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

Relief From Jaw Pain

August 17, 2021 by Dr. Steve Chaney

A TMJ Story That Has A Happy Ending

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Summer And The Living Is Easy

As the song goes: ”…Summertime and the living is e-a-s-y….” Here in Florida, we know that the living is easy because it’s so hot who wants to be doing anything except either sitting in the shade, or inside in the air conditioning. Personally, I don’t think this summer was so bad, especially the evenings, but then, I really hate the cold so maybe my opinion is biased.

To stay in alignment with “living is easy,” I’m taking the advice of a few experts who teach easy ways to stay calm, motivated, and happy. I’m taking a 30-day break from the news. It’s so much in my face lately that it’s really affecting me in a very negative way. I am going on a “news fast” for 30 days. Absolutely no negative news of any kind for a full month. I’m surrounded by news all day so it’s a challenge, but I’ve found a great substitute: www.GoodNewsNetwork.org. Their mission is to be an antidote to the barrage of negativity experienced in the mainstream media.

This month I had several requests to explain how muscles can be a primary cause of TMJ. The initials “TMJ” stand for Temporal Mandibular Joint. Basically, it’s the hinge that enables you to open your mouth and chew. The problem is when it is pulled out of alignment you have jaw pain. You may also have some painful clicking in the area that is behind your last molars, the location of the joint.

A TMJ Story That Has A Happy Ending

About 15 years ago I was seeing clients in my office, which was located in Dr. Zev Cohen’s medical office. Frequently Dr. Cohen would ask me to look at one of his patients because he felt their problem was muscular, and each time it was being caused by tight muscles. He liked the results we were achieving, and I was happy to be a valuable part of his Internal Medicine team.

On day a young woman, around 32 YO, came in on a Sunday because she had forgotten to have her own doctor fill in a form she needed in order to have surgery performed the next day. Dr. Cohen was open on Sundays (closed on Saturday) so she came to get surgical clearance. I just happened to be there doing some work in my office, but not to see clients.

Dr. Cohen asked the woman why she needed surgery and she explained that her jaw was locked tight, and the Oral surgeon was going to sever the masseter muscle. That simple-sounding surgery has a serious side-effect….you can’t close your mouth! She would have walked around with her mouth hanging open for the rest of her life! Plus, when your mouth is open, you drool. That would have been her life if she hadn’t forgotten to get that form signed!

When Dr. Cohen looked at her masseter muscle, he found it felt like she had stuffed her cheeks with nuts. There were so many spasms that it was locking her back teeth together and she couldn’t open her mouth. She didn’t need surgery, she needed to untie the knots in her masseter muscle.

Since I was there, Dr. Cohen had me work on this muscle, and then as always, I showed her how to do it. It took only about 15 painful minutes to release all the spasms. When I was finished, I had her sit up and I showed her what to do. At the very end I had her pressing on both sides of her jaw, and slowly open her mouth. She was shocked to see that she could do it.

Then I had her take her hands away and just open her mouth. We both started to cry when she opened her mouth all the way without any pain. She was saved from a surgery that would have had a lifetime of drooling and dryness.

I don’t know why her doctor, or the oral surgeon didn’t know to tell her to do this, but it’s something I try to share with as many people as possible. I hope you will pass this newsletter along since you may save someone from the same potential surgery.

The Masseter Muscle

The masseter muscle (circled in red) connects your cheekbone to your jawbone. When it contracts you chew your food or clench your teeth.

If you put your flat fingers (fingerprints) on your cheeks and then clench, you will feel your masseter contract.

If you chew gum or clench your teeth frequently the muscle contracts and then shortens. The problem is, when it is shortened and you try to open your mouth to yawn or put food into your mouth, the muscle won’t lengthen to allow them movement.

If one side is tighter than the other side, your jaw will pull toward the tight side, “click” and hurt when you try to open your mouth. This is the common symptom of TMJ. If both sides are shortened, you won’t be able to open your mouth fully. This is what was happening to the woman I mentioned above.

Relief From Jaw Pain

Press your three fingers into the masseter muscle on both sides of your jaw, but only use pressure on one side.

Press as deeply as you can tolerate and hold the pressure for 5-10 seconds. Lighten up the pressure on that side and repeat on the opposite side.

Do this alternating press/release all over the muscle. Continue alternating, and eventually moving along the entire length of the muscle until you have covered it from your cheek bone to your jawbone.

Finally, press both sides at the same time and slowly open your mouth as wide as possible. Slowly close your mouth, and then repeat this stretch 3-4 times.

Do this as often as needed to get total relief. Since this problem happens because of a repetitive movement, it may return. Just do the treatment before it becomes a problem, and the situation will be eased.

Wishing you well,

Julie Donnelly

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

Do Whole Grains Keep Diabetes Away?

August 10, 2021 by Dr. Steve Chaney

Are Whole Grains Healthy?

Author: Dr. Stephen Chaney

Low carb enthusiasts will tell you that carbohydrates are the villain. They tell you that cutting carbohydrates out of your diet will reduce your risk of obesity, diabetes, heart disease, and cancer.

If they limited their list of villainous foods to highly processed foods with white flour and/or added sugars, many nutrition experts would agree with them. There is widespread agreement in the nutrition community that we eat far too much of these foods.

However, I don’t have to tell you that many low carb diets also eliminate whole grains, fruits, and beans from their diets based solely on the carbohydrate content of these foods. Is this good advice? Is there any data to back up this claim?

The short answer is no. Last week I shared a study showing that fruits reduced your risk of developing type 2 diabetes.

This week I will review a study looking at the effect of whole grain consumption on the risk of developing type 2 diabetes.

How Was This Study Done?

This study combined data from women in the Nurses’ Health Study (1984-2014) and the Nurses’ Health Study II (1991-2017), and men in the Health Professionals Follow-Up Study (1986-2016). There were 158,259 women and 36,525 men in these three studies.

None of the participants had type 2 diabetes, cardiovascular disease, or cancer at the time they entered the studies.

At the beginning of each study and every 4 years later the participants were asked to fill out a food frequency questionnaire to collect information about their usual diet over the past year. Validation studies showed that the diets of the participants changed little over the interval of the studies. [Note: This is a strength of these studies. Many clinical studies only collect dietary data at the beginning of the study, so there is no way of knowing whether the participant’s diets changed over time.]

The participants in these studies were followed for an average of 24 years. They were sent follow-up questionnaires every two years to collect information on diseases they had been diagnosed with over the past two years. Participants who reported type 2 diabetes were sent a supplementary questionnaire to confirm the diagnosis.

This study measured the effect of whole grain consumption, and frequently consumed whole grain foods, on the long term (24 year) risk of developing type 2 diabetes.

The data were adjusted for multiple possible confounding variables (other factors that might affect the risk of developing type 2 diabetes) including age, ethnicity, smoking status, alcohol intake, multivitamin use, healthy eating index (a measure of how healthy the overall diet was), caloric intake, obesity, family history of diabetes, and use of oral contraceptives or postmenopausal hormones.

In addition, a stratified analysis was performed to assess the extent to which obesity, physical activity, smoking status, and family history of diabetes influenced the outcome.

In short, this was a very rigorous and well-controlled study.

Do Whole Grains Keep Diabetes Away?

Total whole grain consumption was divided into five groups ranging from 2 servings per day to < 0.1 serving per day. When participants with the highest whole grain intake were compared to those with the lowest whole grain intake:

Whole grain consumption was associated with a 29% lower risk of developing type 2 diabetes.

- The association between whole grain consumption and reduced risk of developing type 2 diabetes was stronger for lean individuals (45% reduction in risk) than for overweight (34% reduction in risk) or obese individuals (23% reduction in risk).

- The association between whole grain consumption and reduced risk of developing type 2 diabetes was not affected by physical activity, smoking status, or family history of diabetes.

When they looked at the entire range of whole grain intake among participants in the study:

The risk reduction for developing type 2 diabetes was nonlinear.

- The greatest portion of risk reduction (30% decreased risk) occurred between 0 and 2 servings/day.

- However, the reduction in risk continued to decrease at a slower rate up to 4.5 servings/day (38% decreased risk), the highest intake recorded for participants in this study.

When they looked at the most frequently consumed whole grain foods and compared the risk of developing type 2 diabetes for participants consuming one or more servings per day compared with less than 1 serving per month:

People consuming whole grain cold breakfast cereals were 19% less likely to develop type 2 diabetes.

People consuming whole grain breads were 21% less likely to develop type 2 diabetes.

People consuming popcorn were 8% more likely to develop type 2 diabetes.

Once again, the risk reduction was nonlinear.

For whole grain cold breakfast cereals risk reduction plateaued at around 0.5 servings per day.

For whole grain breads the greatest portion of risk reduction occurred at around 0.5 servings per day (17% decreased risk), but the reduction in risk continued to decrease at a slower rate up to 4 servings/day (28% decreased risk).

