supplementation

Is Supplementation Important For Hospitalized Patients?

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Why Does Supplementation Matter During Hospitalization?

Author: Dr. Stephen Chaney

Hospitalized Elderly PatientI have often said that age doesn’t necessarily bring wisdom, but it does bring perspective. When I first started teaching medical students in the early 70’s, the idea that optimal nutrition was important for hospitalized patients was new and exciting.

A series of groundbreaking papers documented that many patients, especially elderly patients, were in poor nutritional status when they entered the hospital. For these patients optimizing their nutrition while they were in the hospital and shortly thereafter:

  • Reduced mortality and increased recovery from whatever treatment they were undergoing.
  • Reduced the incidence of sepsis (systemic infection) and other severe side effects of the treatment.
  • Reduced recovery time in the hospital.
  • Allowed them to return to their normal daily activities more quickly after they left the hospital.

Those discoveries revolutionized medicine. Every hospital now provides tube feeding and iv infusions for very ill and nutritionally compromised patients. And these innovations have improved the effectiveness of hospital care.

So, when I saw a recent paper (GE Baggs et al, Clinical Nutrition, 42: 2116-2123, 2023) with the title “Impact of a specialized oral nutritional supplement on the quality of life in older adults following hospitalization”, my initial thought was this was old news.

But then I read further. You see, feeding tubes and iv infusions are very effective. But if you or a loved one has ever been hospitalized for a serious illness or accident, you also know they are very expensive.

When I read this study, I realized they were talking about a less expensive option, the equivalent of providing these patients with a multivitamin and a protein shake providing certain critical nutrients. That got my attention.

How Was This Study Done?

clinical studyThis study utilized data from something called the NOURISH [Nutrition effect On Unplanned Readmissions and Survival in Hospitalized patients] trial. This trial enrolled hospitalized older adults with malnutrition. As the title of the trial suggests, this study tested the effect of the nutritional intervention I will describe below on unplanned readmissions after hospitalization (which you want to be as low as possible) and survival after hospitalization (which you want to be as long as possible).

That study reported that hospitalized patients who received the prescribed supplement experienced:

  • Improved nutritional status.
  • Improved survival and reduced readmission after leaving the hospital.

This study re-analyzed the same data set to determine whether the same patients also experienced improved quality of life. Here are the specifics of the study:

Elderly (average age = 78) patients who were recently admitted to the hospital with a diagnosis of congestive heart failure, acute myocardial infarction (heart attack), pneumonia, or COPD were screened for nutritional status. From this group, 622 patients with moderate or severe malnutrition were selected for the study. Patients with this combination of age, severe cardiopulmonary disease, and poor nutritional status generally have poor outcomes and increased risk of readmission.

The patients were randomly split into two groups. One group received standard care. The second group received a beverage containing 20 grams of protein, 1.5 grams of beta-hydroxy-beta-methylbutyrate (HMB), plus vitamin D and other essential micronutrients.

[Note: HMB is a metabolite of the amino acid leucine. And, like leucine, HMB stimulates an increase in muscle protein synthesis, reduces loss of muscle mass during hospitalization, and enhances the regain of muscle mass during recovery. HMB and leucine give essentially equivalent results.]

The second group received a placebo beverage containing 12 grams of carbohydrate, 10 mg of vitamin C, but no protein, HMB, or other micronutrients.

Patients were instructed to drink 2 servings of the beverage a day during hospitalization and for the first 90 days after discharge from the hospital.

On the day they were discharged from the hospital (day 0) and on 30, 60, and 90 days after discharge the patients met with trained coordinators who administered questionnaires assessing their quality of life.

Is Supplementation Important For Hospitalized Patients?

Hospitalized Elderly Patient RecoveringWhen compared to the placebo, the supplement described above provided significant improvements in:

  • General health on days 0, 30, 60, and 90 after leaving the hospital.
  • Mental health on days 60 and 90 after leaving the hospital.
  • Vitality and social functioning on day 90 after leaving the hospital.

In addition, there was a trend towards improvement for:

  • Physical functioning, reduced body pain, and mental health-related role limitations [for example, taking care of a spouse].

The authors concluded, “Among malnourished, hospitalized patients (aged ≥ 65 years), supplementation with S-ONS [their acronym for the supplement used in this study] during hospitalization and 90 days post discharge resulted in improved quality of life. These benefits complement survival benefits previously shown in the NOURISH trial analysis.”

Why Was This Supplement Effective?

You will notice that the beverage used was relatively high in protein (20 grams) and included added HMB to help increase muscle mass. It also contained a variety of micronutrients.

There are two reasons for this design.

  • You have heard the saying, “It’s all downhill after age 30.” With muscle mass the downhill slide starts around age 50. This age-related loss of muscle mass is referred to as sarcopenia.

Sarcopenia can be slowed by resistance training plus diet or supplementation that provides around 20 grams of protein plus either leucine or HMB 2-3 times a day.

However, many older adults have trouble fixing healthy meals and end up protein and micronutrient deficient.

  • Severely ill patients enter what is referred to as a catabolic state. They break down their muscle and energy stores at a high rate. This is also true for patients recovering from major surgery or trauma.

The catabolic state dramatically increases protein and calorie needs just to prevent the body from cannibalizing its own tissue. Again, previous studies have shown that a protein supplement providing around 20 grams of protein and either HMB or leucine can slow this process.

What Does This Mean For You?

QuestionsThere are two major take home lessons from this study.

1) Who needs supplementation?

I have covered this topic in previous issues of “Health Tips From the Professor”, but let me summarize the key points here.

  • Supplementation can fill the gaps in an inadequate diet. Multiple studies have shown that most Americans get inadequate levels of one or more essential nutrients from their diet. And restrictive diets ranging from vegan to keto create additional nutritional deficiencies.
    • And, for this purpose, supplementation need not be complicated. A multivitamin and a plant protein shake to replace some of the animal protein in the typical American diet would suffice.
  • Supplementation can reduce the risk of certain chronic diseases. We should not think of supplementation as a “magic bullet”, but I do recommend it as part of a holistic approach to wellness.
    • In this case supplementation starts with a protein shake and a multivitamin, but often includes targeted nutrients such as omega-3s.

But this study reminds us of another key point about supplementation.

  • We should supplement before we need it most. The seniors in this study were already “behind the 8 ball” when they were admitted to the hospital because they were malnourished – something that likely could have been prevented with a simple program of supplementation and exercise.

This is a lesson that applies to all of us.

    • Chronic diseases like high blood pressure, diabetes, and cancer “sneak up on us”. They often develop years before we or our doctors recognize them. Studies show that diet and supplementation reduce the risk of developing these diseases, but they are much more difficult to reverse once you have them.
    • Most hospitalizations are unplanned. And if we enter the hospital with optimal nutritional status, the outcome of our treatment is much better than if we enter the hospital in poor nutritional status.
    • Colds and viruses strike without warning. We are much more likely toward them off or recover more quickly if we are in good nutritional status when we are exposed.

2) What kind of supplement do we need? Don’t misunderstand me. There are times when tube feeding and iv infusions are absolutely essential for some hospitalized patients. 

But this study showed that a well-designed protein supplement containing the essential micronutrients was sufficient for most elderly, malnourished patients hospitalized with severe cardiopulmonary diseases.

  • The formulation used in this study was produced by a pharmaceutical company. However, any high-quality protein supplement providing 20 grams of protein with added leucine or HMB plus a multivitamin supplement should provide the same benefits at a lower cost. The multivitamin could be in tablet or powder form.
  • The catabolic state associated with hospitalization also increases energy requirements. The protein supplement used in these studies had 350 calories and 44 grams of carbohydrate.

Most commercial protein supplements are designed for weight loss or weight maintenance and have fewer calories. So, for hospitalized patients extra calories would need to be provided in the form of foods containing healthy carbohydrates and fat.

The Bottom Line 

Recent studies have shown that providing elderly, malnourished patients with a simple, inexpensive supplement regimen during and following hospitalization leads to better outcomes and better quality of life for the hospitalized patients. These findings illustrate two important concepts about supplementation:

  • The time to supplement is before you need it. Most hospitalizations are unplanned, and your outcome will be much better if you enter the hospital in optimal nutritional status.
  • Supplementation need not be complex and expensive. The supplement regimen used in this study is equivalent to a high-quality protein supplement with added leucine or HMB plus a multivitamin.

For more details about these studies 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

_______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

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

 

 

Which Vitamins Reduce Breast Cancer Risk?

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How Can You Reduce Your Risk Of Breast Cancer?

Author: Dr. Stephen Chaney 

Breast cancer is scary. The good news is that treatment has gotten much better. Breast cancer is no longer a death sentence. But most women would prefer to avoid breast cancer surgery, radiation, and/or chemotherapy if they could.

Could something as simple as supplementation reduce your risk of developing breast cancer? If so, which vitamins should you be taking? Or, put another way, which vitamins reduce breast cancer risk?

If you ask your doctor, they will tell you, “Supplementation is a waste of money. Vitamins don’t reduce your risk of getting cancer.” And they will be correct! That’s because these are the wrong questions.

Let me explain. These are “one size fits all” questions. Studies to answer these questions start with healthy women and asks if vitamin supplementation reduces breast cancer risk for all of them. The answer to that question is, “No”. Multiple studies have confirmed this.

But the truth is more complicated. We should be asking, “Who benefits from vitamin supplementation”, instead of, “Does everyone benefit from supplementation?”Supplementation Perspective

I have summed up this concept with the Venn diagram on the right. Every woman does not need supplementation. But those with poor diet, increased need, genetic predisposition, and/or certain diseases may benefit from supplementation. That is why we should be asking, “Who needs supplementation?”.

Unfortunately, while this concept of individualized treatment has led to dramatic advances for cancer drug development, it has been virtually ignored for studies on supplementation and breast cancer risk.

The current study (H Song et al., Nutrients, 14: 2644, 2022) is an exception. It asks whether obese women who wish to reduce their risk of breast may benefit more from certain micronutrients than women of normal weight.

How Was This Study Done?

Clinical StudyThe data for this analysis came from the KoGES study. This was a study administered by the Korea Agency for Disease Control and Prevention between 2004 and 2016. It was designed to provide a scientific basis for personalized prevention of chronic diseases in the Korean population.

Of the 211,721 participants enrolled in the original KoGES study, this study included data from 41,593 women who:

  • Underwent a health examination at 38 health examination centers upon enrollment between 2004 and 2013 and a follow up health examination between 2012 and 2016. The average follow-up period was 4.9 years.
  • Were cancer-free when they enrolled in the study and developed breast cancer prior to their follow-up health examination.
  • Had reliable diet data.

Dietary intake was based on a food frequency questionnaire administered during their initial health screening. Dietary intake of 15 micronutrients (calcium, phosphorous, iron, potassium, vitamin A, sodium, vitamin B1, vitamin B2, vitamin B6, niacin, folic acid, vitamin C, vitamin E, zinc, and cholesterol) and 4 macronutrients (energy, protein, fat, and carbohydrate) was determined from the food frequency data and compared to the Korean Dietary Reference Intakes (KDRIs). [Note: The Korean DRIs are slightly different than US standards.]

  • The women were then divided into two groups based on whether they consumed more or less than the Korean DRIs for each nutrient.

Which Vitamins Reduce Breast Cancer Risk?

Vitamin SupplementsThere were two major findings from this study.

1) When the investigators grouped all the women in the study together:

    • none of the 15 micronutrients and 4 macronutrients analyzed in this study influenced breast cancer risk.
    • This confirms most previous studies that have been designed as a “one size fits all” study. So, if your doctor was relying on this kind of study, they were technically correct in saying that vitamin supplements don’t appear to reduce breast cancer risk.

