Dr. Steve Chaney

Is Your Doctor’s Advice Based On Good Science?

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You Need To Be Your Health Advocate

Author: Dr. Stephen Chaney 

ProfessorI taught medical students for 40 years. During that time, I did my best to emphasize the importance of basing their practice on “evidence-based medicine”. So, it broke my heart when I saw recent headlines claiming that more than 90% of healthcare interventions (drugs and medical procedures) were not based on high-quality evidence.

Even worse, the headlines claimed that the harm caused by healthcare interventions was not adequately investigated and may, therefore, be under-reported.

When I saw these headlines, I knew I had to investigate further to see if the claims were true and report what I found to you, my readers.

I would not have been surprised by headlines claiming that some healthcare interventions were based on low-quality evidence. For example:

  • Hormone replacement therapy was widely prescribed to manage menopause symptoms until it was discovered to increase the risk of breast cancer. Since then, the hormones used have been reformulated, it is only recommended for severe menopause symptoms, and only for the shortest possible time.
  • Antiarrhythmic drugs were widely prescribed to reduce mortality from heart attacks until a placebo-controlled trial showed they actually increased mortality.
  • A drug called oseltamivir was widely prescribed for the flu until a systematic review of clinical studies showed it was ineffective.

But I, like many of my colleagues, assumed that these cases were rare. However, recent reviews have called this assumption into question. But most of those reviews had a small sample size or did not adequately evaluate the quality of the studies included in the review.

The study (J Howick et al, Journal of Clinical Epidemiology, 148: 160-169, 2022) behind these headlines was designed to avoid those limitations and provide a more accurate estimate of the percentage of clinical interventions that are based on high-quality evidence.

It evaluated 1,567 healthcare interventions that had been studied in Cochrane Reviews, which are considered the gold-standard of evidence-based medicine (I will describe Cochrane Reviews in more detail below, so you can appreciate why they are considered the gold standard).

What Is A Cochrane Review?

certifiedAt this point you are probably wondering what the Cochrane Review is and why it is considered the gold standard of evidence-based medicine. I have covered this in previous articles. But I am not expecting you to remember it (I never told you there would be a quiz). So, I will repeat the information here.

The Cochrane Collaboration consists of 30,000 volunteer scientific experts from across the globe whose sole mission is to analyze the scientific literature and publish reviews of health claims so that health professionals, patients, and policy makers can make evidence-based choices about health interventions.

The Cochrane Collaboration reviews all the relevant studies on a topic, exclude those that are biased or weak, and make their recommendations based on only the strongest studies. They use a systematic approach called GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) that has been endorsed by over 100 organizations worldwide to assess the quality of the studies. The scientists writing Cochrane Reviews are trained in how to use the GRADE evaluation system before they are allowed to write a review.

In one sense, Cochrane reviews are what is called a “meta-analysis”, in which data from numerous studies are grouped together so that a statistically significant conclusion can be reached. However, Cochrane Collaboration reviews differ from most meta-analyses found in the scientific literature in a very significant way.

Many published meta-analyses simply report “statistically significant” conclusions. However, statistics can be misleading. As Mark Twain said: “There are lies. There are damn lies. And then there are statistics”.

The problem is that the authors of most meta-analyses group studies together without considering the quality of studies included in their analysis. This creates a “Garbage In – Garbage Out” effect. If the quality of individual studies is low, the quality of the meta-analysis will also be low. Simply put, the conclusions from some published meta-analyses are not worth the paper they are written on.

The Cochrane Collaboration also reports statistically significant conclusions from their meta-analyses. However, they also carefully consider the quality of each individual study in their analysis based on the GRADE system. They look at possible sources of bias. They look at the design and size of the studies. Finally, they ask whether the conclusions are consistent from one study to the next. They clearly define the quality of evidence that backs up each of their conclusions as follows:

  • High-quality evidence.Further research is unlikely to change their conclusion. This is generally reserved for conclusions backed by multiple high-quality studies that have all come to the same conclusion.
  • Moderate-quality evidence.This conclusion is likely to be true, but further research could have an impact on it.
  • Low-quality evidence.Further research is needed and could alter the conclusion. They are not judging whether the conclusion is true or false. They are simply saying more research is needed to reach a definite conclusion.

Now perhaps you understand why Cochrane Reviews are considered the gold standard of evidence-based medicine.

How Was This Study Done?

The authors started with 6928 reviews that compared a healthcare intervention with either a placebo or no intervention between January 1, 2008, and March 5, 2021. They then randomly selected 1,567 reviews for this study. They asked the following 3 questions for each Cochrane Review:

  • Was the evidence for a positive outcome high-quality, as rated by the GRADE system?
  • Were the results statistically significant?
  • Did the review authors consider the intervention to be effective?

Is Your Doctor’s Advice Based On Good Science?

Doctor With PatientAs I said earlier, the results were unnerving to say the least. When the authors applied their 3 criteria to the 1,567 Cochrane Reviews they found:

  • Only 10% of the medical interventions (drugs and medical procedures) were supported by high-quality evidence.
    • In other words, 90% of the time the evidence wasn’t good enough to determine whether the intervention worked or not.
  • Only 6.8% of the interventions studied had a positive, statistically significant outcome.
  • Only 5.6% of the medical interventions studied were judged to be effective by the Cochrane Review authors.
  • The harm of medical interventions was poorly studied. Only 36.8% of clinical interventions were evaluated for potential harms of the intervention, and most of those data were of low quality.
    • Of the Cochrane Reviews that evaluated potential harms, there was evidence of statistically significant harm in 22% of the interventions.

The authors concluded,

“Using rigorous methods for judging quality of evidence, more than 9 in 10 healthcare interventions studied within Cochrane Reviews do not have high-quality evidence to support their effectiveness and safety. This probably can be remedied by high-quality studies in priority areas.”

“Potential harms of healthcare interventions were measured more rarely than benefits…These studies should measure harms as rigorously as benefits.”

“Practitioners and the public should be aware that most frequently used interventions are not supported by high-quality evidence.”

Putting This Study Into Perspective 

SkepticI should start by saying that this study does not reflect poorly on your doctor. They have your best interest in mind, and they are doing their best to keep up with a constantly changing medical landscape.

In most cases, the advice your doctor gives you is based on clinical guidelines issued by medical societies and government agencies. This study is an indictment of those agencies for not evaluating the quality of the clinical studies used to formulate their clinical guidelines.

With that out of the way, it is fair to ask whether criteria these authors used were too strict. And, in fact, the authors gave this quite a bit of thought. Here are some of the questions the authors asked.

  1. Were the authors of the Cochrane Reviews biased in their evaluation? While you can never eliminate the possibility of bias:
    • The Cochrane Collaboration puts a great deal of effort into training reviewers in how to use the GRADE system without bias.
    • If the opinions of the review authors were removed as a criterion, it would have a minimal impact on the outcome of this study. As reported above, only 6.8% of healthcare interventions had a positive outcome that was supported by high-quality data.

2) Is the GRADE system for evaluating the quality of clinical studies too stringent? The authors considered this possibility, but:

    • Prior to GRADE individual meta-analyses used different methods to evaluate the quality of clinical studies, so it was difficult to compare the conclusions of these meta-analyses.
    • The GRADE system was designed, evaluated, and accepted by top experts around the world to unify how the quality of clinical studies is evaluated.
    • This study found that only 30% of the healthcare interventions were supported by even moderate quality evidence according to GRADE. In other words, even when less stringent standards are used, a high percentage of healthcare interventions may be ineffective.

3) Does relying solely on Cochrane Reviews underrepresent the percentage of healthcare interventions based on high-quality evidence?

    • Cochrane Reviews are primarily undertaken for interventions that are controversial and/or a least one major study suggests the intervention may be ineffective or harmful. Since Cochrane Reviews are less likely to have been conducted on well-established, non-controversial healthcare interventions, it is possible that this study underrepresented the percentage of healthcare interventions backed by high-quality studies.
    • However, a recent study that did not use Cochrane Reviews or the GRADE system concluded that only 22% of healthcare interventions were likely to be beneficial. Once again, even when less stringent standards are used, a high percentage of healthcare interventions may be ineffective.

However, the authors did point out that there may be situations in which high-quality evidence is not needed to recommend a particular healthcare intervention. For example, when inaction leads to dire consequences and there are no other treatment options, a healthcare intervention supported by moderate or low-quality evidence might be preferable to no action at all.

You Need To Be Your Health Care Advocate 

questionsYou are probably wondering what this study means for you. Unfortunately, the authors of this study did not provide a list of healthcare interventions that were not supported by high-quality evidence. So, I can’t provide you with a list of interventions to avoid.

At one point, the authors of this study said, “Patients, doctors, and policy makers should consider the lack of high-quality evidence supporting the benefits and harms of many interventions in their decision-making.” However,

  • Doctors are very busy. They don’t have time to read and evaluate the quality of clinical studies. They rely on the clinical guidelines issued by policy makers (medical societies and government agencies).
  • Policy makers don’t like to admit they were wrong and are very slow to revise their clinical guidelines.

That means you must be the advocate for your health. I’m not suggesting that you question every recommendation your doctor makes. However, you should research major healthcare interventions and discuss the pros and cons with your physician.

  • Dr. Google can be wildly inaccurate, but it is a place to start. You can look up the side effects of drugs your doctor is recommending, downsides of medical treatments they are recommending, and/or other treatment options for your medical condition. I like to focus on reliable sites such as the Cleveland Clinic, Mayo Clinic, and the NIH. WebMD is often, but not always, a reliable source.
  • Ask other health professionals about alternative approaches and/or other doctors they may recommend for your condition. Ask friends who have had the same condition what medical interventions worked for them and if they have other doctors they recommend.
  • Then discuss some of these with your doctor. He or she should be willing to discuss the pros and cons of their recommendations and alternate approaches. If not, ask for a second opinion or consult other doctors.

Of course, you should always be open to the possibility that no other good options exist, and some intervention is essential. I’m just suggesting you evaluate your options fully and discuss them with your doctor before starting any major healthcare intervention.

The Bottom Line 

A recent study evaluated quality of clinical studies supporting many common healthcare interventions (drugs and medical treatments). The study found that:

  • Only 5.6% of healthcare interventions studied were supported by high-quality evidence.
  • This study is not an outlier. Previous studies have come to similar conclusions.
  • The evidence of harms caused by healthcare interventions has not been adequately studied and could be as high as 22%.

As someone who taught the importance of evidence-based medicine to medical students for 40 years, I was appalled by this finding. And as patients trying to navigate the medical system, you should be appalled as well.