For popcorn, the risk reduction curve was non-linear. There was a slight, non-significant, decrease in risk at about 0.2 servings per day, followed by a steady increase in risk up to 1.75 servings per day (24% increased risk).

When they looked at less frequently consumed whole grain foods and compared the risk of developing type 2 diabetes for participants consuming two or more servings per week compared with less than 1 serving per month:

People consuming oatmeal were 21% less likely to develop type 2 diabetes.

People consuming brown rice were 12% less likely to develop type 2 diabetes.

People consuming added bran were 15% less likely to develop type 2 diabetes.

There were not enough people consuming these whole grains for the investigators to determine how many servings were optimal.

The authors concluded, “Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, whole grain bread, brown rice, and added bran, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.”

Are Whole Grains Healthy?

This is a very impressive study. As described above, it is a large (194,784 participants), long lasting (24 years), and well-designed study. With this data in mind, we can answer several important questions.

Are Whole Grains Healthy?

This study explodes the myth that you should avoid whole grains if you want to prevent diabetes. Instead, the study shows that whole grain consumption decreases your risk of developing type-2 diabetes.

I recently reviewed another large, well-designed study showing that whole grain consumption reduces your risk of dying from heart disease, cancer, and all causes combined.

So, clearly whole grains are good for you. They should be an important part of your diet.

Which Whole Grains Are Healthy?

According to this study, whole grain breakfast cereals, whole grain breads, oatmeal, brown rice, and bran are all healthy. All of them significantly reduce your risk of developing type 2 diabetes. Other whole grains are likely to be healthy too, but Americans consume so little of them, they could not be analyzed in this study.

However, there are some caveats:

You have to read labels carefully. Unless it says “100% whole grain”, it probably contains more refined grains than whole grains.

- Yes, food manufacturers are intentionally deceptive. Who knew?

You have to look at the food, not just “whole grain” on the label.

- It is hard to imagine, but Dr. Kellogg originally created breakfast cereals as health food. However, today many “whole grain” cereals are loaded with sugar and artificial ingredients. They are highly processed foods that are anything but healthy.

- The case of popcorn is a perfect example. Popcorn is loaded with fiber. It should reduce your risk of diabetes. However, in this study it increased the risk of diabetes. That’s because 70% of the popcorn that Americans consume is purchased either pre-popped or ready to pop. It contains unhealthy ingredients like salt, butter, sugar, trans fats, and artificial flavors. It is a highly processed food. Air popped popcorn without the added ingredients is probably very healthy.

Why Are Whole Grains Healthy?

Dr. Strangelove and his buddies have told you to avoid all grains because they contain carbohydrates that are converted to sugar. That is good advice for refined grains. Not only are they rapidly converted to sugar. But they are also found in highly processed foods along with sugar, fat, and a witch’s brew of chemicals.

However, whole grains are different. Yes, whole grains are carbohydrate-rich foods, and the carbohydrate is converted to sugar during digestion. But:

They also contain fiber, which slows the digestion of the carbohydrate and delays the absorption of the sugar released during digestion.

The carbohydrate is trapped in a cellular matrix, which must be digested before the carbohydrate can be released.

In addition:

Whole grains contain nutrients and phytonutrients not found in refined grains.

The fiber in whole grains supports the growth of friendly bacteria in the gut.

How Many Whole Grain Foods Should I Be Eating?

This study found that you get the biggest “bang for your buck” when you go from 0 to around 2 servings per day of whole foods.

If you aren’t fond of whole grain foods, that is good news. It is also in line with USDA recommendation that half the grains we eat should be whole grains. You don’t need to eat whole grains with every meal.

If you are a purist, you can reduce your diabetes risk even more by increasing your whole grain intake up to at least 4.5 servings per day, the highest intake measured in this study.

Are Low Carb Diets Healthy?

Low carb diets may be effective for short term weight loss, but there is no evidence that they are healthy long term. And, because they cut out one or more food groups many experts feel they are likely to be unhealthy long term.

My advice is to forget “low carb” and focus on “healthy carb” instead.

Eliminate refined carbs and the highly processed foods they are found in.

Include fruits, whole grains, and beans as part of your diet. They are high carbohydrate foods, but, as this and other studies have shown, the carbohydrates in those foods are healthy carbs.

The Bottom Line

Low carb enthusiasts tell you to eliminate whole grains from your diet if you want to reduce your risk of developing diabetes. Is this true? Is it good advice?

A recent study put this advice to the test. It was a large (194,784 participants), long lasting (24 years), and well-designed study. Here is what the study found.

When participants with the highest whole grain intake were compared to those with the lowest whole grain intake:

Whole grain consumption was associated with a 29% lower risk of developing type 2 diabetes.

When they looked at the entire range of whole grain intake among participants in the study:

The risk reduction for developing type 2 diabetes was nonlinear.

The greatest portion of risk reduction (30% decreased risk) occurred between 0 and 2 servings/day.

But the reduction in risk continued to decrease at a slower rate up to 4.5 servings/day (38% decreased risk), the highest intake recorded for participants in this study.

When they looked at individual foods, whole grain breakfast cereals, whole grain bread, oatmeal, brown rice, and added bran all reduced diabetes risk.

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

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

Does An Apple A Day Keep Diabetes Away?

August 3, 2021 by Dr. Steve Chaney

A Holistic Approach To Preventing Diabetes

Author: Dr. Stephen Chaney

Low carb enthusiasts will tell you that carbohydrates are the villain. They tell you that cutting carbohydrates out of your diet will reduce your risk of obesity, diabetes, heart disease, and cancer.

If they limited their list of villainous foods to foods with white flour and/or added sugars, many nutrition experts would agree with them. There is widespread agreement in the nutrition community that we eat far too much of these foods.

However, I don’t have to tell you that many low carb diets also eliminate fruits, whole grains, and beans from their diets based solely on the carbohydrate content of these foods. Is this good advice? Is there any data to back up this claim?

The short answer is no. In fact, most studies suggest the opposite is true. I have covered these studies in previous issues of “Health Tips From The Professor”. For example:

In one issue I covered studies showing the people consuming primarily plant-based diets weigh less, have less inflammation, and have a lower risk of diabetes, heart disease, and high blood pressure than people consuming the typical American diet.

In another issue I shared studies showing that women consuming a plant-based low carb diet weigh less, and have reduced risk of diabetes and heart disease than women consuming a meat-based low carb diet.

However, these studies looked at the effect of the whole diet, not individual components of the diet.

This week I will review a study (NP Bondonno et al, The Journal of Clinical Endocrinology & Metabolism, 2021, doi:10.1210/clinem/dgab335) looking at the effect of fruit consumption on the risk of developing type 2 diabetes.

Next week I will review a study looking at the effect of whole grain consumption on the risk of developing type 2 diabetes.

How Was This Study Done?

This study made use of data from the Australian Diabetes Obesity And Lifestyle Study. This study recruited 7675 Australians 25 years or older from 7 states and territories in Australia in 1999 and 2000 and followed them for 5 years. The characteristics of the study population were:

Gender = 45% male, 55% female
Average age = 54 years
Average BMI = 26.8 (slightly overweight)
Did not have diabetes at time of entry into the study.

The participants filled out a food frequency questionnaire at the time of entry into the study. This questionnaire was used to analyze:

the amount of fruit consumed.

the amounts of vegetables, red meat, and processed meat consumed.

how many calories were consumed.

At the time of entry into the study several measurements were taken that assessed whether the participants had an increased risk of developing diabetes (otherwise known as pre-diabetes). These included:

Fasting plasma glucose and insulin levels.

A 2-hour glucose tolerance test. The results of this test were used to calculate insulin resistance and insulin sensitivity.

The study also recorded any participants who were diagnose with diabetes over the next 5 years.

Does An Apple A Day Keep Diabetes Away?

The data from this study were statistically adjusted for confounding variables (Other variables that might affect the risk of diabetes). Many confounding variables were included in the adjustment, but the ones of interest to us are age, sex, physical activity, obesity, caloric intake, and intakes of alcohol, vegetables, red meat, and processed meat.

After adjustment for all these variables the results were:

At the beginning of the study:

Fruit intake was inversely associated with insulin levels and insulin resistance.

Fruit intake was directly associated with insulin sensitivity.

In other words, the more fruit people ate, the less likely they were to have prediabetes at the time they entered the study.

At 5 years:

Fruit intake was inversely associated with diabetes.

Fruit juice had no effect on diabetes risk.

In other words, the more fruit people ate, the less likely they were to develop diabetes 5 years later. Fruit juice, on the other hand, had no beneficial effect on diabetes risk.

The benefit of fruit intake plateaued at 2-3 servings a day.

In other words, you don’t need to become a fruitarian. A modest intake of fruit (2-3 servings a day) is all you need.