2) But when the investigators separated the women by weight, an interesting dichotomy was observed:

    • For obese women (BMI ≥ 25 kg/m2):
      • Vitamin C intake above the recommended Korean DRI (100 mg/day) reduced the risk of breast cancer by 46%.
      • Vitamin B6 intake above the recommended Korean DRI (1.4 mg/day) reduced the risk of breast cancer by 52%.
    • For women of normal weight (BMI < 25 kg/m2) neither vitamin C nor vitamin B6 had any effect on breast cancer risk.

The authors concluded, “In obese women, exceeding the recommended daily intake levels of vitamin C and vitamin B6 was associated with a lower risk of breast cancer. However, other micronutrients were not associated with breast cancer risk in these women.” [Note: Supplement use was not included in the diet survey, so above recommended intake of C and B6 was from foods consumed, not from supplements.]

What Does This Study Mean For You?

Questioning WomanThis study is a perfect example of why we should be asking, “Who benefits from vitamin supplementation”, instead of, “Does everyone benefit from supplementation?”

In terms of the Venn diagram I introduced above, some people consider obesity a disease.

But whether you consider obesity a disease or not, it does increase the need for many nutrients. So, it is conceivable that extra vitamins C and B6 might provide benefits in obese women that are not seen in non-obese women.

This is, of course, a ground-breaking study. It is the first study of its kind and deserves to be followed by other studies to confirm this observation. Ideally, these studies would test whether the same effect is seen in other population groups and determine the optimal dose of vitamin C and B6 to reduce breast cancer risk.

However, I am not optimistic that these studies will be done. It is easy to get funding for the “do vitamin supplements benefit everyone?” studies that confirm the existing prejudice against vitamin supplementation.

It is much harder to obtain funding for “who benefits from vitamin supplementation?” studies that challenge the existing paradigm. But these are the kind of studies that are needed most.

How Can You Reduce Your Risk Of Breast Cancer?

As I said, this is the first study of its kind, so you could consider the results as preliminary. However, assuming it might be true:

  • I do not recommend megadoses of vitamins C and B6. The above average intake of C and B6 in this study came from food alone. And we do not have any dose response studies that might define an optimal dose of C and B6.
  • I do recommend balance. Based on this study, multivitamins should provide enough C and B6 to have a meaningful effect on breast cancer risk. And multivitamins are inexpensive and risk-free.

In addition, there are things you can do that are proven to reduce breast cancer risk. Here is what the American Cancer Society recommends:

  • Get to and stay at a healthy weight.
  • Be physically active and avoid time sitting.
  • Follow a healthy eating plan.
  • It is best not to drink alcohol.
  • Think carefully about using hormone replacement therapy.

I provide more detail about each of these recommendations in a recent article in “Health Tips From the Professor”.

The Bottom Line 

Most doctors will tell you that supplementation does not reduce your risk of breast cancer. And that opinion is backed up by multiple published clinical studies.

But the problem is that these studies are all asking the wrong question. They are asking, “Does supplementation reduce the risk of breast cancer for all women?”. A better question would be, “Which women benefit from supplementation?”

A recent study asked both of those questions. They looked at the effect of 15 micronutrients on breast cancer risk.

  1. When the investigators grouped all the women in the study together:
    • None of the 15 micronutrients influenced breast cancer risk.

2) But when the investigators separated the women by weight, an interesting dichotomy was observed:

    • For obese women (BMI ≥ 25 kg/m2):
      • Vitamin C intake above the recommended intake reduced the risk of breast cancer by 46%.
      • Vitamin B6 intake above the recommended intake reduced the risk of breast cancer by 52%.
    • For women of normal weight (BMI < 25 kg/m2) neither vitamin C nor vitamin B6 had any effect on breast cancer risk.

The authors concluded, “In obese women, exceeding the recommended daily intake levels of vitamin C and vitamin B6 was associated with a lower risk of breast cancer. However, other micronutrients were not associated with breast cancer risk in these women.”

For more information on this study, what it means for you, and proven methods for reducing breast cancer risk 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

 

500th Issue Celebration

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Nutrition Breakthroughs Over The Last Two Years

Author: Dr. Stephen Chaney 

celebrationIn the nearly ten years that I have been publishing “Health Tips From The Professor”, I have tried to go behind the headlines to provide you with accurate, unbiased health information that you can trust and apply to your everyday life.

The 500th issue of any publication is a major cause for celebration and reflection – and “Health Tips From The Professor” is no different.

I am dedicating this issue to reviewing some of the major stories I have covered in the past 100 issues. There are lots of topics I could have covered, but I have chosen to focus on three types of articles:

  • Articles that have debunked long-standing myths about nutrition and health.
  • Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.
  • Articles about the issues that most directly affect your health.

Best Ways To Lose Weight

weight lossSince it is almost January, let’s start with a couple of articles about diet and weight loss (or weight gain). I have covered the effectiveness of the Paleo, Keto, Mediterranean, DASH, vegetarian, and Vegan diets for both short and long-term weight loss in my book “Slaying The Food Myths”, so I won’t repeat that information here. Instead, I will share a few updates from the past 100 issues.

My Tips On The Best Approach For Losing Weight: Every health guru has a favorite diet they like to promote. I am different. My book, Slaying the Food Myths, is probably the first “anti-diet” diet book ever written. Based on my years of research I can tell you that we are all different. There is no single diet that is best for everyone. In this article I have summarized my tips for selecting the weight loss diet that is best for you.

The US News & World Report’s Recommendation For the Best Diets: Each year US News & World Report assembles some of the top nutrition experts in the country and asks them to review popular diets and rank them for effectiveness and safety. In this article I summarize their ratings for 2022.

Does Intermittent Fasting Have A Downside? In previous articles in “Health Tips From the Professor” I have reported on studies showing that intermittent fasting is no more effective for weight loss than any other diet that restricts calories to the same extent. But does intermittent fasting have a downside? In this article I reported on a study that suggests it does.

Can A Healthy Diet Help You Lose Weight? Most investigators simply compare their favorite diet to the standard American diet. And any diet looks good compared to the standard American diet. In this article I reported on a study that compared two whole food diets that restricted calories by 25% to the standard American diet. One calorie-restricted diet was more plant-based and the other more meat-based. You may be surprised at the results.

Omega-3s

Omega-3s continue to be an active area of research. Here are just a few of the top studies over the past two years.omega3s

Do Omega-3s Oil Your Joints? In this article I reviewed the latest information on omega-3s and arthritis.

Do Omega-3s Add Years To Your Life? In this article I discussed a study that looks at the effect of omega-3s on longevity.

The Omega-3 Pendulum: In this article I discuss why omega-3 studies are so confusing. One day the headlines say they are miracle cures. A few weeks later the headlines say they are worthless. I discuss the flaws in many omega-3 studies and how to identify the high-quality omega-3 studies you can believe.

Do Omega-3s Reduce Congestive Heart Failure? In this article I review a recent study on omega-3s and congestive heart failure and discuss who is most likely to benefit from omega-3 supplementation.

Plant-Based Diets

Vegan FoodsWill Plant-Based Proteins Help You Live Longer? In this article  I review a study that looks at the effect of swapping plant proteins for animal proteins on longevity.

Can Diet Add Years To Your Life? In this article  I review a study that takes a broader view and asks which foods add years to your life.

Is A Vegan Diet The Secret To Weight Loss? This is an update of my previous articles on vegan diets. This article asked whether simply changing from a typical American diet to a vegan diet could influence weight loss and health parameters in as little as 16 weeks. The answer may surprise you.

Is A Vegan Diet Bad For Your Bones? No diet is perfect. This article looks at one of the possible downsides to a vegan diet. I also discuss how you can follow a vegan diet AND have strong bones. It’s not that difficult.

Anti-Inflammatory Diets

What Is An Anti-Inflammatory Diet? In this article  I discuss the science behind anti-inflammatory diets Inflammationand what an anti-inflammatory diet looks like.

Can Diet Cause You To Lose Your Mind? In this article  I discuss a study looking at the effect of an inflammatory diet on dementia. The study also looks at which foods protect your mind and which ones attack your mind.

Do Whole Grains Reduce Inflammation? You have been told that grains cause inflammation. Refined grains might, but this study shows that whole grains reduce inflammation.

Nutrition And Pregnancy

pregnant women taking vitaminsHere are the latest advances in nutrition for a healthy pregnancy.

The Perils Of Iodine Deficiency For Women. In this article I reviewed the latest data showing that iodine is essential for a healthy pregnancy and discuss where you can get the iodine you need.

Do Omega-3s Reduce The Risk Of Pre-Term Births? You seldom hear experts saying that the data are so definitive that no further studies are needed. In this article I reviewed a study that said just that about omega-3s and pre-term births.

Does Maternal Vitamin D Affect ADHD? In this article I reviewed the evidence that adequate vitamin D status during pregnancy may reduce the risk of ADHD in the offspring.

How Much DHA Should You Take During Pregnancy? In this article I reviewed current guidelines for DHA intake during pregnancy and a recent study suggesting even higher levels might be optimal.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

Children’s Nutrition

Here are the latest insights into children’s nutrition.Obese Child

Are We Killing Our Children With Kindness? In this article I reviewed a recent study documenting the increase in ultra-processed food consumption by American children and the effect it is having on their health. I then ask, is it really kindness when we let our children eat all the sugar and ultra-processed food they want?

Is Diabetes Increasing In Our Children? In this article I reviewed a study documenting the dramatic increase in diabetes among American children and its relationship to ultra-processed food consumption and lack of exercise.

How Much Omega-3s Do Children Need? In this article I reviewed an study that attempts to define how much omega-3s are optimal for cognition (ability to learn) in our children.

Diabetes

diabetesHere are some insights into nutrition and diabetes that may cause you to rethink your diet.

Does An Apple A Day Keep Diabetes Away? You may have been told to avoid fruits if you are diabetic. In this article I reviewed a study showing that fruit consumption actually decreases your risk of diabetes. Of course, we are all different. If you have diabetes you need to figure out which fruits are your friends and which are your foes.

Do Whole Grains Keep Diabetes Away? You may have also been told to avoid grains if you are diabetic. In this article I reviewed a study showing that whole grain consumption actually decreases your risk of diabetes. Once again, we are all different. If you have diabetes you need to figure out which grains are your friends and which are your foes.

Heart Disease

Here is an interesting insight into nutrition and heart disease that may cause you to rethink your diet.

Is Dairy Bad For Your Heart? You have been told that dairy is bad for your heart AND that it is good for your heart. Which is correct? In this article I discuss some recent studies on the topic and conclude the answer is, “It depends”. It depends on your overall diet, your weight, your lifestyle, and your overall health.

Breast Cancer

Here are some facts about breast cancer every woman should know.breast cancer

The Best Way To Reduce Your Risk Of Breast Cancer In this article I review two major studies and the American Cancer Guidelines to give you 6 tips for reducing your risk of breast cancer.

The Truth About Soy And Breast Cancer You have been told that soy causes breast cancer, and you should avoid it. In this article I review the science and tell you the truth about soy and breast cancer.

Supplementation

Vitamin SupplementsSome “experts” claim everyone should take almost every supplement on the market. Others claim supplementation is worthless. What is the truth about supplementation?

What Do The 2020-2025 Dietary Guidelines Say About Supplements? Every 5 years the USDA updates their Dietary Guidelines for foods and supplements. In this article I discuss what the 2020-2025 Dietary Guidelines say about supplements. Yes, the USDA does recommend supplements for some people.

