 3 weight loss scams making headlines today.

3 Weight Loss Scams to Avoid

 

Fake Weight Loss Marketing Schemes

weight loss scams to avoidThe first 2 weight loss scams fall into the category of ones that lighten your wallet. In a recent press release the FTC recently charged two Florida-based supplement manufacturers of concocting elaborate, but completely fraudulent, marketing schemes to sell their weight loss products– one containing forskolin and another containing white kidney bean extract.

The schemes started with the marketers hacking people’s email accounts and sending messages touting the fake products to all of their contacts. The messages were worded in such a way that the email appeared to be a recommendation of the product coming from a trusted friend or family member.

The emails were linked to fake “news websites” that were designed to look like they were put up by an independent consumer reporter who had reviewed and endorsed the product rather than by the product manufacturers. These web sites featured glowing testimonials from consumers who had supposedly lost significant weight using those products. Of course, the fake “news websites” contained links that took consumers to websites where they could purchase the products.

In the complaint they filed in court, the FTC said “these weight loss claims are false and lack scientific support”.  In plain English, the FTC was saying that the testimonials were made up and there was no scientific evidence that the products actually worked.  The fake “news websites” also said that the products were endorsed by Oprah and a television show called “The Doctors.”   The FTC said that both of those claims were also false.

And, if all of this weren’t enough, the defendants in these two cases then approached people who had legitimate health and weight loss blogs with large followings and offered them affiliate status if they would feature links to the fake “news websites” the defendants had constructed. In plain English, affiliate status means that the owners of the blogs receive a commission whenever someone started from their blog and clicked all the way through to one of the defendant’s sites and bought a product*.

The FTC is seeking an immediate injunction that would shut down these fraudulent marketing schemes and prevent the companies from selling fake products that don’t work.  I hope the FTC is successful at obtaining the injunction against both companies, and I hope it happens quickly. Unscrupulous manufacturers like this need to be put out of business.  Please, be careful to avoid these kind of weight loss scams.

*Just so you know, I have also been approached by companies offering “Health Tips From the Professor” affiliate status for marketing their products.  I have chosen not to do that.  I don’t want to become like so many other popular health blogs that seem to be more about marketing than about health.  I will not feature any product I don’t believe in on my site.  Integrity is more important than money.

 

Weight Loss Products That Might Actually Kill You

weight loss drugThe third of the weight loss scams is of the more dangerous kind – one that might even kill you.

The FDA recently sent a warning letter to a marketing company called The Ultimate Weight Loss Company claiming that 3 of their weight loss products that were labeled as containing bee pollen actually contained two undeclared drugs that the FDA has banned for consumer use.

The first undeclared drug in their products is a compound called phenolphthalein, which was widely used in laxative drugs. It was also widely used in weight loss products because its laxative effect also causes water loss from the body – giving the appearance of rapid weight loss. However, research in the 90s suggested that it also increased the risk of several cancers.  Laxative and weight loss drugs containing phenolphthalein were subsequently withdrawn from the market and the FDA currently classifies phenolphthalein as an unapproved drug.

The second undeclared drug in their products is a compound called sibutramine. Sibutramine suppresses appetite and increases metabolic rate. It was the active ingredient in a weight loss drug called Meridia, which was initially approved by the FDA in 1997.

The problem is that, like many drugs that increase metabolic rate, sibutramine also increases heart rate. While that is relatively benign for some people, it can cause arrhythmia, heart attack and stroke in anyone with a weakened cardiovascular system.

A large clinical study published in 2010 (James et al, New England Journal of Medicine, 363: 905-917, 2010) showed that Meridia significantly increased the risk of heart attack and stroke in subjects with preexisting heart disease. Shortly after that the FDA declared that it caused an unacceptably high risk of heart attack and stroke, and it was withdrawn from the market. The FDA currently classifies subutramine as an unapproved drug as well.