In case you haven’t noticed, 2-3 servings of fruit a day matches USDA recommendations – and the recommendations of almost every other governmental and medical organization. What do they know that you didn’t know?

The most commonly eaten fruits in this study were apples (23%), bananas (20%), and oranges and other citrus fruits (18%). Enough people ate these three fruits that their effects on the risk of developing diabetes could be analyzed separately.

The beneficial effect of each of these fruits plateaued at about one serving a day.

In other words, an apple a day does keep diabetes away. However, apples can’t do it alone. You need a variety of fruits for optimal benefit.

The authors concluded, “A healthy diet including whole fruits, but not fruit juice, may play a role in mitigating type 2 diabetes risk.”

A Holistic Approach To Preventing Diabetes

This study explodes the myth that you should avoid fruits if you want to prevent diabetes. Yes, fruits do contain sugar, but:

They also contain fiber, which slows the absorption of that sugar.

The sugar is trapped in a cellular matrix, which must be digested before that sugar can be released. That also slows the absorption of sugar.

This is why fruit consumption reduces the risk of diabetes while fruit juice consumption does not.

However, I don’t want to give you the impression that you can reduce your risk of diabetes just by consuming more fruit. You need a holistic approach. Here are diabetes prevention tips from the American Diabetes Association.

Get more physical activity.

- The greatest benefit comes from a fitness program that includes both aerobic exercise and resistance training.

2) Get plenty of fiber.

- Include fruits, vegetables, whole grains, beans, and nuts in your diet.

3) Lose extra weight.

- One recent study showed that losing as little as 7% of your body weight and exercising regularly could reduce your risk of developing diabetes by almost 60%.

4) Skip fad diets and simply make healthier food choices.

- “Low-carb diets, the glycemic index diet, and other fad diets may help you lose weight initially. But their effectiveness at preventing diabetes and their long-term effects aren’t known. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients.”

5) See your doctor on a regular basis and have your blood sugar tested, especially if you are overweight, have a family history of diabetes, or are over 45.

The Bottom Line

Low carb enthusiasts tell you to eliminate fruits from your diet if you want to reduce your risk of developing diabetes. Is this true? Is it good advice?

A recent study put this advice to the test. The study recruited 7675 Australians 25 years or older and followed them for 5 years. It correlated fruit intake with measures of prediabetes at the beginning of the study and correlated fruit intake with the onset of diabetes over the next 5 years. Here is what the study found.

The more fruit people ate, the less likely they were to have prediabetes at the time they entered the study.

The more fruit people ate, the less likely they were to develop diabetes 5 years later.

The benefit of fruit intake plateaued at 2-3 servings a day. In other words, you don’t need to become a fruitarian. A modest intake of fruit (2-3 servings a day) is all you need.

The beneficial effect of each of these fruits plateaued at about one serving a day.

In other words, an apple a day keeps diabetes away. However, apples can’t do it alone. You need a variety of fruits for optimal benefit.

The authors concluded, “A healthy diet including whole fruits, but not fruit juice, may play a role in mitigating type 2 diabetes risk.”

For more details about this study and a holistic approach to reducing your risk of diabetes recommended by the American Diabetes Association, 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 Diet And Gut Bacteria Affect Our Health

July 27, 2021 by Dr. Steve Chaney

Why Is Your Microbiome Important?

Author: Dr. Stephen Chaney

We have known for years that primarily plant-based diets are healthy. As I have shared in my book, “Slaying The Food Myths”, people who consume primarily plant-based diets have lower risk of heart disease, diabetes, and some cancers and live longer than people who consume the typical American diet.

But why is that?

Is it the nutrients, phytonutrients, and fiber plant foods provide?

Is it because plant foods are lower in saturated fats and are good sources of healthier monounsaturated and polyunsaturated fats?

Or is it because plant foods have a low caloric density, which makes it easier to maintain a healthy weight?

The answer, of course, is that all the above are important. But is there something else? Is there a “missing link” we don’t talk about much? Many experts think our microbiome (our gut bacteria) is that missing link.

You have heard the saying, “We are what we eat”. You might be scratching your head and saying, “I could eat cabbages all day long, but I am never going to become a cabbage.” It seems like a crazy saying.

But for our microbiome that saying is true. What we call fiber, our gut bacteria call food. Consequently, vegetarians and meat eaters have very different populations of gut bacteria in their microbiome. The question, of course, is whether these differences influence our health. This central question has spurred multiple research studies on our microbiome in recent years.

Two central themes have emerged from these studies:

There are certain populations of gut bacteria that are associated with healthy outcomes (lower risk of obesity, diabetes, heart disease, and some cancers). We can think of these as “good bacteria”.

- There are certain populations of gut bacteria that are associated with unhealthy outcomes (increased risk of obesity, diabetes, heart disease, and some cancers). We can think of these as “bad bacteria”.

People consuming primarily plant-based diets tend to have more of the “good bacteria” and less of the “bad bacteria” in their gut microbiome.

However, most of these studies have been small and have looked at individual foods rather than the effect of the overall diet.

The study (KK Koponen et al, American Journal Of Clinical Nutrition, 2021; doi.org/10.1093/ajcn/nqab077 I will describe today was designed to overcome those limitations.

Metabolism 101: What Are Short Chain Fatty Acids And Why Are They Important?

To fully understand the findings of this study, you need to understand what short chain fatty acids are and why they are important. Simply put, short chain fatty acids are the end products of fiber digestion by some species of gut bacteria in our intestines. The major short chain fatty acids in our intestines are acetate (2 carbons), propionate (3 carbons), and butyrate (4 carbons).

There are the key facts about short chain fatty acids you should know:

They are formed by anaerobic fermentation of dietary fiber by our gut bacteria. However:

- Not all gut bacteria can produce short chain fatty acids.

- The amount and type(s) of dietary fiber determine whether the gut bacteria that can produce short chain fatty acids are present.

2) Acetate is readily absorbed into the bloodstream and is utilized for fat production and other biosynthetic pathways.

3) Short chain fatty acids, especially butyrate, are the primary energy source for cells lining the colon. Because of this, they have several important health benefits.

- They support the immune cells that line our intestine. This helps strengthen our immune system.

- They help maintain the integrity of the intestinal wall. This helps protect against leaky gut syndrome.

- They reduce inflammation. This reduces the risk of inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.

- They reduce the risk of colon cancer.

4) In addition, small amounts of propionate and butyrate can be absorbed into the bloodstream. Butyrate is of particular interest because it has the potential to regulate gene expression.

- There is some evidence that short chain fatty acid production in the intestine is correlated with reduced risk of inflammatory diseases, obesity, type 2 diabetes, and heart disease, but these studies remain controversial.

How Was This Study Done?

This study made use of data from the FINRISK Study. This study was conducted by the Finnish Institute of Health and Welfare every 5 years between 1972 and 2012 to assess risk factors for noncommunicable diseases, health behavior, and their changes in adult Finns.

This study included 4930 individuals from the 2002 FINRISK assessment. The characteristics of the group were:

53% female, 47% male.
Average age = 48.
Average BMI = 26.9 (slightly overweight).

Upon entry into the study, the participants were asked to fill out a food frequency questionnaire.

The data from this questionnaire were used to calculate a Healthy Food Choices (HFC) score based on the Nordic Nutrition Dietary Guidelines for a healthy diet.

- The HFC score ranged from 9-745 and was based on the consumption of fiber-rich breads; vegetables (including beans and lentils); fruits; berries; fresh, non- sweetened berry and fruit juices; fish; poultry; low-fat cheeses; salad dressings and oils; nuts; and seeds.

- In the words of the authors, “A high HFC score effectively acts as an indicator of a healthy omnivorous Nordic diet rich in plants, fiber, and polyunsaturated fatty acids.”

The data were also used to calculate a total dietary fiber score.

The participants were also asked to provide a stool sample. DNA was extracted from the stool sample and sequenced to determine the number and types of bacteria in their gut microbiome. These data were analyzed for:

Bacterial diversity (greater bacterial diversity is associated with better health outcomes).

Species of gut bacteria known to be associated with better health outcomes.

Species of bacteria known to produce short chain fatty acids.

How Diet And Gut Bacteria Affect Our Health

Microbiome research is complex. But here is a description of the results in simple terms.

Both the Healthy Food Choice (HFC) and fiber scores correlated positively with:

Bacterial diversity (greater bacterial diversity is associated with better health outcomes).

Species of gut bacteria known to be associated with better health outcomes.

Species of bacteria known to produce short chain fatty acids that are associated with better health outcomes.

Simply put, a healthy, primarily plant-based Nordic diet produces the kind of gut microbiome that is associated with better health outcomes.

