Dr. Steve Chaney, Author at Health Tips From The Professor

Are Carnitine Supplements A Boon Or A Bust?

March 14, 2023 by Dr. Steve Chaney

What Is The Truth About Carnitine And Heart Disease?

Author: Dr. Stephen Chaney

If you are a weightlifter or bodybuilder, chances are you are taking an L-carnitine supplement, or a protein shake fortified with L-carnitine. That is because L-carnitine has been promoted for increasing muscle mass and physical performance for so long that most people have come to believe it must be true. Is it true, or is it just another food myth?

If you visit Dr. Strangelove’s website, you may also be told that carnitine supplementation is beneficial for weight loss, migraines, baldness, ADHD and autism, chronic fatigue syndrome, and/or low energy, muscle loss, and cognitive decline in older adults. Are these claims fact or fiction?

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for carnitine supplements? Could they also be bad for your heart?

A recent systematic review (AG Sawicka et al, Journal of the International Society of Sports Nutrition, 17: 49, 2020) of L-carnitine supplementation answers these important questions. The authors called their study “The bright and dark sides of L-carnitine supplementation” because they set out to systematically investigate the benefits and potential risks of L-carnitine supplementation.

But before I share the results of this study, I need to give you a little background on L-carnitine. It is time for another Biochemistry 101 segment.

Biochemistry 101: What You Need To Know About Carnitine

Carnitine plays an essential role in human metabolism. It is required for transport of fatty acids into our mitochondria so they can be used to generate energy. Without carnitine we would be unable to utilize most of the fats in our diet as an energy source.

As you might expect, carnitine is essential for any tissues that have mitochondria, but it is particularly important for high energy tissues like skeletal and heart muscle.

For most of us, our liver and kidneys make all the carnitine we need. So, we don’t really need carnitine from food or supplements.

However, we do get significant amounts of carnitine from red meat, much smaller amounts of carnitine from other animal foods, and almost no carnitine from plant foods. Adults consuming diets with red meat and other animal foods get about 60-180 mg of carnitine a day from their diet, whereas vegans only get around 10-12 mg/day.

Uptake of carnitine from the blood into muscle tissues requires insulin. Thus, carnitine uptake into muscle is significantly less on a low-carbohydrate or keto diet than it is on a mixed diet containing carbohydrates.

Finally, our kidneys do an excellent job of regulating blood carnitine levels, with excess carnitine being excreted into the urine. Thus, total body carnitine levels are virtually the same with high-carnitine and low-carnitine diets.

This raises the question: “Are L-carnitine supplements good for you?”

Now, let’s talk about the dark side of carnitine. I have discussed this in a previous issue of “Health Tips From the Professor”. Here is a brief summary:

People who eat a lot of red meat harbor a species of bacteria in their intestine that converts carnitine to trimethylamine (TMA). We don’t know whether this species of gut bacteria is favored by the presence of red meat in the diet or the absence of certain fruits, whole grains, and legumes from the diet of meat eaters.
The TMA is reabsorbed into the bloodstream, and the liver converts TMA to TMAO (trimethylamine N-oxide).
TMAO is associated with an increased risk of heart attack, stroke, and heart failure.

When you think about it, this is a perfect example of double jeopardy. Red meat is high in carnitine, and red meat eaters have gut bacteria that result in carnitine being converted to a compound that may increase the risk of heart disease.

This raises the question: “Are L-carnitine supplements bad for you?”

Let’s look at these two questions. First, I will discuss the recent review. Then I will put the conclusions of that review into perspective by looking at what other health experts say

Are Carnitine Supplements A Boon Or A Bust?

Most previous studies of carnitine supplementation have lasted only two or three weeks, which may not be long enough to measure an effect of carnitine supplementation on performance. So, the authors of this review paper selected studies that lasted 11 weeks or more for their review.

The review included 11 studies. They lasted either 12 or 24 weeks. Participants received doses ranging from 1 gm to 4.5 gm of L-carnitine per day. Here are the conclusions of the review:

Participants receiving L-carnitine alone had no increase in muscle carnitine content.

Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]

One study compared male vegetarians with male omnivores. The omnivores had no increase in muscle carnitine content, but the vegetarians did. [The study did not analyze the diets of the omnivores and vegetarians, but it is probably safe to assume that the carbohydrate content was higher on the vegetarian diet.]

There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was good for you. It resulted in little or no increase in muscle carnitine levels or in physical performance.

Two of the 11 studies measured plasma TMAO levels. These studies found that L-carnitine supplementation resulted in a significant increase in plasma TMAO levels.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

What Is The Truth About Carnitine And Heart Disease?

Is carnitine good for you? With respect to this question, the conclusions of this review are similar to the conclusions of other health experts.

For example, in their Fact Sheet On Carnitine For Health Professionals the NIH states “Some athletes take carnitine to improve performance. However, twenty years of research finds no consistent evidence that carnitine supplements can improve exercise or physical performance in healthy subjects—at doses ranging from 2–6 grams/day administered for 1 to 28 days. For example, carnitine supplements do not appear to increase the body’s use of oxygen or improve metabolic status when exercising, nor do they necessarily increase the amount of carnitine in muscle.”

The NIH fact sheet goes on to list some diseases causing muscle loss or muscle weakness, for which L-carnitine supplementation is appropriate. However, in these cases, the carnitine supplementation should be recommended by health professionals.

Is carnitine bad for your heart? The link between carnitine and heart disease risk is a bit more complicated. As I mentioned above, there is an association between red meat consumption and blood TMAO levels and an association between blood TMAO levels and heart disease.

Is it TMAO that increases the risk of heart disease or is it some other component (saturated fat, for example) of red meat that increases the risk of heart disease? Nobody knows. More research is needed.

There is also a “red herring” that complicates the TMAO story. It turns out that TMAO helps fish survive the high pressures they encounter in the deep ocean. Thus, many fish are high in TMAO, and fish consumption also increases blood TMAO levels.

Are the bad effects of TMAO in fish outweighed by the heart healthy components in fish (omega-3s, for example)? Nobody knows. More research is needed.

To summarize:

1) There is no reason to take L-carnitine supplements unless directed by your health professional. There is little evidence they will help your physical performance. There is also no good evidence to support the other benefits of L-carnitine you find listed on Dr. Strangelove’s blog or the website of your favorite supplement company.

2) L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure. [Note: Based on what we know about the role of gut bacteria in TMAO production, vegans could probably take L-carnitine supplements without causing an increase in TMAO levels. However, that is probably a moot point. There is no evidence that L-carnitine is more effective for vegans than it is for omnivores.]

The Bottom Line

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for L-carnitine supplements? Could they also be bad for your heart?

A recent review looked at these questions. Here are the conclusions of the review:

Participants receiving L-carnitine alone had no increase in muscle carnitine content.

Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]

There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was beneficial. It resulted in little or no increase in muscle carnitine levels or in physical performance.

This review also found that L-carnitine supplementation resulted in a significant increase in plasma TMAO, a compound that has been associated with an increased risk of heart disease.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

The NIH has also issued a fact sheet for health professionals summarizing research on L-carnitine over the past 20 years. The conclusions from their fact sheet can be best summarized as:

2) L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure.

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 You Create Your Personal Fountain Of Youth?

March 7, 2023 by Dr. Steve Chaney

Can A Healthy Lifestyle Improve Your Healthspan?

Author: Dr. Stephen Chaney

Ever since Ponce de Leon led an expedition to the Florida coast in 1513, we have been searching for the mythical “Fountain Of Youth”. What does that myth mean?

Supposedly, just by immersing yourself in that fountain you would be made younger. You would experience all the exuberance and health you enjoyed when you were young. There have been many snake oil remedies over the years that have promised that. They were all frauds.

But what if you had it in your power to live longer and to retain your youthful health for most of those extra years. The ability to live healthier longer is something that scientists call “healthspan”. But you can think of it as your personal “Fountain Of Youth”.

Now comes the important question, “Can a healthy lifestyle improve your healthspan?” We know a healthy lifestyle is good for us. Most of us know what a healthy lifestyle is. But it’s so hard. Is it worth it? Will it actually increase our lifespan? Will it increase our healthspan?

Today I am sharing two studies from the prestigious Harvard T.H. Chan School of Public Health that answer those questions.

The first study (Y Li et al, Circulation, 138: 345-355, 2018) looks at the effect of a healthy lifestyle on lifespan (how many years you can live).

The second study (Y Li et al, British Medical Journal, 368: 16669, 2020) looks at the effect of a healthy lifestyle on healthspan (how many disease-free years you can live).

How Were The Studies Done?

These studies started by combining the data from two major clinical trials:

The Nurse’s Health Study, which ran from 1980 to 2014.

The Health Professional’s Follow-Up Study, which ran from 1986-2014.

These two clinical trials enrolled 78,865 women and 42,354 men and followed them for an average of 34 years. During this time there were 42,167 deaths. All the participants were free of heart disease, type 2 diabetes, and cancer at the time they were enrolled. Furthermore, the design of these clinical trials was extraordinary.

A detailed food frequency questionnaire was administered every 2-4 years. This allowed the investigators to calculate cumulative averages of all dietary variables.

Participants also filled out questionnaires that captured information on disease diagnosis every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of disease for each participant during the study. More importantly, 34 years is long enough to measure the onset of diseases like heart disease, diabetes, and cancer – diseases that require decades to develop.

- The questionnaires also captured information on medicines taken and lifestyle characteristics such as body weight, exercise, smoking and alcohol use.

For analysis of diet quality, the investigators use something called the “Alternative Healthy Eating Index”. [The original Healthy Eating Index was developed about 10 years ago based on the 2010 “Dietary Guidelines for Americans”. Those guidelines have since been updated, and the “Alternative Healthy Eating Index” is based on the updated guidelines.] You can calculate your own Alternative Healthy Eating Index below, so you can see what is involved.

