Dr. Steve Chaney

How Diet And Gut Bacteria Affect Our Health

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Why Is Your Microbiome Important? 

Author: Dr. Stephen Chaney

Vegan FoodsWe 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, microbiomevegetarians 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?

professor owlTo 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:

  1. 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?

Clinical StudyThis 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

MicrobiomeMicrobiome 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?

happy gut bacteriaThe 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.High Fiber Foods
    • 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?

Questioning WomanThis 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?

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Treatment To Straighten Your Ankle 

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney 

Happy July

sunThings 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?

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Are Nitrates Good For You Or Bad For You? 

Author: Dr. Stephen Chaney

health benefits of beetroot juiceWe 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?

Clinical StudyThis 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?

strong heartIntake 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?

ConfusionYou 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?

spinachYour 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

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?

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?

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Enjoy Your Cookouts Without Increasing Cancer Risk 

Author: Dr. Stephen Chaney

Barbecue GatheringIt 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?

Grilled HamburgersA 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

Grilled Chicken With VeggiesOur 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

  1. 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?

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Why Are Dietary Studies So Confusing? 

Author: Dr. Stephen Chaney

heart diseaseYou 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?

Clinical StudyThis 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?

confusionSo, 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

Doctor With Patient

  • 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.

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.”

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?

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Which Omega-3s Are Beneficial? 

Author: Dr. Stephen Chaney

Premature BabyPreterm 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?

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.

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 riskclinically proven 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?

Clinical StudyThe 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?

pregnant women taking omega-3The 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:Questioning Woman

#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

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What Causes Plantar Fasciitis Pain?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney 

June, Glorious June

sunFlorida 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 70th 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 80th 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 2nd 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.

Is The Paleo Diet Based On A Myth?

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Are Starchy Foods Bad For Us? 

Author: Dr. Stephen Chaney

the paleo dietThe Paleo Diet is still very popular. And it does have its good points. It is a whole food diet. It eliminates sodas, junk foods, and highly processed foods. Any diet that does that can’t be all bad.

But is it unnecessarily restrictive? It eliminates starchy foods like grains, beans, peas, and corn. It is true that widespread consumption of these foods did not occur until after the agricultural revolution some 12,000 years ago. Our paleolithic ancestors probably did not consume significant quantities of these foods.

But did they consume other starchy foods? Our ideas about this have come primarily from comparing the diets of modern man with the diets of the few primitive hunter-gatherer populations that currently exist in our world. Based on that comparison, some Paleo advocates have concluded that the paleolithic diet contained few, if any, starchy foods.

More importantly, some Paleo advocates have gone a step further to assert that our bodies are not designed to eat starchy foods. They claim that foods like grains, legumes, corn, and potatoes are bad for us. They should be avoided.

How can we test whether these claims are true? After all, we don’t have any way of directly determining whether our paleolithic ancestors ate starchy foods or not. Or do we? That question is the topic of a new study (JA Fellows et al, PNAS, 118 No. 20 e2021655118 I will share with you today.

But first I need to acquaint you with what starch is and how we digest it. Once again, it is time for Biochemistry 101.

Biochemistry 101

professor owlStarch is simply a long polymer of glucose molecules. Digestion of starch starts in our mouth. Our saliva contains an enzyme called alpha-amylase that breaks the bond between adjacent glucose molecules. Alpha-amylase breaks starch down sequentially, first to maltodextrin (a shorter polymer of glucose molecules), then to maltose (two glucose molecules), and finally to glucose.

[Note: The nutrition gurus that tell you to read labels and avoid foods with maltodextrin are ignoring the fact that we produce maltodextrin naturally whenever we digest starch in the foods we eat.]

All humans contain the alpha-amylase gene. Simply put, that means that all humans have the potential to digest starchy foods.

However, not all humans have the same number of copies of the alpha-amylase gene. When we habitually consume a diet containing starchy foods, our bodies duplicate the alpha-amylase gene until our saliva contains enough alpha-amylase to easily digest the amount of starchy foods we are consuming. Simply put, that means our bodies are designed to easily adapt to the amount of starchy foods in our diet.

Most modern human populations have between six and 30 copies of the alpha-amylase gene. Our saliva contains a lot of alpha-amylase. However, the few primitive hunter-gatherer societies that still exist in our world have only two or three copies of the alpha-amylase gene. Their saliva contains very little alpha-amylase.

It is this difference that has led to the hypothesis that our paleolithic ancestors did not possess salivary alpha-amylase, which implies they didn’t eat starchy foods. This hypothesis also assumes that humans only began producing significant quantities of salivary alpha-amylase after the agricultural revolution when starchy foods like grains, rice, and beans became widely available.

This hypothesis is one of the central tenets of the Paleo diet. But we need to remember that it is just a hypothesis. It has not been directly tested because we thought there was no way to determine the starch content of the paleolithic diet – until now. However, before we get to the study that explodes this hypothesis, I want to revisit the Paleo Diet myths I described in an earlier issue of “Health Tips From The Professor”. I call this next section “Unicorns And The Paleo Diet”.