When the authors analyzed the contribution of individual components of the diet to a healthy microbiome:

Vegetables; berries; fruits; fiber-rich breads; salad dressings and oils; low-fat cheeses; poultry; fresh, unsweetened juices; and fish were all positively associated with a healthy microbiome.

- Each of these foods supported the growth of different gut bacteria that contributed to the healthy microbiome.

- Simply put, none of these foods was sufficient by itself. It was a healthy diet with all these foods that resulted in a healthy microbiome.

Nuts and seeds did not affect the microbiome. This may have been because there was too little of them in the diet to have a significant effect.

Red and processed meats were negatively associated with a healthy microbiome.

The authors concluded, “Our results from a large, population-based survey confirm and extend the findings of other, smaller-scale studies that plant- and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiome with a greater potential to produce short chain fatty acids.”

The authors also said, “The associated between red and processed meat products and the gut microbiome cannot be ignored either…[Our data] indicate that increased usage of red and processed meat is associated with the microbiome composition in an opposite manner to that of a healthy diet.”

Why Is Your Microbiome Important?

The most important message from this and previous studies is that your gut microbiome is the “missing link” between a healthy diet and a healthy body.

Simply put, healthy diet →→→healthy microbiome→→→healthy body

However, I also need to acknowledge microbiome research is in its infancy. That is because our microbiome is very complex:

We have around 38 trillion microorganisms (give or take a few trillion) in our intestine. That means we have slightly more microorganisms than we do cells in our body.

Each of us have more than 1,000 different species of bacteria in our intestine.

Collectively, these bacteria have around 750,000 genes. That is 30 times more than the number of genes in our DNA.

Finally, we all have different species of bacteria in our intestines. We are all unique.

The only simplifying principle is that these bacteria exist in communities that generally group together. Unraveling the complexities and identifying the communities of bacteria in our intestines requires high throughput DNA sequencing and supercomputers to analyze the data.

Studies like this one can identify the associations between diet and distinct communities of bacteria. They can even identify which foods in the diet support the growth of these bacterial communities. Other studies can identify the association between distinct communities of bacteria and healthy outcomes.

The strength of this study is that it identifies the kind of diet and the kinds of food that support the communities of bacteria associated with healthy outcomes. However, these are just associations. They don’t tell us why these associations occur. Specifically:

We don’t know why certain diets are associated with different communities of gut bacteria. However, we do know several things.

- High fiber diets are a major driving force in creating a healthy gut microbiome. This is because what we call fiber, our gut bacteria call food.

- The diet should contain a variety of high fiber foods. This is because different kinds of fiber support the growth of different kinds of gut bacteria, and the diversity of our gut microbiome is associated with healthy outcomes. As I have said before, “We have 5 food groups for a reason”.

- However, the type of fat and the type of protein in the diet also influence the type of bacteria that thrive in our intestines. We know less about why that is.

We also don’t know why certain communities of gut bacteria are associated with healthy outcomes.

- The exception is communities of bacteria that produce short chain fatty acids. We do have a good idea why short chain fatty acids are associated with gut health.

However, the fact we don’t know why these associations occur, doesn’t detract from the strength of these associations.

The associations between a healthy, primarily plant-based diet and a healthy microbiome are not based on this study alone. The same associations have been seen in multiple studies.

The associations between a healthy microbiome and better health outcomes have also been seen in multiple studies.

The evidence for these associations is too strong to ignore.

What Does This Study Mean For You?

This study shows that a healthy Nordic diet is associated with a healthy microbiome. “But what is a healthy Nordic diet?”, you might ask. Simply put, it is a whole food, omnivorous, primarily plant-based diet with Scandinavian food preferences.

And, if pickled herring, potato pancakes, and meatballs aren’t your favorite foods, never fear. You have lots of other options:

The Mediterranean diet is essentially the same diet with Mediterranean food preferences.

The DASH diet is essentially the same diet with American food preferences.

You can start with a semi-vegetarian diet and tailor it to your food preferences. Of course, some common sense is required here. You will need to primarily include whole, unprocessed food preferences in your diet.

Let me close with some simple advice I have shared before:

We are what we eat. Our microbiome (gut bacteria) reflects what we eat.

What we call fiber, our gut bacteria call food. A primarily plant-based diet is best because our friendly gut bacteria thrive on the fiber it provides.

We have 5 food groups for a reason. Each plant food group provides different kinds of fiber and feeds different families of friendly gut bacteria. We eliminate plant food groups at our peril.

We should think of red meat as a condiment, not a main course. Plants contain antidotes to many of the harmful ingredients in red meat. Two to three ounces of steak as part of a green salad or stir fry is much healthier than an 8-ounce steak and fries.

The Bottom Line

Most previous studies on the effect of diet on our microbiome have been small and have looked at individual foods rather than the effect of the overall diet. In this week’s “Health Tips From the Professor” I report on a large, well-designed study that examined the effect of a healthy Nordic diet on our microbiome.

In case you were wondering, the investigators defined a healthy Nordic diet as a whole food diet that:

Includes lots of fruits, vegetables, and whole grains and is, therefore, high in fiber.

Uses fish, poultry, and low-fat cheeses as its primary protein source.

Minimizes red and processed meats.

Has more polyunsaturated oils than saturated fats.

Reflects Scandinavian food preferences.

This study found that a healthy Nordic diet correlated positively with:

Bacterial diversity (greater bacterial diversity is associated with better health outcomes).

Species of gut bacteria known to be associated with better health outcomes.

Species of bacteria known to produce short chain fatty acids that are associated with better gut health outcomes.

Simply put, a healthy, primarily plant-based Nordic diet produces the kind of gut microbiome that is associated with better health outcomes. To put this into perspective, a healthy Nordic diet is similar to a healthy Mediterranean diet or a healthy DASH diet except that the Mediterranean diet reflects Mediterranean food preferences, and the Dash diet reflects American food preferences.

The most important message from this and previous studies is that your gut microbiome is the “missing link” between a healthy diet and a healthy body.

Simply put, healthy diet →→→healthy microbiome→→→healthy body

I summed up the article with some simple advice I have shared before:

We are what we eat. Our microbiome (gut bacteria) reflects what we eat.

What we call fiber, our gut bacteria call food. A primarily plant-based diet is best because our friendly gut bacteria thrive on the fiber it provides.

We have 5 food groups for a reason. Each plant food group provides different kinds of fiber and feeds different families of friendly gut bacteria. We eliminate plant food groups at our peril.

We should think of red meat as a condiment, not a main course. Plants contain antidotes to many of the harmful ingredients in red meat. Two to three ounces of steak as part of a green salad or stir fry is much healthier than an 8-ounce steak and fries.

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

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

Can Tight Muscles Make You Pigeon Toed?

July 20, 2021 by Dr. Steve Chaney

Treatment To Straighten Your Ankle

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Happy July

Things are hot here in Sarasota – today the temperature was 95 degrees in the sun. Fortunately, my office is in the shade. On the plus side it rained, and my garden was dancing with delight.

I’m happy to say I taught a live, in-person class last weekend. It came together quickly, so there were only a few massage therapists attending, each bringing their own model. I’m so happy to get back to teaching live classes again. Zoom gets really old (as I imagine a lot of you already agree). Later this month things ramp up and I’m heading to the Florida State Massage Therapy Association Convention in St. Augustine. I’ll be teaching there too, and happily communicating with a lot of massage therapists.

My therapy practice is back to normal again. Most people (including me) have had both shots. And if someone hasn’t, I just ask them to wear a mask. Not the worst thing in the world, and much better than being in pain. I’ve missed my clients and I look forward to seeing them again.

Meanwhile, I’ve been seeing many clients who are in pain, and I’m pleased to say, the results have been really excellent. There is one person who stands out because she had a condition I hadn’t seen before, or at least I don’t remember seeing before.

A Turned-In Ankle

My client was actually in to see me for a totally different condition, but while I was working on her I noticed that her left foot was turned in.

I thought it might be a bone/structural problem, but when I took my hand, I was able to make her ankle go almost straight. As a result, I knew it was muscular, and therefore there was a good chance treating the muscle could make a big difference.

It turns out her foot had been turned in for a very long time, not debilitating, but more annoying. She didn’t know what could have caused it, but my guess was she sprained her ankle at some time in the past. She said it had been sprained years earlier.

One of the interesting facts about a muscle that is sprain, or otherwise repetitively strained muscle, is it can shorten to that new length and stay that way for years and years. I had a client in New York who sprained his ankle in 1964, and I met him in 2005. The muscles were so tight that he walked as if his ankle was fused, there was absolutely no ankle movement at all. It turned out to just be severely tightened muscles holding his ankle firm, preventing the joint from moving in any direction. It took a lot of treatments, and him doing self-treatments, but we got his ankle back to normal even after all those years!

Back to my Sarasota client……

The muscles involved ended up being the Tibialis Anterior and Extensor Hallucis Longus. Both muscles originate on the front of your lower leg.