Finally, the investigators included five lifestyle-related factors – diet, smoking, physical activity, alcohol consumption, and BMI (a measure of obesity) – in their estimation of a healthy lifestyle. Based on the best available evidence, they defined “low-risk” in each of these categories. Study participants were assigned 1 point for each low-risk category they achieved. Simply put, if they were low risk in all 5 categories, they received a score of 5. If they were low risk in none of the categories, they received a score of 0.

Low risk for each of these categories was defined as follows:

- Low risk for a healthy diet was defined as those who scored in the top 40% in the Alternative Healthy Eating Index.

- Low risk for smoking was defined as never smoking.

- Low risk for physical activity was defined as 30 minutes/day of moderate or vigorous activities.

- Low risk for alcohol was defined as 0.5-1 drinks/day for women and 0.5-2 drinks/day for men.

- Low risk for weight was defined as a BMI in the healthy range (18.5-24.9 kg/m²).

Can A Healthy Lifestyle Improve Your Healthspan?

The investigators compared participants who scored as low risk in all 5 categories with participants who scored as low risk in 0 categories (which would be typical for many Americans). For simplicity, I will refer to people who scored as low risk in 5 categories as having a “healthy lifestyle” and those who scored as low risk in 0 categories as having an “unhealthy lifestyle”.

The results of the first study were:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle (estimated life expectancy of 93 versus 79).

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle (estimated life expectancy was 87 versus 75).

It was not necessary to achieve a perfect lifestyle. Life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors of the study concluded: “Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults. Our findings suggest that the gap in life expectancy between the US and other developed countries could be narrowed by improving lifestyle factors.”

The results of the second study were:

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women who had an unhealthy lifestyle (estimated disease-free life expectancy of 85 years versus 74 years).

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle (estimated disease-free life expectancy of 81 years versus 73 years).

Again, disease-free life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors concluded: “Adherence to a healthy lifestyle at mid-life [They started their analysis at age 50] is associated with a longer life expectancy free of major chronic diseases. Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

Can You Create Your Personal Fountain Of Youth?

I posed the question at the beginning of this article, “Can you create your personal Fountain Of Youth”?” These two studies showed that you can improve both your life expectancy and your disease-free life expectancy by simply changing your lifestyle. So, the answer to the original question appears to be, “Yes, you can improve your healthspan. You can create your personal “Fountain of Youth.”

However, as a nation we appear to be moving in the wrong direction. The percentage of US adults adhering to a healthy lifestyle has decreased from 15% in 1988-1992 to 8% in 2001-2006.

Finally, I know you have some questions, and I have answers.

Question: What about supplementation? Will it also improve my healthspan?

Answer: When the investigators analyzed the data, they found that those with the healthiest lifestyles were also more likely to be taking a multivitamin. So, they attempted to statistically eliminate any effect of supplement use on the outcomes. That means these studies cannot answer that question.

However, if you calculate your Alternate Healthy Eating Index below, you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

Question: I cannot imagine myself reaching perfection in all 5 lifestyle categories? Should I even try to achieve low risk in one or two categories?

Answer: The good news is that there was a linear increase in both life expectancy and disease-free life expectancy as people went from low-risk in one category to low-risk in all 5 categories. I would encourage you to try and achieve low risk status in as many categories as possible, but very few of us, including me, achieve perfection in all 5 categories.

Question: I am past 50 already. Is it too late for me to improve my healthspan?

Answer: Diet and some of the other lifestyle behaviors were remarkably constant over 34 years in both the Nurse’s Health Study and the Health Professional’s Follow-Up Study. That means that the lifespan and healthspan benefits reported in these studies probably resulted from adhering to a healthy lifestyle for most of their adult years.

However, it is never too late to start improving your lifestyle. You may not achieve the full benefits described in these studies, but you still can add years and disease-free years to your life.

How To Calculate Your Alternative Healthy Eating Index

You can calculate your own Alternative Healthy Eating Index score by simply adding up the points you score for each food category below.

Vegetables

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = 1 cup green leafy vegetables or ½ cup for all other vegetables.

Do not count white potatoes or processed vegetables like French fries or kale chips.

Fruits

Count 2½ points for each serving you eat per day (up to 4 servings).

One serving = 1 piece of fruit or ½ cup of berries.

(do not count fruit juice or fruit incorporated into desserts or pastries).

Whole Grains

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = ½ cup whole-grain rice, bulgur and other whole grains, cereal, and pasta or 1 slice of bread.

(For processed foods like pasta and bread, the label must say 100% whole grain).

Sugary Drinks and Fruit Juice

Count 10 points if you drink 0 servings per week.

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 7 or more servings per week (≥1 serving per day).

One serving = 8 oz. fruit juice, sugary soda, sweetened tea, coffee drink, energy drink, or sports drink.

Nuts and Beans

Count 10 points if you eat 7 or more servings per week (≥1 serving per day).

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 0 servings per week.

One serving = 1 oz. nuts or seeds, 1 Tbs. peanut butter, ½ cup beans, 3½ oz. tofu.

Red and Processed Meat

Count 10 points if you eat 0 servings per week.

Count 7 points for 3-4 servings per week (½ serving per day).

Count 3 points for 3 servings per week (1 serving per day).

Count 0 points for ≥1½ servings per day.

One serving = 1½ oz. processed meats (bacon, ham, sausage, hot dogs, deli meat)

Or 4 oz. red meat (steak, hamburger, pork chops, lamb chops, etc.)

Seafood

Count 10 points if you eat 2 servings per week.

Count 5 points for 1 serving per week.

Count 0 points for 0 servings per week.

1 serving = 4 oz.

Now that you have your total, the scoring system is:

41 or higher is excellent
37-40 is good
33-36 is average (remember that it is average to be sick in this country)
28-32 is below average
Below 28 is poor

Finally, for the purposes of these two studies, a score of 37 or higher was considered low risk.

The Bottom Line

Two recent studies have developed a healthy lifestyle score based on diet, exercise, body weight, smoking, and alcohol use. When they compared the effect of lifestyle on both lifespan (life expectancy) and healthspan (disease-free life expectancy), they reported:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle.

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle.

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women had an unhealthy lifestyle.

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle.

It is not necessary to achieve a perfect lifestyle. Lifespan and healthspan increased in a linear fashion for each low-risk lifestyle behavior (diet, exercise, body weight, smoking, and alcohol use) achieved.

These studies did not evaluate whether supplement use also affects healthspan.

- However, if you calculate your diet with the Alternate Healthy Eating Index they used (see above), you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

The authors concluded: “Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

For more details, including how to calculate your Alternative Healthy Eating Index, 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.

How To Talk With Your Doctor About Cancer

February 28, 2023 by Dr. Steve Chaney

How Can You Partner With Your Doctor?

Author: Dr. Stephen Chaney

Few things in life are more devastating than a cancer diagnosis. One day life is going on smoothly. The next day everything is in doubt. And before you know it, you are listening to your cancer doctor recommend a frightening treatment protocol.

Because of my 40-year career in cancer drug development at the University of North Carolina, people who are newly diagnosed with cancer often contact me for advice.

Let me start by making it clear that I am not a medical doctor, much less an oncologist or radiologist. Thus, I am not qualified to give medical advice on cancer treatment.

However, I worked with many oncologists and radiologists during my career at UNC, so I can offer perspectives about the advice your doctor is giving you and counsel you on what questions to ask your doctor(s).

I love helping people. But rather than have all of you calling me, I thought it would be best to put my advice in writing and send it to all my “Health Tips From the Professor” subscribers.

Is Your Doctor Being Honest With You?

The complaint I hear most often is, “I don’t feel my doctor is being honest with me. I feel that he or she is overselling the benefits of cancer treatment, whether it is chemotherapy, radiation, surgery, or some combination of them.”

There is some truth to that perspective, but you need to understand why that is. There are four reasons, and I will save the two most important reasons for last.

People go into medicine to cure disease. Doctors are action oriented. They will recommend the best treatment available, even if its success rate is low because they feel the alternative is unthinkable. The idea of letting cancer run its course is abhorrent to them.

2) Cancer doctors focus on the cures, not the failures. In my time at UNC a couple of oncology residents rotated through my lab to gain some research experience. I was amazed that they were able to remain so positive when they had many patients who were dying. Then it hit me. They comforted the patients they weren’t able to help and took their joy from the cures they were able to obtain.

3) The worst thing a doctor can do is to take away a patient’s hope. Our minds are powerful. If a patient is to have any chance of defeating cancer, they first must believe it is possible.

4) Cancer is a fearsome opponent. There are spontaneous remissions. There are miraculous cures. But left untreated, the cancer usually wins. And that is your doctor’s greatest fear.

How To Talk With Your Doctor About Cancer

So, how do you find out the truth about your doctor’s treatment recommendations. You could Google it, but Dr. Google’s medical advice is often unreliable.

There is a simpler way. Your doctor(s) will be honest with you if you ask them the right questions and assure them you can deal with the answers they give. That last point is key. You should only ask these questions if you can accept whatever the answer may be.

If bad news would devastate you, you shouldn’t ask these questions. And your doctor may not feel he or she could be honest with you.

Before I give you the questions, let me share some definitions you need to know. These definitions give you a more precise definition of success of the cancer treatment your doctor is suggesting. Any treatment your doctor recommends will be supported by multiple clinical trials that provide data for each of these definitions.

Partial Remission is a decrease in the signs and symptoms of cancer. Your tumor has shrunk, but it is still detectable.

Complete Remission is a disappearance of all signs and symptoms of cancer. However, some cancer cells may remain.

Duration of Remission is the average time between the end of treatment and the return (recurrence) of the cancer.

Cure is usually defined as a complete remission that lasts 5 years or more.

With these definitions in mind, here are the questions to ask (only if you want to know the answers).