The authors of this study said, “Patients, doctors, and policy makers should consider the lack of high-quality evidence supporting the benefits and harms of many interventions in their decision-making.” However,

  • Doctors are very busy. They don’t have time to read and evaluate the quality of clinical studies. They rely on the clinical guidelines issued by policy makers (medical societies and government agencies).
  • Policy makers don’t like to admit they were wrong and are very slow to revise their clinical guidelines.

That means you must be the advocate for your health. I’m not suggesting that you question every recommendation your doctor makes. However, you should research major healthcare interventions and discuss the pros and cons with your physician.

For more details on this study and my discussion of how you can research major healthcare interventions recommended by your doctor, read the article above.

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

Does Magnesium Protect Your Heart?

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Do You Need A Magnesium Supplement?

Author: Dr. Stephen Chaney 

Getting an adequate amount magnesium from our diet should not be a problem. Magnesium is found in a wide variety of foods with the best sources being legumes (beans), nuts, seeds, whole grains, green leafy vegetables, and dairy foods.

The problem is:

  • None of these foods contain enough magnesium by themselves to provide the RDA (420 mg/day for men and 320 mg/day for women) for magnesium. We need to consume a variety of these foods every day – something most Americans aren’t doing.
  • These foods are decent sources of magnesium only in their unprocessed form. And most Americans consume more highly processed foods than whole, unprocessed foods.
  • Two to three servings of dairy provide a decent amount of magnesium, but many Americans are cutting back on dairy. And plant-based dairy substitutes often provide much less magnesium than the dairy food they replace.
  • Finally, green leafy vegetables (iceberg lettuce doesn’t count) don’t make it into the American menu as often as they should.

As a result, recent studies find that at least 50% of Americans are not getting enough magnesium in their diet. In fact, the average magnesium intake in this country is 268 mg/day for men and 234 mg/day for women. And the figures are not very different in other developed countries.

Does it matter? Recent studies have shown that an adequate intake of dietary magnesium is associated with lower risks of cardiovascular diseases (CVD) and all-cause mortality. This may be because of the of role of magnesium in supporting heart muscle contraction, normal heart rhythm, and blood pressure regulation. Adequate magnesium intake is also associated with lower risk of type 2 diabetes.

But what if you have already had a heart attack? Is it too late for magnesium to make a difference? A recent study (I Evers et al, Frontiers in Cardiovascular Medicine, August 12, 2022) was designed to answer this question.

The authors examined the effect of magnesium intake on cardiovascular disease (CVD) mortality, all-cause mortality, and coronary heart disease (CHD) mortality in patients who had experienced a recent heart attack.

[Note: CHD is defined as heart disease due to clogged coronary arteries, such as a heart attack. CVD includes CHD plus diseases caused by other clogged blood vessels, such as strokes and peripheral artery disease].

How Was The Study Done?

clinical studyThe authors used data from a previous study that had enrolled 4,365 Dutch patients aged 60-80 (average age = 69) who had experienced a heart attack within approximately 4 years prior to enrollment and followed them for an average of 12.4 years. All patients were receiving standard post-heart attack drug therapy.

The characteristics of the patients enrolled in the study were as follows:

  • Male 79%, female 21%
  • Average magnesium intake = 302 mg/day
  • Percent magnesium deficient: 72% of men and 67% of women
  • Percent taking magnesium supplements = 5.4%
  • Percent on drugs to lower blood pressure = 90%
  • Percent on statins = 86%
  • Percent on diuretics = 24%

Upon entry into the study the patients were asked to fill out a 203-item food frequency questionnaire reflecting their dietary intake over the past month. Trained dietitians reviewed the questionnaires and phoned the participants to clarify any unclear or missing items. The questionnaires were linked to the 2006 Dutch Food Composition Database to calculate magnesium intake and other aspects of their diets.

The patients were divided into 3 groups based on their energy adjusted magnesium intakes and those in the highest third (>322 mg/day) were compared to those in the lowest third (<238 mg/day) with respect to cardiovascular disease (CVD), all-cause mortality, and coronary heart disease (CHD) mortality.

The comparisons were statically adjusted for fiber intake (most magnesium-rich foods are also high fiber foods), diuretic use (diuretics reduce magnesium levels in the blood), age, sex, smoking, alcohol use, physical activity, obesity, education level, caloric intake, calcium, vitamin D, sodium from foods, potassium, heme iron, vitamin C, beta-carotenoids, polyunsaturated fatty acids, saturated fatty acids, overall diet quality based on the Dutch Dietary Guidelines, systolic blood pressure, kidney function, and diabetes. In other words, the data were adjusted for every conceivable variable that could have influenced the outcome.

Does Magnesium Protect Your Heart?

When those with the highest magnesium intake (>322 mg/day) were compared to those with the lowest intake (<283 mg/day):

  • Cardiovascular disease (CVD) mortality was reduced by 28%.
  • All-cause mortality was reduced by 22%.
  • Coronary heart disease (CHD) mortality was reduced by 16%, but that reduction was not statistically significant.

They then looked at the effect of some variables that might affect CVD risk on the results.

  • Diabetes, kidney function, iron intake, smoking, alcohol use, blood pressure, most dietary components and overall diet quality had no effect on the results.
  • The results were also not affected when patients using a magnesium supplement were excluded from the analysis. This suggests the effect of magnesium from diet and supplementation is similar.
  • However, diuretic use had a significant effect on the results.
    • For patients using diuretics, high magnesium intake versus low magnesium intake reduced CVD mortality by 45%.

How Much Magnesium Do You Need?

Question MarkYou may have noticed that the difference between the highest magnesium intake group and the lowest intake group was, on average, only 39 mg/day. So, the authors also used a statistical approach that utilized data from each individual patient to produce a graph of magnesium intake versus risk of CVD, total, and CHD mortality. For all 3 end points the graphs showed an inverse, linear relationship between magnesium and mortality.

From this, the authors were able to calculate the effect of each 100mg/day increase in magnesium intake on mortality risk. Each 100mg/day of added magnesium reduced the risk of:

  • CVD mortality by 38%.
  • All-cause mortality by 30%.
  • CHD mortality by 33%, and these results were borderline significant.

The inverse relationship between magnesium intake was observed at intakes ranging from around 200 mg/day to around 450 mg/day, which represented the range of dietary magnesium intake in this Dutch population group.

This study did not define an upper limit to the beneficial effect of magnesium intake because the graphs had not plateaued at 450 mg/day, suggesting that higher magnesium intakes might give even better results.

The authors concluded, “We observed a strong, linear inverse association of dietary magnesium with CVD and all-cause mortality after a heart attack, which was most pronounced in patients who used diuretics. Our findings emphasize the importance of an adequate magnesium intake in CVD patients, on top of cardiovascular drug treatment.”

I might add that this is the first study to look at the effect of magnesium on long-term survival after a heart attack.

Do You Need A Magnesium Supplement? 

magnesium supplements benefitsAs I said earlier, the best dietary sources of magnesium are beans, nuts, seeds, whole grains, green leafy vegetables, and dairy foods. And:

  • None of these foods contain enough magnesium by themselves to provide the RDA (420 mg/day for men and 320 mg/day for women) for magnesium.
  • These foods are decent sources of magnesium only in their unprocessed form.

When unprocessed, each of these foods provides 20 to 60 mg of magnesium per serving. If we use an average value of 40 mg/serving, you would need in the range of 8-10 servings/day of these foods in their unprocessed form to meet the RDA for magnesium.

You could get a more accurate estimate of the magnesium content of your diet using the “Magnesium Content of Selected Foods” table from the NIH Factsheet on Magnesium.

Now you are ready to ask yourself two questions:

  1. Does my current diet provide the RDA for magnesium?

2. If not, am I willing to make the dietary changes needed to increase my magnesium levels to RDA levels?

If your answer to both questions is no, you should probably consider a magnesium supplement. A supplement providing around 200 mg of magnesium should bring all but the worst diets up to the recommended magnesium intake.

The current study did not define an upper limit for the beneficial effect of magnesium on survival after a heart attack but suggested that intakes above 450 mg/day might be optimal.

I do not recommend megadoses of magnesium, but intakes from diet and supplementation that slightly exceed the RDA appear to be safe. In their Magnesium Factsheet, the NIH states, “Too much magnesium…does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine.”

The only concern is that magnesium from supplements is absorbed much more rapidly than magnesium from foods, and this can cause gas, bloating, and diarrhea in some individuals. For this reason, I recommend a sustained release magnesium supplement, so the magnesium is absorbed more slowly.

Finally, we should not consider magnesium as a magic bullet. The current study statistically eliminated every known variable that might affect survival after a heart attack, so it could estimate the beneficial effects of magnesium alone.

However, survival after a heart attack will likely be much greater if diet, exercise, and body mass are also optimized.

The Bottom Line 

Recent studies have shown that an adequate intake of dietary magnesium is associated with lower risks of cardiovascular diseases (CVD) and all-cause mortality.

But what if you have already had a heart attack? Is it too late for magnesium to make a difference? A recent study of heart attack patients in Holland was designed to answer this question.

The authors examined the effect of magnesium intake on cardiovascular disease (CVD) mortality, all-cause mortality, and coronary heart disease (CHD) mortality in patients who had experienced a recent heart attack.

When heart attack patients with the highest magnesium intake (>322 mg/day) were compared to those with the lowest intake (<283 mg/day):

  • Cardiovascular disease (CVD) mortality was reduced by 28%.
  • All-cause mortality was reduced by 22%.
  • Coronary heart disease (CHD) mortality was reduced by 16%, but that reduction was not statistically significant.

The authors went on to look at the inverse linear relationship between magnesium intake and mortality risk. They found that each 100mg/day of added magnesium reduced the risk of:

  • CVD mortality by 38%.
  • All-cause mortality by 30%.
  • CHD mortality by 33%, and these results were borderline significant.

The authors concluded, “We observed a strong, linear inverse association of dietary magnesium with CVD and all-cause mortality after a heart attack…Our findings emphasize the importance of an adequate magnesium intake in CVD patients…”

I might add that this is the first study to look at the effect of magnesium on long-term survival of patients who have suffered a heart attack.

For more details on this study and my discussion of whether you might benefit from a magnesium supplement, 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.

Carpal Tunnel Pain Relief Without Surgery

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How To Release Tight Muscles That Cause Carpal Tunnel

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Fall, Glorious Fall

I love Florida, but I must say I really miss the changing of the leaves like I enjoyed when I lived in New York.  October was magical!  The trees painting a picture of red, gold, maroon, yellow, and green, and the smells that are so familiar to anyone who has ever lived in the north.

Fires burning to heat chilly homes, apple cider, baking pies and cookies because we could get back into the kitchen as the weather cooled down.  And of course, Halloween.