Both muscles invert your foot (turn it in toward midline) so, in this case, her left toes were pointing toward her right arch, as shown in the picture above.

Treatment To Straighten The Ankle

The self-treatment for these muscles is easy, but it can be painful at about the point where you see the ball in the picture to the left, and again closer to the bottom of your ankle.

Just put the ball to the outside of your shinbone and press down, moving your leg so the ball is rolling down toward your ankle. You are actually making the Tibialis Anterior muscle a little longer as you press out the knots in the muscle fibers.

Curl your toes as shown if you feel like your arch is going to cramp.

In the next photo I’m showing the right ankle in pain and working with my left hand.

Sit with your sore right leg crossed over your left leg. It helps if you have your right ankle on top of your left knee (I couldn’t do it because I’m taking my own picture and couldn’t get the right angle).

Press your left fingers as deeply into the Extensor Hallucis Longus muscle as you can. If your right ankle is on top of your left knee, you will be able to use two hands to do the treatment. Just put your fingers on top of each other to get more pressure.

The Results

I treated all the muscles of the lower leg, paying special attention to the two muscles mentioned. I’m happy to say that when I finished and she stood up, her feet were almost straight. With more self-treatment every day, her foot will straighten out.

My client was originally here on June 11th, and as an update, she came in today – July 1st – and her foot looked just fine. She continued to do the self-treatments I taught her, and we are happy to say, the problem is solved!

I love what I do for a living, it really makes a difference in people’s lives. Sometimes in small ways, and many times in really big ways.

Wishing you well,

Julie Donnelly

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

Is Nitrate From Vegetables Good For Your Heart?

July 13, 2021 by Dr. Steve Chaney

Are Nitrates Good For You Or Bad For You?

Author: Dr. Stephen Chaney

We have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

Recent research has suggested that the nitrates found naturally in fruits and vegetables may also play a role in protecting our hearts. Here is what recent research shows:

The nitrates from fruits and vegetables are converted to nitrite by bacteria in our mouth and intestines.

- Fruits and vegetables account for 80% of the nitrate in our diet. The rest comes from a variety of sources including the nitrate added as a preservative to processed meats.

- Although all fruits and vegetables contain nitrates, the best sources are green leafy vegetables and beetroot. [Beet greens are delicious and also a good source of nitrate, but beetroot is the part of the beet we usually consume.]

Nitrite is absorbed from our intestine and converted to nitric oxide by a variety of enzymes in our tissues.

Both reactions require antioxidants like vitamin C, which are also found in fruits and vegetables.

Nitric oxide has several heart healthy benefits. For example:

It helps reduce inflammation in the lining of blood vessels. Inflammation stimulates atherosclerosis, blood clot formation, and is associated with an increased risk of heart disease.

It relaxes the smooth muscle cells that surround our blood vessels. This makes the blood vessels more flexible and helps reduce blood pressure.

It prevents smooth muscle cells from proliferating, which prevents them from invading and constricting our arteries. This, in turn, has the potential to reduce the risk of atherosclerosis.

It prevents platelet aggregation. This, in turn, has the potential to reduce the risk of heart attack and stroke due to blood clots that block the flow of blood to our heart or brain.

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. This study (CP Bondonno et al, European Journal of Epidemiology, doi.org/10.1007/s10654-021-00747-3) was designed to answer that question.

How Was This Study Done?

This study made use of data from the Danish Diet, Cancer, and Health Program. That program enrolled 53,150 participants from Copenhagen and Aarhus between 1993 and 1997 and followed them for an average of 21 years. None of the participants had a diagnosis of cancer or heart disease at the beginning of the study.

Other characteristics of the participants at the time they were enrolled in the study were:

46% male

Average age = 56

BMI = 26 (20% overweight)

Average systolic blood pressure = 140 mg Hg

Average diastolic blood pressure = 84 mg Hg

At the beginning of the study, participants filled out a 192-item food frequency questionnaire that assessed their average intake of various food and beverage items over the previous 12 months. The vegetable nitrate content of their diets was analyzed using a comprehensive database of the nitrate content of 178 vegetables. For those vegetables not consumed raw, the nitrate content was reduced by 50% to account for the nitrate loss during cooking.

Blood pressure was measured at the beginning of the study. Data on the incidence (first diagnosis) of heart disease during the study was obtained from the Danish National Patient Registry. Data were collected on diagnosis of the following heart health parameters:

Cardiovascular disease (all diseases of the circulatory system).

Ischemic heart disease (lack of sufficient blood flow to the heart). The symptoms of ischemic heart disease range from angina to myocardial infarction (heart attack).

Ischemic stroke (lack of sufficient blood flow to the brain).

Hemorrhagic stroke (bleeding in brain).

Heart failure.

Peripheral artery disease (lack of sufficient blood flow to the extremities).

Is Nitrate From Vegetables Good For Your Heart?

Intake of nitrate from vegetables ranged from 18 mg/day (<1/3 serving of nitrate-rich vegetables per day) to 168 mg (almost 3 servings of nitrate-rich vegetables per day). The participants were grouped into quintiles based on their vegetable nitrate intake. When the group with the highest vegetable nitrate intake was compared to the group with the lowest vegetable nitrate intake:

Systolic blood pressure was reduced by 2.58 mg Hg.

Diastolic blood pressure was reduced by 1.38 mg Hg.

Risk of cardiovascular disease was reduced by 14%.

Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.

Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.

Risk of heart failure was reduced by 17%.

Risk of peripheral artery disease was reduced by 31%.

Risk of hemorrhagic stroke (bleeding in the brain) was not significantly reduced.

Two other observations were of interest:

Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion. However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.

Only about 21.9% of the improvement in heart health could be explained by the decrease in blood pressure. This is not surprising when you consider the other beneficial effects of nitric oxide described above.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Are Nitrates Good For You Or Bad For You?

You are probably thinking, “Wait a minute. I thought nitrates and nitrites were supposed to be bad for me. Which is it? Are nitrates good for me or bad for me?”

It turns out that nitrates and nitrites are kind of like Dr. Jekyll and Mr. Hyde. They can be either good or bad. It depends on the food they are in and your overall diet.

Remember the beginning of this article when I said that the conversion of nitrates to nitric oxide depended on the presence of antioxidants? Vegetables are great sources of antioxidants. So, when we get our nitrate from vegetables, most of it is converted to nitric oxide. And, as I discussed above, nitric oxide is good for us.

However, when nitrates and nitrites are added to processed meats as a preservative, the story is much different. Processed meats have zero antioxidants. And the protein in the meats is broken down to amino acids in our intestine. The amino acids combine with nitrate to form nitrosamines, which are cancer-causing chemicals. Nitrosamines are bad for us.

Of course, we don’t eat individual foods by themselves. We eat them in the context of a meal. If you eat small amounts of nitrate-preserved processed meats in the context of a meal with antioxidant-rich fruits and vegetables, some of the nitrate will be converted to nitric oxide rather than nitrosamines. The processed meat won’t be as bad for you.

What Does This Study Mean For You?

Your mother was right. You should eat your fruits and vegetables!

The USDA recommends at least 3 servings of vegetables and 2 servings of fruit a day.

Based on this study, at least one of those servings should be nitrate-rich vegetables like green leafy vegetables and beets.

If you don’t like any of those, radishes, turnips, watercress, Bok choy, Chinese cabbage, kohlrabi, chicory leaf, onion, and fresh garlic are also excellent sources of nitrate.

The good news is that you may not need to eat green leafy vegetables and beets with every meal. If this study is correct, one serving per day may have heart health benefits. That means you can enjoy a wide variety of fresh fruits and vegetables as you try to meet the USDA recommendations.

Finally, if you don’t like any of those foods, you may be asking, “Can’t I just take a nitrate supplement?”

For blood pressure, there are dozens of clinical trials, and the answer seems to be yes – especially when the nitrate comes from vegetable sources and the supplement also contains an antioxidant like vitamin C.

For heart health benefits, the answer is likely to be yes, but clinical trials to confirm that would take decades. Double blind, placebo-controlled trials of that duration are not feasible, so we will never know for sure.

Moreover, you would not be getting all the other health benefits of a diet full of fresh fruits and vegetables. Supplementation has its benefits, but it is not meant to replace a healthy diet.

The Bottom Line

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. A recent study was designed to answer that question.

When the study compared people with the highest vegetable nitrate intake to people with the lowest vegetable nitrate intake:

Blood pressure was significantly reduced.

The risk of cardiovascular disease was reduced by 14%.

Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.

Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.

Risk of heart failure was reduced by 17%.

Risk of peripheral artery disease was reduced by 31%.

Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion.

However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Of course, you may have heard that nitrates and nitrites are bad for you. I discuss that in the article above.

For more details about this study, information about vegetable nitrate supplements, 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.

Would You Like Cancer With That Burger?