What percentage of patients undergoing this treatment achieve remission? Is the remission partial or complete? How long does the remission last on the average? If the cancer does recur, can it be treated successfully a second time?

[Even if remission is relatively brief, it may give a chance to put your affairs in order and check a few items off your bucket list. This knowledge is important for many cancer patients.]

2) What percent of patients are cured?

[Every patient receives this information differently. But at least you, rather than your doctor, are making the choice of whether likelihood of being cured is worth the downsides of the treatment.]

3) What are the side effects of the treatment? How much does the treatment cost?

4) What is the prognosis if you do nothing? How long will you live? What will your quality of life be like?

[Sometimes the quality of life if you do nothing is better than the quality of life during treatment because of treatment side effects. This can be an important factor for treatments that have a short duration of remission and/or a very low cure rate.]

As you can appreciate, the answers to these questions can lead to some heart wrenching decisions. That’s why I caution you to only ask these questions if you can handle the answers.

Finally, it is important to remember that the answers your doctor gives you represent the average response of thousands of patients. None of us are average. Your response to treatment and your response to doing nothing depend on your age, overall health, lifestyle factors, genetics, and factors that none of us understand. That makes your decision even more difficult.

How Can You Partner With Your Doctor?

The second most common complaint I hear from patients going through this process is that their doctor isn’t listening to them. They would like to explore treatments with fewer side effects or alternative therapies with no side effects. But their doctor refuses to even consider those possibilities. He or she will say there is no proof those treatments work. It’s their way or the highway.

If you search the internet, many alternative health gurus will tell you this is because:

Big Pharma has doctors in its pocket. It spends a lot of money convincing doctors their drugs are the best treatment available.

The medical profession is prejudiced against supplementation and alternative therapies.

The AMA controls what treatments doctors can and cannot recommend. It can yank the medical license from doctors who dare recommend anything except the AMA-approved treatment.

There is some truth to each of these statements. But there are two other factors that are overlooked by most of these “health gurus”:

The proof is much greater for conventional treatment than for alternative therapies. Conventional treatments are supported by multiple clinical studies involving thousands of patients.

This is the standard of proof for conventional treatments. But this kind of proof can cost millions of dollars. Pharmaceutical companies can undertake these kinds of studies because they can recover that cost with a successful cancer drug. But there is no financial incentive to provide that level of proof for alternative therapies.

As I said before, cancer is a deadly foe. More importantly, left untreated it can rapidly progress from a highly treatable stage to a stage where any treatment is unlikely to be successful.

This is the greatest fear of your cancer doctor. If you tell them you want to explore an alternative therapy, they are worried that they won’t see you again until your cancer has become untreatable.

With that in mind, let me suggest how you might partner with your doctor.

Start by stating that you would like to try an alternative therapy or a less aggressive medical treatment before you try the treatment your doctor recommended.

But also tell your doctor that you would like him or her to monitor you on a frequent basis to determine whether your approach is working.

And if your approach isn’t working, you will consider again the treatment your doctor recommended.

This is what partnership with your doctor looks like. And it allays their greatest fear that they won’t see you again until your cancer has become untreatable.

If your doctor says no, listen very carefully to their reasoning (You may want to bring a relative or friend with you because they may hear your doctor’s response differently than you do). For example, it could be that your kind of tumor is so aggressive it doesn’t allow a window of opportunity to explore other options.

However, if you are unsatisfied with your doctor’s answer, that is what second opinions are for.

The Bottom Line

You are being asked to make the most important decision of your life.

I spent 40 years of my life working on cancer drug development. I’m not a medical doctor. I can’t tell you what to do. But in this article, I tell you:

What questions to ask your doctor, and…

How to partner with your doctor…

…to help you navigate the most difficult decisions of your life.

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.

Recovering From A Meniscus Tear

February 21, 2023 by Dr. Steve Chaney

Regain Full Flexibility And Get Back To The Sports You Love

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

While February is the shortest month of the year, to our northern family and friends it is the longest, seemingly endless, month.

Where I live in Sarasota Florida, winter brings us near-perfect days and cooler nights. It’s my favorite time of year. And of course, we all celebrate the holiday of love – Valentine’s Day!

Just a bit of trivia: In 1868, Richard Cadbury released the first Valentine’s Day box of chocolates, followed in 1902 with the first conversation hearts from the New England Confectionery Company. In the 1840s, Esther A. Howland created the first commercial Valentine’s Day cards in the United States. Hallmark first offered Valentine’s Day cards in 1913 and began producing them in 1916. (Thanks to Wikipedia for all this interesting info).

What Is A Meniscus?

One of my clients asked me to talk about a medial meniscus tear, and that is a topic that is “near and dear to me” because I had a severed medial meniscus from a ski accident.

The meniscus is something that many people aren’t familiar with, unless they have had a meniscus tear, then you definitely know all about it. It hurts!

All of the major joints are complicated with many ligaments and other structures, each having an important function.

The knee joint is straightforward.

The lateral (outside of knee joint) and medial (inside of knee joint) meniscus cushion the femur (thigh) bone and tibia (shin bone) so your knee can bend and straighten without wearing down the bone.

Ligaments that surround the knee joint hold the bones together and form a tight, secure joint.

How Does A Meniscus Tear?

Trauma to the knee joint, especially a twisting movement, will tear the meniscus.

In 1995 I had a ski accident where I severed the medial meniscus, but I didn’t have insurance at the time. I paid the $1000 for an MRI to find out why my knee was in so much pain, and why my knee felt like it was going to totally separate.

It turned out that I not only severed my left medial meniscus, I also tore my anterior cruciate ligament (ACL), The ACL holds your bones together from front to back. When this tore, I felt like whenever stepped down my upper leg still kept going forward. It was a scary feeling, I felt like my leg was going to come apart at my knee. Yikes!

Recovering From A Meniscus Tear

I need to remind you that I am not a doctor, nor do I have medical training to advise you about what to do. This message isn’t meant to replace your physician’s advice.

When I found myself with a severed medial meniscus and a torn ACL, and I didn’t have medical insurance, I didn’t know what to do! Fortunately, I was working along with Zev Cohen, MD. My therapy practice was in Dr Cohen’s office, and he would often ask me to see one of his patients who were in pain when he knew it wasn’t caused by any systemic or visceral problems. I totally respected Dr. Cohen because he truly wanted his patients to get better, even if it meant he was going to bring in a massage therapist!

As a result, when Dr. Cohen told me that my meniscus would heal with scar tissue, I believed him. And it worked! The only glitch was the scar tissue made my knee stiff, so I started to do a movement that I believed would stretch the scar tissue enough so I could bend my knee properly. And that worked too!

Regain Full Flexibility And Get Back To The Sports You Love

A Stretch for AFTER Your Meniscus Heals

Caution: Do Not do this stretch until your knee is completely healed.

Stand with your feet directly under your hips. Hold on to a closed door, being sure you’re on the side of the door that pushes out, so you are pulling it shut as you do the stretch.

While keeping your knees straight up from your ankle, squat down, stopping when you start to feel pain in your knee. Stay there, and then go just a little bit further. Don’t push, it’s better to go slowly so your muscles stretch safely. Scar tissue is really dense, it doesn’t stretch easily (if at all) so you need to slowly allow the scar tissue to loosen.

I can’t guarantee that this will work for you but let me tell you what happened to me. I was doing this stretch multiple times a day, stopping when it would be too painful – or when I just ran out of time. Then one day – success!

One day I was squatting down and suddenly something released, and I ended up sitting on the floor with my knees totally bent!

Since then, I’ve been able to get back to skiing, and I have ZERO pain!

Wishing you well,

Julie Donnelly

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.

Which Diets Are Best In 2023?

February 14, 2023 by Dr. Steve Chaney

Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Many of you started 2023 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 6 weeks ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

Perhaps the diet isn’t working as well as advertised…

Perhaps the diet is too restrictive. You are finding it hard to stick with…

Perhaps you are always hungry or constantly fighting food cravings…

Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…

Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2023”. For the full report, click on this link.

How Was This Report Created?

US News & World Report recruited a panel of 30 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 24 most popular diets.

The diets evaluated are not the same each year. Last year they evaluated the top 40 most popular diets. This year they only reviewed the top 24.

That means some good diets were left off the list. For example, the vegan diet is very healthy, but it is also very restrictive. Very few people follow a pure vegan diet, so it didn’t make the top 24 most popular. However, this year’s list did include several primarily plant-based diets that are more popular with the general public.

The panel is also not the same each year. Some experts are rotated off the panel, and others are added. The experts rate each diet in seven categories:

How easy it is to follow.

Its ability to produce short-term weight loss.

Its ability to produce long-term weight loss.

its nutritional completeness.

Its safety.

Its potential for preventing and managing diabetes.

Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct eleven sets of Best Diets rankings:

Best Diets Overall ranks diets on several different parameters, including whether all food groups are included in the diet, the availability of the foods needed to be on the diet and the use of additional vitamins or supplements. They considered if the diet was evidence-based and adaptable to meet cultural, religious, or other personal preferences. In addition, the criteria also included evaluation of the prep and planning time required for the diet and the effectiveness of the diet for someone who wants to get and stay healthy.

Best Plant-Based Diets used the same approach as Best Diets Overall to rank the eight plans emphasizing minimally processed foods from plants that were included in this year’s ratings.

Best Commercial Diet ratings used the same approach to rank 15 commercial diet programs that require a participation fee or promote the use of branded food or nutritional products.

Best Long-Term Weight-Loss Diet ratings were generated by combining the safety of the rate of weight loss promoted and the likelihood of the plan to result in successful long-term weight loss and maintenance of weight loss.

Best Fast Weight-Loss Diets were scored on their effectiveness for someone who wants to lose weight in three months or less.

Best Diabetes Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for diabetes, the nutritional quality of the diet, and research evidence-based support for the diet.