Of course, some of you are probably saying to yourself: “My heart is fine. If this drug suppresses my appetite and revs up my metabolism, where can I get it?”  My response is: “Not so fast. Here are a few statistics you should know”:

  • 47% of Americans are at risk for heart disease, and many don’t know that they have a problem until they drop dead from their first heart weight loss drugs killattack.

Unfortunately, the combination of phenophthalein and sibutramine are still used in fraudulent weight loss products because they work. These two drugs together might actually give you 10 pounds or more of weight loss in the first couple of weeks. They might also kill you.  They are certainly weight loss scams to avoid.

In their warning letter to The Ultimate Weight Loss Company the FDA said that their products pose “a threat to consumers because sibutramine is known to substantially increase blood pressure and/or pulse rate in some patients and may present a significant risk for patients with coronary artery disease, congestive heart failure, arrhythmias, or stroke. This product may also interact, in life-threatening ways, with other medications a consumer may be taking”

The problem is not just that the weight loss products manufactured by this company contained unapproved drugs that are dangerous. The problem is that those compounds weren’t on the label.  The label claimed the products contained bee pollen.  The consumer had no way of knowing that the products might be dangerous.

Even worse, as soon as the FDA shuts down this company, another one will pop up somewhere else. The combination of phenolphthalein and sibutramine is one of the  weight loss scams that turn up time after time.

How Can You Protect Yourself From Weight Loss Scams?

It is definitely “buyer beware” in the weight loss industry. Unscrupulous manufacturers and weight loss scams abound. You have learned from this article that:

  • You can’t trust testimonials. They are often fabricated.
  • You can’t trust before and after pictures. They can be photoshopped and purchased over the internet.
  • You can’t trust endorsements by celebrities or doctors. Endorsements can be bought and sold, and sometimes they are just fabricated.
  • You can’t trust claims about “proven results.” They often aren’t backed by real science.
  • You can’t even trust product labels. Some products contain dangerous ingredients that aren’t even on the label.
  • You can’t even trust the FDA and FTC to protect you. They are doing their best, but two new scams pop up for every one they shut down.

So what can you do to keep from being ripped off or endangering your health?  Here are my top 4 recommendations for avoiding weight loss scams.

  • Don’t be taken in by claims of rapid weight loss, effortless weight loss, or “magic” ingredients. The experts tell us weight loss should not exceed one or two pounds per week and should include lifelong lifestyle change. If the ads claim anything else, run in the other direction.
  • There are no “magic” foods or “magic” combinations of protein, fat and carbohydrate.  It also doesn’t matter whether the diet is Paleolithic age or space age. Weight loss simply requires calories in to be less than calories out.
  • Look for clinical studies published in peer reviewed scientific journals showing that the weight loss program actually works.
  • Choose companies that have established a reputation for quality and integrity over a period of decades, not just a few months or a year or two. Weight loss scams come and go. Good reputations take a long time to develop.

 

 

The Bottom Line

Weight loss scams have been in the headlines recently.

  • The FTC recently announced legal action two companies selling weight loss products containing forskolin or white kidney bean extract. According to the FTC the companies were using a “fraudulent marketing scheme” and the weight loss claims for their products were “false and lacked scientific support”.
  • The FDA recently announced legal action against a company selling three weight loss products which they claimed contained bee pollen, but which actually contained two unapproved and dangerous drugs that can cause heart attack and stroke in susceptible people.

In both cases the products seemed legitimate. They seemed safe. When you read the details of the FTC and FDA cases it becomes apparent that:

  • You can’t trust testimonials. They are often fabricated.
  • You can’t trust before and after pictures. They can be photoshopped and purchased over the internet.
  • You can’t trust endorsements by celebrities or doctors. Endorsements can be bought and sold, and sometimes they are just fabricated.
  • You can’t trust claims about “proven results”. They often aren’t backed by real science.
  • You can’t even trust product labels. Some products contain dangerous ingredients that aren’t even on the label.
  • You can’t even trust the FDA and FTC to protect you. They are doing their best, but two new scams pop up for every one they shut down.

In the article above you will find my top 4 recommendations for avoiding weight loss scams.