Who Benefits Most From Supplementation? Not everyone benefits equally from supplementation. In this article I discuss who benefits the most from supplementation.

Should Cancer Patients Take Supplements? Doctors routinely tell their cancer patients not to take supplements. Is that the best advice? In this article I review a study that answers that question.

Can You Trust Supplements Marketed on Amazon? Amazon’s business model is to sell products at the lowest possible price. But do they check the quality of the products marketed on their site? In this article  I review a study that answers that question.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

The Bottom Line 

I have just touched on a few of my most popular articles above. You may want to scroll through these articles to find ones of interest to you that you might have missed over the last two years. If you don’t see topics that you are looking for, just go to https://chaneyhealth.com/healthtips/ and type the appropriate term in the search box.

In the coming years, you can look for more articles debunking myths, exposing lies and providing balance to the debate about the health topics that affect you directly. As always, I pledge to provide you with scientifically accurate, balanced information that you can trust. I will continue to do my best to present this information in a clear and concise manner so that you can understand it and apply it to your life.

Final Comment: You may wish to share the valuable resources in this article with others. If you do, then copy the link at the top and bottom of this page into your email. If you just forward this email and the recipient unsubscribes, it will unsubscribe you 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.

 

Should Cancer Patients Take Supplements?

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Does Supplementation Interfere With Cancer Treatment?

Author: Dr. Stephen Chaney

SupplementationSupplementation for cancer patients is a controversial topic.

  • Dr. Strangelove and his friends promote a variety of herbal ingredients, vitamins, and minerals as a cure for various kinds of cancer.
  • Unscrupulous supplement companies hype their cancer “cures”.
  • Doctors often tell their patients to avoid all supplements while they are being treated for cancer.
  • Nutrition experts and some doctors tell us that a good diet and basic supplementation help normal cells recover from cancer treatment and improve patient outcomes.

Where is the truth? For this article I will break it down into three questions:

1) Does supplementation improve outcomes for cancer patients? That is the topic of the study (AL Shaver et al, Cancers, 13: 6276, 2021) I will review today.

2) Does supplementation interfere with cancer treatment? I will provide a perspective and practical advice on this question based on my 40 years of cancer research.

3) Does supplementation prevent (reduce the risk of) cancer? I have covered this topic in previous issues of “Health Tips From the Professor”. Just put cancer or breast cancer in the search box to find the relevant articles.

But before I answer these questions, I should cover my favorite topic as a Biochemist, “Metabolism 101”. Specifically, “Does Stress Increase Our Need For Supplementation?”

Metabolism 101: Does Stress Increase Our Need For Supplementation? 

professor owlLet me start out by saying that there are two kinds of stress.

  • Psychological stress is our body’s response to a hectic day or a stressful work environment.
  • Metabolic stress is our body’s response to trauma or a major disease.

Dr. Strangelove and his buddies will tell you that psychological stress increases your nutritional needs. And they just happen to have the perfect blend of vitamins and minerals for you. However, this is a myth.

Psychological stress has relatively little effect on your nutritional needs. If you have a nutritional deficiency, supplementation can help you cope with psychological stress, but psychological stress doesn’t create nutritional deficiencies.

Metabolic stress, on the other hand, has a major effect on your nutritional needs.

  • Trauma and major diseases put you in a catabolic state. Catabolism literally means “breaking down”. You are breaking down your body tissues at an alarming rate. This affects every aspect of your health, including your immune system.
  • Trauma and major disease also increase your need for certain micronutrients. Plus, there are often loss of appetite and mobility issues that prevent you from getting the nutrients you need.
  • Research in the 60s and 70s showed that providing hospitalized patients with protein, energy in the form of healthy fats and carbohydrates, and micronutrients significantly shortened hospital stays and improved outcomes. Today, nutritional support is the standard of care for severely ill hospital patients.

Cancer is the poster child for metabolic stress.

  • It forces the body into a catabolic state to provide nutrients the cancer needs to grow.
    • That is why cancer patients often experience dramatic weight loss and weakness from muscle loss.
    • Catabolism also weakens the immune system, which is one of the most important tools in our fight against cancer.
  • To make matters worse:
    • Cancer treatment destroys normal cells as well as tumor cells. Because of this cancer patients sometimes die from the treatment, not the cancer.
    • Cancer treatment often causes nausea and/or suppresses appetite, which makes it even harder for cancer patients to get the nutrients they need from their diet.

Because of this, you would think that nutritional support would be the standard of care for cancer patients, but it isn’t. Because of fears that nutritional support might “feed cancer cells” or interfere with chemotherapy, there have been very few studies of supplementation in cancer patients. That is what makes this study so important.

How Was This Study Done?

Clinical StudyThis study took advantage of the fact that supplementation is prevalent among cancer patients even though their doctors may not have recommended it.

This study drew on data from the 2011-2012 National Health and Nutritional Examination Survey (NHANES). NHANES is a yearly survey that monitors the health and nutritional status of non-institutionalized adults in the US population.

NHANES participants were asked to respond to a medical condition questionnaire in their homes by a trained interviewer. In one portion of the interview, they were asked if they had ever been told they had cancer, arthritis, diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), or hypertension. The participants were also asked if they had been hospitalized with one of those diseases.

The study consisted of 14 million people who answered ‘yes’ to the question, “Have you ever been told you had a cancer or malignancy?” The participants were selected to give an equal number of supplement users and non-users who were closely matched for age, sex, race, and other demographics.

All NHANES participants were asked to fill in two 24-hour dietary recalls separated by 3-10 days. The dietary recalls included supplement use but did not identify the kind of supplements used.

Finally, participants in the NHANES survey were asked to rate their physical and mental health on a scale from 1 (excellent health) to 5 (poor health). Participants were also asked to indicate on how many days in the past 30 days their physical or mental health was not good. A quality-of-life score was calculated from these data.

Does Supplementation Improve Outcomes For Cancer Patients?

good newsThe study found that for cancer patients:

  • Hospitalization rates were 12% for supplement users versus 21% for non-users.
  • This is important because:
    • Cancer patients who have been hospitalized have 6-fold higher odds of all-cause mortality than those who do not require hospitalization.
    • Health care costs the first year after cancer diagnosis average $60,000 versus an estimated $350-$3,500 yearly cost of supplementation.
  • The self-reported quality of life score was significantly higher for supplement users versus non-users.

This study strongly supports the idea that supplementation significantly improves quality of life and health outcomes in cancer patients.

  • This finding is consistent with previous studies showing that nutrition support significantly improves health outcomes for hospitalized patients admitted with trauma or other major diseases.
    • A major strength of the study is the large sample size (> 14 million US adults).
    • A major limitation of this study is that the NHANES survey does not record which supplements people were using.

The authors concluded, “Adequate nutrition provides a cost-effective strategy to achieving potentially optimal health [for cancer patients]. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes for different kinds of cancer…Given the overall cost-effectiveness of dietary supplementation, there is a need for better provider education about how to talk with cancer survivors about their nutrient status and filling nutrient gaps through both food and supplements. Immune-supportive supplementation may prove to be a clinically effective and important tool that is accessible via telemedicine.”

Does Supplementation Interfere With Cancer Treatment?

Question MarkThe reason that supplementation is not more widely recommended for cancer patients is two-fold.

1) There is a fear among many doctors that improved nutrition will feed the cancer cells and promote tumor growth.

    • This thinking is like the famous quote from a general during the Vietnamese war that, “It was necessary to destroy the village in order to save it [from the Viet Cong]”.
    • We need healthy normal cells to fight the cancer and for good quality of life while we are fighting the cancer. We need to protect these cells while we are destroying the cancer cells. We cannot afford to destroy the whole “village”.
    • For example, both cancer treatment and the catabolism associated with the cancer weaken the immune system, and a strong immune system is essential to successfully fight the cancer.

2) There is also a fear that supplementation will interfere with cancer treatment. This is a more legitimate fear and deserves a more in-depth analysis.

    • There are some instances where supplementation can clearly interfere with treatment. For example,
      • Radiation treatment relies on the production of free radicals. High-dose antioxidants have been shown to interfere with radiation treatment.
      • Some drugs act by suppressing folate levels in cells. High-dose B complex or folic acid supplements would clearly interfere with these drugs. However, high-dose folic acid supplementation is often used before and after drug treatment to “rescue” normal cells.
    • There are other cases where supplementation is likely to interfere with treatment.
      • A few drugs depend in part on free radical formation. High-dose antioxidants have the potential to interfere with these drugs.
      • Some herbal supplements activate enzymes involved in the metabolism of certain anti-cancer drugs. While these interactions are rare, they could interfere with the effectiveness of these drugs. [Note: This concern only applies to certain herbal supplements. It does not apply to vitamin-mineral supplements.]
    • Most other fears about supplement-drug interactions are theoretical. There are neither potential mechanisms nor evidence to support those fears.

However, there is a strategy for minimizing the potential for supplement-drug interactions based on the science of pharmacokinetics. Simply put:

  • Most cases of supplement-drug interactions can be avoided by assuring that high doses of anti-cancer drugs and nutrients that might interfere with those drugs are not present in the bloodstream at the same time.
  • Pharmocokinetic studies tell us that most anticancer drugs and nutrients are cleared from the bloodstream in 24-48 hours.
  • So, my standard recommendation is to avoid supplementation for a day or two prior to cancer treatment and wait to resume supplementation for a day or two after cancer treatment. This recommendation does not apply to radiation treatment since it is done on a daily basis.

However, there are a few drugs that are cleared from the bloodstream more slowly, so it is always best to check with your pharmacist or doctor before deciding on the appropriate window to avoid supplementation. The goal is always to protect normal cells without interfering with the drug’s ability to kill cancer cells.

Should Cancer Patients Take Supplements?

SupplementationWith the information I have shared above in mind, I am now ready to answer the question I posed at the beginning of this article, “Should cancer patients take supplements?” The answer is a qualified, “Yes”.

Let me start with the yes, and then talk about the qualifications.

  • This study makes clear that cancer is like every other major disease that can land you in the hospital. Nutritional support, including protein supplements, vitamins, and minerals, can reduce your risk of hospitalization, get you out of the hospital quicker, and improve your quality of life.
  • A strong immune system is important for fighting cancer, so immune-supporting supplements may also be important for cancer patients.
  • Note I did not say that supplementation can cure cancer. There is little evidence to support that claim.
  • The role of supplementation in preventing cancer is complex. I have covered this in previous issues of “Health Tips From the Professor”. Let me summarize by saying that supplementation can play a role in preventing cancer when nutrient levels are suboptimal. However, the evidence that megadoses of nutrients can prevent cancer is scant.

The qualifications mostly revolve around taking supplements while undergoing cancer treatment. To summarize what I said above:

  • There are a few cases in which supplements clearly interfere with cancer treatment.
  • There are other cases in which supplements are likely to interfere with cancer treatment.
  • However, in most cases supplement-treatment interactions are only theoretical.
  • In most cases any interaction between supplements and anti-cancer drugs can be minimized by avoiding supplementation for a day or two prior to cancer treatment and waiting to resume supplementation for a day or two after cancer treatment.
  • However, there are exceptions to this rule, so it is always best to consult your pharmacist or doctor if in doubt.

The Bottom Line

A recent study looked at the effect of supplementation for patients with cancer. The study found that for cancer patients:

  • Hospitalization rates were 12% for supplement users versus 21% for non-users.
  • This is important because:
    • Cancer patients who have been hospitalized have 6-fold higher odds of all-cause mortality than those who do not require hospitalization.
    • Health care costs the first year after cancer diagnosis average $60,000 versus an estimated $350-$3,500 yearly cost of supplementation.
  • The self-reported quality of life was significantly higher for supplement users versus non-users.