July 6, 2021 by Dr. Steve Chaney

Enjoy Your Cookouts Without Increasing Cancer Risk

Author: Dr. Stephen Chaney

It is July and backyard cookouts are in full swing. One question that you probably won’t hear from your host or hostess is “Would you like cancer with that burger?” But perhaps that is exactly the question they should be asking.

You probably didn’t really want to know that when fat from the meat hits the hot coals, carcinogens form that are deposited on the meat.

You probably also didn’t want to know that when you cook meat to high temperatures the amino acids in the meat combine to form cancer causing substances.

And you really didn’t want to know that a recent study showed that men who consume well-done red meat were ~60% more likely to develop advanced prostate cancer.

Would You Like Cancer With That Burger?

A recent study compared 531 people ages 40-79 who had recently been diagnosed with advanced prostate cancer with 527 matched controls. Both groups were asked about their dietary intake of meats, usual meat cooking methods and doneness of the meat.

The results were quite striking:

Increased consumption of hamburgers was associated with a 79% increased risk of advanced prostate cancer.

Increased consumption of processed meat was associated with a 57% increased risk of advanced prostate cancer.

Grilled red meat was associated with a 63% increased risk of advanced prostate cancer.

Well done red meat was associated with a 52% increased risk of advanced prostate cancer.

However, those percentages are a little bit difficult to compare, because “increased consumption” was defined relative to what the usual consumption or cooking practice was. So put another way, weekly consumption of…

3 or more servings of red meat or…

5 or more servings of processed meat or…

1 or more servings of grilled or well-done red meat…

…were associated with a 50% increased risk of advanced prostate cancer.

In contrast, consumption of white meat was not associated with increased prostate cancer risk, no matter what the cooking method was used.

Enjoy Your Cookouts Without Increasing Cancer Risk

Our local newspaper recently carried some tips by Dr. Denise Snyder from the Duke University School of Nursing on how you could reduce the risk of giving your guests cancer the next time you are the chef at your backyard cookout.

Here are her suggestions:

Grill fruits and vegetables instead of meat. That was her idea, not mine. My editorial comment would be that grilling white meat (fish or chicken) may also be OK.

Use the lowest temperature that will cook your food thoroughly and keep the grill rack as high as possible.

Use a meat thermometer so that you can make sure that as soon as the meat is thoroughly cooked you remove it from the grill. We usually overcook the meat to make sure that it is done.

Shorten your grill time by microwaving the meat first, using thinner leaner cuts of meat or cutting up the meat and making kabobs.

Trim as much fat from the meat as possible before you cook it.

Line your grill rack with aluminum foil poked with holes. This allows the fat to drip down but minimizes the exposure of the meat to the carcinogens formed when the fat hits the coals.

Marinate your meats before grilling. That has been shown to reduce the formation of cancer-causing chemicals.

And, of course, avoid processed meats like hot dogs and sausage completely because they have been shown to increase the risk of cancer and diabetes no matter how they are cooked.

So, here’s to a healthier cookout. Bon appétit!

The Bottom Line

You already knew that red meat and processed meats may increase your risk of cancer, but how you cook your red meat also matters. Grilling your meat and/or cooking it until it is well done appear to significantly increase your risk of developing advanced prostate cancer.

2) In contrast, consumption of white meat was not associated with increased cancer risk, no matter what the cooking method was used.

3) I have included several tips on how you can reduce the cancer risk associated with grilling red meats in the article above so you can enjoy both your cookouts and your health.

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

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

Which Diet Is Best For Your Heart?

June 29, 2021 by Dr. Steve Chaney

Why Are Dietary Studies So Confusing?

Author: Dr. Stephen Chaney

You are concerned about your heart.

Perhaps it is because of genetics. Everyone on one side of your family tree had their first heart attack in their mid-forties.

Perhaps it is because your doctor has warned you that your heart is a ticking time bomb. Unless you make some drastic changes, you will die of a heart attack in the near future.

Perhaps you already have some symptoms of heart disease, and you are scared.

You want to make some changes. You want to protect your heart. What should you do?

The short answer is that a holistic approach is best, and I will share the American Heart Association recommendations below. But let’s start by asking what you should eat. There are two important questions:

#1: Which diet is best for your heart?

A whole food vegan diet, the Mediterranean diet, and the DASH diet are all strong contenders for the best heart healthy diet.

But there are many other diets that claim to be heart healthy. Some enthusiasts even claim the Paleo and keto diets are heart healthy.

The problem is that few studies have compared these diets against each other. That makes it difficult to settle the question of which diet is best for your heart.

#2: Which protein source is best for your heart – plant protein, fish, poultry, or red meat?

Plant and fish protein are both strong contenders for the most heart healthy protein.

Poultry has the reputation of being more heart healthy than red meat. But this has become controversial. Some recent studies suggest poultry is no better than red meat in terms of heart health.

Fortunately, a recent study (F Petermann-Rocha et al, European Heart Journal, 42: 1136-1143, 2021) has made this comparison. It compared vegetarians, fish eaters, poultry eaters, and red meat eaters for the risk of developing heart disease.

How Was This Study Done?

This study made use of data from the UK Biobank program. The UK Biobank program recruited over 500,000 participants (ages 37-73) from England, Wales, and Scotland between 2006 and 2010 and followed them for an average of 8.5 years.

At entry into the program, each participant filled out a touchscreen questionnaire, had physical measurements taken, and provided biological samples.

Dietary intake was assessed based on the touchscreen questionnaire and the average of 5 24-hour dietary recalls. The participants were divided into four groups based on this dietary analysis:

Vegetarians (All participants in the study consumed cheese and eggs, so this group would more accurately be described as lacto-ovo-vegetarians).

Fish eaters.

Poultry eaters.

Red meat eaters.

Over the next ~8.5 years, each group was compared with respect to the following heart health parameters:

Risk of developing cardiovascular disease (all diseases of the circulatory system).

Risk of developing ischemic heart disease (lack of sufficient blood flow to the heart. The most common symptom of ischemic heart disease is angina).

Risk of having a myocardial infarction (commonly referred to as a heart attack).

Risk of having a stroke.

Risk of developing heart failure.

Which Diet Is Best For Your Heart?

The study compared vegetarians, fish eaters, and poultry eaters with red meat eaters with respect to each of the heart disease parameters listed above. The results were:

When fish eaters were compared with meat eaters, they had:

- 7% lower risk of cardiovascular diseases of all types.

- 21% lower risk of ischemic heart disease (angina).

- 30% lower risk of myocardial infarction (heart attack).

- 21% lower risk of stroke.

- 22% lower risk of heart failure.

When vegetarians were compared with meat eaters, they had:

- 9% lower risk of cardiovascular diseases of all types.

- Lower, but statistically non-significant, risk of other heart disease parameters.

When poultry eaters were compared with meat eaters there were no significant differences in heart disease outcomes.

The authors concluded, “Eating fish rather than meat or poultry was associated with a lower risk of adverse cardiovascular outcomes…supporting its role as a healthy diet that should be encouraged. Vegetarianism was only associated with a lower risk of cardiovascular disease incidence.”

Why Are Dietary Studies So Confusing?

So, you are probably thinking, “Are diets with fish protein really more heart healthy than diets with plant protein?”

Fish have a lot going for them. They are an excellent source of heart healthy omega-3 fats. And, when substituted for red meat protein, they decrease intake of saturated fats.”

But plant protein has a lot going for it as well. Numerous studies have shown that vegetarian diets are more heart healthy than the typical American diet. And only plant-based diets have been shown to reverse atherosclerosis.

So, why are dietary studies so confusing? The problem is that diets are complex. They have many moving parts. When we focus on one aspect of a diet, we are ignoring the rest of the diet. The food we have focused on may be healthy. But if it is paired with unhealthy foods, the overall diet can still be unhealthy.

The current study is a perfect example of that principle:

The participants represented a cross section of the British population. All the “diets” were high in sugar, sugary drinks, saturated fat, and processed meals bought from the supermarket. None of them were optimal.

In addition to consuming cheese and eggs, “vegetarians” consumed more crisps, slices of pizza, and smoothie drinks than meat-eaters. [In case you were wondering, the English refer to small thin salty snacks like potato chips as crisps. They reserve the term chips for what we call French Fries.]

“Vegetarians” also consumed a lot of highly processed vegetarian alternatives designed to taste like other meat products.

On the other hand, fish eaters consumed more fruits and vegetables than meat-eaters. It wasn’t just the fish that made this diet more heart healthy.

In other words, the “vegetarian diet” in this study was not nearly as healthy as the whole food vegetarian diets that have previously been shown to be heart healthy. And the “fish-eaters diet” was healthier than the “meat-eaters diet” because of both the fish and the extra fruits and vegetables these people were consuming.