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 Multivitamins Reduce the Risk of Miscarriage?

Written by Dr. Steve Chaney on . Posted in Multivitamins and Miscarriage, Vitamins and Health, Weight Loss

Will A Multivitamin A Day Keep YourBaby Healthy?

Author: Dr. Stephen Chaney

multivitamins reduce risk of miscarriageThe standard medical advice for years has been to take a prenatal supplement (basically a multivitamin with extra folic acid, iron and sometimes calcium) both before and during pregnancy. Does that really make a difference? Will it reduce the risk of miscarriage? Will it give you a healthier baby?  A recent study suggests that multivitamin use may significantly decrease your risk of miscarrying, but before going into the study you need a little background.

 

It’s a new world. It used to be that a woman didn’t know for sure that she was pregnant until she had missed one or two periods and finally got an appointment with her doctor – a month or two after conception actually occurred. In today’s world accuracy in home pregnancy tests allow women to learn they are pregnant much earlier – often before the first missed period.

With the early detection of pregnancy has come the realization that miscarriage rates are much higher than previously assumed. In spite of improved prenatal care, the rate of miscarriages in the US increased by 1% per year between 1985 and 2005. In part that is because women using the in-home pregnancy tests are detecting their pregnancies much early. However, it also reflects the fact that early miscarriages are often asymptomatic. They can only be detected by negative pregnancy tests.

With that in mind, let’s look at the study.

Do Multivitamins Reduce the Risk of Miscarriage?

pregnancy and miscarriageThis study (Louis et al, Fertility and Sterility, doi.org.10.1016/j.fertnstert.2016.03.009, 2016), had a very interesting design. It enrolled 501 couples ages 18-40 from Michigan and Texas who were actively trying to become pregnant into something called the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. The women in the study were instructed in the use of a commercial fertility urine test to help the couples plan their intercourse to maximize the chances of conceiving. They were also instructed in the use of a commercial pregnancy urine test to determine the onset and potential loss of pregnancy (miscarriage).

The couples were given no guidance on health practices to follow before and during pregnancy. They were interviewed individually upon enrolment to obtain sociodemographic, lifestyle, and medical history information. They were asked to keep a daily journal recording things like cigarettes use, consumption of alcoholic or caffeinated beverages, and multivitamin use (The journal did not distinguish between over-the-counter multivitamins and prescribed prenatal vitamins).

Of the couples who enrolled in the study, 347 (69%) of them became pregnant. Three of the women conceived twins and were eliminated from the study. Of the remaining 344 women, 98 (28%) of them experienced a miscarriage during the first 22 weeks. No miscarriages were observed after 22 weeks.

When they looked at risk factors that affected pregnancy loss (miscarriages):

  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.

Putting This Study Into Perspective

This was a fairly well designed study, but it is a single study.  Let’s put each of the main findings in the context of previous studies.

Multivitamin Use: Earlier studies have shown that supplements containing extra folic acid probably reduce miscarriages. However, now that foods are routinely fortified with folic acid in the US, the benefit of multivitamins and prenatal supplements has become more controversial. Some studies have shown, like this one, that multivitamins reduce miscarriage risk. Others did not. However, multivitamin use before and during pregnancy has relatively few risks, so it is still probably a good idea.

Caffeinated Beverages: There have been relatively few studies to date on the effect of caffeinated beverages on miscarriage risk, but the few that have been performed tend to agree that caffeinated beverages may increase the risk of miscarriage. While the data are far from definitive at this point, it is probably a good idea to limit your caffeinated beverages before and during pregnancy.

Age: Age is a well-established risk factor for miscarriages. While many consider 40 as the threshold for increased risk, this study and several other recent studies suggest it may be closer to 35. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.

Other Factors:This study did not find an effect of obesity, smoking or alcohol on pregnancy risk. However, many other studies have shown that each of these increases the risk of miscarriage. It’s probably a good idea to drop a few extra pounds and avoid both smoking and alcohol if you wish to maximize your chances of a successful pregnancy outcome.