This study strongly supports the idea that supplementation significantly improves quality of life and health outcomes in cancer patients.

  • This finding is consistent with previous studies showing that nutrition support significantly improves health outcomes for hospitalized patients admitted with trauma or other major diseases.

The authors concluded, “Adequate nutrition provides a cost-effective strategy to achieving potentially optimal health [for cancer patients]. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes for different kinds of cancer…Given the overall cost-effectiveness of dietary supplementation, there is a need for better provider education about how to talk with cancer survivors about their nutrient status and filling nutrient gaps through both food and supplements. Immune-supportive supplementation may prove to be a clinically effective and important tool that is accessible via telemedicine.”

For more details, a discussion on the effect of supplementation on cancer treatment, and a summary of what this study 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.

Who Benefits Most From Supplementation?

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Supplements Are Part of a Holistic Lifestyle

Author: Dr. Stephen Chaney

need for supplementsThe headlines about supplementation are so confusing. Are they useful, or are they a waste of money? Will they cure you, or will they kill you? I feel your pain.

I have covered these questions in depth in my book, “Slaying The Supplement Myths”, but let me give you a quick overview today. I call it: “Who Benefits Most From Supplementation?” I created the graphic on the left to illustrate why I feel responsible supplementation is an important part of a holistic lifestyle for most Americans. Let me give you specific examples for each of these categories.

 

Examples of Poor Diet

No Fast FoodYou have heard the saying that supplementation fills in the nutritional gaps in our diets, so what are the nutritional gaps? According to the USDA’s 2020-2025 Dietary Guidelines for Americans, many Americans are consuming too much fast and convenience foods. Consequently, we are getting inadequate amounts of calcium, magnesium, and vitamins A, D, E and C. Iron is considered a nutrient of concern for young children and pregnant women. In addition, folic acid, vitamin B6, and iodine are nutrients of concern for adolescent girls and pregnant women.

According to a recent study, regular use of a multivitamin is sufficient to eliminate all these deficiencies except for calcium, magnesium and vitamin D (J.B. Blumberg et al, Nutrients, 9(8): doi: 10.3390/nu9080849, 2017). A well-designed calcium, magnesium and vitamin D supplement may be needed to eliminate those deficiencies.

In addition, intake of omega-3 fatty acids from foods appears to be inadequate in this country. Recent studies have found that American’s blood levels of omega-3s are among the lowest in the world and only half of the recommended level for reducing the risk of heart disease (K.D. Stark et al, Progress In Lipid Research, 63: 132-152, 2016; S.V. Thuppal et al, Nutrients, 9, 930, 2017; M Thompson et al, Nutrients, 11: 177, 2019). Therefore, omega-3 supplementation is often a good idea.

In previous editions of “Health Tips From the Professor” I have talked about our “mighty microbiome”, the bacteria and other microorganisms in our intestine. These intestinal bacteria can affect our tendency to gain weight, our immune system, inflammatory diseases, chronic diseases such as diabetes, cancer, and heart diseases, our mood—the list goes on and on. This is an emerging science. We are learning more every day, but for now it appears our best chances for creating a health-enhancing microbiome are to consume a primarily plant-based diet and take a probiotic supplement.

Finally, diets that eliminate whole food groups create nutritional deficiencies. For example, vegan diets increase the risk of deficiencies in vitamin B12, vitamin D, calcium, iron, zinc and long chain omega-3 fatty acids. A recent study reported that the Paleo diet increased the risk of calcium, magnesium, iodine, thiamin, riboflavin, folate and vitamin D deficiency (A. Genomi et al, Nutrients, 8, 314, 2016). The Keto diet is even more restrictive and is likely to create additional deficiencies.

Examples of Increased Need

pregnant women taking omega-3We have known for years that pregnancy and lactation increase nutritional requirements. In addition, seniors have increased needs for protein, calcium, vitamin D and vitamin B12. In previous issues of “Health Tips From the Professor” I have also shared recent studies showing that protein requirements are increased with exercise.

Common medications also increase our need for specific nutrients. For example, seizure medications can increase your need for vitamin D and calcium. Drugs to treat diabetes and acid reflux can increase your need for vitamin B12. Other drugs increase your need for vitamin B6, folic acid, and vitamin K. Excess alcohol consumption increases your need for thiamin, folic acid, and vitamin B6. These are just a few examples.

Vitamin D is a special case. Many people with apparently adequate intake of vitamin D have low blood levels of 25-hydroxy vitamin D. It is a good idea to have your blood 25-hydroxy vitamin D levels measured on an annual basis and supplement with vitamin D if they are low.

More worrisome is the fact that we live in an increasing polluted world and some of these pollutants may increase our needs for certain nutrients. For example, in a recent edition of “Health Tips From the Professor” I shared a study reporting that exposure to pesticides during pregnancy increases the risk of giving birth to children who will develop autism, and that supplementation with folic acid during pregnancy reduces the effect of pesticides on autism risk. I do wish to acknowledge that this is a developing area of research. This and similar studies require confirmation. It is, however, a reminder that there may be factors beyond our control that have the potential to increase our nutritional needs.

Examples of Genetics Influencing Nutritional Needs

nutrigenomicsThe effect of genetic variation on nutritional needs is known as nutrigenomics. One of the best-known examples of nutrigenomics is genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene.  MTHFR gene mutations increase the risk of certain birth defects, such as neural tube defects. MTHFR mutations also slightly increase the requirement for folic acid. A combination of food fortification and supplementation with folic acid have substantially decreased the prevalence of neural tube defects in the US population. This is one of the great success stories of nutrigenomics. Parenthetically, there is no evidence that methylfolate is needed to decrease the risk of neural tube defects in women with MTHFR mutations.

Let me give you a couple of additional examples:

One of them has to do with vitamin E and heart disease (A.P. Levy et al, Diabetes Care, 27: 2767, 2004). Like a lot of other studies there was no significant effect of vitamin E on cardiovascular risk in the general population. But there is a genetic variation in the haptoglobin gene that influences cardiovascular risk. The haptoglobin 2-2 genotype increases oxidative damage to the arterial wall, which significantly increases the risk of cardiovascular disease. When the authors of this study looked at the effect of vitamin E in people with this genotype, they found that it significantly decreased heart attacks and cardiovascular deaths.

This has been confirmed by a second study specifically designed to look at vitamin E supplementation in that population group (F. Micheletta et al, Arteriosclerosis, Thrombosis and Vascular Biology, 24: 136, 2008). This is an example of a high-risk group benefiting from supplementation, but in this case the high risk is based on genetic variation.

Let’s look at soy and heart disease as a final example. There was a study called the ISOHEART study (W.L. Hall et al, American Journal of Clinical Nutrition, 82: 1260-1268, 2005 (http://ajcn.nutrition.org/content/82/6/1260.abstract); W.L. Hall et al, American Journal of Clinical Nutrition, 83: 592-600, 2006) that looked at a genetic variation in the estrogen receptor which increases inflammation and decreases levels of HDL. As you might expect, this genotype significantly increases cardiovascular risk.

Soy isoflavones significantly decrease inflammation and increase HDL levels in this population group. But they have no effect on inflammation or HDL levels in people with other genotypes affecting the estrogen reception. So, it turns out that soy has beneficial effects, but only in the population that’s at greatest risk of cardiovascular disease, and that increased risk is based on genetic variation.

These examples are just the “tip of the iceberg”. Nutrigenomics is an emerging science. New examples of genetic variations that affect the need for specific nutrients are being reported on a regular basis. We are not ready to start genotyping people yet. We don’t yet know enough to design a simple genetic test to predict our unique nutritional needs. That science is 10-20 years in the future, but this is something that’s coming down the road.

What the current studies tell us is that some people are high-risk because of their genetic makeup, and these are people for whom supplementation is going to make a significant difference. However, because genetic testing is not yet routine, most people are completely unaware that they might be at increased risk of disease or have increased nutritional requirements because of their genetic makeup.

Examples of Disease Influencing Nutritional Needs

Finally, let’s consider the effect of disease on our nutritional needs. If you look at the popular literature, much has been written about the effect of stress on our nutritional needs. In most case, the authors are referring to psychological stress. In fact, psychological stress has relatively minor effect on our nutritional needs.

Metabolic stress, on the other hand, has major effects on our nutritional needs. Metabolic stress occurs when our body is struggling to overcome disease, recover from surgery, or recover from trauma. When your body is under metabolic stress, it is important to make sure your nutritional status is optimal.

The effects of surgery and trauma on nutritional needs are well documented. In my book, “Slaying The Supplement Myths”, I discussed the effects of disease on nutritional needs in some detail. Let me give you a brief overview here. It is very difficult to show beneficial effects of supplementation in a healthy population (primary prevention). However, when you look at populations that already have a disease, or are at high risk for disease, (secondary prevention), the benefits of supplementation are often evident.

For example, studies suggest that vitamin E, B vitamins, and omega-3s each may reduce heart disease risk, but only in high-risk populations. Similarly, B vitamins (folic acid, B6 and B12) appear to reduce breast cancer risk in high risk populations.

Who Benefits Most From Supplementation?

Question MarkWith this information in mind, let’s return to the question: “Who benefits most from supplementation? Here is my perspective.

1) The need for supplementation is greatest when these circles overlap, as they do for most Americans.

2) The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

So, let’s step back and view the whole picture. The overlapping circles are drawn that way to make a point. A poor diet doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, disease, or metabolic stress, supplementation is likely to be beneficial. The more overlapping circles you have, the greater the likely benefit you will derive from supplementation.

That is why I feel supplementation should be included along with diet, exercise, and weight control as part of a holistic approach to better health.

The Bottom Line

In this article I provide a perspective on who benefits most from supplementation and why. There are four reasons to supplement.

  1. Fill Nutritional gaps in our diet

2) Meet increased nutritional needs due to pregnancy, lactation, age, exercise, many common medications, and environmental pollutants.

3) Compensate for genetic variations that affect nutritional needs.

4) Overcome needs imposed by metabolic stress due to trauma, surgery, or disease.

With this information in mind, let’s return to the question: “Who benefits most from supplementation? Here is my perspective.

  1. A poor diet alone doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, or metabolic stress, supplementation is likely to be beneficial. The more overlap you have, the greater the likely benefit you will derive from supplementation.

2) The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

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.

Can Vegans Have Strong Bones?

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When Is Supplementation Important? 

Author: Dr. Stephen Chaney

Healthy BoneWhole food, vegan diets are incredibly healthy.

  • They have a low caloric density, which can help you maintain a healthy weight.
  • They are anti-inflammatory, which can help prevent all the “itis” diseases.
  • They are associated with reduced risk of diabetes, heart disease, and some cancers.
  • Plus a recent study has shown that vegans age 60 and older require 58% fewer medications than people consuming non-vegetarian diets.

But vegan diets are incomplete, and as I have said previously, “We have 5 food groups for a reason”. Vegan diets tend to be low in several important nutrients, but for the purposes of this article I will focus on calcium and vitamin D. Vitamin D is a particular problem for vegans because mushrooms are the only plant food that naturally contain vitamin D, and the vitamin D found in mushrooms is in the less potent D2 form.

Calcium and vitamin D are essential for strong bones, so it is not surprising that vegans tend to have less dense bones than non-vegans. But are these differences significant? Are vegans more likely to have broken bones than non-vegans?

That is the question the current study (DL Thorpe et al, American Journal of Clinical Nutrition, 114: 488-495, 2021) was designed to answer. The study also asked whether supplementation with calcium and vitamin D was sufficient to reduce the risk of bone fracture in vegans.