In the words of the authors, “…As a group, vegetarians consumed more unhealthy foods, such as crisps, than meat eaters. Therefore, vegetarians should not be considered a homogeneous group, and avoidance of meat will not be sufficient to reduce health risk if the overall diet is not healthy.”

My summary:

Whole food plant-based diets (the true definition of vegetarianism) are very heart healthy. [Note: The diet in this study was lacto-ovo-vegetarian rather than a true vegetarian diet. However, recent studies have suggested that addition of small amounts of dairy and eggs to a vegetarian diet may make them more heart healthy rather than less heart healthy.]

Primarily plant-based diets with fish as the main protein source (otherwise known as pescatarian diets) are also very heart healthy.

If you want a healthy heart, choose the one that best fits your preferences and your lifestyle.

A Holistic Approach: The American Heart Association Recommendations

If you smoke, stop.

Choose good nutrition.

- Choose a diet that emphasizes vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts.

- Choose a diet that limits sweets, sugar-sweetened beverages, and red meats.

- Reduce high blood cholesterol and triglycerides.

- Reduce your intake of saturated fat, trans fat and cholesterol.

Lower High Blood Pressure.

Be physically active every day.

- Aim for at least 150 minutes per week of moderate-intensity physical activity per week.

Aim for a healthy weight.

Manage diabetes.

Reduce stress.

Limit alcohol.

Have a regular physical checkup.

The Bottom Line

A recent study in the United Kingdom compared vegetarians, fish eaters, poultry eaters, and red meat eaters for the risk of developing heart disease and the risk of dying from heart disease. The results were:

When fish eaters were compared with meat eaters, they had:

- 7% lower risk of cardiovascular diseases of all types.

- 21% lower risk of ischemic heart disease (angina).

- 30% lower risk of myocardial infarction (heart attack).

- 21% lower risk of stroke.

- 22% lower risk of heart failure.

When vegetarians were compared with meat eaters, they had:

- 9% lower risk of cardiovascular diseases of all types.

- Lower, but statistically non-significant, risk of other heart disease parameters.

When poultry eaters were compared with meat eaters there were no significant differences in heart disease outcomes.

However, the “vegetarian diet” in this study was not nearly as healthy as the whole food vegetarian diets that have previously been shown to be heart healthy. And the “fish-eaters diet” was healthier than the “meat-eaters diet” because of both the fish and the extra fruits and vegetables this group of people were consuming.

In the words of the authors, “…As a group, vegetarians consumed more unhealthy foods, such as crisps [potato chips], than meat eaters. Therefore, vegetarians should not be considered a homogeneous group, and avoidance of meat will not be sufficient to reduce health risk if the overall diet is not healthy.”

My summary:

Whole food plant-based diets (the true definition of vegetarianism) are very heart healthy.

Primarily plant-based diets with fish as the main protein source (otherwise known as pescatarian diets) are also very heart healthy.

If you want a healthy heart, choose the one that best fits your preferences and your lifestyle.

For more details about 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.

How Much Omega-3 Should You Take During Pregnancy?

June 22, 2021 by Dr. Steve Chaney

Which Omega-3s Are Beneficial?

Author: Dr. Stephen Chaney

Preterm births (births occurring before 37 weeks) are increasing in this country. Just between 2018 and 2019, the percentage of preterm births increased by 2% to over 10% of all pregnancies. That is a concern because preterm births are associated with an increased risk of:

Visual impairment.
Developmental delays.
Learning difficulties.
Problems with normal development of lungs, eyes, and other organs.

Plus, it is expensive to keep premature babies alive. One recent study estimated that reducing the incidence of preterm births by around 50% could reduce health care costs by $6 billion in the United Stated alone.

Of the 10% preterm births, 2.75% of them are early preterm births (births occurring before 34 weeks). Obviously, the risk of health problems and the cost of keeping them alive is greatest for early preterm babies.

We don’t know why preterm births are increasing, but some experts feel it is because in this country:

More older women are having babies.

There is increased use of fertility drugs, resulting in multiple babies

Unfortunately, there is no medical standard for identifying pregnancies at risk for preterm birth. Nor is there any agreement around prevention measures for preterm births.

However, recent research has suggested that some premature births may be caused by inadequate omega-3 status in the mother and can be prevented by omega-3 supplementation.

What Do We Know About Omega-3s And Risk Of Preterm Births?

The 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.

Fortunately, a group called the Cochrane Collaboration has recently reviewed these studies. 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. Their reviews are considered the gold standard of evidence-based medicine.

This is because most 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 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.

The Cochrane Collaboration reviews are different. They also report 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.

For omega-3s and pregnancy, the Cochrane Collaboration performed a meta-analysis and review of 70 randomized controlled trials that compared the effect of added omega-3s on pregnancy outcomes with the effect of either a placebo or no omega-3s. These trials included almost 19,927 pregnant women.

This Cochrane Collaboration Review looked at all the claims for omega-3s and pregnancy outcome, but they concluded that only two of the claims 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 [the effect of] omega-3s and placebo [on preterm births] are not needed at this point.”

In other words, they are saying this conclusion is definite. The Cochrane Collaboration has declared that omega-3 supplementation should become part of the standard of medical care for pregnant women.

However, the Cochrane Collaboration 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 this study. The study 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).

I have discussed these findings in more detail in a previous issue of “Health Tips From The Professor”

How Was This Study Done?

The current study (SE Carlson et al, EClinicalMedicine, 2021) is a first step towards answering those questions.

The authors of this study focused on how much DHA supplementation is optimal during pregnancy. This is an important question because there is currently great uncertainty about how much DHA is optimal:

The American College of Obstetrics and Gynecology recommends supplementation with 200 mg/day of DHA. However, that recommendation assumes that the increase will come from fish and was influenced by concerns that omega-3-rich fish are highly contaminated with heavy metals and PCBs.

Another group of experts was recently asked to develop guidelines for omega-3 supplementation during pregnancy. They recommended pregnant women consume at least 300 mg/day of DHA and 220 mg/day of EPA.

The WHO has recommended of minimum dose of 1,000 mg of DHA during pregnancy.

Many prenatal supplements now contain 200 mg of DHA, but very few provide more than 200 mg.

Accordingly, the authors took the highest and lowest recommendations for DHA supplementation and asked whether 1,000 mg of DHA per day was more effective than 200 mg of DHA at reducing the risk of early preterm births. Their hypothesis was that 1,000 mg of DHA would be more effective than 200 mg/day at preventing early preterm births.

This study was a multicenter, double-blind, randomized trial of 1032 women recruited at one of three large academic medical centers in the United States (University of Kansa, Ohio State University, and University of Cincinnati).

The women were ≥ 18 years old (average age = 30) and between 12 and 20 weeks of gestation when they entered the study.

The breakdown by ethnicity was 50% White, 22% Black or African American, 22% Hispanic, 6% Other.

18% had a prior preterm birth (<37 weeks) and 7% had a prior early preterm birth (<34 weeks).

Prior to enrollment in the study 47% of the participants reported taking a DHA supplement and 19% of the participants took a DHA supplement with > 200 mg/day.

All the participants received 200 mg DHA capsules and were told to take one capsule daily. The participants were also randomly assigned to take 2 additional capsules that contained a mixture of corn and soybean oil (the 200 mg DHA/day group) or 2 capsules that contained 400 mg of DHA (the 1,000 mg DHA/day group). The capsules were orange flavored so the participants could not distinguish between the DHA capsules and the placebo capsules.

Blood samples were drawn upon entry to the study and either just prior to delivery or the day after delivery to determine maternal DHA status.

The study was designed to look at the effect of DHA dose (1,000 mg or 200 mg) on early preterm birth (<34 weeks), preterm birth (<37 weeks), low birth weight (< 3 pounds), and several other parameters related to maternal and neonatal health.

How Much Omega-3 Should You Take During Pregnancy?

The primary findings from this study were:

The rate of early preterm births (<34 weeks) was less (1.7%) for pregnant women taking 1,000 mg of DHA/day compared to 200 mg/day (2.4%).

The rate of late preterm births (between 34 and 37 weeks) was also less for women taking 1,000 mg of DHA/day compared to 200 mg/day.

Finally, low birth weight and the frequency of several maternal and neonatal complications during pregnancy, delivery, and immediately after delivery were also lower with 1,000 mg/day of supplemental DHA than with 200 mg/day.

This confirms the authors’ hypothesis that supplementation with 1,000 mg/day of DHA is more effective than 200 mg/day at reducing the risk of early preterm births. In addition, this study showed that supplementation with 1,000 mg of DHA/day had additional benefits.

This study did not have a control group receiving no DHA. However:

The US average for early preterm births is 2.74%.

For the women in this study who had previous pregnancies, the rate of early preterm birth was 7%.

Of course, the important question for any study of this type is whether all the women benefited equally from supplementation. Fortunately, this study was designed to answer that question.