The world has changed so much.  Remember how we could go out in costume with our friends, no adults needed, and go from door to door, shouting “Trick or Treat!”  We’d come home with a pillowcase (or plastic pumpkin) filled with candy.  Such sweet memories.

In Florida we are entering our most wonderful time of year. It’s starting to get cooler, the humidity is going down, and hurricane season is almost over. Hooray!  It’s great to be outdoors again!

Carpal Tunnel Syndrome – It’s Not Just In Your Wrist

In 1997 I learned a serious consequence of having carpal tunnel syndrome – I had to shut down my therapy practice. I went to doctors, physical therapy, and massage, yet nothing worked. The pain just kept getting worse.

I couldn’t pick up a pen or open a door.  I couldn’t work. What would you do if suddenly you couldn’t use your hand because the pain was so great?

Happily, I was able to figure out which muscles were actually causing the problem, and after releasing the tension I was quickly out of pain.

It’s complicated, but incredibly logical.

The Symptoms Of Carpal Tunnel Syndrome (CTS)

carpal tunnel syndromeFor me, it eventually felt like someone was cutting my wrist with a razor blade, and I couldn’t even pick up a pencil or hold a glass.

If you’re like me, your symptoms came on slowly.  I had a twinge, like an electric shock in my wrist or fingers.  Nothing serious and I’d just shake it off.  Perhaps you’ve done the same thing.

Gradually it happened more frequently, and the intensity increased.  I was heading into a problem that almost ended my career.

While I was told I had CTS and I needed to have surgery, I knew that scar tissue would grow over the median nerve, and I could end up in worse condition than where I was already.

I was forced by necessity to find a solution. I concentrated on the path of the median because it is this nerve that is key to carpal tunnel syndrome.

The Median Nerve Pathway

It all starts with pressure on the median nerve.

 

The median nerve starts in your neck, innervating your arm and hand. When it is pressed upon it will cause burning and numbness somewhere along its path, especially into your wrist, thumb and first two fingers.

The Opponens Pollicis Muscle

The nerve passes under and through several arm muscles, through the carpal tunnel in your wrist, and finally a muscle of your thumb called the opponens pollicis muscle impinges on the nerve.

The tight muscles entrap the median nerve, but they also put a strain on your wrist and hand.  The analogy I use is pulling your hair and your scalp hurts. In the same way, the muscle pulls on the insertion points on your wrist and hand, and you feel pain.

I’m not trying to make anyone a muscular therapist, so I’m not mentioning the Latin names.  If you have the symptoms of carpal tunnel syndrome, and if you’re interested and would like more information, please contact me.

My experience showed me that I had to treat each muscle from my neck to my hand several times every day. My clients were the catalyst for my sharing the self-treatment process that has reversed the symptoms of CTS for hundreds of people over the years.

One Treatment That Helps

There are six muscle groups that need to be treated for the release of the median nerve.

As I worked on myself, I discovered how they all needed to be fully released or the relief was temporary.  Then again, at that point I welcomed any relief, regardless of how short-lived.

The following treatment is for the muscle of your thumb, called “opponens pollicis.” This muscle pulls your thumb into the center of your palm.

An important factor is the muscle originates on the ligament that goes across the top of the carpal tunnel. When it gets tight it is pulling hard on the ligament and it presses down onto the median nerve.  This causes your thumb and first two fingers to go numb.

Bend your middle finger of the working hand.

Press the knuckle into the thick muscle at the base of your thumb.

Close the fingers of the hand you are treating so you can direct your thumb. This is an important step, or your knuckle will keep flipping over the muscle.

Move deeply in a direction that goes from your thumb to the middle of your wrist.

If you find as especially painful point, stay on it for 15-30 seconds.

 

How To Release Tight Muscles That Cause Carpal Tunnel

As I mentioned above there are six muscle groups that need to be treated to release the tension on the median nerve.

I realized that the only people who were benefiting from the treatment I developed were people who lived no more than 25 miles away from my office.

As a result, I hired a videographer and asked Zev Cohen, MD to join with me to explain the entire process.  It’s easy to do as you watch the DVD (also available as an MP4) and use the specialized tool I developed since many people can’t do it the way I did it for myself.

There’s also a workbook with still pictures of all the    treatments, and a chart that shows exactly where to press.

Carpal tunnel syndrome can seriously alter your day-to-day living!  Yet it can be reversed in as little time as one-hour!

Please share this information with anyone you know who is suffering from hand/wrist pain and numbness.

For more information go to: https://julstromethod.com/cts/

Coming In November

Foot pain can stop you in your tracks, regardless of whether you are a runner, or you just like to stroll along a garden path.

The discussion in November will be about foot pain that is diagnosed as plantar fasciitis.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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

Can Tomatoes Be Engineered To Produce Vitamin D3?

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The Good And Bad Of Genetically Modified Foods

Author: Dr. Stephen Chaney 

GM FruitsThe Floodgates have been opened. The USDA has just approved a genetically engineered purple tomato that contains the anthocyanins found in blueberries, blackberries, and eggplant. It could be appearing in your supermarkets as early as next spring.

And that is just the beginning. Several other genetically modified tomatoes are waiting in the wings. One example is a tomato that has been genetically engineered to produce vitamin D3 (J Li et al, Nature Plants, 8: 611-616, 2022).

“Why would you want that?”, you might ask. The rationale is simple:

  • And vitamin D insufficiency is not a trivial matter. In the words of the authors, in addition to bone health, vitamin D insufficiency “impacts immune function and inflammation and is associated with increased risk of…cancer, Parkinson’s disease, depression, neurocognitive decline, dementia, and the risk of coronavirus disease…”
  • Add to that the fact that tomatoes are grown and consumed in more than 170 countries worldwide. The authors felt that increasing the vitamin D content of tomatoes could be a simple and effective way to improve the vitamin D status of millions of people around the world.

In their own words, “We have developed a new dietary source of vitamin D in plants to meet the increasing demand for ways to address vitamin D insufficiency, which is of particular relevance to those adopting plant-rich, vegetarian or vegan diets.”

But is that true and is it safe? That is the topic of today’s health tip. But before I cover those topics, I should give you some background on vitamin D metabolism in humans and in plants.

Metabolism 101: Vitamin D Metabolism In Humans & Plants

7-dehydrocholesterol is the precursor to vitamin D3 in both humans and plants, but the amount of 7-dehydrocholesterol and the metabolic pathways producing it are very different.

Human Vitamin D3 Metabolism:

  • In humans, cholesterol is the precursor to 7-dehydrocholesterol. About 70% of cholesterol is synthesized by the liver, with the remaining 30% coming from our diet.
  • 7-dehydrocholesterol is synthesized from cholesterol in the epidermis (outer layer) of our skin. It is present in large amounts there but is present in only small amounts in the rest of the body.
  • UVB light is a component of sunlight, and UVB light drives the conversion of 7-dehydrocholesterol into vitamin D3 in our skin.

Plant Vitamin D3 Metabolism:

  • In plants, the pathway is reversed. 7-dehydrocholesterol is synthesized from other plant sterols. And 7-dehydrocholesterol is converted to cholesterol.
  • Cholesterol, in turn, is used to synthesize glycoalkaloid compounds that protect the plants from pests.
    • The gylcoalkaloids differ from plant to plant. In tomatoes the major ones are α-tomatine and esculeoside A and B.
    • α-tomatine and esculeoside A and B protect tomatoes from fungal, microbial, insect, and herbivoral attack.
  • Normally, 7-dehydrocholesterol and cholesterol present in very low amounts in plants because they are used to synthesize protective glycoalkaloid compounds.
  • UVB light is still required to convert 7-dehydrocholesterol to vitamin D3.

Can Tomatoes Be Engineered To Produce Vitamin D3?

Using modern genetic engineering techniques, the authors knocked out (deleted) the gene coding for the protein responsible for converting 7-dehydrocholesterol to cholesterol in tomatoes (shown as the red X in the figure above).

TomatoesIn the fruit:

  • 7-dehydrocholesterol levels are undetectable in ripe fruit of the wild-type tomato but were substantial in fruit of mutant tomatoes lacking the gene for converting 7-dehydrocholesterol to cholesterol.
  • As expected, levels of α-tomatine and esculeoside A and B were substantially lower in the fruit of mutant plants.
  • 7-dehydrocholesterol was evenly distributed in the skin and flesh of the fruit, which limited the ability of UVB light to convert all the 7-dehydrocholesterol to vitamin D3.
  • Even so, a one-hour exposure of the fruit to UVB light produced about 2 μg of vitamin D3 in a medium sized tomato.
    • That is equivalent to the vitamin D3 found in two eggs or 6 ounces of tuna, which are both recommended sources of vitamin D3.
    • The only non-fortified foods that are better sources of vitamin D3 are salmon and trout, which provide about 15 μg of vitamin D3 in a 3-ounce serving
  • The authors further speculated that the vitamin D3 content could be increased even more by:
    • Cutting the fruit into slices and air drying them in sunlight.
    • Removing the gene that produces UV-protecting chalcones in the skin of the fruit, thus allowing UVB light to penetrate further into the fruit. This is typical thinking by some of my scientific colleagues. If one mutation is good, two or more would be even better.

The authors concluded, “We have developed a new dietary source of vitamin D in plants to meet the increasing demand for ways to address vitamin D insufficiency”

In the leaves:

  • Qualitatively, the results were similar to those seen with the fruit.
    • 7-dehydrocholesterol levels were very low in the wild-type tomato but were substantially increased in the mutant tomatoes.
    • Levels of α-tomatine and esculeoside A and B were substantially lower in the leaves of the mutant plants.
  • Quantitatively, however, the results were different.
    • The amounts of 7-dehydrocholesterol were 300 to 600-fold higher in the leaves than in the ripe fruit.
    • The amount of vitamin D3 produced by a one-hour exposure to UVB light was 1,000-fold higher in the leaves than in the ripe fruit.
  • While people don’t eat the leaves of tomato plants, the authors visualized a different use for this material.
    • They envisioned using what would otherwise be waste vegetative material from growing tomatoes to produce vitamin D3 for vitamin D supplements.
    • This would be particularly beneficial for vegans because most vegan sources of vitamin D are vitamin D2, which is less effective than vitamin D3.

In the words of the authors, “The leaves of the mutant plants are rich sources of 7-dehydrocholesterol…[and could be used] for the manufacture of vitamin D3 supplements from plants that would be suitable for vegans…”

The Good And Bad Of Genetically Modified Foods

good news bad newsLike much else in today’s world of social media and online blogs and podcasts, both the benefits and risks of genetic engineering have been greatly exaggerated. I have discussed this topic at length in a previous issue  of “Health Tips From The Professor”.