If You Are Pregnant, What Does This Study Mean For You? 

preventing miscarriageThis study supports multivitamin use before and during pregnancy and suggests that excessive consumption of caffeinated beverages may have a negative effect on pregnancy outcome. However, it doesn’t significantly alter the standard medical advice for what you should do before and during pregnancy.

  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

The Bottom Line

 A recent study showed:

 

  • Daily multivitamin use by the woman prior to conception reduced the risk of miscarriage by 55%. If the vitamin use was continued through the first 7 weeks of pregnancy, the risk of miscarriage was reduced by 79%.
  • Consumption of two or more caffeinated beverages/day by either partner prior to conception and during early pregnancy significantly increased the risk of miscarriage
  • The miscarriage rate was almost double for women over 35, which is consistent with previous studies.
  • No effect of obesity, cigarette smoking, and alcohol use on miscarriage risk was seen in this study, which is different from most previous studies.
  • This study reinforces the recommendation for multivitamin or prenatal vitamin use, but the standard medical advice for a successful pregnancy isn’t really changed:
  • Daily multivitamin use, both prior to and during pregnancy, is probably a good idea. Not all studies agree, but some studies suggest that it will significantly decrease the risk of miscarriage.
  • Obesity and diabetes increase miscarriage risk. The good news is that even a 5-10% weight loss often is sufficient to reverse diabetes and may improve pregnancy outcome as well.
  • If you are over 35, your risk of suffering a miscarriage is significantly increased. That doesn’t mean that you shouldn’t try to have a baby if you are over 35, but it does mean that you will probably want to avoid any lifestyle factors that might increase your risk of miscarriage.
  • Smoking and alcohol use should be avoided. Both are likely to increase your risk of miscarriage.
  • Recent studies suggest that the consumption of two or more caffeinated beverages a day may also increase your risk of miscarriage, so don’t overindulge in caffeinated beverages. Be aware that it’s not just coffee and tea that are caffeinated. Many sodas are caffeinated as well.

 

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.

8 Weight Loss Myths

Written by Dr. Steve Chaney on . Posted in current health articles, Diets, Exercise, Fitness and Health, Food and Health, Lose Weight, Weight Loss

Why Your Weight Is Increasing Rather Than Decreasing

Author: Dr. Stephen Chaney

 

weight lossUsually I review scholarly publications of clinical studies, but occasionally I find an article in the popular press that’s so good I just have to share it with you. The lead article about weight loss by Bonnie Liebman in the April 2015 issue of Nutrition Action is just such an article. She called it “8 Weight Mistakes”, but I think “8 Weight Loss Myths” would be a better title.

There are certain weight loss myths that are repeated so often that most people believe they are true. Unfortunately, each one of these myths is a “fat trap” that can sabotage your efforts to achieve a healthy weight. If your New Year’s weight loss resolution isn’t going as well as you would like, it may be because you are still holding on to one or more of these myths.

Weight Loss Myth #1: I Can Lose It Later

It’s easy to tell yourself that you don’t need to watch your weight during the holidays or while you are on vacation. After all you can cut back a bit when those special occasions are over and lose that extra weight. What makes that belief particularly insidious is that it actually worked for you when you were in your teens or early twenties. Why doesn’t it work anymore? There are 4 reasons:

  • dietOn most diets you lose muscle as well as fat. I have talked about this in a previous article, High Protein Diets and Weight Loss , but muscle is important because it burns off calories much faster than fat.
  • Your organs become smaller. For example, as you lose weight your heart doesn’t have to service as many miles of blood vessels, so it can become smaller as well. That’s important because your heart works so hard pumping blood that it burns off calories much faster than resting muscle.
  • Once you have lost a significant amount of weight exercise burns fewer calories. If you don’t believe that, try lugging an extra 10 or 20-pound weight up a flight of stairs.
  • Your metabolism slows down. This is particular true if you try to lose weight too fast as I have explained in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor.

