Dr. Steve Chaney

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.

Does Processed Food Give You Gas?

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Why Does Processed Food Give You Gas?

Author: Dr. Stephen Chaney 

Does it feel like a war is going on in your belly every time you eat? It could be IBD (inflammatory bowel disease). IBD can take several forms, but the two most common are Crohn’s disease and ulcerative colitis.

What do we know about IBD?

  • The symptoms of IBD can make you miserable. They include:
    • Abdominal pain and cramping.
    • Diarrhea with occasional bouts of constipation.
    • Gas and bloating.
    • Loss of appetite and/or unexpected weight loss.
  • There are about 1.6 million Americans with IBD and 70,000 new cases/year.
    • The prevalence of IBD in the United States has increased by 34% between 2006 and 2016.
  • As you might suspect from its name, IBD is a chronic inflammation of the gastrointestinal tract.
    • It is thought to be caused by “dysbiosis of the gastrointestinal track” (In layman’s terms that means damage to your intestine caused by too many bad bacteria and not enough good bacteria).
    • There is also a genetic component to the disease. Some people are much more susceptible to IBD than others.

If you watch TV, you know that there are drugs for treating IBD. The ads make them sound like miracle drugs. But if you listen carefully, you also know that these drugs have a long list of side effects. And some of the side effects are pretty scary.

Are There Natural Approaches For Controlling IBD?

BacteriaSo, if your belly is a bit rumbly, you might be wondering if there is a more natural approach you could take. We know that diet affects the balance between bad and good bacteria in our intestine. Could something as simple as changing your diet, quell the fire in your belly?

While the answer seems obvious, it has been hard to prove. The results of previous studies have been inconclusive. That is because previous studies:

  • Included too few people. 1.6 million people in the US with IBD may sound like a lot, but that represents only 0.4% of the population. Unless you have a really big study, there won’t be enough people who develop IBD to give you statistically significant results.
  • Were too short. IBD doesn’t develop overnight.
  • Did not include a diverse enough population. Previous studies were confined to individual countries or specific regions within a country.

This study (N Narula et al, British Medical Journal, 2021;374:n1554) was designed to overcome the limitations of previous studies. It also looked at the effect of diet on IBD from a different perspective than most previous studies.

  • It did not focus on the effect of individual foods on IBD. Since consumption of processed foods is known to affect the population of intestinal bacteria, the authors of this study asked whether processed food consumption might influence the likelihood of developing IBD.

How Was The Study Done?

Clinical StudyThe authors of this study used data collected from the PURE (Prospective Urban Rural Epidemiology) study between January 1, 2003, and December 31, 2016. The PURE study collected data from a very diverse population. Specifically, it collected data from 21 low-, middle-, and high-income countries across 7 geographical regions (Europe, North America, South America, Africa, Middle East, South Asia, Southeast Asia, and China).

  • This study followed 116,087 adults aged 35-70 years (average age 50, percent women = 60%) in the PURE study for an average of 9.7 years. During that time, 467 participants (0.4%) developed IBD.
  • All participants filled out a baseline food-frequency questionnaire that had been designed and validated for foods specific to their country.
  • Participants were asked if they had a diagnosis of Crohn’s disease or ulcerative colitis as part of an annual follow-up questionnaire. To assure the accuracy of these answers they were validated with medical records whenever possible.

Does Processed Food Give You Gas?

Does processed food give you gas? Does it give you abdominal pain, diarrhea, and bloating? In short, does it give you IBD? That is the question this study was designed to answer. Here are the results of the study:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the PURE study.
  • When the investigators looked at different categories of processed foods:
    • Processed meat intake increased the risk of IBD by 2.07-fold.
    • Soft drink intake increased the risk of IBD by 1.94-fold.
    • Refined sweetened food intake increased the risk of IBD by 2.58-fold.
    • Salty food and snack intake increased the risk of IBD by 2.06-fold.
  • When the investigators looked at different categories of unprocessed foods:
    • White meat, red meat, dairy, starchy foods, fruits, vegetables, and legumes had no effect on the risk of developing IBD.
    • Sodium intake (as measured by urinary excretion of sodium) also had no effect on the risk of developing IBD.

Why Does Processed Food Give You Gas?