On the one hand, my genetic engineering colleagues tend to focus on the genetic alteration that is beneficial and ignore other changes in the genetically altered food that could pose some risk.

  • I would be the first to admit that most of the risks are very small and unlikely to occur, but I think each potential risk should be thoroughly investigated before we release the genetically altered plant into the world.
  • As an analogy, I will use the story of Pandora’s Box. Pandora was given the box by an angry Greek God, who told her never to open it. But her curiosity got the beat of her. Once Pandora opened the box, she released sickness, death, and other evils into the world. And once they had been released, there was no way to get them back into the box. We don’t want to run this kind of risk with genetically altered plants.

On the other hand, there are the “Chicken Little’s” of the world who assume every potential risk is real and warn us that, “The sky is falling”. Most of the risks are theoretical only. They may never happen. I am just saying they should be examined before we release genetically altered plants into the wild.

In this article, I will try to avoid both extremes. I will put on my “sceptic’s hat” (Every good scientist keeps one of those in his or her closet) and carefully evaluate the benefits and the risks associated with using both the fruit and the leaves of this genetically altered tomato plant.

Tomato Fruit Engineered To Produce Vitamin D3

The Benefit:

The benefit is obvious. As the authors said, tomatoes are a widely consumed worldwide. The availability of an inexpensive plant source of vitamin D3 could go a long way towards improving vitamin D status in third world countries where vitamin D3 supplementation may not be practical.

SkepticMy Concerns:

  1. Are there health risks?
  • Most genetically engineered foods contain a protein sequence that is not found in the non-modified food. This raises the possibility of food allergies to the novel protein. The good news is that a protein has been removed in this mutant plant. There is no novel protein, so the chance of these tomatoes triggering food allergies is extremely small.
  • However, these fruits do contain altered DNA. As I said in my previous article, one could imagine scenarios in which this could pose a health risk. I also pointed out that this is a theoretical concern, not one that has been proven to occur.
  • In addition, these fruits have been irradiated with high-intensity UVB light for an hour. This converts some of the 7-dehydrocholesterol to vitamin D3. But what else does it do to the fruit? Are some of the changes harmful? The authors didn’t ask.
  • Finally, these fruits don’t just have higher levels of vitamin D3. They also have much higher levels of 7-dehydrocholesterol than normal tomatoes. In humans, 7-dehydrocholesterol is made in the skin epidermis and there is very little in other tissues.

Is dietary 7-dehydrocholesterol a problem? We don’t know. One recent study speculated that dietary 7-dehydrocholesterol may increase the risk of atherosclerotic cardiovascular disease more than dietary cholesterol. Perhaps more study is required before we assume that this genetic modification is only beneficial.

   2) Are there environmental risks?

  • The same genetic change that increases the 7-dehydrocholesterol content of the fruit decreases α-tomatine and esculeoside A and B levels. As I stated above, α-tomatine and esculeoside A and B protect tomatoes from fungal, microbial, insect, and herbivoral attack (In my yard, herbivoral attack would be deer).
  • The authors did not describe how these tomatoes were grown, but I would assume it was in a hothouse. That is customary for studies of newly genetically engineered foods.
  • This raises the question of how pest susceptible these tomatoes would be when cultivated outdoors. Would increased amounts of pesticides and fungicides be needed to raise them? If so, what would the environmental impact be? The authors gave no indication that they had thought about the environmental impact if, in fact, these modified tomatoes were widely grown to solve the vitamin D insufficiency, as they proposed.

3) Is there a risk of cross-pollination?

  • This is a major concern for any genetically modified crop. If the modified gene were easily spread to nearby fields by cross-pollination, it could decease crop diversity and create major problems for organic farmers. Again, the authors gave no indication that they had even thought about this issue.

4) Would these tomatoes be accepted in developed countries?

  • I ask this question because the genetically modified Flavr Savr tomato was introduced in the US in 1996 thumbs down symbolwith much fanfare, only to be withdrawn from the market in 1999 due to lack of consumer demand.
  • And this tomato is both genetically engineered and irradiated. I am guessing most consumers would simply prefer to take a vitamin D3

My overall evaluation. Despite what you may hear from genetic engineering gurus, I would give these genetically engineered tomato fruits a thumbs down. There are too many unresolved questions and concerns to consider them to be a beneficial addition to our food supply.

Tomato Leaves Engineered To Produce Vitamin D3

The Benefit:

Again, the benefit is obvious. As the authors said, most experts consider vitamin D3 superior to vitamin D2, and there are no plant sources of vitamin D3 that can be used to produce vitamin D3 supplements. Leaves from this genetically modified tomato plant could be an inexpensive vegan source of vitamin D3.

My Concerns:

1.  Are there health risks?

  • Despite what the “Chicken Little’s” of the world may have told you, there are no health risks when an individual food ingredient is purified from a genetically modified organism. For example, vitamin D3 purified from these genetically modified tomato leaves will contain no genetic material (DNA), no protein, no UV-damaged molecules, and no 7-dehydrocholesterol. It will be chemically and biologically indistinguishable from vitamin D3 obtained from any other source.

2)  Are there environmental risks?

  • The environmental risks are the same as for the fruit.

3)  Is there a risk of cross-pollination?

  • The risk of cross-pollination is the same as for the fruit.

thumbs up4)  Would this source of vitamin D3 be accepted in developed countries?

  • This should not be a concern. Nutrients from genetically modified microorganisms are widely used in natural supplements. And UVB irradiation is already used in the production of both vitamin D2 and vitamin D3 Any UV-damaged molecules are removed in the final purification steps.

My overall evaluation. I would give the tomato leaves a tentative thumbs up. If the environmental and cross-pollination concerns can be overcome, the leaves could be a valuable vegan source of vitamin D3.

The Bottom Line 

Vitamin D insufficiency is a major problem, both worldwide and in the United States. A group of scientists have attempted to solve this problem by producing a genetically modified tomato plant that produces 7-dehydrocholesterol, which can be converted to vitamin D3 by UVB irradiation.

Plant foods are not generally a good source of vitamin D3. Tomatoes are grown and consumed in over 170 countries. Therefore, the scientists proposed widespread cultivation of this genetically modified tomato plant as a solution to worldwide vitamin D insufficiency.

In addition, the leaves of these genetically modified tomato plants contain more 7-dehydrocholesterol than the fruit. Most experts consider vitamin D3 superior to vitamin D2, and there are no plant sources of vitamin D3. The authors of this study further proposed that the leaves from this genetically modified tomato plant could be an inexpensive vegan source of vitamin D3.

As I have discussed in a previous “Health Tips From The Professor” article, both the benefits and risks of genetically modified foods have been greatly overstated. In this article, I evaluated both the benefits and risks of using the fruit as a plant source of vitamin D3 and the leaves to produce vegan vitamin D3 supplements.

Based on a careful evaluation of benefits and risks I give the genetically modified fruit a thumbs-down. There are simply too many unanswered questions.

On the other hand, I give vegan vitamin D3 supplements produced from the leaves a tentative thumbs up depending on whether environmental and cross-pollination concerns can be overcome.

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.

Can You Trust Amazon Supplements?

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Author: Dr. Stephen Chaney 

Question MarkI am often asked whether you can trust supplements purchased on Amazon. I have avoided answering that question publicly because I don’t wish to have any legal issues with Amazon.

However, I recently came across a published study (C Crawford et al, JAMA Network Open. 2022;5(8):e2226040 ) that partially answers that question. Normally, I review and comment on articles I share. However, today I will only use direct quotes from the article without comment to avoid any personal legal jeopardy.

Why Was The Study Done?

In the words of the authors,

Immune Support“Cold, flu, and immunity supplement sales have skyrocketed since the start of the COVID-19 pandemic…Supporting immunity or boosting the immune system has become an important reason for using dietary supplement products even though some of the claims may be misleading or not scientifically accurate. In addition, information regarding whether there are any risks associated with such products and ingredients is lacking.”

“The growth in e-commerce, sales, and manufacturing of dietary supplements, coupled with the limited resources for regulating dietary supplements, has created a challenge in keeping up with the market. Adulteration, misbranding, and misleading claims are regularly reported.”

“Since December 2020, Amazon has been requiring sellers to provide outlined quality control documentation and a certificate of analysis (testing results) for supplements sold on that platform. These new requirements could help ensure products are less risky and not adulterated.”

“In this case series, 30 products…marketed to support and boost the immune system…were selected and purchased from Amazon since the introduction of the new requirements by Amazon in December 2020. We tested the products to determine whether their product labels were accurate and whether any product was misbranded or adulterated.”

How Was The Study Done?

In the words of the authors,

clinical study

“On the Amazon website, we searched the key word immune in ‘all departments’ and then sorted results by ‘featured’. The first 30 dietary supplement products that appeared as results with 4 or more stars [highest rated] were eligible and selected for analysis in May 2021.”

“One sample of each selected product was purchased and sent to the University of Mississippi’s National Center for Natural Product’s Research for product analysis. Liquid chromatography-mass spectrometry was used to determine the quality of the 30 dietary supplement products…The list of ingredients detected through analysis for each product was compared with the ingredients on the product’s Supplement Facts label to determine whether the product’s label was accurate.”

 

What Did The Study Show?

In the words of the authors,

Shocking“Seventeen of the 30 products tested had inaccurate labels based on the product analysis. Of the 17 products with inaccurate labels:

  • 13 had ingredients listed on the labels that were not detected through analysis, such that their labels were misbranded. Ingredients missing from products ranged from 1 to 6 ingredients from any single product.
  • Nine products had substances detected but not claimed on the product label…some of which may be considered adulterated. [For example] One ingredient not claimed on the label but found in 3 products marketed as containing elderberry was Orza sativa (black rice seed).
  • Five [products] were misbranded and contained additional components not claimed on the label.”

“The 30 immune health dietary supplements tested and analyzed had claims related to immune support, immune defense, and bolstering of the immune system.

  • Examples of such claims included “all seasons immune support”, “immune strengthening ingredients,” “a powerhouse immune system booster”, and “booster up your immune system”.
  • Fifteen of the products tested additionally had scientific sounding claims by using terms such as “research-based” or “research supported”, “clinically studied”, “scientifically proven”, “supported by…gold-standard clinical studies,” and “backed by science.”

“The price of these products ranged from $11.93 to $90.48 for an approximate 30-day supply with the median cost of $25.33 per month…The mean price of the 17 products scoring less than 4 [This is a different scoring system than the one used on the Amazon website. It is a scoring system based on the quality of the product. Less than 4 represents lower quality products] was approximately $25 for a 30-day supply, and the mean price for those scoring 4 or more [higher quality products] was $31.”