How Was This Study Done?

Clinical StudyThe data for this study were obtained from the Adventist Health Study-2. This is a study of ~96,000 members of the Seventh-day Adventist Church in North America who were recruited into the study between 2002 and 2007 and followed for up to 15 years.

Seventh-day Adventists are a good group for this kind of study because the Adventist church advocates a vegan diet consisting of legumes, whole grains, nuts, fruits, and vegetables. However, it allows personal choice, so a significant number of Adventists choose modifications of the vegan diet and 42% of them eat a nonvegetarian diet.

This diversity allows studies of the Adventist population to not only compare a vegan diet to a nonvegetarian diet, but also to compare it with the various forms of vegetarian diets.

This study was designed to determine whether vegans had a higher risk of hip fractures than non-vegan Adventists. It was performed with a sub-population of the original study group who were over 45 years old at the time of enrollment and who were white, non-Hispanic. The decision to focus on the white non-Hispanic group was made because this is the group with the highest risk of hip fractures after age 45.

At enrollment into the study all participants completed a comprehensive lifestyle questionnaire which included a detail food frequency questionnaire. Based on the food frequency questionnaire participants were divided into 5 dietary patterns.

  • Vegans (consume only a plant-based diet).
  • Lacto-ovo-vegetarian (include dairy and eggs in their diet).
  • Pesco-vegetarians (include fish as well as dairy and eggs in their diet).
  • Semi-vegetarians (include fish and some non-fish meat (primarily poultry) as well as dairy and eggs in their diet).
  • Non-vegetarians (include all meats, dairy, and eggs in their diet). Their diet included 58% plant protein, which is much higher than the typical American diet, but much less than the 96% plant protein consumed by vegans.

Every two years the participants were mailed follow-up questionnaires that included the question, “Have you had any fractures (broken bones) of the wrist or hip after 2001? Include only those that came from a fall or minor accident.”

Can Vegans Have Strong Bones?

Unhealthy BoneThe results of this study were striking.

  • When men and women were considered together there was an increasing risk of hip fracture with increasing plant-based diet patterns. But the differences were not statistically significant.
  • However, the effect of diet pattern on the risk of hip fractures was strongly influenced by gender.
    • For men there was no association between diet pattern and risk of hip fractures.
    • For women there was an increased risk of hip fractures across the diet continuum from nonvegetarians to vegans, with vegan women having a 55% higher risk of hip fracture than nonvegetarian women.
  • The increased risk of hip fractures in vegan women did not appear to be due to other lifestyle differences between vegan women and nonvegetarian women. For example:
    • Vegan women were almost twice as likely to walk more than 5 miles/week than nonvegetarian women.
    • Vegan women consumed more vitamin C and magnesium, which are also important for strong bones, than nonvegetarian women.
    • Vegan women got the same amount of daily sun exposure as nonvegetarian women.
  • The effect of diet pattern on the risk of hip fractures was also strongly influenced by supplementation with Calcium Supplementcalcium and vitamin D.
    • Vegan women who did not supplement with calcium and vitamin D had a 3-fold higher risk of hip fracture than nonvegetarian women who did not supplement.
    • Vegan women who supplemented with calcium and vitamin D (660 mg/day of calcium and 13.5 mcg/day of vitamin D on average) had no increased risk of hip fracture compared to nonvegetarian women who supplemented with calcium and vitamin D.
  • In interpreting this study there are a few things we should note.
    • The authors attributed the lack of an effect of a vegan diet on hip fracture risk in men to anatomical and hormonal differences that result in higher bone density for males.
    • In addition, because the average age of onset of osteoporosis is 15 years later for men than for women, this study may not have been adequately designed to measure the effect of a vegan diet on hip fracture in men. Ideally, the study should have enrolled participants who were at least 60 or older if it wished to detect an effect of diet on hip fractures in men.
    • Finally, because the study enrolled only white, non-Hispanic women into the study, it does not tell us the effect of a vegan diet on women of other ethnicities. Once again, if there is an effect, it would likely occur at an older age than for white, non-Hispanic women.

The authors concluded, “Without combined supplementation of both vitamin D and calcium, female vegans are at high risk of hip fracture. However, with supplementation the excessive risk associated with vegans disappeared.”

Simply put, vegan diets are very healthy. They reduce the risk of heart disease, high blood pressure, diabetes, some cancers, and inflammatory diseases.

However, the bad news is:

  • Vegan women have a lower intake of both calcium and vitamin D than nonvegetarian women.
  • Vegan women have lower bone density than nonvegetarian women.
  • Vegan women have a higher risk of hip fracture than nonvegetarian women.

The good news is:

  • Supplement with calcium and vitamin D eliminates the increased risk of hip fracture for vegan women compared to nonvegetarian women.

When Is Supplementation Important?

Supplementation PerspectiveMuch of the controversy about supplementation comes from a “one size fits all” mentality. Supplement proponents are constantly proclaiming that everyone needs nutrient “X”. And scientists are constantly proving that everyone doesn’t need nutrient “X”. No wonder you are confused.

I believe in a more holistic approach for determining whether certain supplements are right for you. Dietary insufficiencies, increased need, genetic predisposition, and diseases all affect your need for supplementation, as illustrated in the diagram on your left. I have discussed this approach in more detail in a previous issue (https://chaneyhealth.com/healthtips/do-you-need-supplements/) of “Health Tips From the Professor”.

But today I will just focus on dietary insufficiencies.

  • Most Americans consume too much highly processed fast and convenience foods. According to the USDA, we are often getting inadequate amounts of calcium, magnesium, and vitamins A, D, E and C. Iron is also considered a nutrient of concern for young children and pregnant women.
  • According to a recent study, regular use of a multivitamin is sufficient to eliminate most these deficiencies except for calcium, magnesium, and vitamin D. A well-designed calcium, magnesium and vitamin D supplement may be needed to eliminate those deficiencies.
  • In addition, intake of omega-3 fatty acids from foods appears to be inadequate in this country. Recent studies have found that American’s blood levels of omega-3s are among the lowest in the world and only half of the recommended level for reducing the risk of heart disease. Therefore, omega-3 supplementation is often a good idea.

Ironically, “healthy” diets are not much better when it comes to dietary insufficiencies. That is because many of these diets eliminate one or more food groups. And, as I have said previously, we have 5 food groups for a reason.

Take the vegan diet, for example:

  • There is excellent evidence that whole food, vegan diets reduce the risk of heart disease, diabetes, inflammatory diseases, and some cancers. It qualifies as an incredibly healthy diet.
  • However, vegan diets exclude dairy and meats. They are often low in protein, vitamin B12, vitamin D, calcium, iron, zinc, and long chain omega-3 fatty acids. Supplementation with these nutrients is a good idea for people following a vegan diet.
  • The study described above goes one step further. It shows that supplementation with calcium and vitamin D may be essential for reducing the risk of hip fractures in vegan women.

There are other popular diets like Paleo and keto which claim to be healthy even though there are no long-term studies to back up that claim.

  • However, those diets are also incomplete. They exclude fruits, some vegetables, grains, and most plant protein sources.
  • A recent study reported that the Paleo diet increased the risk of calcium, magnesium, iodine, thiamin, riboflavin, folate, and vitamin D deficiency. The keto diet is even more restrictive and is likely to create additional deficiencies.
  • And it is not just nutrient deficiencies that are of concern when you eliminate plant food groups. Plants also provide a variety of phytonutrients that are important for optimal health and fiber that supports the growth of beneficial gut bacteria.

In short, the typical American diet has nutrient insufficiencies. “Healthy” diets that eliminate food groups also create nutrient insufficiencies. Supplementation can fill those gaps.

The Bottom Line

Vegan diets are incredibly healthy, but:

  • They eliminate two food groups – dairy, and meat protein.
  • They have lower calcium and vitamin D intake than nonvegetarians.
  • They also have lower bone density than nonvegetarians.

The study described in this article was designed to determine whether vegans also had a higher risk of bone fractures. It found:

  • Vegan women who don’t supplement have a 3-fold higher risk of hip fracture than nonvegetarian women.
  • The increased risk of hip fractures in vegan women did not appear to be due to other lifestyle differences between vegan women and nonvegetarian women.
  • Supplementation with calcium and vitamin D (660 mg/day of calcium and 13.5 mcg/day of vitamin D on average) eliminated the difference in risk of hip fracture between vegan women and nonvegetarian women.

In the article above I discuss the importance of supplementation in assuring diets are nutritionally complete.

  • In short, the typical American diet has nutrient insufficiencies. “Healthy” diets that eliminate food groups also create nutrient insufficiencies. Supplementation can fill those gaps.

For more details about the study and a discussion of which supplements may be needed to assure nutritionally adequate diets, 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.

Is DNA Testing Valuable?

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What Is The True Value Of DNA Tests? 

Author: Dr. Stephen Chaney

Genetic TestingDNA testing is hot! DNA testing companies claim they can tell you your disease risk and personalize your diet and supplement program – all based on the sequence of your DNA.

On the other hand, most reputable medical sources say these DNA testing companies overpromise and underdeliver. They tell you that diet, lifestyle, and supplement recommendations based only on your DNA sequence are often inaccurate.

So, what should you believe? At this point you are probably wondering:

  • Is DNA testing valuable or is it a waste of money?
  • Is there a way to make DNA testing more accurate?
  • What is the true value of DNA testing to you, the consumer?

I will consider these 3 questions in my article below. But first let me share two stories about DNA testing, one true and the other fictional.

Perspectives on DNA Testing

When the human genome was first sequenced in 2003, it took 13 years and cost millions of dollars. That was an nutrigenomicsexciting time. Many of us in the scientific community thought we were on the verge of a revolution in human health and longevity. We would soon be able to tell individuals their risk of developing various diseases.

Even better, we would be able to tell them the kind of diet and supplementation they needed to avoid those diseases. We would be able to personalize our nutritional recommendation for every individual based on their genome – something we called nutrigenomics.

How naive we were! It has turned out to be much more complicated to design personalized nutrition recommendations based on someone’s genome than we ever imagined.

Today an analysis of your genome requires hours and costs less than $200. That represents a tremendous advance in technology. However, we are no closer to being able to make personal nutrition recommendations based on our DNA sequence today than we were 18 years ago.

Why is that? Let me share a fictional story because it provides a clue. In 1997, when I was still a relatively young scientist, I saw a film called GAATACA. [If you are looking for an entertaining film to watch, it is still available on some streaming services.]

This film envisioned a future society in which parents had their sperm and eggs sequenced so that their children would be genetically perfect. In that society the term “love child” had been redefined as a child who had been conceived without prior DNA sequencing.

The hero of this film was, of course, a love child. He was born with a genetic predisposition for heart disease. He was considered inferior, a second-class citizen of this future world.

Without giving away the plot of the film (I don’t want to spoil the enjoyment for you if you are thinking of watching it), he overcame his genetic inferiority. With a strict regimen of diet and physical fitness he became stronger and healthier than many of his genetically perfect peers.

This is when I first began to realize that our DNA does not have to be our destiny. We have the power to overcome bad genetics. We also have the power to undermine good genetics.

You might be wondering, “How can this be? Why doesn’t our DNA determine our destiny” I will answer that question in two parts.

  • First, I will share what experts say about the value of DNA testing.
  • Then I will put on my professor hat and discuss “Genetics 101 – What we didn’t know in 2003” (When the genome was first sequenced).

Is DNA Testing Valuable?