Best Heart-Healthy Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for hypertension and other forms of heart disease, the nutritional quality of the diet, and evidence-based support for the diet.

Best Diets for Bone and Joint Health were calculated equally on the effectiveness of the diet for someone who wants to lower their risk factors for inflammation and improve bone and joint health, as well as the nutritional quality and research evidence-based support for the diet.

Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.

Easiest Diets to Follow represents panelists’ averaged scores for the relevant lifestyle questions, including whether all food groups are included and if the recommended foods are readily available at the average supermarket.

Best Family-Friendly Diets were calculated equally on their adaptability for the whole family, including cultural, religious, and personal preferences, the time required to plan and prep, nutritional value and access to food at any supermarket.

Which Diets Are Best In 2023?

Are you ready? If this were an awards program, I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 3 and bottom 3 diets in each category (If you would like to see where your favorite diet ranked, click on this link.

[Note: I excluded commercial diets from this review. (I have a brief discussion of commercial diets below). If you notice a number missing in my summaries, it is because I eliminated one or more commercial diet from my summary.]

Best Diets Overall

The Top 3:

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 6 consecutive years.

#2 (tie): DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#2 (tie): Flexitarian Diet (A flexible semi-vegetarian diet).

The Bottom 3:

#20: Keto Diet (A high protein, high fat, very low carb diet designed to achieve ketosis).

#21: Atkins Diet (The granddaddy of the high animal protein, low carb, high fat diets).

#24: Raw Food Diet (A diet based on eating foods that have not been cooked or processed).

Best Plant-Based Diets Overall

The Top 3:

#1: Mediterranean Diet.

#2: Flexitarian Diet.

#3: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

The Bottom 3:

Since only 8 diets were included in this category, even the bottom 3 are pretty good diets, so I did not include a “list of shame” in this category.

Best Long-Term Weight-Loss Diets

The Top 3:

#1: DASH Diet

#2 (tie): Volumetrics Diet (A diet based on the caloric density of foods).

#2 (tie): Mayo Clinic Diet (A diet designed to establish lifelong healthy eating habits).

The Bottom 3:

#22 (tie): Keto Diet.

#22 (tie): Atkins Diet.

#24: Raw Food Diet.

Best Fast Weight-Loss Diets

The Top 3:

#1: Keto Diet

#2: Atkins Diet

#7 (tie): Mayo Clinic Diet

#7 (tie): South Beach Diet

#7 (tie): Volumetrics Diet

The Bottom 3:

The diets at the bottom of this list were designed for health and weight maintenance rather than rapid weight loss, so I did not include a “list of shame” in this category.

Best Diabetes Diets

The Top 3:

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3:

#20: Atkins Diet

#21: Paleo Diet (A diet based on what our paleolithic ancestors presumably ate. It restricts grains and dairy and is heavily meat-based).

#22: Raw Food Diet.

Best Heart-Healthy Diets

The Top 3:

#1: DASH Diet

#2: Mediterranean Diet

#3 (tie): Ornish Diet (A whole food, semi-vegetarian diet designed to promote heart health).

#3 (tie): Flexitarian Diet

The Bottom 3:

#22 (tie): Raw Foods Diet

#22 (tie): Paleo Diet

#24: Keto Diet

Best Diets for Bone and Joint Health

The Top 3:

#1 (tie): DASH Diet

#1 (tie): Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3:

#21 (tie): Raw Foods Diet

#21 (tie): Paleo Diet

#22: Atkins Diet

#23: Keto Diet

Best Diets for Healthy Eating

The Top 3:

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

The Bottom 3:

#22: Keto Diet

#23: Atkins Diet

#24: Raw Foods Diet

Easiest Diets to Follow

The Top 3:

#1 (tie): Flexitarian Diet

#1 (tie): TLC Diet (This diet was designed by the NIH to reduce cholesterol levels and promote heart health.)

#3 (tie): Mediterranean Diet

#3 (tie): DASH Diet

The Bottom 3:

#19: Atkins Diet

#20: Keto Diet

#22: Raw Foods Diet

Which Diets Are Best For Rapid Weight Loss?

There are 2 take-home lessons from the rapid weight loss category:

If you are looking for rapid weight loss, any whole food restrictive diet will do.

- Last year’s diet analysis included the vegan diet, and both vegan and keto diets ranked near the top of the rapid weight loss category. Keto and vegan diets are both very restrictive, but they are polar opposites in terms of the foods they allow and restrict.

- - The keto diet is a meat heavy, very low carb diet. It restricts fruits, some vegetables, grains, and most legumes.

- - The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.

- The Atkins and keto diets toppled this year’s rapid weight loss list, but they were joined by the Mayo Clinic, South Beach, and volumetrics diets. Those diets are also restrictive, but, like the vegan diet, they are very different from the Atkins and keto diets.

- I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) Whole food, very low carb diets like Atkins and keto are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

- If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss.

Which Diet Should You Choose?

With rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

1) Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

2) Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

“Why is that?”, you might ask? The answer is simple. And it’s not that all 30 experts were prejudiced against low carb diets. It’s that the major primarily plant-based diets like Mediterranean, DASH, and flexitarian are backed by long-term clinical studies showing they are healthy and significantly reduce the risk of diabetes, heart disease, and other chronic diseases.

On the other hand, there are no long-term studies showing the Atkins and keto diets are healthy long term. And since the Atkins diet has been around for more than 50 years, the lack of clinical evidence that it is healthy long term is damming.

3) Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian. They are also at or near the top of almost every diet category.

4) Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

On the minus side, none of the diets include sodas, junk foods, and highly processed foods. These foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.

On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

What About Commercial Diets?

I chose not to review commercial diets by name, but let me make a few observations.

If you look at the gaps in my lists, it should be apparent that several commercial diets rank near the top for fast weight loss, but near the bottom on most healthy diet lists.

I do not recommend commercial diets that rely on ready-to-eat, low-calorie, highly processed versions “of your favorite foods”.

- These pre-packaged meals are expensive. Unless you are a millionaire, you won’t be able to afford these meals for the rest of your life.

- These pre-packaged meals are not teaching you healthy eating habits that will allow you to keep the weight off.

If you wish to spend your hard-earned dollars on a commercial diet, choose a diet that:

- Relies on whole foods from all 5 food groups.

- Teaches and provides support for the type of lifestyle change that leads to permanent weight loss.

Meal replacement shakes can play a role in healthy weight loss if:

- They are high quality and use natural ingredients as much as possible.

- They are part of a holistic lifestyle change program.

The Bottom Line

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are 2 general principles:

If you are looking for rapid weight loss, any whole food restrictive diet will do.

2) If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss. Atkins and keto diets are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

#2: Which diet should you choose? Here the principles are:

Choose a diet that fits your needs.

2) Choose diets that are healthy and associated with long term weight loss.

3) Choose diets that are easy to follow.

4) Choose diets that fit your lifestyle and dietary preferences.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you and my thoughts on commercial diets, read the article above.

Which Supplements Are Good For Your Heart?

February 7, 2023 by Dr. Steve Chaney

How Should You Interpret This Study?

Author: Dr. Stephen Chaney

February is Heart Health month. So, it is fitting that we ask, “What is the status of heart health in this country?” The American Heart Association just published an update of heart health statistics through 2019 (CW Tsao et al, Circulation, 145: e153-e639, 2022). And the statistics aren’t encouraging. [Note: The American Heart Association only reported statistics through 2019 because the COVID-19 pandemic significantly skewed the statistics in 2020 and 2021].

The Good News is that between 2009 and 2019:

All heart disease deaths have decreased by 25%.
Heart attack deaths have decreased by 6.6%.
Stroke deaths have decreased by 6%.

The Bad News is that:

Heart disease is still the leading cause of death in this country.
Someone dies from a heart attack every 40 seconds.
Someone dies from a stroke every 3 minutes.

Diet, exercise, and weight control play a major role in reducing the risk of heart disease. Best of all, they have no side effects. They represent a risk-free approach that each of us can control.

But is there something else? Could supplements play a role? Are supplements hype or hope for a healthy heart?

All the Dr. Strangeloves in the nutrition space have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study (P An et al, Journal of the American College of Cardiology, 80: 2269-2285, 2022) has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

How Was This Study Done?

This was a major clinical study carried out by researchers from the China Agricultural University and Brown University in the US. It was a meta-analysis, which means it combined the data from many published clinical trials.

The investigators searched three major databases of clinical trials to identify:

884 randomized, placebo-controlled clinical studies…

Of 27 types of micronutrients…

With a total of 883,627 patients…

Looking at the effectiveness of micronutrient supplementation lasting an average of 3 years on either…

- Cardiovascular risk factors like blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides…or…

- Cardiovascular outcomes such as coronary heart disease (CHD), heart attacks, strokes, and deaths due to cardiovascular disease (CVD) and all causes.

[Note: Coronary heart disease (CHD) refers to build up of plaque in the coronary arteries (the arteries leading to the heart). It is often referred to as heart disease and can lead to heart attacks (myocardial infarction). Cardiovascular disease (CVD) is a more inclusive term that includes coronary heart disease, stroke, congenital heart defects, and peripheral artery disease.]

The investigators also included an analysis of the quality of the data in each of the clinical studies and rated the evidence of each of their findings as high quality, moderate quality, or low quality.

Which Supplements Are Good For Your Heart?

The top 3 heart-healthy supplements in this study were:

Omega-3 Fatty Acids:

Increased HDL cholesterol and decreased triglycerides, both favorable risk factors for heart health.
Deceased risk of heart attacks by 15%, all CHD events by 14%, and CVD deaths by 7% (see definitions of CHD and CVD above).
The median dose of omega-3 fatty acids in these studies was 1.8 g/day.
The evidence was moderate quality for all these findings.