What Did The Authors Say About The Results?

Scientists-ConversingIn the words of the authors,

“Dietary supplements, which consumers buy to improve their health can be costly…The public has a right to know that they are buying what is stated on the label when spending money on dietary supplements. This is certainly not always the case, as we found that only 13 of the 30 products were accurate…Although we cannot assume any product will confer a benefit, we would certainly not expect any harm; however, there is a risk that misbranded and/or adulterated products could cause harm.”

“Claims made on the labels of most dietary supplement products [in this study] seem to stretch what would be considered as allowable claims, which can by statute and/or FDA regulations be made for dietary supplements. Some other claims sounded scientific but did not have any peer-reviewed publication cited. Therefore, it is unknown how or whether these claims were substantiated.”

The Bottom Line 

The authors concluded,

“This case series analysis suggests that quality control measures have not been sufficient for most immune health dietary supplements advertised and sold on the Amazon website. Moreover, some claims made on most of these immune support products do not appear consistent with any of the categories of claims defined by FDA regulations. Most products tested had inaccurate labels, and the claims made on these labels may mislead consumers into purchasing products when information on whether they are actually beneficial is limited. Consumers should be aware that these products may potentially not contain what is stated on the label.”

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.

Can Healthy Eating Help You Lose Weight?

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Who Benefits Most From A Healthy Diet?

Author: Dr. Stephen Chaney 

fad dietsFad diets abound. High protein, low carb, low fat, vegan, keto, paleo – the list is endless. They all claim to be backed by scientific studies showing that you lose weight, lower your cholesterol and triglycerides, lower your blood pressure, and smooth out your blood sugar swings.

They all claim to be the best. But any reasonable person knows they can’t all be the best. Someone must be lying.

My take on this is that fad diet proponents are relying on “smoke and mirrors” to make their diet look like the best. I have written about this before, but here is a brief synopsis:

  • They compare their diet with the typical American diet.
    • Anything looks good compared to the typical American diet.
    • Instead, they should be comparing their diet with other weight loss diets. That is the only way we can learn which diet is best.
  • They are all restrictive diets.
    • Any restrictive diet will cause you to eat fewer calories and to lose weight.
    • As little as 5% weight loss results in lower cholesterol & triglycerides, lower blood pressure, and better control of blood sugar levels.

Simply put, any restrictive diet will give you short-term weight loss and improvement in blood parameters linked to heart disease, stroke, and diabetes. But are these diets healthy long term? For some of them, the answer is a clear no. Others are unlikely to be healthy but have not been studied long term. So, we don’t know whether they are healthy or not.

What if you started from the opposite perspective? Instead of asking, “Is a diet that helps you lose weight healthy long term?”, what if you asked, “Can healthy eating help you lose weight?” The study (S Schutte et al, American Journal of Clinical Nutrition, 115: 1-18, 2022) I will review this week asked that question.

More importantly, it was an excellent study. It compared a healthy diet to an unhealthy diet with exactly the same degree of caloric restriction. And it compared both diets to the habitual diet of people in that area. This study was performed in the Netherlands, so both weight loss diets were compared to the habitual Dutch diet.

How Was The Study Done?

clinical studyThis was a randomized controlled trial, the gold standard of clinical studies. The investigators recruited 100 healthy, abdominally obese men and women aged 40-70. At the time of entry into the study none of the participants:

  • Had diabetes.
  • Smoked
  • Had a diagnosed medical condition.
  • Were on a medication that interfered with blood sugar control.
  • Were on a vegetarian diet.

The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • Continue with their habitual diet.

The study lasted 12 weeks. The participants met with a dietitian on a weekly basis. The dietitian gave them the foods for the next week and monitored their adherence to their assigned diet. They were advised not to change their exercise regimen during the study.

At the beginning and end of the study the participants were weighed, and cholesterol, triglycerides, and blood pressure were measured.

Can Healthy Eating Help You Lose Weight?

Vegetarian DietTo put this study into context, these were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other simple sugars than the “low-nutrient-quality” diet.

At the end of 12 weeks:

  • Participants lost significant weight on both calorie-restricted diets compared to the group that continued to eat their habitual diet.
    • That is not surprising. Any diet that successfully restricts calories will result in weight loss.
  • Participants on the high-nutrient quality diet lost 33% more weight than participants on the low-nutrient-quality diet (18.5 pounds compared to 13.9 pounds).
  • Participants on the high-nutrient quality diet lost 50% more inches in waist circumference than participants on the low-nutrient-quality diet (1.8 inches compared to 1.2 inches).
    • This is a direct measure of abdominal obesity.

When the investigators measured blood pressure, fasting total cholesterol levels, and triglyceride levels:Heart Healthy Diet

  • These cardiovascular risk factors were significantly improved on both diets.
    • Again, this would be expected. Any diet that causes weight loss results in an improvement in these parameters.
  • The reduction in total serum cholesterol was 2.5-fold greater and the reduction in triglycerides was 2-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.
  • The reduction in systolic blood pressure was 2-fold greater and the reduction in diastolic blood pressure was 1.67-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, healthy eating helped them lose weight and improved their health.

Who Benefits Most From A Healthy Diet?

None of the participants in this study had been diagnosed with diabetes when the study began. However, all of them were middle-aged, overweight, and had abdominal obesity. That means many of them likely had some degree of insulin resistance.

Because of some complex metabolic studies that I did not describe, the investigators suspected that insulin resistance might influence the relative effectiveness of the two energy-restricted diets.

To test this hypothesis, they used an assay called HOMA-IR (homeostatic model assessment of insulin resistance). Simply put, this assay measures how much insulin is required to keep your blood sugar under control.

They used a HOMA-IR score of 2.5 to categorize insulin resistance among the participants.

  • Participants with a HOMA-IR score >2.5 were categorized as insulin-resistant. This was 55% of the participants.
  • Participants with a HOMA-IR score ≤2.5 were categorized as insulin-sensitive. This was 45% of the participants.

When they used this method to categorize participants they found:

  • Insulin-resistant individual lost about the same amount of weight on both diets.
  • Insulin-sensitive individuals lost 66% more weight on the high-nutrient-quality diet than the low-nutrient-quality diet (21.6 pounds compared to 13.0 pounds).

The investigators concluded, “Overweight, insulin-sensitive subjects may benefit more from a high- than a low-nutrient-quality energy-restricted diet with respect to weight loss…”

What Does This Study Mean For You?

Questioning WomanSimply put this study confirms that:

  • Caloric restriction leads to weight loss, and…
  • Weight loss leads to improvement in cardiovascular risk factors like total cholesterol, triglycerides, and blood pressure.
    • This is not new.
    • This is true for any diet that results in caloric restriction.

This study breaks new ground in that a high-nutrient quality diet results in significantly better:

  • Weight loss and…
  • Reduction in cardiovascular risk factors…

…than a low-nutrient quality diet. As I said above, the distinction between a “high-nutrient-quality” diet and a “low-nutrient-quality” diet may not be what you might have expected.

  • Both diets were whole food diets. Neither diet allowed sodas, sweets, and highly processed foods.
  • Both included fruits, vegetables, grains, and lean meats.
  • Both reduced caloric intake by 25%.
    • If you want to get the most out of your weight loss diet, this is a good place to start.

In this study the investigators designed their “high-nutrient-quality” diet so that it contained:

  • More plant protein in the form of soy protein.
    • In this study they did not reduce the amount of animal protein in the “high-nutrient-quality” diet. They simply added soy protein foods to the diet. I would recommend substituting soy protein for some of the animal protein in the diet.
  • More fiber.
    • The additional fiber came from substituting whole grain breads and brown rice for refined grain breads and white rice, adding soy protein foods, and adding an additional serving of fruit.
  • More healthy fats (monounsaturated and omega-3 fats).
    • The additional omega-3s came from adding a fish oil capsule providing 700mg of EPA and DHA.
  • Less simple sugars. While this study focused on fructose, their high-nutrient-quality diet was lower in all simple sugars.

ProfessorAll these changes make great sense if you are trying to lose weight. I would distill them into these 7 recommendations.

  • Follow a whole food diet. Avoid sodas, sweets, and highly processed foods.
  • Include all 5 food groups in your weight loss diet. Fruits, vegetables, whole grains, dairy, and lean proteins all play an important role in your long-term health.
  • Eat a primarily plant-based diet. My recommendation is to substitute plant proteins for at least half of your high-fat animal proteins. And this study reminds us that soy protein foods are a convenient and effective way to achieve this goal.
  • Eat a diet high in natural fibers. Including fruits, vegetables, whole grains, beans, nuts, seeds, and soy foods in your diet is the best way to achieve this goal.
  • Substitute healthy fats (monounsaturated and omega-3 fats) for unhealthy fats (saturated and trans fats) in your diet. And this study reminds us that it is hard to get enough omega-3s in your diet without an omega-3 supplement.
  • Reduce the amount of added sugar, especially fructose, from your diet. That is best achieved by eliminating sodas, sweets, and highly processed foods from the diet. I should add that fructose in fruits and some healthy foods is not a problem. For more information on that topic, I refer you to a previous “Health Tips” article .
  • Finally, I would like to remind you of the obvious. No diet, no matter how healthy, will help you lose weight unless you cut back on calories. Fad diets achieve that by restricting the foods you can eat. In the case of a healthy diet, the best way to do it is to cut back on portion sizes and choose foods with low caloric density.

I should touch briefly on the third major conclusion of this study, namely that the “high-nutrient quality diet” was not more effective than the “low-nutrient-quality” diet for people who were insulin resistant. In one sense, this was not news. Previous studies have suggested that insulin-resistant individuals have more difficulty losing weight. That’s the bad news.

However, there was a silver lining to this finding as well:

  • Only around half of the overweight, abdominally obese adults in this study were highly insulin resistant.
    • That means there is a ~50% chance that you will lose more weight on a healthy diet.
  • Because both diets restricted calories by 25%, insulin-resistant individuals lost weight on both diets.
    • That means you can lose weight on any diet that successfully reduces your caloric intake. That’s the good news.
    • However, my recommendation would still be to choose a high-nutrient quality diet that is designed to reduce caloric intake, because that diet is more likely to be healthy long term.

The Bottom Line 

A recent study asked, “Can healthy eating help you lose weight?” This study was a randomized controlled study, the gold standard of clinical studies. The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • Continue with their habitual diet.

These were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other simple sugars than the “low-nutrient-quality” diet.