As noted above, each woman was asked whether they took any DHA supplements at the time they enrolled in the study, and 47% of the women in the study were taking DHA supplements when they enrolled. In addition, the DHA status of each participant was determined from blood samples taken at the time the women were enrolled in the study. When the authors split the women into groups based on their DHA status at the beginning of the study:

For women with low DHA status the rate of early preterm births was 2.0% at 1,000 mg of DHA/day versus 4.1% at 200 mg of DHA/day.

For women with high DHA status the rate of early preterm births was around 1% for both 1,000 mg of DHA/day and 200 mg of DHA/day.

In other words, DHA supplementation only appeared to help women with low DHA status. This is good news because:

DHA status is an easy to measure predictor of women who are at increased risk of early preterm birth.

This study shows that supplementation with 1,000 mg of DHA/day is effective at reducing the risk of early premature birth for women who are DHA deficient.

In the words of the authors, “Clinicians could consider prescribing 1,000 mg DHA daily during pregnancy to reduce early preterm birth in women with low DHA status if they are able to screen for DHA.”

Which Omega-3s Are Beneficial?

DHA is the most frequently recommended omega-3 supplement during pregnancy.

It is not difficult to understand why that is.

DHA is a major component of the myelin sheath that coats every neuron in the brain. [You can think of the myelin sheath as analogous to the plastic coating on a copper wire that allows it to transmit electricity from one end of the wire to the other.]

Unlike other components of the myelin sheath, the body cannot make DHA. It must be provided by the diet.

During the third trimester, DHA accumulates in the human brain faster than any other fatty acid.

Animal studies show that DHA deficiency during pregnancy interferes with normal brain and eye development.

Some, but not all, human clinical trials show that DHA supplementation during pregnancy improves developmental and cognitive outcomes in the newborn.

Recent studies have shown that most women in the United States only get 60-90 mg/day of DHA in their diet.

Clearly, DHA is important for fetal brain development during pregnancy, and most pregnant women are not getting enough DHA in their diet. This is why most experts recommend supplementation with DHA during pregnancy. And this study suggests supplementation with 1,000 mg/day is better than 200 mg/day. However, two important questions remain:

#1: Is 1,000 mg of DHA/day optimal? The answer is, “We don’t know”. This study compared the highest recommended dose (1,000 mg/day) with the lowest recommended dose (200mg/day) and concluded that 1,000 mg/day was better than 200 mg/day.

But would 500 or 800 mg/day be just as good as 1,000 mg/day? We don’t know. More studies are needed.

#2: Can DHA do it all, or are other omega-3s also important for a healthy pregnancy? As noted above, the emphasis on supplementation with DHA was based on the evidence for a role of DHA in fetal brain development during pregnancy.

But is DHA or EPA more effective at preventing early preterm birth and maternal pregnancy complications? Again, we don’t know.

As noted above, the Cochrane Collaboration concluded that omega-3s were effective at reducing early preterm births but was unable to evaluate the relative effectiveness of EPA and DHA because their review included studies with DHA only, EPA only, and EPA + DHA.

This is an important question because the ability of the body to convert EPA to DHA and vice versa is limited (in the 10-20%) range. This means that if both EPA and DHA are important for a healthy pregnancy, it might not be optimal to supplement with a pure DHA or pure EPA supplement.

Based on currently available data if you are pregnant or thinking of becoming pregnant, my recommendations are:

Chose a supplement that provides both EPA and DHA.

Because the evidence is strongest for DHA at this time, chose an algal source of omega-3s that has more DHA than EPA.

Aim for a dose of DHA in the 500 mg/day to 1,000 mg/day range. Remember, this study showed 1,000 mg/day was better than 200 mg/day but did not test whether 500 or 800 mg/day might have been just as good.

As more data become available, I will update my recommendations.

The Bottom Line

The Cochrane Collaboration recently released a report saying that the evidence was definitive that omega-3 supplementation during pregnancy reduced the risk of early preterm births. However, they were not able to reach a definitive conclusion on the optimal dose of omega-3s or the relative importance of EPA and DHA at preventing early preterm birth.

Most experts recommend that pregnant women supplement with between 200 mg/day and 1,000 mg/day of DHA.

A recent study asked whether 1,000 mg of DHA/day was better than 200 mg/day at reducing the risk of early preterm birth. The study found:

The rate of early preterm births (<34 weeks) was less (1.7%) for pregnant women taking 1,000 mg of DHA/day than pregnant women taking 200 mg/day (2.4%).

For women with low DHA status at the beginning of the study, the rate of early preterm births was 2.0% at 1,000 mg of DHA/day versus 4.1% at 200 mg of DHA/day.

For women with high DHA status at the beginning of the study, the rate of early preterm births was around 1% for both 1,000 mg of DHA/day and 200 mg of DHA/day.

The authors concluded, “Clinicians could consider prescribing 1,000 mg DHA daily during pregnancy to reduce early preterm birth in women with low DHA status…”

There are two important caveats:

This study did not establish the optimal dose of DHA. The study concluded that 1,000 mg/day was better than 200 mg/day. But would 500 or 800 mg/day be just as good as 1,000 mg/day? We don’t know. More studies are needed.

This study did not establish the relative importance of EPA and DHA for reducing the risk of early preterm births. DHA is recommended for pregnant women based on its importance for fetal brain development. But is DHA more important than EPA for reducing the risk of early preterm births? Again, we don’t know. More studies are needed.

For more details about this study and my recommendations, 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.

Treatment For Plantar Fasciitis Pain

June 15, 2021 by Dr. Steve Chaney

What Causes Plantar Fasciitis Pain?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

June, Glorious June

Florida is heating up and mid-day is pretty hot, but the rest of the USA is just entering the best time of year (if you love warm weather). And I think the best part is that the days are longer so we can get out and enjoy life more.

Last month was the beginning of me trying to get in shape to do the El Camino de Santiago. This 500-mile trek was beautifully shown in a 2011 movie titled “The Way,” starring Martin Sheen. It’s something I had wanted to do to celebrate my 70^th birthday, but then I broke both bones of my left ankle in half (OUCH) and had lots of complications. Now I’m determined to try again for my 80^th birthday which is several years away. As a result, I have a lot of time to get in shape. I’ll keep you updated as the months go past. Let me know if you have ever done this trip, I’d love to hear your experiences.

As the beginning of my training, I did a 5K race on May 1st – walking, not running. I was shocked when I came in 2^nd place for my age group. Of course, at my age the competition is limited, but I still have a trophy here in my office to applaud my efforts.

It seems like a perfect time to talk about foot pain that can prevent you from walking around your house, never mind a 500-mile cross-country journey. Let’s look into plantar fasciitis – pain in the arch of the foot.

What Causes Plantar Fasciitis Pain?

If you have arch pain, don’t rub your foot! There is a good chance the pain is actually coming from your lower leg. You will understand as we discuss the logic of the body and how lower muscles cause the pain. By the way, this treatment is also great for healing a sprained ankle, so it is doubly helpful!

The Muscles Involved In Plantar Fasciitis

The muscles of your lower leg, specifically the Tibialis Anterior, Peroneus, Gastrocnemius and Soleus, all insert into your foot.

The tibialis anterior inserts into your arch and pulls your foot so you can lean on the outside of your foot.

The peroneus tendon inserts into the bone at the outside of your foot and pulls up on the bone so your foot rolls in toward your arch. Your two calf muscles insert into your heel bone (talus) and can be pulling it backward, so you can lift your heel up from the floor.

The culmination of these movements is your arch is being pulled to the left, the right, and backward. Your arch hurts and too many people are addressing their arch, but not the muscles that are causing the strain.

Treatment For Plantar Fasciitis Pain

In my books, Treat Yourself to Pain-Free Living and The Pain-Free Athlete, I show you how to treat all the muscles of your leg. If you are suffering with plantar fasciitis, or if you’ve had a sprained ankle, you would benefit by getting one of these books.

Meanwhile, I would like to share one self-treatment that will help.

Treating Your Tibialis Anterior Muscle

Using the Perfect Ball, place the ball as shown in the picture to the left. The ball is just to the outside of your shin bone, and just below your knee joint.

Press down on the ball and move your leg do the ball rolls down your leg. If you feel like your arch will cramp, curl your toes as shown.

Go all the way down your leg to just above your ankle.

About midway down your shin, you will find an exceptionally tender area. That is the knot (spasm) that is putting pressure on the inside of your arch. Just stay still on the spasm until it releases. Sometimes it can be so painful that you need to lift your weight up off the ball for a little bit while you collect your breath.

Keep doing the pressure-release until the pain in your tibialis anterior muscle is gone.

If you have one of my books, I suggest you do all the treatments shown in the chapter about the lower leg, including each of the techniques for the back of your ankle.

Wishing you well,

Julie Donnelly

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