Folic Acid:

Decreased LDL cholesterol (moderate quality evidence) and decreased blood pressure and total cholesterol (low quality evidence).
Decreased stroke risk by 16% (moderate quality evidence).

Coenzyme Q10:

Decreased triglycerides (high quality evidence) and reduced blood pressure (low quality evidence).
Decreased the risk of all-cause mortality by 32% (moderate quality evidence).
These studies were performed with patients diagnosed with heart failure. Coenzyme Q10 is often recommended for these patients, so the studies were likely performed to test the efficacy of this treatment.

There were three micronutrients (vitamin C, vitamin E, and vitamin D) that did not appear to affect heart disease outcomes.

Finally, as reported in previous studies, β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

In terms of the question I asked at the beginning of this article, this study concluded that:

Omega-3, folic acid, and coenzyme Q10 supplements represent hope for a healthy heart.
Vitamin C, vitamin E, and vitamin D supplements represent hype for a healthy heart.
β-carotene supplements represent danger for a healthy heart.

But these conclusions just scratch the surface. To put them into perspective we need to dig a bit deeper.

How Should You Interpret This Study?

In evaluating the significance of these findings there are two things to keep in mind.

#1: This study is a meta-analysis and meta-analyses have both strengths and weaknesses.

The strength of meta-analyses is that by combining multiple clinical studies they can end up with a database containing 100s of thousands of subjects. This allows them to do two things:

It allows the meta-analysis to detect statistically significant effects that might be too small to detect in an individual study.
It allows the meta-analysis to detect the average effect of all the clinical studies it includes.

The weakness of meta-analyses is that the design of individual studies included in the analysis varies greatly. The individual studies vary in things like dose, duration, type of subjects included in the study, and much more.

This is why this study rated most of their conclusions as backed by moderate- or low-quality evidence. [Note: The fact that the authors evaluated the quality of evidence is a strength of this study. Most meta-analyses just report their conclusions without telling you how strong the evidence behind those conclusions is.]

#2: Most clinical studies of supplements (including those included in this meta-analysis) have two significant weaknesses.

Most studies do not measure the nutritional status of their subjects prior to adding the supplement. If their nutritional status for a particular nutrient was already optimal, there is no reason to expect more of that nutrient to provide any benefit.
Most studies measure the effect of a supplement on a cross-section of the population without asking who would be most likely to benefit.

You would almost never design a clinical study that way if you were evaluating the effectiveness of a potential drug. So, why would you design clinical studies of supplements that way?

With these considerations in mind, let me provide some perspective on the conclusions of this study.

Coenzyme Q10:

This meta-analysis found that coenzyme Q10 significantly reduced all-cause mortality in patients with heart failure. This is consistent with multiple clinical studies and a recent Cochrane Collaboration review.

Does coenzyme Q10 have any heart health benefits for people without congestive heart failure? There is no direct evidence that it does, but let me offer an analogy with statin drugs.

Statin drugs are very effective at reducing heart attacks in high-risk patients. But they have no detectable effect on heart attacks in low-risk patients. However, this has not stopped the medical profession from recommending statins for millions of low-risk patients. The rationale is that if they are so clearly beneficial in high-risk patients, they are “probably” beneficial in low-risk patients.

I would argue a similar rationale should apply to supplements like coenzyme Q10.

Omega-3s:

This study found that omega-3 reduced both heart attacks and the risk of dying from heart disease. Most previous meta-analyses of omega-3s and heart disease have come to the same conclusion. However, some meta-analyses have failed to find any heart health benefits of omega-3s. Unfortunately, this has allowed both proponents and opponents of omega-3 use for heart health to quote studies supporting their viewpoint.

However, there is one meta-analysis that stands out from all the others. A group of 17 scientists from across the globe collaborated in developing a “best practices” experimental design protocol for assessing the effect of omega-3 supplementation on heart health. They conducted their clinical studies independently, and when their data (from 42,000 subjects) were pooled, the results showed that omega-3 supplementation decreased:

Premature death from all causes by 16%.
Premature death from heart disease by 19%.
Premature death from cancer by 15%.
Premature death from causes other than heart disease and cancer by 18%.

This study eliminates the limitations of previous meta-analyses. That makes it much stronger than the other meta-analyses. And these results are consistent with the current meta-analysis.

Omega-3s have long been recognized as essential nutrients. It is past time to set Daily Value (DV) recommendations for omega-3s. Based on the recommendations of other experts in the field, I think the DV should be set at 500-1,000 mg/day. I take more than that, but this would represent a good minimum recommendation for heart health.

Folic acid:

As with omega-3s, this meta-analysis reported a positive effect of folic acid on heart health. But many other studies have come up empty. Why is that?

It may be because, between food fortification and multivitamin use, many Americans already have sufficient blood levels of folic acid. For example, one study reported that 70% of the subjects in their study had optimal levels of folates in their blood. And that study also reported:

Subjects with adequate levels of folates in their blood received no additional benefit from folic acid supplementation.
However, for subjects with inadequate blood folate levels, folic acid supplementation decreased their risk of heart disease by ~15%.

We see this pattern over and over in supplement studies. Supplement opponents interpret these studies as showing that supplements are worthless. But a better interpretation is that supplements benefit those who need them.

The problem is that we don’t know our blood levels of essential nutrients. We don’t know which nutrients we need, and which we don’t. That’s why I like to think of supplements as “insurance” against the effects of an imperfect diet.

Vitamins E and D:

The situation with vitamins E and D is similar. This meta-analysis found no heart health benefit of either vitamin E or D. That is because the clinical studies included in the meta-analysis asked whether vitamin E or vitamin D improved heart health for everyone in the study.

Previous studies focusing on patients with low blood levels of these nutrients and/or at high risk of heart disease have shown some benefits of both vitamins at reducing heart disease risk.

So, for folic acid, vitamin E, and vitamin D (and possibly vitamin C) the take-home message should be:

Ignore all the Dr. Strangeloves telling you that these vitamins are “magic bullets” that will dramatically reduce your risk of heart disease.
Ignore the naysayers who tell you they are worthless.
Use supplementation wisely to make sure you have the recommended intake of these and other essential nutrients.

β-carotene:

This meta-analysis reported that β-carotene increased the risk of heart disease. This is not a new finding. Multiple previous studies have come to the same conclusion.

And we know why this is. There are many naturally occurring carotenoids, and they each have unique heart health benefits. A high dose β-carotene supplement interferes with the absorption of the other carotenoids. You are creating a deficiency of other heart-healthy carotenoids.

If you are not getting lots of colorful fruits and vegetables from your diet, my recommendation is to choose a supplement with all the naturally occurring carotenoids in balance – not a pure β-carotene supplement.

The Bottom Line

The Dr. Strangeloves in the nutrition space all have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

This study was a meta-analysis of 884 clinical studies with 883,627 participants. It reported:

Omega-3 supplementation deceased risk of heart attacks by 15% and all cardiovascular deaths by 7%.
Folic acid supplementation decreased stroke risk by 16%.
Coenzyme Q10 supplementation decreased the risk of all-cause mortality in patients with heart failure by 32%.
Vitamin C, vitamin E, vitamin D did not appear to affect heart disease outcomes.
β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

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

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

Can Lifestyle Overcome Bad Genes?

January 31, 2023 by Dr. Steve Chaney

Lifestyle, Genetics, And Dementia Risk

Author: Dr. Stephen Chaney

Alzheimer’s disease and other forms of dementia are among the most feared diseases of aging. What use is it to have a healthy body, a loving family, and a successful career if you can’t remember any of it? You should be able to enjoy your Golden years, not see them slip through your fingers.

If you have a family history of dementia or have sent your DNA off for testing and learned you are genetically predisposed to dementia, you are probably worried.

Perhaps the scariest thing about Alzheimer’s is that the medical community has no answers. There are no drugs to prevent or cure Alzheimer’s and brain transplants are out of the question. Some medical professionals will tell you nothing can be done, but is that true?

Before I answer that question 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 genes do not have to determine our destiny. We have the power to overcome bad genetics. We also have the power to undermine good genetics.

With that in mind, let’s return to Alzheimer’s. Studies have suggested that a healthy lifestyle can help reduce your risk of developing Alzheimer’s and other forms of dementia. But what about genetics? Will a healthy lifestyle only reduce your risk of dementia if your genetic risk is low, or will it be equally effective when your genetic risk is high? Can lifestyle overcome genetics?

The current study (A Tin et al, Neurology, 99: e154-e163, 2022) was designed to answer these questions.

How Was This Study Done?

This study included 11,561 participants from the Atherosclerosis Risk In Communities (ARIC) study. The ARIC study recruited middle-aged adults (average age of 54) from both urban and rural areas of the United States and followed them for 26 years. The participants were 57% female and 53% white.

Simply put, the study was designed to look at the effect of a healthy lifestyle on the genetic risk of developing dementia.

A healthy lifestyle was defined based on something called “Life’s Simple 7” (LS7) score.

The LS7 score was developed by the American Heart Association to define the effect of lifestyle on the risk of developing heart disease. However, it works equally well for defining the effect of lifestyle on risk of developing dementia.

The LS7 score consists of 7 modifiable health factors.

- The factors are diet, physical activity, BMI (a measure of obesity), smoking, total cholesterol, blood pressure, and fasting blood glucose.

The data for deriving the LS7 scores were derived from data gathered from each participant when they enrolled in the ARIC study.

- Diet was assessed by a 66-item food frequency questionnaire.

- Physical activity and smoking were assessed in separate questionnaires.

- BMI, blood pressure, total cholesterol, and fasting blood glucose were measured during a visit to a designated clinic at the beginning of the study.

Each modifiable health factor was separated into 3 categories (ideal, intermediate, and poor) and the highest score was assigned to the ideal category. The LS7 score was the sum of the scores from all 7 modifiable health factors.