At the end of 12 weeks:

  • Participants on the high-nutrient quality diet lost 33% more weight than participants on the low-nutrient-quality diet (18.5 pounds compared to 13.9 pounds).

When the investigators measured cardiovascular risk factors at the end of 12 weeks:

  • The reduction in total serum cholesterol was 2.5-fold greater and the reduction in triglycerides was 2-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.
  • The reduction in systolic blood pressure was 2-fold greater and the reduction in diastolic blood pressure was 1.67-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, healthy eating helped them lose weight and improved their health.

For more details on this study, what this study means for you, and my 7 recommendations for a healthy weight loss diet, 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 Shoulder Pain

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A Simple Self-Treatment For The Infraspinatus Muscle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

This summer has been HOT! HOT! HOT!

HotHigh temperature records were broken not just in the USA, but all over the world!  The funny thing is it was sometimes hotter up north than down here in Florida.  A snowbird client came in several weeks ago and told me they came back to Florida because they don’t have central air in their house up north (never needed it before).  That’s pretty incredible.

Now, I won’t say it’s cool outside, but September is not quite as hot as the summer months.  Which brings me to my treatment of the month – shoulder pain.

With it so hot I believe that a lot of people are getting relief be being in a pool, or a lake, or the ocean.  People are enjoying swimming, and if you are swimming a lot, you could easily get shoulder pain. There is a muscle called the Infraspinatus that is a key muscle for swimmers, so let’s chat about it.

A Swimmer’s Nemesis And Power – The Infraspinatus Muscle

This is what the back of your left shoulder looks like if you took off your skin – fascinating!

There are 16 muscles that all insert into your shoulder, each pulling your arm in a different direction.  Each is important and you use them all every day. But we won’t go into all of them this month, we’re just looking at the large muscle inside the red circle.  (I’m not an artist so saying “circle” is just using creative license – LOL)

This is the Infraspinatus, which originates on the surface of your shoulder blade (the scapula). It inserts into the tip of your arm bone (the humerus), and when it contracts it pulls your arm back.

Think of taking a tennis serve, or doing a backstroke in the pool, and you can visualize the movement this muscle makes.

How A Muscle Works To Move A Joint

Did you ever play “tug of war” with a stick and rope when you were young?  Basically, that’s how muscles work together to move our joints.  When the side that is on the right is pulling on the rope, the stick moves to the right. The only way the stick moves in the opposite direction, in this analogy it moves toward the left, is the right side needs to stop pulling and the left side starts to pull. When that happens, the stick moves toward the left.

This is exactly what happens in our body when we want to move a joint. Two muscles insert into a bone that is at the joint.  One muscle (let’s say the infraspinatus) pulls on the insertion point at the tip of the shoulder on your arm bone (humerus), and your arm moves back.  A muscle in the front of your shoulder/chest (pectoralis major) needs to release for your arm to move in that direction.

Then, when you want to bring your arm forward, the pectoralis major contracts and pulls on your humerus, and the infraspinatus must release tension so your arm can move.  It’s pretty simple, and it’s exactly what happens with every joint in your body.

In my books, Treat Yourself to Pain-Free Living and The Pain-Free Athlete, I show you how to self-treat all the shoulder muscles. This month I’m going to share with you how to self-treat the infraspinatus muscle.

A Simple Self-Treatment For The Infraspinatus Muscle

As I mentioned, there are 16 muscles that move your shoulder in all the directions you do every day.  It is important to have each of the muscles free of spasms in order to have full range-of-motion. With that said, here is the self-treatment for the infraspinatus muscle.

You can use a slightly used tennis ball to treat the muscle, although it may be too soft to be effective. I’ve found a new tennis ball may be too hard. I strongly recommend that you never use a lacrosse ball as it is much too hard and could easily bruise the bone. A bone bruise can cause pain for up to a year, so it’s certainly something to avoid.

I prefer my Perfect Ball because it is solid in the center and has a layer of softness around the outside.  This softness enables you to work deeply into the muscle without potentially bruising the bone.

The pictures below show you where the muscle is located and where to place the ball.  You can either lean into the ball on a wall, or you can lie on the floor as shown below.

When you locate a “hot spot,” where it hurts as you press on the point, just stay there for 30 seconds.

Next, release the pressure for 5 seconds to allow blood to flow into the muscle, and then press into the muscle again.  Continue this until it no longer hurts, and then look for another point. Repeat this on each painful point to enable a full release of tension and relieve pain and stiffness.

Even without working on the other muscles of the shoulder, you’ll get considerable relief by treating the infraspinatus muscle.

Have You Listened To My TEDx Talk?

The title is “The Pain Question No One Is Asking.”  It points a finger at a HUGE missing piece in our health care, one that affects millions of people.  The topic is controversial, so much so that it almost wasn’t approved because it asks a question that certain people don’t want brought to light.

You can see it by going to YouTube and putting in “Julie Donnelly, Pain”.

Please “like” and “share” it with others so TED will see that this is a subject people want to know more about.  Thanks!

Looking Ahead To October

Next month we will be looking at the #2 most prevalent pain problem in the USA.  Carpal tunnel syndrome (CTS) is debilitating, and incredibly painful.  I know because CTS shut down my therapy practice in 1997.  I’ll tell you the short version of that situation and how it was the catalyst for me developing the self-treatments that reversed it for me. I’m happy to say that the self-treatments I developed have also helped hundreds of people around the world eliminate this problem from their lives.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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

Can Diet Protect Your Mind?

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Which Diet Is Best?

Author: Dr. Stephen Chaney 

can diet prevent alzheimer'sAlzheimer’s is a scary disease. There is so much to look forward to in our golden years. We want to enjoy the fruits of our years of hard work. We want to enjoy our grandkids and perhaps even our great grandkids. More importantly, we want to be able to pass on our accumulated experiences and wisdom to future generations.

Alzheimer’s and other forms of dementia have the potential to rob us of everything that makes life worth living. What is the use of having a healthy body, family, and fortune if we can’t even recognize the people around us?

Alzheimer’s and other forms of dementia don’t happen overnight. The first symptoms of cognitive decline are things like forgetting names, where you left things, what you did last week. For most people it just keeps getting worse.

Can diet protect your mind? Recent studies have given us a ray of hope. For example, several meta-analyses have shown that adherence to the Mediterranean diet was associated with a 25-48% lower risk of cognitive decline and dementia.

However, there were several limitations to the studies included in these meta-analyses. For example:

  • For most of the studies the diet was assessed only at the beginning of the study. We have no idea whether the participants followed the same diet throughout the study. This means, we cannot answer questions like:
    • What is the effect of long-term adherence to a healthy diet?
    • Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet?
  • These studies focused primarily on the Mediterranean diet. This leaves the question:
    • What about other healthy diets? Is there something unique about the Mediterranean diet, or do other healthy diets also reduce the risk of cognitive decline?

This study (C Yuan et al, American Journal of Clinical Nutrition, 115: 232-243, 2022) was designed to answer those questions.

How Was The Study Done?

clinical studyThe investigators utilized data from The Nurse’s Health Study. They followed 49,493 female nurses for 30 years from 1984 to 2014. The average age of the nurses in 1984 was 48 years, and none of them had symptoms of cognitive decline at the beginning of the study.

The nurse’s diets were analyzed in 1984, 1986, and every 4 years afterwards until 2006. Diets were not analyzed during the last 8 years of the study to eliminate something called “reverse causation”. Simply put, the investigators were trying to eliminate the possibility that participants in the study might change their diet because they were starting to notice symptoms of cognitive decline.

The data from the dietary analyses were used to calculate adherence to 3 different healthy diets:

  • The Mediterranean diet.
  • The DASH diet. The DASH diet was designed to reduce the risk of high blood pressure. But you can think of it as an Americanized version of the Mediterranean diet.
  • The diet recommended by the USDA. Adherence to this diet is evaluated by something called the Alternative Healthy Eating Index or AHEI.

Adherence to each diet was calculated by giving a positive score to foods that were recommended for the diet and a negative score for foods that were not recommended for the diet. For more details, read the article.

In 2012 and 2014 the nurses were asked to fill out questionnaires self-assessing the early stages of cognitive decline. They were asked if they had more trouble than usual:

  • Remembering recent events or remembering a short list of items like a grocery list (measuring memory).
  • Understanding things, following spoken instructions, following a group conversation, or following a plot in a TV program (measuring executive function).
  • Remembering things from one second to the next (measuring attention).
  • Finding ways around familiar streets (measuring visuospatial skills).

The extent of cognitive decline was calculated based on the number of yes answers to these questions.

Can Diet Protect Your Mind?

Vegan FoodsHere is what the investigators found when they analyzed the data:

At the beginning of the study in 1984 there were 49,493 female nurses with an average age of 48. None of them had symptoms of cognitive decline.

  • By 2012-2014 (average age = 76-78) 46.9% of them had cognitive decline and 12.3% of them had severe cognitive decline.

Using the data on dietary intake and the rating systems specific to each of the diets studied, the investigators divided the participants into thirds based on their adherence to each diet. The investigators then used these data to answer two important questions that no previous study had answered:

#1: What is the effect of long-term adherence to a healthy diet? To answer this question the investigators averaged the dietary data obtained every 4 years between 1984 and 2006 to obtain cumulative average scores for adherence to each diet. When the investigators compared participants with the highest adherence to various healthy diets for 30 years to participants with the lowest adherence to those diets, the risk of developing severe cognitive decline was decreased by:

  • 40% for the Mediterranean diet.
  • 32% for the DASH diet.
  • 20% for the USDA-recommended healthy diet (as measured by the AHEI score).

#2: Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet? To answer this question, the investigators looked at participants who started with the lowest adherence to each diet and improved to the highest adherence by the end of the study. This study showed that improving from an unhealthy diet to a healthy diet over 30 years decreased the risk of developing severe cognitive decline by:

  • 20% for the Mediterranean diet.
  • 25% for the DASH diet.

There were a few other significant observations from this study.

  • The inverse association between healthy diets and risk of cognitive decline was greater for nurses who had high blood pressure.
    • This is an important finding because high blood pressure increases the risk of cognitive decline.
  • The inverse association between healthy diets and risk of cognitive decline was also greater for nurses who did not have the APOE-ɛ4 gene.
    • This illustrates the interaction of diet and genetics. The APOE-ɛ4 gene increases the risk of cognitive decline. Healthy diets reduced the risk of cognitive decline in nurse with the APOE-ɛ4 gene but not to the same extent as for nurses without the gene.

This study did not investigate the mechanism by which healthy diets reduced the risk of cognitive decline, but the investigators speculated it might be because these diets:

  • Were anti-inflammatory.
  • Supported the growth of healthy gut bacteria.