SkepticAs I said above, most scientists are skeptical about the ability of DNA testing to predict our ideal diet and supplementation regimens. For example, here are two recent reviews on the current status of DNA testing. [Note: These scientists are using “science speak”. Don’t worry if you don’t understand all the terms. I will explain their message in simpler terms in the next section.]

One review (C Murgia and MM Adamski, Nutrients, 366, 2017) published in 2017 concluded: “The potential applications to nutrition of this invaluable tool [DNA sequencing] were apparent since the genome was mapped…However, fifteen years and hundreds of publications later, the gap between genome mapping and health practice is not yet closed.”

“The discovery of other levels of control, including epigenetics [modifications of DNA that affect gene expression] and the intestinal microbiome complicate the interpretation of genetic data. While the science of nutritional genomics remains promising, the complex nature of gene, nutrition and health interactions provides a challenge for healthcare professionals to analyze, interpret and apply to patient recommendations.”

Another review (M Gaussch-Ferre et al, Advances in Nutrition, 9: 128-135, 2018) published in 2018 concluded: “Overall, the scientific evidence supporting the dissemination of genomic information for nutrigenomic purposes [predicting ideal diet and supplement regimens] remains sparse. Therefore, additional knowledge needs to be generated…”

In short, the experts are saying we still don’t know enough to predict the best diet or the best supplements based on genetic information alone.

Genetics 101 – What We Didn’t Know In 2003

GeneticistIn simple terms the experts who published those reviews are both saying that the linkage between our DNA sequence and either diet or supplementation is much more complex than we thought in 2003 when the genome was first sequenced.

That is because our understanding of genetics has been transformed by two new areas of research, epigenetics and our microbiome. Let me explain.

  1. Epigenetics has an important influence on gene expression. When I was a graduate student, we believed our genetic destiny was solely determined by our DNA sequence. That was still the prevailing viewpoint when the human genome project was initiated. As I said above, we thought that once we had our complete DNA sequence, we would know everything we needed to know about our genetic destiny.

It turns out that our DNA can be modified in multiple ways. These modifications do not change the DNA sequence, but they can have major effects on gene expression. They can turn genes on or turn them off. More importantly, we have come to learn that these DNA modifications can be influenced by our diet and lifestyle.

This is the science we call epigenetics. We have gone from believing we have a genome (DNA sequence) that is invariant and controls our genetic destiny to understanding that we also have an “epigenome” (modifications to our DNA) that is strongly influenced by our diet and lifestyle and can change day-to-day.

2) Our microbiome also has an important influence on our health and nutritional status. microbiomeSimply put, the term microbiome refers to our intestinal microbes. Our intestinal bacteria are incredibly diverse. Each of us has about 1,000 distinct species of bacteria in our intestines. 

Current evidence suggests these intestinal bacteria influence our immune system, inflammation and auto-immune diseases, brain function and mood, and our predisposition to gain weight – and this may just be the tip of the iceberg.

More importantly, our microbiome is also influenced by our diet and lifestyle, and environment. For example, vegetarians and meat eaters have entirely different microbiomes.

Furthermore, the effect of diet and lifestyle on our microbiome also changes day to day. If you change your diet, the species of bacteria in your microbiome will completely change in a few days.

If you are wondering how that could be, let me [over]simplify it for you:

    • What we call fiber, our gut bacteria call food.
    • Different gut bacteria thrive on different kinds of fiber.
    • Different plant foods provide different kinds of fiber.
    • Whenever we change the amount or type of fiber in our diet, some gut bacteria will thrive, and others will starve.
    • Bacteria grow and die very rapidly. Thus, the species of bacteria that thrive on a particular diet quickly become the predominant species in our gut.
    • And when we change our diet, those gut bacteria will die off and other species will predominate.

Finally, our microbiome also influences our nutritional requirements. For example, some species of intestinal bacteria are the major source of biotin and vitamin K2 for all of us and the major source of vitamin B12 for vegans. Other intestinal bacteria inactivate and/or remove some vitamins from the intestine for their own use. Thus, the species of bacteria that populate our intestines can influence our nutritional requirements.

Now that you know the complexity of gene interactions you understand why we are not ready to rely on DNA tests alone. That science is at least 10-20 years in the future. Companies that tell you otherwise are lying to you.

What Is The True Value Of DNA Tests? 

The TruthBy now you are probably thinking that my message is that DNA tests are worthless. Actually, my message is a bit different. What I, and most experts, are saying is that DNA tests are of little value by themselves.

To understand the true value of DNA tests, let me start with defining a couple of terms you may vaguely remember from high school biology – genotype and phenotype.

  • Genotype is your genes.
  • Phenotype is you – your health, your weight, and your nutritional needs. Your phenotype is determined by your genes plus your diet and your lifestyle.

With that in mind, let’s review the take-home messages from earlier sections of this article.

  • The take-home message from the two stories in “Perspectives on DNA Testing” is that our DNA does not have to be our destiny. We have the power to overcome bad genetics. We also have the power to undermine good genetics.
  • The take-home message from “Genetics 101” is that while the genes we inherit do not change, the expression of those genes is controlled in part by:
    • Epigenetic modifications to the DNA. And those epigenetic modifications are controlled by our diet and our lifestyle.
    • Our microbiome (gut bacteria). And our microbiome is controlled by our diet and our lifestyle.

Now we are ready to answer the question, “What is the true value of DNA testing?” There are actually two answers to this question. You have probably guessed the first answer by now, but you will be surprised by the second.

  1. DNA testing can only indicate the potential for obesity, the potential for nutritional deficiencies, and the potential for disease. But whether that potential is realized depends on our diet and lifestyle. Therefore, the true value of DNA testing comes from adding a comprehensive analysis of diet and lifestyle to the DNA test results. That includes:
    • Questionnaires that assess diet, lifestyle, health goals, and health concerns.

For example, your genetics may indicate an increased need for vitamin D. This is a concern if your vitamin D intake is marginal but may not be a concern if you are getting plenty of vitamin D from your diet, supplementation, and sun exposure.

    • Direct measurements of obesity such as height and weight (from which BMI can be calculated) and waist circumference (belly fat is more dangerous to our health than fat stored elsewhere in our body).

For example, most Americans have a genetic predisposition to obesity, but not everyone is obese. If you are overweight or obese, your nutrition and lifestyle recommendations should include approaches to reduce your weight. If not, these recommendations are not needed, even if you have a genetic predisposition to obesity.

    • Blood pressure and blood markers of disease risk (cholesterol, triglycerides, and blood sugar).

For example, you may have genetic predisposition to high blood pressure or high cholesterol. If either of these are high, your recommendations should include nutrition and lifestyle approaches to lower them. However, if you are already keeping them under control through diet and lifestyle, no further changes may be necessary.

2) While the scientific community now knows the limitations of DNA testing, this information has not filtered down to the general public. This brings me to the second value of DNA testing. Several recent studies have shown that people are much more likely to follow recommendations based on DNA testing than recommendations based on dietary questionnaires, blood markers of disease, or even recommendations from their physician.

The Bottom Line

DNA testing is hot! DNA testing companies claim they can tell you your disease risk and personalize your diet and supplement program – all based on the sequence of your DNA.

On the other hand, most reputable medical sources say these DNA testing companies overpromise and underdeliver. They tell you that diet, lifestyle, and supplement recommendations based only on your DNA sequence are often inaccurate. They are of little value if they are only based on DNA testing.

So, what is the true value of DNA testing? To answer that question, we need to know two things:

1) Our DNA is not our destiny. We have the power to overcome bad genetics. We also have the power to undermine good genetics.

2) While the genes we inherit do not change, the expression of these genes is controlled in part by:

    • Epigenetic modifications to the DNA. And those epigenetic modifications are controlled by our diet and our lifestyle.
    • Our microbiome (gut bacteria). And our microbiome is controlled by our diet and our lifestyle.

With this information in mind, we are ready to answer the question, “What is the true value of DNA testing?” The true value of DNA testing is tw0-fold:

1) It comes from adding a comprehensive analysis of diet and lifestyle to the DNA test results. This includes:

    • Questionnaires that assess diet, lifestyle, health goals, and health concerns.
    • Direct measurements of obesity such as height and weight (from which BMI can be calculated) and waist circumference (belly fat is more dangerous to our health than fat stored elsewhere in our body).
    • Blood pressure and blood markers of disease risk (cholesterol, triglycerides, and blood sugar).

2) In addition, several recent studies have shown that people are much more likely to follow recommendations based on DNA testing than recommendations based on dietary questionnaires, blood markers of disease, or even recommendations from their physician.

For more details and explanations of the statements in “The Bottom Line”, 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.

Are Vegan Diets Bad For Your Bones?

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The Secrets To A Healthy Vegan Diet

Author: Dr. Stephen Chaney

Frail ElderlyOsteoporosis is a debilitating and potentially deadly disease associated with aging. It affects 54 million Americans. It can cause debilitating back pain and bone fractures. 50% of women and 25% of men over 50 will break a bone due to osteoporosis. Hip fractures in the elderly due to osteoporosis are often a death sentence.

As I discussed in a previous issue of “Health Tips From The Professor”, a “bone-healthy lifestyle requires 3 essentials – calcium, vitamin D, and weight bearing exercise. If any of these three essentials is presence in inadequate amounts, you can’t build healthy bones. In addition, other nutrients such as protein, magnesium, zinc, vitamin B12, and omega-3 fatty acids may play supporting roles.

Vegan and other plant-based diets are thought to be very healthy. They decrease the risk of heart disease, diabetes, and some cancers. However, vegan diets tend to be low in calcium, vitamin D, zinc, vitamin B12, protein, and omega-3 fatty acids. Could vegan diets be bad for your bones?

A meta-analysis of 9 studies published in 2009 (LT Ho-Pham et al, American Journal of Clinical Nutrition 90: 943-950, 2009) reported that vegans had 4% lower bone density than omnivores, but concluded this difference was “not likely to be clinically relevant”.

However, that study did not actually compare bone fracture rates in vegans and omnivores. So, investigators have followed up with a much larger meta-analysis (I Iguacel et al, Nutrition Reviews 77, 1-18, 2019) comparing both bone density and bone fracture rates in vegans and omnivores.

How Was This Study Done?

Clinical StudyThe investigators searched the literature for all human clinical studies through November 2017 that compared bone densities and frequency of bone fractures of people consuming vegan and/or vegetarian diets with people consuming an omnivore diet.

  • Vegan diets were defined as excluding all animal foods.
  • Vegetarian diets were defined as excluding meat, poultry, fish, seafood, and flesh from any animal but including dairy foods and/or eggs. [Note: The more common name for this kind of diet is lacto-ovo vegetarian, but I will use the author’s nomenclature in this review.]
  • Omnivore diets were defined as including both plant and animal foods from every food group.

The investigators ended up with 20 studies that had a total of 37,134 participants. Of the 20 studies, 9 were conducted in Asia (Taiwan, Vietnam, India, Korea, and Hong-Kong), 6 in North America (the United States and Canada), and 4 were conducted in Europe (Italy, Finland, Slovakia, and the United Kingdom).

Are Vegan Diets Bad For Your Bones?

Here is what the investigators found:

Unhealthy BoneBone density: The clinical studies included 3 different sites for bone density measurements – the lumbar spine, the femoral neck, and the total body. When they compared bone density of vegans and vegetarians with the bone density of omnivores, here is what they found:

Lumbar spine:

    • Vegans and vegetarians combined had a 3.2% lower bone density than omnivores.
    • The effect of diet was stronger for vegans (7% decrease in bone density) than it was for vegetarians (2.3% decrease in bone density).