Just in case you are still a doubter, Ms. Liebman shared a study in her article that showed most people never lose all of the weight they gained during the holidays before the next holiday season starts. Does that sound familiar?

Weight Loss Myth #2: Once It’s Off, It’ll Stay Off

weight loss dietYou’ve heard this one before. However, even on the most successful diets, weight loss is temporary. Most people eventually regain all the weight they’ve lost and more. Again I’ve also covered the reason for this in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor. To spare you the trouble of reading the book I will share the secret with you. Simply put: “Diets never work long term. Only true lifestyle change can lead to long term weight loss.”

However, that doesn’t stop people from believing that the next “magic” diet will be their ticket to permanent weight loss. It always amazes me that people fall for this same myth time after time.

Weight Loss Myth #3: Fat Is Fat, No Matter Where It Is

Most of you probably already knew that belly fat (the so-called apple shape) is metabolically more dangerous to our health than thigh & leg fat (the so-called pear shape). However, some of the other information Ms. Liebman shared was a surprise to me.

  • It turns out that belly fat is actually easier to lose than thigh & leg fat. As you add fat to your lower body you create lots of new fat cells fat is fat(2.6 billion new fat cells for every 3.5 pounds of fat). Once you add that extra fat to your lower body you’re pretty much stuck with it.
  • Of course, you can’t add new fat to your belly forever without creating new fat cells, and once you’ve created those new fat cells you may be stuck with your belly fat as well.

Weight Loss Myth #4: You Have To Go Out Of Your Way To Overeat

It’s really difficult to understand how anyone could believe in this myth. The fact is that we live in a “fat world”. There are fast food restaurants on virtually every street corner in every city and in virtually every mall in this country. Restaurant portion sizes are through the roof. Every social interaction seems to be centered around food or drink.

You don’t need to go out of your way to overeat. Overeating has become the American way. You actually need to go out of your way to avoid overeating.

Weight Loss Myth #5: All Extra Calories Are Equal

Research has confirmed what many of you probably suspected already. All calories are NOT equal. Calories from alcohol, saturated fats, trans fats and sugars make a beeline for your belly where they are converted into the most dangerous form of fat.

Weight Loss Myth #6: I Can Just Boost My Metabolism

boost metabolismMany Americans cling to the false hope that they can eat whatever they want as long as they take some sort of magic herb or pill to boost their metabolism. The fact is that natural metabolic boosters like green tea have a very modest effect on metabolism. They can play a role in a well-designed diet program, but they will never allow you to eat whatever you want and lose weight.

As for those magic herbs and drugs that promise to burn off fat calories without you lifting a finger, my advice is to avoid them like the plague. I’ve talked about many of them in my previous “Health Tips From the Professor” articles. For example, you might be interested in my articles Are Dietary Supplements Safe? or Are Diet Pills Safe?. The bottom line is that these metabolic boosters are dangerous – and they just might kill you.

Weight Loss Myth #7: There’s A Magic Bullet Diet

Hope springs eternal. Perhaps that’s why so many new diets appear each year. Some diets are low fat, some are low carbohydrate, some hearken back to cave man times, and others are just plain weird. Some of them actually do give better weight loss than others short term. However, when you follow people on those diets for two years or more, none of them work very well (see myth #2), and there isn’t a dimes worth of difference between them.

Weight Loss Myth #8: I Can Work Off The Extra Calories

exerciseThis is perhaps the most pervasive myth of all. This is the one that sells millions of gym memberships every January.

Don’t get me wrong. Diet plus exercise can be very beneficial because it helps you retain muscle mass as you are losing weight, especially if you are consuming enough protein to support the exercise.

However, exercise alone isn’t going to help you nearly as much as you think.

  • You’d have to ride your bicycle for an hour and 25 minutes to offset the 500 calorie dessert you just consumed at your favorite restaurant.
  • Exercise helps some people more than others. Studies show that some people get hungrier when they exercise. As a result, they eat more calories and actually gain weight rather than losing it.
  • Finally, don’t rely on your fitness trackers. Most of them grossly overestimate the calories you burn through exercise. If you use a fitness tracker you should cut their estimates for calories burned by 50% or more.