The investigators concluded, “Our findings support the beneficial roles of long-term adherence to the [Mediterranean, DASH, and USDA] dietary patterns for maintaining cognition in women…Further, among those with initially relatively low-quality diets, improvement in diet quality was associated with a lower likelihood of developing severe cognitive decline. These findings indicate that improvements in diet quality in midlife and later may have a role in maintenance of cognitive function among women.”

Which Diet Is Best?

Mediterranean Diet FoodsIn a sense this is a trick question. That’s because this study did not put the participants on different diets. It simply analyzed the diets the women were eating in different ways. And while the algorithms they were using were diet-specific, there was tremendous overlap between them. For more specifics on the algorithms used to estimate adherence to each diet, read the article.

That is why the investigators concluded that all three diets they analyzed reduced the risk of cognitive decline rather than highlighting a specific diet. However, based on this and numerous previous studies the evidence is strongest for the Mediterranean and DASH diets.

And I would be remiss if I didn’t also mention the MIND diet. While it was not included in this study, the MIND diet:

  • Was specifically designed to reduce cognitive decline.
  • Can be thought of as a combination of the Mediterranean and DASH diets.
  • Includes data from studies on the mind-benefits of individual foods. For example, it recommends berries rather than all fruits.

The MIND diet has not been as extensively studied as the Mediterranean and DASH diets, but there is some evidence that it may be more effective at reducing cognitive decline than either the Mediterranean or DASH diets alone.

Which Foods Are Best?

AwardThe authors of this study felt it was more important to focus on foods rather than diets. This is a better approach because we eat foods rather than diets. With that in mind they analyzed their data to identify the foods that prevented cognitive decline and the foods increased cognitive decline. This is what they found:

  • Fruits, fruit juices, vegetables, fish, nuts, legumes, low-fat dairy, and omega-3 fatty acids (fish oil) reduced the risk of cognitive decline.
  • Red and processed meats, omega-6 fatty acids (most vegetable oils), and trans fats increased the risk of cognitive decline.

While this study did not specifically look at the effect of processed foods on cognitive decline, diets high in the mind-healthy foods listed above are generally low in sodas, sweets, and highly processed foods.

What Does This Study Mean For You?

Question MarkThe question, “Can diet protect your mind”, is not a new one. Several previous studies have suggested that healthy diets reduce the risk of cognitive decline, but this study breaks new ground. It shows for the first time that:

  • Long-term adherence to a healthy diet can reduce your risk of cognitive decline by up to 40%.
    • This was a 30-year study, so we aren’t talking about “diet” in the traditional sense. We aren’t talking about short-term diets to drop a few pounds. We are talking about a life-long change in the foods we eat.
  • If you currently have a lousy diet, it’s not too late to change. You can reduce your risk of cognitive decline by switching to a healthier diet.
    • This is perhaps the best news to come out of this study.

Based on current evidence, the best diets for protecting against cognitive decline appear to be the Mediterranean, DASH, and MIND diets.

And if you don’t like restrictive diets, my advice is to:

  • Eat more fruits, fruit juices, vegetables, fish, nuts, legumes, low-fat dairy, and omega-3 fatty acids (fish oil).
  • Eat less red and processed meats, omega-6 fatty acids (most vegetable oils), and trans fats.
  • Eat more plant foods and less animal foods.
  • Eat more whole foods and less sodas, sweets, and processed foods.

And, of course, a holistic approach is always best. Other lifestyle factors that help reduce your risk of cognitive decline include:

  • Regular exercise.
  • Weight control.
  • Socialization.
  • Memory training (mental exercises).

The Bottom Line 

Alzheimer’s is a scary disease. What is the use of having a healthy body, family, and fortune if we can’t even recognize the people around us?

A recent study looked at the effect of diet on cognitive decline in women. The study started with middle-aged women (average age = 48) and followed them for 30 years. The investigators then used these data to answer two important questions that no previous study had answered:

#1: What is the effect of long-term adherence to a healthy diet? When the investigators compared participants with the highest adherence to various healthy diets for 30 years to participants with the lowest adherence to those diets, the risk of developing severe cognitive decline was decreased by:

  • 40% for the Mediterranean diet.
  • 32% for the DASH diet.
  • 20% for the USDA recommendations for a healthy diet.

#2: Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet? This study showed that improving from an unhealthy diet to a healthy diet over 30 years decreased the risk of developing severe cognitive decline by:

  • 20% for the Mediterranean diet.
  • 25% for the DASH diet.

The investigators concluded, “Our findings support the beneficial roles of long-term adherence to the [Mediterranean, DASH, and USDA] dietary patterns for maintaining cognition in women…Further, among those with initially relatively low-quality diets, improvement in diet quality was associated with a lower likelihood of developing severe cognitive decline. These findings indicate that improvements in diet quality in midlife and later may have a role in maintenance of cognitive function among women.”

For more details on the study, which diets, and which foods are best for protecting your mind, and what this study means for you, read the article above.

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

How Much Omega-3s Do Children Need?

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What Does This Study Mean For Your Children?

Author: Dr. Stephen Chaney 

It is back to school time again. If you have children, you are probably rushing around to make sure they are ready.

  • Backpack…Check.
  • Books…Check
  • School supplies…Check
  • Omega-3s…???

Every parent wants their child to do their best in school. But do they need omega-3s to do their best? I don’t need to tell you that question is controversial.

Some experts claim that omega-3 supplementation in children improves their cognition. [Note: Cognition is defined as the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. In layman’s terms that means your child’s ability to learn.]

Other experts point out that studies in this area disagree. Some studies support these claims. Others don’t. Because the studies disagree these experts conclude there is no good evidence to support omega-3 supplementation in children.

The authors of this study (ISM van der Wurff et al, Nutrients, 12: 3115, 2020) took a different approach. They asked why these studies disagreed. They hypothesized that previous studies disagreed because there is a minimal dose of omega-3s needed to achieve cognitive benefits in children. In short, they were asking how much omega-3s do children need.

They based their hypothesis on recent studies showing that a minimum dose of omega-3s is required to show heart health benefits in adults.

What Have We Learned From Studies on Omega-3s And Heart Health?

Omega-3s And Heart DiseaseThe breakthrough in omega-3/heart health studies came with the development of something called the omega-3 index. Simply put, omega-3s accumulate in our cell membranes. The omega-3 index is the percent omega-3s in red blood cell membranes and is a good measure of our omega-3 status.

Once investigators began measuring the omega-3 index in their studies and correlating it with heart health, it became clear that:

  • An omega-3 index of ≤4% correlated with a high risk of heart disease.
  • An omega-3 index of ≥8% correlated with a low risk of heart disease.
  • Most Americans have an omega-3 index in the 4-6% range.
  • Clinical studies in which participants’ omega-3 index started in the low range and increased to ~8% through supplementation generally showed a positive effect of omega-3s on reducing heart disease risk. [I say generally because there are other factors in study design that can obscure the effect of omega-3s.]

This is the model that the authors adopted for their study. They asked how much omega-3s do children need to show a positive effect of omega-3s on their cognition (ability to learn).

How Was The Study Done?

Clinical StudyThe authors included 21 studies in their analysis that met the following criteria:

  • All studies were placebo controlled randomized clinical trials.
  • The participants were 4-25 years old and had not been diagnosed with ADHD.
  • Supplementation was with the long-chain omega-3s DHA and/or EPA.
  • The trial assessed the effect of omega-3 supplementation on cognition.

I do not want to underestimate the difficulties the authors faced in their quest. The individual studies differed in:

  • The dose of omega-3s.
    • The relative amount of DHA and EPA.
    • Whether omega-3 index was measured. Only some of the studies measured fatty acid levels in the blood. The authors were able to calculate the omega-3 index in these studies.
  • How cognition (ability to learn) was measured.
  • The age of the children.
    • 20 of the studies were done with children (4-12 years old) or late adolescents (20-25 years old).
    • Only one study was done on early to middle adolescents (12-20 years old).
  • All these variables influence the outcome and could obscure the effect of omega-3s on cognition.

In short, determining the omega-3 dose-response for an effect on cognition was a monumental task. It was like searching for a needle in a haystack. These authors did a remarkable job.

How Much Omega-3s Do Children Need?

Child Raising HandHere is what the scientists found when they analyzed the data:

  • 60% of the studies in which an omega-3 index of ≥6% was achieved showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 20% of the studies that did not achieve an omega-3 index of 6%.
    • That is a 3-fold difference in effectiveness once a threshold of 6% omega-3 index was reached.
  • 50% of the studies in which a dose of ≥ 450 mg/day of DHA + EPA was used showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 25% of the studies that used <450 mg/day DHA + EPA.
    • That is a 2-fold difference in effectiveness once a threshold of 450 mg/day DHA + EPA was given.

The authors concluded, “Daily supplementation of ≥450 mg/day DHA and/or EPA and an increase in the omega-3 index to >6% makes it more likely to show efficacy [of omega-3s] on cognition (ability to learn) in children and adolescents.”

What Does This Study Tell Us?

Question MarkIt is important to understand what this study does and does not tell us.

This study does not:

  • Prove that omega-3 supplementation can improve cognition (ability to learn) in children and adolescents.
  • Define optimal levels of DHA + EPA.
  • Tell us whether DHA, EPA, or a mixture is better.

It was not designed to do any of these things. It was designed to give us a roadmap for future studies. It tells us how to design studies that can provide definitive answers to these questions.

This study does:

  • Define a threshold dose of DHA + EPA for future studies (450 mg/day).
  • Tells us how to best use the omega-3 index in future studies. To obtain meaningful results:
    • Participants should start with an omega-3 index of 4% or less.
    • Participants should end with an omega-3 index of 6% or greater.
  • In my opinion, future studies would also be much more effective if scientists in this area of research could agree on a single set of cognitive measures to be used in all subsequent studies.

In short, this study provides critical information that can be used to design future studies that will be able to provide definitive conclusions about omega-3s and cognition in children.

What Does This Study Mean For Your Children?

child geniusAs a parent or grandparent, you probably aren’t interested in optimizing the design of future clinical studies. You want answers now.

Blood tests for omega-3 index are available, but they are not widely used. And your insurance may not cover them.

So, for you the most important finding from this study is that 450 mg/day DHA + EPA appears to be the threshold for improving a child’s cognition (their ability to learn).

  • 450 mg/day is not an excessive amount. The NIH defines adequate intakes for omega-3s as follows:
  • 4-8 years: 800 mg/day
  • 9-13 years: 1 gm/day for females, 1.2 gm/day for males
  • 14-18 years: 1.1 gm/day for females and 1.6 gm/day for males.
  • With at least 10% of that coming from DHA + EPA

Other organizations around the world recommend between 100 mg/day and 500 mg/day DHA + EPA depending on the age and weight of the child and the organization.