Femoral neck:

    • Vegans and vegetarians combined had a 3.7% lower bone density than omnivores.
    • The effect of diet was stronger for vegans (5.5% decrease in bone density) than it was for vegetarians (2.5% decrease in bone density).

Whole body:

    • Vegans and vegetarians combined had a 3.2% lower bone density than omnivores.
    • The effect of diet was statistically significant for vegans (5.9% decrease in bone density) but not for vegetarians (3.5% decrease in bone density). [Note: Statistical significance is not determined by how much bone density is decreased. It is determined by the size of the sample and the variations in bone density among individuals in the sample.]

Bone FractureBone Fractures: The decrease in bone density of vegans in this study was similar to that reported in the 2009 study I discussed above. However, rather than simply speculating about the clinical significance of this decrease in bone density, the authors of this study also measured the frequency of fractures in vegans, vegetarians, and omnivores. Here is what they found.

  • Vegans and vegetarians combined had a 32% higher risk of bone fractures than omnivores.
  • The effect of diet on risk of bone fractures was statistically significant for vegans (44% higher risk of bone fracture) but not for vegetarians (25% higher risk of bone fractures).
  • These data suggest the decreased bone density in vegans is clinically significant.

The authors concluded, “The findings of this study suggest that both vegetarian and vegan diets are associated with lower bone density compared with omnivorous diets. The effect of vegan diets on bone density is more pronounced than the effect of vegetarian diets, and vegans have a higher fracture risk than omnivores. Both vegetarian and vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.”

The Secrets To A Healthy Vegan Diet

Emoticon-BadThe answer to this question lies in the last statement in the author’s conclusion, “Both vegetarian and vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.” 

The problem also lies in the difference between what a nutrition expert considers a vegan diet and what the average consumer considers a vegan diet. To the average consumer a vegan diet is simply a diet without any animal foods. What could go wrong with that definition? Let me count the ways.

  1. Sugar and white flour are vegan. A vegan expert thinks of a vegan diet as a whole food diet – primarily fruits, vegetables, whole grains, beans, nuts, and seeds. A vegan novice includes all their favorites – sodas, sweets, and highly processed foods. And that may not leave much room for healthier vegan foods.

2) Big Food, Inc is not your friend. Big Food tells you that you don’t need to give up the taste of animal foods just because you are going vegan. They will just combine sugar, white flour, and a witch’s brew of chemicals to give you foods that taste just like your favorite meats and dairy foods. The problem is these are all highly processed foods. They are not healthy. Some people call them “fake meats” or “fake cheeses”. I call them “fake vegan”.

If you are going vegan, embrace your new diet. Bean burgers may not taste like Big Macs, but they are delicious. If need other delicious vegan recipe ideas, I recommend the website https://forksoverknives.com.

3) A bone healthy vegan diet is possible, but it’s not easy. Let’s go back to the author’s phrase “…vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.” A vegan expert will do the necessary planning. A vegan novice will assume all they need to do is give up animal foods. 

As I said earlier, vegan diets tend to be low in calcium, vitamin D, zinc, vitamin B12, protein, and omega-3 fatty acids. Let’s look at how a vegan expert might plan their diet to get enough of those bone-healthy nutrients.

    • Calcium. The top plant sources of calcium are leafy greens and soy foods at about 100-250 mg (10-25% of the DV) of calcium per serving. Some beans and seeds are moderately good sources of calcium. Soy foods are a particularly good choice because they are a good source of calcium and contain phytoestrogens that stimulate bone formation.

A vegan expert makes sure they get these foods every day and often adds a calcium supplement.

    • Protein. Soy foods, beans, and some whole grains are the best plant sources of protein.soy

It drives me crazy when a vegan novice tells me they were told they can get all the protein they need from broccoli and leafy greens. That is incredibly bad advice.

A vegan expert makes sure they get soy foods, beans, and protein-rich grains every day and often adds a protein supplement.

    • Zinc. There are several plant foods that supply around 20% the DV for zinc including lentils, oatmeal, wild rice, squash and pumpkin seeds, quinoa, and black beans.

A vegan expert makes sure they get these foods every day and often adds a multivitamin supplement containing zinc.

    • Vitamin D and vitamin B12. These are very difficult to get from a vegan diet. Even vegan experts usually rely on supplements to get enough of these important nutrients.

4) Certain vegan foods can even be bad for your bones. I divide these into healthy vegan foods and unhealthy “vegan” foods. 

    • Healthy vegan foods that can be bad for your bones include.
      • Pinto beans, navy beans, and peas because they contain phytates.
      • Raw spinach & swiss chard because they contain oxalates.
      • Both phytates and oxalates bind calcium and interfere with its absorption.
      • These foods can be part of a healthy vegan diet, but a vegan expert consumes them in moderation.
    • Unhealthy “vegan” foods that are bad for your bones include sodas, salt, sugar, and alcohol.
      • The mechanisms are complex, but these foods all tend to dissolve bone.
      • A vegan expert minimizes them in their diet.

5) You need more than diet for healthy bones. At the beginning of this article, I talked about the 3 Weight Trainingessentials for bone formation – calcium, vitamin D, and exercise. You can have the healthiest vegan diet in the world, but if you aren’t getting enough weight bearing exercise, you will have low bone density. Let me close with 3 quick thoughts:

    • None of the studies included in this meta-analysis measured how much exercise the study participants were getting.
    • The individual studies were generally carried out in industrialized countries where many people get insufficient exercise.
    • The DV for calcium in the United States is 1,000-1,200 mg/day for adults. In more agrarian societies dietary calcium intake is around 500 mg/day, and osteoporosis is almost nonexistent. What is the difference? These are people who are outside (vitamin D) doing heavy manual labor (exercise) in their farms and pastures every day.

In summary, a bone healthy vegan lifestyle isn’t easy, but it is possible if you work at it.

The Bottom Line 

A recent meta-analysis asked two important questions about vegan diets.

  1.     Do vegans have lower bone density than omnivores?

2) Is the difference in bone density clinically significant? Are vegans more likely to suffer from bone fractures?

The study found that:

  • Vegans had 5.5%–7% lower bone density than omnivores depending on where the bone density was measured.
  • Vegans were 44% more likely to suffer from bone fractures than omnivores.

The authors of the study concluded, ““The findings of this study suggest that…vegan diets are associated with lower bone density compared with omnivorous diets, and vegans have a higher fracture risk than omnivores…Vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.”

In evaluating the results of this study, I took a detailed look at the pros and cons of vegan diets and concluded, “A bone healthy vegan lifestyle isn’t easy, but it is possible if you work at it.”

For more details about study and my recommendations for a bone healthy vegan lifestyle read the article above.

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

Does Vitamin D Prevent Type 1 Diabetes?

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Does Genetics Influence Supplementation Benefits?

diabetesThe cause of type 1 diabetes is a mystery. If you go to an authoritarian source like the Mayo Clinic, you will discover that:

  • Type 1 diabetes is an autoimmune disease that selectively attacks the insulin-producing islet cells of the pancreas.
  • Certain genetic variants predispose individuals to type 1 diabetes.
  • The autoimmune response may be triggered by a viral infection or other unknown environmental factors in genetically susceptible individuals.
  • The incidence of type 1 diabetes increases as you travel away from the equator, which suggests that vitamin D may be involved.

The idea that vitamin D may be involved is an important concept because it suggests that vitamin D supplementation might reduce the risk of developing type 1 diabetes. This idea was reinforced by a Finnish study (E Hyponnen et al, Lancet, 358: 1500-1503, 2001) published in 2001 showing the vitamin D supplementation of newborn infants reduced the incidence of type 1 diabetes at age 1.

However, subsequent studies in other parts of the world have had mixed results. Some have confirmed the results of the Finnish study. Others have come up empty.

Similarly, some studies have shown a correlation between low 25-hydroxyvitamin D levels in the blood and the development of type 1 diabetes in children, while other studies have found no correlation.

Why the discrepancy between studies? Some of the differences can be explained by differences in the populations studied or differences in study design. But what if there were another variable that none of the previous studies has considered?

The study (JM Norris et al, Diabetes, 67: 146-154, 2018) I review this week describes just such a variable. The authors of the study hypothesized that the association between 25-hydroxyvitamin D levels and the risk of developing type 1 diabetes is influenced by mutations that affect the way vitamin D works in the body. Previous studies have not taken these mutations into account. If the author’s hypothesis is true, it might explain why these studies have produced conflicting results.

In this article, I will answer 3 questions:

  • Does vitamin D prevent type 1 diabetes?
  • If so, is supplementation with vitamin D important?
  • Who will benefit most from vitamin D supplementation?

But, before I answer those questions, I should begin by providing some background. I will start by reviewing the how diet, increased need, disease, and genetics influence the likelihood that we will benefit from supplementation. Then I will review vitamin D metabolism.

Does Genetics Influence Supplementation Benefits?

need for supplementsThe reason so many studies find no benefit from supplementation is that they are asking the wrong question. They are asking “Does supplementation benefit everyone?” That is an unrealistic expectation.

I have proposed a much more realistic model (shown on the left) for when we should expect supplementation to be beneficial. Simply put, we should ask:

  • Is the diet inadequate with respect to the nutrient that is being studied?
  • Is there an increased need for that nutrient because of age, gender, activity level, or environment?
  • Is there a genetic mutation that affects the metabolism or need for that nutrient?
  • Is there an underlying disease state that affects the need for that nutrient?

When clinical studies are designed without taking this paradigm into account, they are doomed to fail. Let me give you some specific examples.

  • The Heart Outcomes Prevention Evaluation study concluded supplementation with folate and other B vitamins did not reduce heart disease risk. The problem was that 70% of the people in the study were getting adequate amounts of folate from their diet at the beginning of the study. For those individuals not getting enough folate in their diet, B vitamin supplementation decreased their risk of heart disease by 15%. This is an example of poor diet influencing the need for supplementation.

The other three examples come from studies on the effect of vitamin E supplementation on heart disease that I summarized in an article in “Health Tips From The Professor” a few years ago. Here is a brief synopsis.

  • The Women’s Health Study concluded that vitamin E did not decrease heart disease risk in the general population. However, the study also found that in women over 65 (who are at high risk of heart disease), vitamin E supplementation decreased major cardiovascular events and cardiovascular deaths by 25%. This is an example of increased need because of age and gender influencing the need for supplementation.
  • The Women’s Antioxidant Cardiovascular Study” concluded that vitamin E did not decrease heart disease risk in the general population. However, when they looked at women who already had cardiovascular disease at the beginning of the study, vitamin E supplementation decreased risk of heart attack, stroke, and cardiovascular death by 23%. This is an example of an underlying disease affecting the need for supplementation.
  • The HOPE study concluded that vitamin E did not decrease heart disease risk in the general population. However, when they looked at individuals with a mutation that increases the risk of heart disease, vitamin E supplementation significantly decreased their risk of developing heart disease. This is an example of genetics affecting the need for supplementation.

These are just a few of many examples. When you ask whether supplementation benefits everyone, the answer is often no. However, when you look at people with inadequate diet, increased need, underlying disease, and/or genetic predisposition, the answer is often yes.

This background sets the stage for the current study. Of course, to understand the author’s hypothesis that mutations in genes involved in vitamin D metabolism might influence the effect of vitamin D on the risk of developing type 1 diabetes, you need to know a little about vitamin D metabolism.

Biochemistry 101: Vitamin D Metabolism

Vitamin D MetabolismWhen sunlight strikes a metabolite of cholesterol in our skin, it is converted to a precursor that spontaneously isomerizes to form vitamin D3. Because this series of reactions is usually not sufficient to provide all the vitamin D3 our bodies require, we also need to get vitamin D3 from diet and supplementation.