 

The Bottom Line

 

A recent article shared the 8 most common weight loss myths. If you actually believe any of these myths, you will have a very difficult time getting your weight under control.

  • I can lose it later.
  • Once it’s off, it’ll stay off.
  • Fat is fat, no matter where it is.
  • You have to go out of your way to overeat.
  • All extra calories are equal (A calorie is a calorie).
  • I can just boost my metabolism.
  • There is a magic bullet diet.
  • I can work off the extra calories.

 

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

 

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Omega-3 Benefits: Lower High Blood Pressure

Posted July 16, 2019 by Dr. Steve Chaney

What Does the FDA Say About Omega-3 Benefit Claims?

Author: Dr. Stephen Chaney

 

 

Among omega-3 benefits is lower high blood pressure.  That claim can be made according to the FDA. 

lower high blood pressureHeart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing.  That is concerning because:

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 410,000 deaths in 2014. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

  • 32% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).
  • Another 33% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 65% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure.  Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss. The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 46% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute but let me start with the FDAs recent approval of what they call “qualified claims” that omega-3s lower blood pressure.

 

What Does the FDA Say About Omega-3 Benefits?

omega-3 benefitsIn my book “Slaying The Supplement Myths” I talk about the “dark side” of the supplement industry. There are far too many companies who try to dupe the public by making outrageous and unsubstantiated claims about their products.

Only the FDA stands between us and those unscrupulous companies, and they take their role very seriously. That is why it is big news whenever the FDA allows companies to make health claims about their products.

Even then, the FDA is very cautious. They allow what they call “qualified” health claims. Basically, that means they are saying there is enough evidence that the health claim is probably true, but not enough evidence to say it is proven.

Of course, if you understand the scientific method, you realize there will always be some studies on both sides of every issue. That is why the only health claims the FDA allows are qualified health claims.

With that background in mind, let’s look at the qualified health claims the FDA allows for omega-3 benefits.

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added five qualified health claims about omega-3s and blood pressure. The 5 claims are very similar, so I will only list two below for the sake of brevity.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.
  • Of course, they add the usual wording about the evidence being inconsistent and inconclusive.

 

Omega-3 Benefits?

measure omega-3 benefits levelWe’ve known for some time that omega-3 fatty acids help lower blood pressure, but two recent studies were instrumental in convincing the FDA to allow these qualified health claims. These studies have highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure (Miller et al, American Journal of Hypertension, 27: 885-896, 2014 ).

This study showed:

  • In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.
  • Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.
  • The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8-week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

This study showed:

  • In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.
  • The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

 

A Holistic Approach to Lower High Blood Pressure

holistic approach to lower high blood pressureThe FDA’s allowed claims about omega-3s are good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

  • The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low fat, low carb and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].
  • Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.
  • Reducing excess weight by 5% reduces systolic blood pressure by 3 points.
  • Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.
  • Nitrates, whether derived from fresh fruits and vegetables or from supplements probably also reduce blood pressure, but we don’t yet know by how much.

If you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus the other omega-3 benefits in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.  What

That’s significant because, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could reduce your risk of:

  • Stroke by 37%.
  • Coronary heart disease by 21%.
  • Death from cardiovascular disease by 25%.
  • Death from all causes by 13%.

 

A Word of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

  • Monitor your blood pressure on a regular basis.
  • If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.
  • Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.
  • Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control with a healthy diet and lifestyle, the less medication your doctor will need to use (That means fewer side effects).

 

The Bottom Line

Heart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing. That is why anything we can do lower blood pressure naturally is important. What does the FDA say about omega-3s and blood pressure?

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added qualified health claims about omega-3s and blood pressure. For example, they now allow the following claims.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.

For more information on the studies that convinced the FDA to allow claims about omega-3s and blood pressure and for a discussion of holistic natural approaches for lowering blood pressure, read the article above.

 

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

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