Question MarkYou may be wondering why does processed food give you gas – and other symptoms of IBD.

The simplest explanation is that whole grains, unprocessed fruits & vegetables, and legumes provide the fiber that supports the growth of friendly gut bacteria. Processed foods displace these foods from our diet.

But these investigators think something else about processed foods may be contributing to the increased risk of IBD. That is because in their study:

  • Processed meat increased the risk of IBD, but unprocessed white and red meat had no effect on IBD.
  • Processed sweetened foods increased the risk of IBD, but unprocessed starchy foods and naturally sweet fruits had no effect on IBD.
  • Processed salty foods and snacks increased the risk of IBD, but sodium intake had no effect on IBD.

The investigators also noted that in mouse studies:

  • Some food additives found in processed foods cause bacteria to stick to the epithelial lining of the intestine and/or cause leaky gut syndrome, both of which can lead to chronic inflammation of the intestine.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “As white meat, unprocessed red meat, dairy, starchy foods, fruits, vegetables, and legumes were not found to be associated with development of IBD, this study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effects of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives on the risk of developing IBD.]

What Does This Study Mean For You?

Questioning WomanIBD is a rare disease (0.4% of the population). If you don’t have digestive issues, it would be easy to ignore this study and continue with a diet of highly processed foods.

However, I would remind you that in recent issues of “Health Tips From the Professor”, I have shared recent studies showing that highly processed foods increase your risk of:

And these studies are just the tip of the iceberg. We know that diets rich in whole grains and unprocessed fruits and vegetables decrease the risk of heart attack, stroke, and Alzheimer’s disease. And a diet rich in whole grains, fruits, and vegetables is the antithesis of a processed food diet.

The evidence is overwhelming. Highly processed foods may be convenient and tasty. But if you value your health, they are not your friends.

The Bottom Line 

A recent study looked at the effect of consuming processed foods on the risk of developing inflammatory bowel disease (IBD). The study found:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the study.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “…This study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effect of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives commonly found in processed foods on the risk of developing IBD.]

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.

Dealing With A Bone Bruise

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My Bone Bruise Experience

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

sunAugust is here and it’s hot in Florida, but that’s why we have air conditioning in our homes, offices, and cars…so that’s okay.  Meanwhile, we can enjoy outdoor sports in the morning, or later in the afternoon after the sun starts to go down.  Or, if you like sunning yourself at the beach, just avoid the strongest sun in the early afternoon.

In late May and June, I spent a good bit of time up north. In May I was in New York for my granddaughter’s college graduation, and in mid-June I was invited to Montreal to help a group of people who had tight muscles and long-standing pain.

As you probably know, I love sharing my work.  I think one of the most important things I do is teaching people how to do self-treatments, so they know how to stop pain FAST!  I was able to do that in Montreal and it was fulfilling for me, and certainly beneficial for the people I worked with.  I’d love to teach all over the USA, and the world!  Hopefully this trip was just the first of many!

In July I had several conversations with people about bone bruises.  It’s always interesting how a topic I had already planned on discussing ends up being a part of conversations with clients.  I guess it’s just confirmation that this is an important topic.

My Bone Bruise Experience

Foot PainSeveral years ago, I was in Hawaii visiting friends.  I used to live in Honolulu, so I had a lot of friends I wanted to see. I set out walking to visit one and by the end of the day I had walked at least seven miles all over town vising different friends.  That was fun, but the problem was, I was in flip-flops.

It ended up being a two-fold problem since every step I took my toes would curl down to hold on my flip-flops.  This overstrained the muscles that are underneath and next to the Achilles tendon.  But that’s another story for another time.

As I stepped off a curb my left heel hit the curb and my heel crashed down onto the road.  I hit it so hard I thought I had to have broken it.  At the minimum I thought I had cracked the bone.  Limping I headed back to my friend’s house and put ice on my foot.

The pain never lessened so I went for an x-ray.  The x-ray showed it wasn’t cracked or broken and I was told it would just heal.  Nice thought.  Months passed, I couldn’t put any weight on my heel, and nothing helped it.