Genetic risk of developing dementia was defined based on something called “The Genetic Risk Score” (GRS).

We have known for years that individuals of European descent who have the APOE ɛ4 gene variant have a 2 to 5-fold increased lifetime risk of developing dementia.

In recent years scientists have discovered several additional gene variants that increase the risk of dementia.

These have been combined with APOE ɛ4 to create a Genetic Risk Score for dementia.

The Genetic Risk Score for each participant was determined by DNA sequencing at the beginning of the study, with the highest score indicating the greatest risk for developing dementia.

The onset and severity of dementia were determined based on 7 clinic visits during the study.

Questionnaires were administered at each visit to assess self-reported dementia symptoms.

Cognitive tests were administered at visits 2 and 4.

Detailed cognitive and functional assessments were conducted at visits 5, 6, and 7.

The data were reviewed by an expert committee of physicians and neuropsychologists to determine dementia status.

Lifestyle, Genetics, And Dementia Risk

At the end of the 26-year study:

When participants with the highest Genetic Risk Scores were compared to those with the lowest Genetic Risk Scores:

- European American participants were 2.7-fold more likely to develop dementia.

- African American participants were 1.55-fold more likely to develop dementia.

When participants with the highest LS7 (healthy lifestyle) scores were compared to those with the lowest LS7 scores:

- European American participants were 40% less likely to develop dementia.

- African American participants were 17% less likely to develop dementia.

- A healthy lifestyle decreased the risk of developing dementia to a comparable extent at all levels of genetic risk for dementia.

The authors concluded, “Higher LS7 scores [a measure of a healthy lifestyle] are largely associated with a lower risk of incident dementia across strata of genetic risk [at all levels of genetic risk], supporting the use of LS7 [a healthy lifestyle] for maintaining brain health and offsetting genetic risk. More studies with larger study populations are needed…”

I should briefly comment on why African Americans were less responsive to both genetic risk and a healthy lifestyle than European Americans. The reasons for these discrepancies are not known, but:

There are socioeconomic factors and health disparities that increase the risk of dementia that are not included in the LS7 score.
A recent study has identified genetic risk factors for dementia that are unique to African Americans that are not included in the genetic risk score used in this study.

Can Lifestyle Overcome Bad Genes?

Dr. James Watson, who was co-discoverer of the DNA double helix and was heavily involved in the sequencing of the human genome, asked that he not be told about his risk of developing Alzheimer’s when his own DNA was sequenced in the early 2000’s. His reasoning was, “Why know the risk if you can’t change it?”

If the study I discussed today is true, you can modify the risk. Your genes don’t have to be your destiny. But is it true?

There is good reason to believe it might be true. Multiple studies have shown that each of the health factors included in LS7 score reduce the risk of developing dementia. However, most of those studies have not looked at the interaction between a healthy lifestyle and genetic risk.

Fortunately, there is another recent study that looked at the interaction between a healthy lifestyle and genetic risk of developing dementia.

This study used a different database (The UK Biobank study which enrolled 500,000 participants) and different criteria for defining a healthy lifestyle (diet, physical activity, smoking, and alcohol use).

However, the conclusions of this study were very similar:

People at high genetic risk were almost twice as likely to develop dementia as those at low genetic risk.

A healthy lifestyle decreased the risk of developing dementia by about 40% for both people at high genetic risk and for people at low genetic risk.

But this study went one step further than the study I discussed in this article. The British study reported that:

People at low genetic risk and an unhealthy lifestyle (the typical American) were just as likely to develop dementia as people at high genetic risk and a healthy lifestyle.

In other words, bad genetics does not doom you to Alzheimer’s and dementia. A healthy lifestyle can cut your risk almost in half. Conversely, good genetics is not a “Get Out of Jail Free” card. You can squander the advantage of good genetics with an unhealthy lifestyle.

And, just like the hero of the movie I discuss at the beginning of this article, a healthy lifestyle may be able to overcome bad genes and make you just as healthy (with respect to the risk of developing dementia) as people with good genes and an unhealthy lifestyle – which includes most Americans.

The Bottom Line

If you have a family history of dementia or have sent your DNA off for testing and learned you are genetically predisposed to dementia, you are probably worried.

Studies have suggested that a healthy lifestyle can help reduce your risk of developing Alzheimer’s and other forms of dementia. But what about genetics? Will a healthy lifestyle only reduce your risk of dementia if your genetic risk is low, or will it be equally effective when your genetic risk is high? Can lifestyle overcome genetics?

A recent study was designed to answer these questions. It found:

When participants with the highest Genetic Risk Scores were compared to those with the lowest Genetic Risk Scores:

- They were 1.5 to 2.7-fold more likely to develop dementia.

When participants with the highest LS7 (healthy lifestyle) scores were compared to those with the lowest LS7 scores:

- They were 17% to 40% less likely to develop dementia.

A healthy lifestyle decreased the risk of developing dementia to a comparable extent at all levels of genetic risk for dementia.

This, and other studies discussed in this issue of “Health Tips For The Professor” suggest that your genes don’t have to determine your destiny. You can overcome bad genes with a healthy lifestyle.

For more details 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.

Is Fast Food Fat Food?

January 24, 2023 by Dr. Steve Chaney

Fat Metabolism Simplified

Author: Dr. Stephen Chaney

If you are like most Americans, you have vowed to lose weight and/or gain health in 2023. But how do you do that? There are hundreds of diets to choose from. And each diet has its “story” – a mixture of pseudo-science and testimonials – designed to convince you to try it.

Forget the pseudo-science. Forget the testimonials. Instead, focus on the one thing these diets have in common. They are all whole food diets. They all eliminate sodas, fast foods, and highly processed convenience foods.

In fact, that may be the simplest thing you can do to lose weight and become healthier. Many experts say that any time you eliminate sodas, fast foods, and convenience foods you will lose weight. If that statement is true, it could explain the American obesity epidemic. Between 1977 and 2017, a span of just 40 years, fast food consumption:

Increased from 6% to 35% (a 6-fold increase) in the 40-65 age group, and…

11% to 46% (a 4-fold increase) in the 12-39 age group.

But is it true? There are certainly reasons to think it might be:

Fast foods are high in fat, sugar, and calories and are low in fiber – all of which are associated with obesity.

Big Food Inc has researched the ideal combination of taste, mouth feel, and effect on blood sugar to create an addiction to fast food.

However, the studies linking fast food consumption to obesity have been flawed.

People who consume fast foods tend to exercise less and have a poorer diet, even when they are eating at home. Previous studies have not distinguished between fast food consumption and other things (diet, exercise, lifestyle) that are also linked to obesity.

Previous studies have often only assessed diet and other lifestyle factors at the beginning or end of the study. There is no way of knowing whether these values are typical for the entire timespan of the study.

Previous studies have only shown associations, not cause and effect.

The current study (AO Odegaard et al, American Journal of Clinical Nutrition, 116: 255-262, 2022) was designed to eliminate many of the flaws in previous studies.

Fat Metabolism Simplified

You have probably heard that belly fat increases your risk of diabetes, heart disease, stroke, Alzheimer’s, and some cancers. This study looked at the effect of fast foods on belly fat, muscle fat, and fatty liver (liver fat).

However, belly fat is both simple and complicated:

It is simple in that it is easy to see. We talk about it as an “apple shape” and we measure it in waste circumference.

It is complicated because, anatomically, there are several subtypes of belly fat, and these authors chose to examine the effect of fast foods on each subtype.

However, the effect of fast foods on each subtype of belly fat, and the metabolic effects of each subtype, are similar. So, in the interest of simplicity, I will combine the subtypes and simply refer to the effect of fast foods on belly fat.

With that in mind, here is all you need to know about biology and metabolism of fat.

In addition to fat accumulation in the abdomen (belly fat), this study also looked fat accumulation in muscle (which I will refer to as muscle fat) and liver (which I will refer to as liver fat).

All three types of fat contribute to metabolic syndrome (prediabetes) characterized by:

Insulin resistance, which leads to an elevation of both glucose and insulin.
High LDL (bad cholesterol) and low HDL (good cholesterol).
High triglycerides.
High blood pressure.
Inflammation

These metabolic effects increase the risk of diabetes, heart disease, stroke, Alzheimer’s, inflammatory diseases, and some cancers.

In addition, liver fat can lead to non-alcoholic liver disease, fibrosis of the liver, and cirrhosis of the liver.

How Was This Study Done?

This study recruited 5115 participants from the Coronary Risk Development in Young Adults (CARDIA) study. This study recruited young adults (average age of 25) in 1985-1986 and followed them for 25 years. The participants were 57% female and 53% white.

As stated above, this study looked at the effect of fast foods on belly fat, muscle fat, and fatty liver (liver fat).

This study had numerous strengths:

Unlike many other studies, variables like diet, fast food intake, and lifestyle were measured at multiple times during the study.

- All participants entered treatment centers for physical exams, bloodwork, and lifestyle questionnaires at entry into the study (year 0) and again at years 2, 5, 7, 10, 15, 20, and 25.

- On years 0, 7, 10, 15, 20, and 25 the questionnaires included the question, “How many times in a week or month do you eat breakfast, lunch, or dinner out in a place such as McDonald’s, Burger King, Wendy’s, Arby’s, Pizza Hut, or Kentucky Fried Chicken?” This question was used to calculate the number of times per week that participants ate fast food meals.

- On years 0, 7, and 10 the quality of the non-fast-food portion of their diet was assessed by asking the participants to complete a comprehensive questionnaire about their typical intake of foods over the past month.

- - Diet quality was calculated using something called an alternative Mediterranean diet score because this calculation excludes foods commonly consumed at fast food restaurants. Thus, this calculation specifically measures the quality of the non-fast-food portion of their diet.

- Each of these variables was averaged over the entire timespan of the study and trends (either an increase or decrease over time) were noted.