However, vitamin D3 is not active by itself. It first needs to be converted to 25-hydroxyvitamin D by our liver and then to the active 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D is an important hormone that regulates many cells in our body.

Some of the 1,25-dihydroxyvitamin D is synthesized by our kidneys and released into the bloodstream. This 1,25-dihyroxyvitamin D binds to vitamin D receptors on the surface of many cells and initiates regulatory pathways that affect metabolism inside the cell.

Other cells take up 25-hydroxyvitamin D and convert it to 1,25-dihydroxyvitamin D themselves. In these cells both the synthesis and regulatory effects of 1,25-dihydroxyvitamin D occur entirely inside the cell.

In both cases, it is 1,25-dihydroxyvitamin D that regulates cellular metabolism. The only difference is the way this regulation is accomplished.

There are two additional points that are relevant to this study.

  • The efficiency of conversion of vitamin D to 25-hydroxyvitamin D varies from person to person.
    • Thus, blood levels of 25-hydroxyvitamin D are considered a more reliable measure of vitamin D status than dietary intake of vitamin D or sun exposure.
    • Blood levels of 25-hydroxyvitamin D levels ≥50 nmol/L are considered optimal, while levels of 30 to <50 nmol/L are considered suboptimal, and levels <30 nmol/L are considered deficient.
  • 1,25-dihydroxyvitamin D binds to the vitamin D receptor on immune cells. This initiates a series of reactions that decrease the risk of autoimmune responses by our immune system.

How Was This Study Done?

Clinical StudyThis study was called TEDDY (The Environmental Determinants Of Type 1 Diabetes in the Young). Between September 2004 and February 2010, 424,788 newborn infants from 6 medical centers in Colorado, Georgia, Washington, Finland, Germany, and Sweden were screened for genes that predispose to type 1 diabetes.

The investigators identified 21,589 high-risk infants, and 8,676 of them were enrolled in this study before age 4 months. Clinic visits for the children occurred every 3 months between 3 and 48 months of age and every 6 months thereafter.

  • A DNA sample was taken at the time they entered the study and analyzed for mutations in genes involved in vitamin D metabolism.
  • 25-hydroxy vitamin D levels were obtained at each office visit. Because some studies have suggested the vitamin D status during the first year of life is important, the data were analyzed in two ways.
    1. An average of all 25-hydroxyvitamin D levels (referred to as “childhood 25-hydroxyvitamin D levels”).
    1. An average of 25-hydroxyvitamin D levels during the first 12 months (referred to as “early infancy 25-hydroxyvitamin D levels”).
  • Serum autoantibodies to pancreatic islet cells were measured at each office visit as a measure of an autoimmune attack on those cells. Persistent autoimmune response was defined as positive autoantibodies on two consecutive office visits.

While this study did not directly measure type 1 diabetes, children with an autoimmune response to their pancreatic islet cells are highly likely to develop type 1 diabetes. Thus, for purposes of simplicity I will refer to “risk of developing type 1 diabetes” rather than “persistent autoimmune response” in describing these results.

    1. 418 children developed persistent autoantibodies to their pancreatic islet cells during the study. The onset of this autoimmune response ranged from 2 months to 72 months with an average of 21 months.
    1. These children were compared to 3 matched controls from their medical center who did not develop an autoimmune response.

This study was remarkable for two reasons:

1) It was much larger than previous studies. This gave it greater power to detect an effect of vitamin D status on the risk of developing type 1 diabetes.

2) This was the first study to ask whether mutations in genes controlling the metabolism of vitamin D influenced the effect of vitamin D on the risk of developing type 1 diabetes.

Does Vitamin D Prevent Type 1 Diabetes?

Vitamin DThe study compared the risk of developing type 1 diabetes in children whose 25-hydroxyvitamin D levels were optimal (≥50 nmol/L) to children whose 25-hydroxyvitamin D levels were suboptimal (30 to <50 nmol/L). The results were:

  • Optimal vitamin D status during childhood was associated with a 31% decrease in the risk of developing type 1 diabetes.
  • Optimal vitamin D status during early infancy (first 12 months) was associated with a 40% decrease in the risk of developing type 1 diabetes.

In other words, having optimal vitamin D status significantly reduces the likelihood of developing of type 1 diabetes in childhood.

  • 25-hydroxyvitamin D levels >75 nmol/L provided no additional benefit.

In other words, you need sufficient vitamin D, but higher levels provide no additional benefit.

  • They tested 5 genes involved in vitamin D metabolism to see if they influenced the effect of vitamin D on the risk of developing type 1 diabetes. Only the VDR (vitamin D receptor) gene had any influence.
    • When the VDR gene was fully functional, optimal vitamin D status had no effect on the risk of developing type 1 diabetes. This means that even suboptimal (30 to <50 nmol/L) levels of 25-hydroxyvitamin D were sufficient to prevent type 1 diabetes when the vitamin D receptor was fully functional.
    • Only 9% of the children in this study were vitamin D deficient (<30 nmol/L 25-hydroxyvitamin D). Presumably, these children would be at high risk of developing type 1 diabetes even with a fully functional VDR gene. However, there were not enough children in that category to test this hypothesis.
  • When they looked at children with mutations in the VDR gene:
    • Optimal vitamin D status during childhood was associated with a 59% decrease in the risk of developing type 1 diabetes.
    • Optimal vitamin D status during early infancy (first 12 months) was associated with a 67% decrease in the risk of developing type 1 diabetes.

In short, the need for optimal vitamin D levels to reduce the risk of developing type 1 diabetes is only seen in children with a mutation in the VDR (vitamin D receptor) gene.

  • This is a clear example of genetics affecting the need for a nutrient.
    • For children with a fully functional VDR gene, even 30-50 nmol/L 25-hydroxyvitamin D was sufficient to reduce the risk of developing type 1 diabetes.
    • However, children with mutations in the VDR gene required ≥50 nmol/L 25-hydroxyvitamin D to reduce their risk of developing type 1 diabetes.
  • This is also an example of genetics affecting the need for supplementation with vitamin D.
    • 42% of the children in this study had suboptimal levels of 25-hydroxyvitamin D. Those who also have a mutation in the VDR gene would require supplementation to bring their 25-hydroxyvitamin D up to the optimal level to reduce their risk of developing type 1 diabetes.
    • Other studies have estimated that up to 61% of children in the US may have suboptimal 25-hydroxyvitamin D levels.

What Does This Study Mean For You?

Questioning WomanLet’s start with the three questions I proposed at the beginning of this article.

1) Does vitamin D prevent type 1 diabetes? Based on this study, the answer appears to be a clear yes. However, this is the first study of this kind. We need more studies that into account the effect of mutations in the VDR gene.

2) If so, is supplementation with vitamin D important? If we think in terms of supplementation with RDA levels of vitamin D or sufficient vitamin D to bring 25-hydroxyvitamin D into the optimal range, the answer is also a clear yes. However, there is no evidence from this study that higher doses of vitamin D provide additional benefits.

3) Who will benefit most from vitamin D supplementation? Based on this study, the children who will benefit the most from vitamin D supplementation are those who have a suboptimal vitamin D status and have a mutation in the VDR (vitamin D receptor) gene. To put this into perspective:

    • Up to 60% of children and adults in this country have suboptimal vitamin D levels.
    • The percentage of suboptimal vitamin D levels is highest for people who are obese, have pigmented skin, are institutionalized (eg, elderly in nursing homes), and/or live far from the equator.
    • Supplementation with a multivitamin containing the RDA for vitamin D reduces the risk of having suboptimal vitamin D status by 2.5 to 5-fold depending on the person’s ethnicity.
    • This study may be just the tip of the iceberg. The vitamin D receptor is also found on many other cells that control important biological functions.

Finally, if you are a parent or parent-to-be, you probably have several questions. Here are the ones I have New Parentsanticipated:

#1: Is my child at risk for developing type 1 diabetes? If you or a close family member has type 1 diabetes, you can assume your child is genetically predisposed to developing type 1 diabetes. Other factors that increase your child’s risk of developing type 1 diabetes are obesity, non-White ethnicity, and geographical location far from the equator.

#2: Should I have my baby tested for genetic predisposition to type 1 diabetes? That is not currently recommended. Just be aware of the risk factors listed above.

#3: Should I have my baby tested for VDR mutations? That is unnecessary. If your child has a VDR mutation, they just need sufficient vitamin D, not mega doses of vitamin D. And there are lots of other reasons for making sure your child gets sufficient vitamin D.

#4: How much vitamin D should my child be getting? The recommendation is 400 IU up to age 1 and 600 IU over age 1.

#5: Should I give my child vitamin D supplements? It is a good idea. For children over age 1, I recommend a multivitamin supplying 600 IU of vitamin D.

For infants, the American Association of Pediatrics recommends 400 IU vitamin D drops, regardless of whether the infants are breast or formula fed. That is because studies during the first year of life show that less than one-fifth of all infants get the recommended 400 IU/d from any source, and fewer than one out of 10 breast-fed infants meet the requirement – even if the mother is getting adequate vitamin D in their diet.

One Caution: I do not recommend exceeding 400 IU for infants or 600 IU for children unless directed by your health care provider. In terms of the risk of developing type 1 diabetes, your child needs sufficient vitamin D, and more is not better.

#6: Should I have my child tested for 25-hydroxyvitamin D levels? That is not done routinely at the present time. However, if your child has one or more of the risk factors listed above, it is a conversation you should have with your health care provider.

The Bottom Line

While it is widely accepted that vitamin D helps reduce the risk of developing type 1 diabetes in childhood, that has been difficult to prove. Clinical studies have provided conflicting results. The authors of a recent study postulated that the discrepancies between studies may have arisen because the studies neglected the effect of mutations in genes controlling vitamin D metabolism which may affect the ability of vitamin D to reduce the risk of developing type 1 diabetes.

This study found that:

1) Infants and children with optimal vitamin D status (25-hydroxyvitamin D levels ≥50 nmol/L) were 31-40% less likely to develop type 1 diabetes than children with suboptimal vitamin D status (25-hydroxyvitamin D = 30 to <50 nmol/L).

2) However, the effect of vitamin D on the risk of developing type 1 diabetes was only seen in children with one or more mutations in the VDR (vitamin D receptor) gene. To interpret this observation, you need to know that:

    • Type 1 diabetes is caused by an autoimmune attack on the pancreatic islet cells that release insulin.
    • 1,25-dihydroxyvitamin D promotes immune tolerance and decreases the risk of autoimmune responses.
    • 1,25-dihydroxyvitamin D exerts this effect by binding to the vitamin D receptor on the surface of immune cells.

3) Thus, mutations in the VDR gene modify the effect of vitamin D on the risk of developing type 1 diabetes. Specifically:

    • When the VDR gene is fully active, even suboptimal levels of vitamin D appear to be sufficient to prevent the development of type 1 diabetes in childhood.
    • However, when the VDR gene has mutations that reduce its activity, suboptimal levels of vitamin D no longer prevent type 1 diabetes. Optimal levels of vitamin D are required to reduce the risk of developing type 1 diabetes.

This is an example of genetics increasing the need for a nutrient (vitamin D) and increasing the need for supplementation to make sure that optimal levels of that nutrient are achieved.

While this study focused on the effect of vitamin D on the development of type 1 diabetes, this may just be the tip of the iceberg. The vitamin D receptor is also found on many other cells that control important biological functions.

For more details, read the article above. You will probably want to read the section “What Does This Mean For You?”, including my recommendations for parents of young children

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

Health Tips From The Professor