It didn’t matter if I used ice or heat, lifted my leg up onto a chair or had my foot on the floor. Cushions in my shoe didn’t help, neither did rubbing it.  The ache went all the way up my leg and into my hip, so I was limping because of my foot, and I was limping because of hip pain.  Yikes!

That’s when I learned about bone bruises.

Dealing With A Bone Bruise

Inflammed HeelGoogle, who knows everything, wasn’t much help.  It told me that “a bone bruise is a traumatic injury” – you think!!

Then it said:

“A bone bruise causes blood and fluid to build up in and around your injured bone: You may have symptoms such as pain, swelling, and a change in color of the injured area.

Most bone bruises eventually heal without any problems. If your bone bruise is very large, your body may have trouble getting blood flow back to the area.”

In any case, I had 3 different x-rays because I couldn’t believe you could have this much pain without having a broken bone.  All of them showed that the bone was definitely not broken.

It took a full year for the pain to stop!

So, I learned two lessons…

1 – Don’t do anything that can bruise a bone.

2 – If I do get a bone bruise, just realize it will really hurt for a long time, nothing works to ease the pain, and eventually it will just go away.

It’s pretty hard to live life and never do anything that could bruise a bone, so just do your best.  It’s one of the reasons I looked for the Perfect Ball that I use when I teach clients how to relieve muscle spasms. I give a Perfect Ball to every client who comes to my office or buys one of my books since I want them to have a great ball that won’t bruise the bone.

One important suggestion is to never use a baseball, golf ball (on your arch), or lacrosse ball, as these can easily cause a bone bruise.

Here’s hoping you never have a bad bone bruise, but if you do, chin up and know it will eventually heal.

Coming Next Month

The summer is a great time for swimming!  It’s hot out and swimming refreshes the body, plus it’s a wonderful form of exercise.

The muscles of the shoulder get strained if you are swimming for extended lengths of time, so that will be our topic of the month.

Treat Yourself To Pain-Free Living

Not only is this the name of my self-treatment book, it’s also a wonderful way to live…..pain-free!

pain free living book

 

The book has:

 

*Lots of information about “why” and “how” muscles cause pain

 

*Over 200 pictures showing you how to release tight muscles

 

*Simple instructions for treating each muscle

For only $47 (plus S&H) you can have direction to find and self-treat aches and pains from your head to your feet!  It’s easy-to-read and easy-to-do.  You don’t need to stay in pain when you can Treat Yourself to Pain-Free Living.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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

Omega-3s Reduce Preterm Births

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Do Omega-3s Make For A Healthy Pregnancy?

Author: Dr. Stephen Chaney 

omega-3s during pregnancy is healthyThe role of omega-3s on a healthy pregnancy has been in the news for some time. Claims have been made that omega-3s reduce preterm births, postnatal depression, and improve cognition, IQ, vision, mental focus, language, and behavior in the newborn as they grow.

The problem is that almost all these claims have been called into question by other studies. If you are pregnant or thinking of becoming pregnant, you don’t know what to believe.

  • Should you eat more fish?
  • Should you take omega-3 supplements?
  • Or should you just ignore the claims about omega-3s and a healthy pregnancy?

These are not trivial questions. Let’s consider preterm births as an example. The medical profession has made enormous advances in keeping premature babies alive. However, premature babies are still at higher risk of several health conditions including:

  • Visual impairment.
  • Developmental Delay.
  • Learning difficulties.

Plus, it is expensive to keep premature babies alive. One recent study estimated that increasing omega-3 intake during pregnancy could reduce health care costs by around $6 billion in the United Stated alone.

Unfortunately, it’s not just omega-3s and pregnancy. The same is true for almost all nutritional health claims. One day a study comes out claiming that nutrient “X” cures some disease or has some miraculous benefit. The bloggers and news media hype that study. Suddenly you see that health claim everywhere. It becomes so omnipresent that you are tempted to believe it must be true.

But wait. A few months later another study comes to opposite conclusion. Now the media is telling you that health claim is false. The months come and go, and new studies keep coming out. Some support the health claim. Others refute it.

Pretty soon the nutrition headlines just become “noise”. You don’t know what to believe. If you want the truth, “Who ya gonna call?”

Who Ya Gonna Call?

ghost bustersIt’s not Ghostbusters. It 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.

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. 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.