- The outcomes of the study (belly fat, muscle fat, and liver fat) were measured at the end of the study (year 25) using CT imaging techniques.

2) The authors identified other factors that may have caused fat accumulation and corrected for them. For example:

- Participants with the highest fast food consumption had lower educational level, lower income, poorer non-fast-food diet quality, lower physical activity, lower alcohol intake, higher caloric intake, and were more likely to be male and black.

- Consequently, the data comparing fast food intake with fat accumulation were corrected for age, sex, race, education, income, smoking, alcohol, diet quality, caloric intake, and physical activity.

Is Fast Food Fat Food?

Fast food intake was equally divided into quintiles ranging from “Never to once a month” to “≥ 3 times per week”. When participants with the highest fast food intake over the past 25 years were compared to those with the lowest:

Their belly fat was higher by 48%.

Their muscle fat was higher by 27%

Their liver fat was 5-fold higher.

Their waist circumference (another measure of belly fat) was 11% (4 inches) more.

Their BMI (a measure of obesity) was 15% higher.

The authors concluded, “The results of this analysis robustly demonstrate that middle-aged adults who ate fast food more frequently over the past 25 years have significantly higher odds of MAFLD [fatty liver disease] and IAAT [belly fat]…aligned with poorer current and future cardiometabolic health [heart disease and diabetes] and chronic disease risk.”

What Does This Study Mean For You?

Several previous studies have shown that fast food consumption leads to fat accumulation and/or obesity. However, this is perhaps the best designed study on the effect of fast foods on fat accumulation and obesity to date. This is because:

It measured fast food consumption, non-fast-food diet quality, exercise, and many other lifestyle factors at multiple times during the 25-year study. That way we can be assured we are looking at fast food consumption and other lifestyle choices over the entire 25-year timespan of the study, not just at the beginning or end of the study.

The authors corrected the data for other lifestyle factors known to influence fat accumulation and obesity. Statistical corrections are never perfect, but these authors did their best to make sure the study only measured the effects of fast food consumption on fat accumulation.

Of course, this kind of study shows associations. It does not prove cause and effect. However, since 25-year double blind, placebo-controlled studies are not possible, this is perhaps the best study we may ever have.

That brings me back to your New Year resolutions. If you are like most Americans, you have probably resolved to lose weight and get healthier in past years – only to end the year fatter and less healthy than you started it.

You have probably tried dozens of diets. They worked for a while, but they were difficult to follow long term, and eventually you abandoned them.

My suggestion this year is to forget the crazy diets. Just go for a simple change. Eliminate sodas, fast foods, and convenience foods from your diet. You will lose weight. And you will be healthier. Guaranteed.

Of course, it’s not that simple. Remember that Big Food Inc has designed these foods to be addictive. Unless you have an iron will, you probably won’t be able to go cold turkey.

You may need a gradual approach. Replace sodas, fast and convenience foods one at a time. Find healthier substitutes for each fast food you replace. Then explore more convenient ways to eat healthy. It will be a journey. But the end results will be worth it.

The Bottom Line

Many studies have implicated sodas, fast and convenience foods in obesity and fat accumulation in our bodies. But these studies have all had their flaws.

A recent study looked at the association between fast food intake and 3 kinds of fat (belly fat, muscle fat, liver fat) over 25 years. All 3 kinds of fat are highly associated with metabolic syndrome (prediabetes) and several chronic diseases. More importantly, this study was designed to eliminate many of the flaws in previous studies.

When participants with the highest fast food intake over the past 25 years were compared to those with the lowest:

Their belly fat was higher by 48%.

Their muscle fat was higher by 27%.

Their liver fat was 5-fold higher.

Their waist circumference (another measure of belly fat) was 11% (4 inches) more.

Their BMI (a measure of obesity) was 15% higher.

Simply put, the best thing you can do for your weight and your health this year is to eliminate sodas, fast foods, and convenience foods from your diet. You will lose weight. And you will be healthier. Guaranteed.

For more details 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.

Relief From Knee Pain

January 17, 2023 by Dr. Steve Chaney

What Causes Knee Pain?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Closing Out the Old Year And Starting A New One

I hope that 2022 was kind to you and your family. Covid seemed to come and go, with new strains popping up every time we turned around. What a year!

In December the foods all seemed to be fattening – delicious for sure, but fattening. Which brings me to the topic of the month. Maybe you are trying to walk off some of the extra calories you put on last month.

Walking will help burn the calories, but it can also come with aches and pains from muscles getting used repetitively.

This month I want to focus on the pain you feel on the outside of your knee after several days of walking more than your body is used to. It can reduce your walks to a slow hobble at best. And that isn’t going to burn off any extra calories.

What Causes Knee Pain?

The muscle I want to talk about this month is Tensor Fascia Lata (called TFL for short).

If you make a fist with both hands and then put them on your hips, you are right on top of the TFL. A small muscle, the TFL attaches to a very long tendon called the iliotibial band (ITB).

This tendon is blamed for pain on the outside of your knee, and while it does insert there so it causes pain when it is tight, it’s only tight because of the TFL.

Sounds like you’re going in circles but let me explain.

The TFL is responsible for stabilizing your knee when you are standing on one foot. You don’t think about it, but you are on one foot with every step to take!

You can feel the muscle contract by pressing your fingertips into the muscle on each hip, and then move from one leg to the other. You’ll feel the muscle tighten.

The repetitive movement causes the muscle to shorten, and it pulls up on the ITB. This will cause tension to be put on the insertion point at your knee and causes pain. It will also limit range-of-motion when you are walking.

It’s interesting that most people don’t feel the pain in their hip, but they definitely feel it on the outside of their knee.

Relief From Knee Pain

If you are experiencing pain on the outside of your knee while walking, your Tensor Fascia Lata muscle is probably too tight. Here is how to treat your TFL muscle.

Place the ball as shown in this picture.

Move around a little bit until you find the tight spot. It will be painful.

Only add enough pressure that it “hurts so good,” and then stay there for 30 seconds. Release the pressure. Repeat 2-3 times until it doesn’t hurt.

Zoom Consultations

Almost every month I have been showing you how to do a self-treatment that I’ve developed. And, as you know, I’ve written books that have all the self-treatments, including many that I don’t put into this newsletter.

However, your specific situation my require more than just the basics that I show here in the newsletter.

You can still get help!

I’ve been doing Zoom consultations for several years, and they really work well.

In fact, you get instruction that is specific to your needs, and often I’ll demonstrate the movement, and I always make sure you are doing it correctly.

Work directly with me by going to https://julstromethod.com/product/private-consultation/.

A picture is worth 1000 words – and a Zoom consultation is priceless!

Next Month: Bunion Relief

We’ll be looking at how muscles can pull on the bones that protrude at the base of your big toe and become a bunion.

Wishing you and your family a Healthy and Happy New Year!

Julie Donnelly

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.

Which Diet Is Best For Diabetics?

January 10, 2023 by Dr. Steve Chaney

What Did This Study Show?

Author: Dr. Stephen Chaney

When you were first diagnosed with diabetes, your doctor probably told you that your life will forever be changed. Among other things he or she probably told you that you would need to make some radical changes to your diet.

But what changes? Both the American Diabetes Association (ADA) and Diabetes UK (the British version of ADA) recommend:

An individualized approach. This recognizes that we are all different. What works for some diabetics may not work for others.

A diet that incorporates more non-starchy vegetables and minimizes added sugars and refined grains.

But these recommendations are vague. Most people want a specific diet to follow. It’s here that Diabetes UK and the ADA part ways.

Diabetes UK gives its highest recommendation to the Mediterranean diet.

The ADA gives equal recommendations to the Mediterranean diet and both low-carbohydrate and very-low carbohydrate diets.

But which diet is best? It’s hard to know because most studies compare one of these diets to the standard American diet (SAD), and anything is better than the standard American diet.

Fortunately, one recent study (CD Gardner et al, American Journal of Clinical Nutrition, 116: 640-652, 2022) directly compares the two extremes of ADA-recommended diets, the Mediterranean diet and the Keto diet.

How Was This Study Done?

This study recruited 33 participants with diabetes or prediabetes from the San Francisco Bay area. The participants in the study:

Were between 41 and 77 years old (average age = 60.5).
Were 61% male, 45% non-Hispanic white, and mostly (85%) college educated.
Had either prediabetes (61%) or diabetes (39%).
Had BMIs ranging from 22.7 (normal) to 39.7 (obese) (average BMI = 30 (borderline obese).
Had elevated levels of HbA1c (hemoglobin A1c, a measure of long-term blood sugar control).

People were excluded from the study if they were:

Underweight (<110 pounds) or morbidly obese (BMI ≥40).
Had extremely high cholesterol (LDL cholesterol >190 mg/dL) or blood pressure (>169 mmHg).
On insulin or certain medications to lower blood sugar levels.

This was a randomized, crossover, interventional study. Simply put, that means:

The study started with participants eating a typical American diet. The intervention was either a Keto diet or a Mediterranean diet.

Each patient was randomly assigned to one of the diets for 12 weeks. Then they “crossed over” to the other diet for 12 weeks. In this type of study each patient serves as their own control.

Finally, there was a 12-week follow-up period in which they could choose which of the two diets to follow.

It was a very well-controlled study:

Participants were given detailed guidelines to follow and received weekly individual education sessions by a registered dietitian and certified diabetes educator.

During the first 4 weeks of each diet, participants were provided at no cost all meals and snacks from a local food delivery service.

During the next 8 weeks of each diet, the participants purchased their own foods using the same guidelines they had been given during the first 4 weeks.

- They were also provided with a recipe booklet and suggestions for diet-compliant menu items at local restaurants for each diet.

This was not designed as a weight loss diet. The participants were provided with 2,800 calories of food per day and instructed to eat until they were full.