  • Most children need supplementation to reach adequate omega-3 intake. The NIH estimates the average child only gets around 40 mg/day omega-3s from their diet. No matter which recommendation you follow, it is clear that most children are not getting the recommended amount of DHA + EPA in their diet.
  • Genetics.
  • Diet.
  • Environment.
  • The value placed on learning by parents and peers.

Supplementation is just one factor in your child’s ability to learn. But it is one you can easily control. . And if your child is like most, he or she is probably not getting enough omega-3s in their diet.

The Bottom Line 

It is back to school time again. Every parent wants their child to do their best in school. But do they need omega-3s to do their best? I don’t need to tell you that question is controversial.

Some studies support these claims, but others don’t. Because the studies disagree some experts conclude there is no good evidence to support omega-3 supplementation in children.

The authors of a recent study took a different approach. They asked why these studies disagreed. They hypothesized that previous studies disagreed because there was a minimal dose of omega-3s needed to achieve cognitive benefits in children. They asked how much omega-3s children need.

They analyzed the data from 21 previous studies looking at the effect of omega-3 supplementation on cognition (ability to learn) in children and adolescents. Their analysis showed:

  • 60% of the studies in which an omega-3 index of ≥6% was achieved showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 20% of the studies that did not achieve an omega-3 index of 6%.
    • That is a 3-fold difference in effectiveness once a threshold of 6% omega-3 index was reached.
  • 50% of the studies in which a dose of ≥ 450 mg/day of DHA + EPA was used showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 25% of the studies that used <450 mg/day DHA + EPA.
    • That is a 2-fold difference in effectiveness once a threshold dose of 450 mg/day DHA + EPA was given.

The authors concluded, “Daily supplementation of ≥450 mg/day DHA + EPA and an increase in the omega-3 index to >6% makes it more likely to show efficacy [of omega-3s] on cognition (ability to learn) in children and adolescents.”

For more details on the study and what it means for your children and grandchildren, 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.

What Is The Truth About Low Carb Diets?

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Why Is The Cochrane Collaboration The Gold Standard?

Author: Dr. Stephen Chaney 

low carb dietAtkins, South Beach, Whole30, Low Carb, high Fat, Low Carb Paleo, and Keto. Low carb diets come in many forms. But they have these general characteristics:

  • They restrict carbohydrate intake to <40% of calories.
  • They restrict grains, cereals, legumes, and other carbohydrate foods such as dairy, fruits, and some vegetables.
  • They replace these foods with foods higher in fat and protein such as meats, eggs, cheese, butter, cream, and oils.
  • When recommended for weight loss, they generally restrict calories.

What about the science? Dr. Strangelove and his friends tell you that low carb diets are better for weight loss, blood sugar control, and are more heart healthy than other diets. But these claims are controversial.

Why is that? I have discussed this in previous issues of “Health Tips From The Professor”. Here is the short version.

  • Most studies on the benefits of low carb diets compare them with the typical American diet.
    • The typical American diet is high in fat, sugar and refined flour, and highly processed foods. Anything is better than the typical American diet.
  • Most low carb diets are whole food diets.
    • Any time you replace sodas and highly processed foods with whole foods you will lose weight and improve your health.
  • Most low carb diets are highly structured. There are rules for which foods to avoid, which foods to eat, and often additional rules to follow.
    • Any highly structured diet causes you to focus on what you eat. When you do that, you lose weight. When you lose weight, your health parameters improve.
    • As I have noted before, short term weight loss and improvement in health parameters are virtually identical for the very low carb keto diet and the very low-fat vegan diet.

With all this uncertainty you are probably wondering, “What is the truth about low carb diets?”

A recent study by the Cochrane Collaboration (CE Naude et al, Cochrane Database of Systematic Reviews, 28 January 2022) was designed to answer this question.

The Cochrane Collaboration is considered the gold standard of evidence-based medicine. To help you understand why this is, I will repeat a summary of how the Cochrane Collaboration approaches clinical studies that I shared two weeks ago.

Why Is The Cochrane Collaboration The Gold Standard?

ghost bustersWho you gonna call? It’s not Ghostbusters. It’s not Dr. Strangelove’s health blog. It’s a group called the Cochrane Collaboration.

The Cochrane Collaboration consists of 30,000 volunteer scientific experts from across the globe whose sole mission is to analyze the scientific literature and publish reviews of health claims so that health professionals, patients, and policy makers can make evidence-based choices about health interventions.

In one sense, Cochrane reviews are what is called a “meta-analysis”, in which data from numerous studies are grouped together so that a statistically significant conclusion can be reached. However, Cochrane Collaboration reviews differ from most meta-analyses found in the scientific literature in a very significant way.

Many published meta-analyses simply report “statistically significant” conclusions. However, statistics can be misleading. As Mark Twain said: “There are lies. There are damn lies. And then there are statistics”.

The Cochrane Collaboration also reports statistically significant conclusions from their meta-analyses. However, they carefully consider the quality of each individual study in their analysis. They look at possible sources of bias. They look at the design and size of the studies. Finally, they ask whether the conclusions are consistent from one study to the next. They clearly define the quality of evidence that backs up each of their conclusions as follows:

  • High-quality evidence. Further research is unlikely to change their conclusion. This is generally reserved for conclusions backed by multiple high-quality studies that have all come to the same conclusion. These are the recommendations that are most often adopted into medical practice.
  • Moderate-quality evidence. This conclusion is very likely to be true, but further research could have an impact on it.
  • Low-quality evidence. Further research is needed and could alter the conclusion. They are not judging whether the conclusion is true or false. They are simply saying more research is needed to reach a definite conclusion.

This is why their reviews are considered the gold standard of evidence-based medicine. If you are of a certain age, you may remember that TV commercial “When EF Hutton talks, people listen.” It is the same with the Cochrane Collaboration. When they talk, health professionals listen.

How Was The Study Done?

Clinical StudyThe authors of this Cochrane Collaboration Report included 61 published clinical trials that randomized participants into two groups.

  • The first group was put on a low carbohydrate diet (carbohydrates = <40% of calories).
  • The second group was put on a “normal carbohydrate” diet (carbohydrates = 45-65% of calories, as recommended by the USDA and most health authorities).
    • The normal carbohydrate diet was matched with the low carbohydrate diet in terms of caloric restriction.
    • Both diets were designed by dietitians and were generally whole food diets.

The participants in these studies:

  • Were middle-aged.
  • Were overweight or obese.
  • Did not have diagnosed heart disease or cancer.
  • May have diagnosed type-2 diabetes. Some studies selected participants that had diagnosed type 2 diabetes. Other studies excluded those patients.

The studies were of 3 types:

  • Short-term: Participants in these studies followed their assigned diets for 3 to <12 months.
  • Long-term: Participants in these studies followed their assigned diets for >12 to 24 months.
  • Short-term with maintenance: Participants in these studies followed their assigned diets for 3 months followed by a 9-month maintenance phase.

What Is The Truth About Low Carb Diets?

The TruthAll the studies included in the Cochrane Collaboration’s meta-analysis randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

This is what the Cochrane Collaboration’s meta-analysis showed.

When they analyzed studies done with overweight participants without type 2 diabetes:

  • Weight loss was not significantly different between low carb and normal carb diets in short-term studies (3 to <12 months), long-term studies (>12 to 24 months), and short-term studies followed by a 9-month maintenance period.
  • There was also no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure and LDL cholesterol.

Since diabetics have trouble controlling blood sugar, you might expect that type 2 diabetics would respond better to low carb diets. However, when they analyzed studies done with overweight participants who had type 2 diabetes:

  • Weight loss was also not significantly different on low carb and normal carb diets.
  • There was no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure, LDL cholesterol, and hemoglobin A1c, a measure of blood sugar control.

Of course, the reason Cochrane Collaboration analyses are so valuable is they also analyze the strength of the studies that were included in their analysis.

You may remember in my article two weeks ago, I reported on the Cochrane Collaboration’s report supporting the claim that omega-3 supplementation reduces pre-term births. In that report they said that the studies included in their analysis were high quality. Therefore, they said their report was definitive and no more studies were needed.

This analysis was different. The authors of this Cochrane Collaboration report said that the published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

What Does This Study Mean For You?

confusionIf you are a bit confused by the preceding section, I understand. That was a lot of information to take in. Let me give you the Cliff Notes version.

In short, this Cochrane Collaboration Report concluded:

  • Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control. Dr. Strangelove has been misleading you again.
  • This finding is equally true for people with and without type 2 diabetes. This calls into question the claim that people with type 2 diabetes will do better on a low carb diet.
  • The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

If you are thinking this study can’t be true because low carb diets work for you, that is because you are comparing low carb diets to your customary diet, probably the typical American diet.

  • Remember that any whole food diet that eliminates sodas and processed foods and restricts the foods you eat will cause you to lose weight. Whole food keto and vegan diets work equally well short-term compared to the typical American diet.
  • And any diet that allows you to lose weight improves heart health parameters and blood sugar control.

If you are thinking about the blogs, books, and videos you have seen extolling the virtues of low carb diets, remember that the Dr. Strangeloves of the world only select studies comparing low carb diets to the typical American diet to support their claims.

  • The studies included in this Cochrane Collaboration report randomly assigned participants to the low carb and normal carb diets and followed them for 3 to 24 months.
    • Both diets were whole food diets designed by dietitians.
    • Both diets reduced caloric intake to the same extent.

What about the claims that low carb diets are better for your long-term health? There are very few studies on that topic. Here are two:

  • At the 6.4-year mark a recent 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. I will analyze this study in a future issue of “Health Tips From The Professor”.
  • At the 20-year mark a series of studies 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 heart disease and diabetes as women consuming a high carbohydrate, low fat diet.
    • However, women consuming a plant-based low carb diet for 20 years gained less weight and had reduced risk of developing heart disease and diabetes as women consuming a high carbohydrate, low fat diet.

My recommendation is to avoid low-carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low-carb version of the Mediterranean diet. It is likely to be healthy long term.

The Bottom Line 

The Cochrane Collaboration, the gold standard of evidence-based medicine, recently issued a report that evaluated the claims made for low carb diets.

All the studies analyzed in the Cochrane Collaboration’s report randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

The Cochrane Collaboration Report concluded:

  • Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control.
  • This is equally true for people with and without type 2 diabetes.
  • The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

My recommendation is to avoid low carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low carb version of the Mediterranean diet. It is likely to be healthy long term.

For more details on the 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.

Health Tips From The Professor