This week we will examine the Cochrane Collaboration’s review titled “Omega-3 Fatty Acid Addition During Pregnancy”.

How Was The Study Done?

Clinical StudyFor this analysis the Cochrane Collaboration reviewed 70 randomized controlled trials which compared the effect of added omega-3s on pregnancy outcomes with either a placebo or a diet no added omega-3s. These trials included almost 19,927 pregnant women.

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. 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 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.

Omega-3s Reduce Preterm Births

clinically provenHere are the conclusions that the Cochrane Collaboration said were supported by high-quality evidence:

  • Omega-3s reduce the risk of preterm births.
  • Omega-3s reduce the risk of low-birth-weight infants.

The authors concluded: “Omega-3 supplementation during pregnancy is an effective strategy for reducing the risk of preterm birth…More studies comparing omega-3s and placebo are not needed at this point.”

In other words, they are saying this conclusion is definite. Omega-3 supplementation should become part of the standard of medical care for pregnant women.

However, they did say that further studies were needed “…to establish if, and how, outcomes vary by different types of omega-3s, timing [stage of pregnancy], doses [of omega-3s], or by characteristics of women.”

That’s because these variables were not analyzed in the Cochrane study. Their review and meta-analysis included clinical trials:

  • Of women at low, moderate, and high risk of poor pregnancy outcomes.
  • With DHA alone, with EPA alone, and with a mixture of both.
  • Omega-3 doses that were low (˂ 500 mg/day), moderate (500-1,000 mg/day), and high (> 1,000 mg/day).

Do Omega-3s Make For A Healthy Pregnancy?

What about the effect of omega-3s on other pregnancy outcomes?

The conclusions the Cochrane Collaboration said were supported by moderate quality evidence included reductions in:

  • Perinatal death.
  • Admissions to the neonatal intensive care unit.

There was not enough high or moderate quality data to determine the effect of omega-3s on other pregnancy outcomes such as postnatal depression. More research is still needed in those areas. However, if you do receive any of these benefits from omega-3 supplementation, you can just consider them as side benefits.

What Does This Report Mean For You?

pregnant women taking omega-31) The proven effect of omega-3 supplementation on preterm births is significant because preterm births increase the risk of:

  • Visual impairment.
  • Developmental Delay.
  • Learning difficulties.

2) The likely effect of omega-3s on admission to neonatal intensive care units is significant because those units are very expensive.

3) The Cochrane study did not determine whether omega-3 supplementation was equally important for women at low, moderate, and high likelihood of poor pregnancy outcomes.

  • Therefore, omega-3 supplementation should be considered for all pregnant women.

4) The Cochrane study did not determine whether omega-3 supplementation was equally important during the first, second, or third trimester.

  • Therefore, omega-3 supplementation should be considered by all women of childbearing age who might become pregnant and throughout pregnancy.

5) The Cochrane study did not determine whether DHA, EPA, or a mixture of the two was most effective.

  • Therefore, your omega-3 supplement should probably contain both DHA and EPA. A group of experts recently recommended  that adults consume at least 650 mg/day of omega-3s with ≥ 220 mg of that coming from DHA and ≥ 220 mg/day coming from EPA.
  • Since most pregnant women in this country consume around 89 mg/day of DHA + EPA, omega-3 supplementation is warranted.

The Bottom Line 

The effect of omega-3s on pregnancy outcomes have been confusing. Some studies conclude that omega-3s are important for a healthy pregnancy. Other studies suggest they are ineffective. What are you to believe?

Fortunately, a group called the Cochrane Collaboration recently conducted a comprehensive review of this topic. This is significant because Cochrane Reviews are internationally recognized as the highest standard in evidence-based health care. They influence the treatment protocols recommended by the medical community.

This Cochrane Review concluded that omega-3 supplementation during pregnancy:

  • Reduces preterm births and low birth weight infants.
  • Likely reduces perinatal death and admissions to the neonatal intensive care unit.

The authors of the review said: “Omega-3 supplementation during pregnancy is an effective strategy for reducing the risk of preterm birth…More studies comparing omega-3s and placebo are not needed at this point.”

In other words, they are saying this conclusion is definite. Omega-3 supplementation should become part of the standard of medical care for pregnant women.

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