Compliance with the diet was assessed in three ways:

- During week 4 and week 12 of each diet phase, 3 unannounced 24-hour dietary recalls (2 on weekdays and 1 on a weekend day) were administered over the phone by a trained nutritionist.

- Participants were also given an app to log in their food intake daily.

- Participants on the Keto diet were given blood ketone monitors and strips.

Finally, at the beginning and end of the study and during weeks 4 and 12 of each diet phase participants went to a medical facility for blood work and weight measurements.

The primary focus of this study was measuring the effect of each diet on HbA1c. HbA1c measures blood sugar control over the previous 12 weeks (which is why each diet phase was 12 weeks long). But the study also measured the effect of each diet on LDL cholesterol, HDL cholesterol, and triglycerides.

What Were The Diets Like?

These were not ordinary versions of the Mediterranean and Keto diets:

Sugar and refined flour are often part of the diet in Mediterranean regions. So, this study used the “Mediterranean Plus (Med-Plus)” diet which restricts both sugar and refined grains.

Keto convenience foods are often a witch’s brew of artificial ingredients. So, this study used the “Well-Formulated Keto Diet (WFKD)” which is composed of whole, unprocessed foods. In fact, both diets were whole food diets.

In summary, the two diets were:

Alike in that both emphasized non-starchy vegetables and minimized sugar and refined grains.

Alike in that they were both whole food diets.

Different in that the Keto diet eliminated legumes, fruits, and whole grains while the Mediterranean diet included them.

The macronutrient composition of the two diets was about what you would expect.

	USDA Guidelines	Baseline	Keto (Weeks 1-4)	Keto (Weeks 5-12)	Med (Weeks 1-4)	Med (Weeks 5-12)
Protein	10-35%	18%	25%	22%	19%	21%
Carbs	45-65%	41%	12%	18%	37%	37%
Fat	<30%	41%	63%	60%	44%	42%

The baseline diet was typical of the American diet. It was higher than recommended for fat. While carbohydrate intake appeared to be moderate, it was high in sugar and refined grains.

The Keto and Mediterranean diet interventions were separated into 2 phases. In phase 1 (weeks 1-4) every meal and snack were provided to the participants. In phase 2 (weeks 5-12) they purchased their own food.

As expected, carbohydrate intake was much lower, fat intake much higher, and protein intake slightly higher than baseline for the Keto diet. And this pattern was maintained during the 8 weeks the participants purchased their own food.

Macronutrient composition on the Mediterranean diet was not much different than baseline and did not change much during weeks 5-12.

The fat composition of the two diets was also different.

	Baseline	Keto (Weeks 1-4)	Keto (Weeks 5-12)	Med (Weeks 1-4)	Med (Weeks 5-12)
Monounsaturated	42%	48%	43%	52%	45%
Polyunsaturated	23%	15%	19%	23%	25%
Saturated	35%	37%	38%	25%	30%

The Keto diet was significantly lower in percent polyunsaturated fat and slightly higher in percent monounsaturated and saturated fat than baseline (the typical American diet) in weeks 1-4. However, remember that the Keto diet was 50% higher in total fat than the other diets. This makes it significantly higher in saturated fat than either the baseline or Mediterranean diets.

As expected, the Mediterranean diet was significantly higher in percent monounsaturated fat and lower in percent saturated fat than baseline in weeks 1-4.

Not surprisingly, both diets trended towards the baseline diet in the 8 weeks participants were buying their own food.

Other interesting differences between the two diets:

The Keto diet contained around 12% plant protein and 88% animal protein, while the Mediterranean diet contained about 50% of each.

Fiber intake decreased by 33% compared to baseline on the Keto diet, while fiber intake increased by 50% on the Mediterranean diet.

In terms of nutritional adequacy, the Keto diet was significantly lower in fiber, vitamin C, folate, and magnesium than the Mediterranean diet.

What Did The Study Show?

1. Participants consumed around 300 fewer calories/day and lost about 15 pounds on both diets.

- The authors speculated this was because both diets were more filling than the baseline diet, presumably because both diets were whole food diets while the baseline diet contained lots of processed foods high in sugar and refined grains.

2) Both diets reduced HbA1c (a cumulative measure of how much the diets improved blood sugar control compared to the baseline diet) by about the same extent.

3) LDL cholesterol (bad cholesterol) increased by about 10% on the Keto diet, while it decreased by about 9% on the Mediterranean diet. This difference was highly significant.

4) HDL cholesterol increased by about the same extent on both diets.

5) Triglycerides decreased by around 20% on the Keto diet and by 10% on the Mediterranean diet. This difference was also highly significant.

6) Finally, adherence to the Keto diet was less than for the Mediterranean diet. Plus, more people chose the Mediterranean diet during the follow-up phase when they were allowed to choose their own diet.

The authors concluded, “HbA1c values…improved from baseline on both diets, likely due to several shared dietary aspects. The WFKT [Keto diet] led to a greater decrease in triglycerides, but also had untoward risks from elevated LDL cholesterol and lower nutrient intakes from avoiding legumes, fruits, and whole, intact grains, as well as being less sustainable [easy to follow long-term].

Which Diet Is Best For Diabetics?

Once again, I have covered lots of information in this blog. But if you are diabetic, you are probably wondering, “What does this mean for me?” Let me start by reviewing the purpose of this study.

This study was designed to compare the two extremes of recommended diets (Mediterranean and Keto) with respect to their effectiveness at keeping blood sugar under control.

These were both more restrictive versions of the two diets than most people follow. In this study, both diets:

- Were whole food diets. No sodas, processed, or convenience foods were allowed.

- Minimized the consumption of sugars and refined grains.

Now let me divide the discussion into two sections:

Which diet is best for diabetics in the short term (in this case, 12 weeks)?

- Participants consumed 300 fewer calories and lost about 15 pounds on both diets in spite of being given more than they could eat and not being encouraged to lose weight.

- - The authors attributed this to whole food diets being more filling.

- - However, it is also consistent with my contention that any restrictive diet will lead to short-term weight loss and improvement in blood sugar control. I summarize the 5 reasons for this phenomenon in last week’s “Health Tips From the Professor” article

- Blood sugar control over 12 weeks, as measured by HbA1c, improved by the same amount on both diets.

- - That is consistent with the American Diabetes Association’s position that a variety of diets, ranging from Mediterranean to Keto, are suitable for diabetics.

- - This also means that you can forget the advice that diabetics need to follow a low carb diet and give up fruits, whole grains, and legumes to keep their blood sugar under control.

- - However, this is not a “get out of jail free card”. Diabetics do need to avoid sodas, processed, and convenience foods and minimize sugar and refined grains.

- There was considerable individual variability. Some people did better on the Mediterranean diet. Others did better on the Keto diet.

- This is consistent with the American Diabetes Association’s recommendation that diabetic diets should be individualized.

In short, this study suggests that in the short term (12 weeks) the Med-Plus and WFKD Keto diets are equally effective at promoting weight loss and improved blood sugar control for both diabetics and prediabetics.

However, there is considerable individual variability, meaning that diabetics can chose the diet that works best for them.

2) Which diet is best for diabetics in the long term?

If both diets are equally effective short term, the important question becomes whether they are equally successful and equally healthy long term.

As noted in the author’s conclusion, this study raised several “red flags” which suggest the Keto diet might be less successful and less healthy long term. But this is a short-term study.

You may be wondering, “What do long-term studies show?” Unfortunately, there are very few long-term studies to guide us. But here is what we do know.

- There are multiple studies showing that the Mediterranean diet reduces the risk of diabetes, heart disease, and some cancers long term. There is no evidence that meat-based low carb diets are healthy long term. This includes the Atkins diet, which has been around more than 50 years.

- A 6-year study reported that the group with the lowest carbohydrate intake had an increased risk of premature death – 32% for overall mortality, 50% for cardiovascular mortality, 51% for cerebrovascular mortality, and 36% for cancer mortality.

- A 20-year study reported that women consuming a meat-based low carb diet for 20 years gained just as much weight and had just as high risk of diabetes and heart disease as women consuming a high carbohydrate, low fat diet.

In short, the few long-term studies we do have suggest that the Mediterranean diet is a better choice for long-term health and reduced risk of diabetes than low-carb diets.

The Bottom Line

If you are diabetic or prediabetic, the American Diabetes association recommends a diet that is individualized and ranges from Mediterranean to low carb and very low carb (Keto).

However, low carb and Keto enthusiasts insist that diabetics need to follow a low carb or very low carb diet. And that seems to make sense. After all, aren’t carbs the problem for diabetics?

To resolve this question, a recent study was designed to compare the two extremes of the ADA-recommended diets (Mediterranean and Keto) with respect to their effectiveness at keeping blood sugar under control.

These were not ordinary versions of the Mediterranean and Keto diets:

Sugar and refined flour are often part of the diet in Mediterranean regions. So, this study used the “Mediterranean Plus (Med-Plus)” diet which restricts both sugar and refined grains.

Keto convenience foods are often a witch’s brew of artificial ingredients. So, this study used the “Well-Formulated Keto Diet (WFKD)” which is composed of whole, unprocessed foods. In fact, both diets were whole food diets.

In short, this study found that in the short term (12 weeks) the Med-Plus and WFKD Keto diets are equally effective at promoting weight loss and improved blood sugar control for both diabetics and prediabetics.

If both diets are equally effective short term, the important question becomes whether they are equally successful and equally healthy long term.

As noted in the author’s conclusion, this study raised several “red flags” suggesting that the WFKD Keto diet may be less successful and less healthy long term than the Med-Plus diet. However, this was a short-term study.

So, the question becomes, “What do long-term studies show?” There are few long-term studies of low-carb diets, but the few long-term studies we do have suggest that the Mediterranean diet is a better choice for both long-term health and reduced risk of diabetes than most low-carb diets.

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

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