Unicorns And the Paleo Diet

the paleo diet and unicornsI titled this section “Unicorns and the Paleo Diet” because both are myths. In fact, the Paleo Diet is based on several myths.

Myth #1: Our ancestors all had the same diet. What we currently know as the Paleo diet is based on the diets of a few primitive hunter-gatherer societies that still exist in some regions of the world. However, when you look at the data more carefully, you discover that the diet of primitive societies varies with their local ecosystems.

The “Paleo diet” is typical of ecosystems in which game is plentiful and fruits and vegetables are less abundant or are seasonal. In ecosystems where fruits and vegetables are abundant, primitive societies tend to be more gatherers than hunters. They eat more fruits and vegetables and less meat.

The assumption that starchy foods were absent in the paleolithic diet is also a myth. For some primitive societies, starchy fruits or starchy roots are a big part of their diet. In short, our paleolithic ancestors ate whatever nature provided.

Myth #2: Our genetic makeup is hardwired around the “paleolithic diet”. In fact, humans are very adaptable. We are omnivores, which means we can eat whatever nature provides. We are designed to thrive in a wide variety of ecosystems. It is this adaptability that has allowed us to expand to every nook and cranny of the world.

For example, the enzymes needed to digest grains are all inducible, which means the body can turn them on when needed. Our paleolithic ancestors may not have eaten much grain, but we can very quickly adapt to the introduction of grains into our diet. As I described above, for alpha-amylase this adaptation occurs through gene duplication.

Myth #3: Our paleolithic ancestors were healthier than modern man: It some respects, the paleolithic diet is healthy, as I mentioned above. However, we need to remember that our paleolithic ancestors rarely lived past 30 or 40. They simply did not live long enough to experience degenerative diseases like heart disease and cancer. We have no idea whether a diet that served our paleolithic ancestors well will keep us healthy into our 70s, 80s and beyond.

How Was This Study Done?

Clinical StudyThis is a fascinating study, and one that would have been impossible just a few years ago. As I have described in previous issues of “Health Tips From the Professor”, studies on our microbiome, the bacteria that inhabit our bodies, is a rapidly evolving area of research.

When we talk about our microbiome, we generally think about our gut bacteria. However, the term “microbiome” includes all the bacteria that reside in our body, including those that reside in our oral mouth.

And, like our gut bacteria, the species of bacteria that reside in our mouth are heavily dependent on the foods we eat. Specifically, there are three species of oral bacteria that thrive on starch. They possess an “amylase binding protein” that allows them to capture salivary alpha-amylase and use it to break down dietary starch so they can use it as an energy source.

Consequently, the abundance of these three bacterial species in the oral microbiome is a precise marker for the amount of starch in a person’s diet. More importantly, high throughput DNA sequencing and supercomputers have made it simple to sequence all the bacteria in the oral microbiome and quantify the relative abundance of these three bacterial species.

You are probably thinking, “That’s fine, but how could you possibly determine the abundance of those bacteria in the mouth of a paleolithic human?” Here is where it gets really interesting!

The bacteria in our mouth form biofilms on our teeth, something we refer to as plaque. If the plaque remains on our teeth long enough, it calcifies, forming what is referred to as dental calculus (tooth tartar).

In the modern world we remove dental biofilms by brushing after every meal. We remove dental plaque and tartar by semi-annual visits to the dentist. But these are recent developments. They are not something our ancestors did.

Our ancestors simply accumulated dental calculus during their lifetime. More importantly, the dental calculus excluded air and water, so it preserved the DNA of the bacteria in their oral microbiome. That was the basis of the current study.

The study was a collaboration of 50 scientists over a 7-year period. The scientists sequenced 124 oral microbiomes from humanoid species in Africa, including Neanderthals (430,000 to 40,000 years ago), Late Pleistocene (129,000 to 11,700 years ago) humans, and modern-day humans.

Bacterial DNA from modern-day humans was obtained from dental calculus obtained during routine dental cleaning procedures by practicing dentists. The older DNA samples were obtained from dental calculus in the teeth of skeletal remains. The oldest DNA sample was obtained from a Neanderthal that lived around 100,000 years ago.

For comparison they also obtained bacterial DNA from the dental calculus of chimpanzees and gorillas, man’s closest primate relatives.

The species of bacteria in the oral microbiome from all these samples were determined by high throughput sequences and computerized analysis using high speed supercomputers.

Is The Paleo Diet Based On A Myth?

Question MarkThere were three important findings from this analysis:

  1. The species of bacteria in the oral microbiome of Neanderthals and Late Pleistocene humans was much more diverse than for modern humans. This suggests that their diets were more diverse (perhaps depending on what foods were available in their environment), while modern diets have become more standardized.

2) The species of bacteria that thrive on starchy foods were remarkably constant in the oral microbiome of all human species from Neanderthals to Late Pleistocene humans to modern-day humans.

3) The species of bacteria that thrive on starchy foods were virtually absent from the oral microbiomes of our most closely related primates – chimpanzees and gorillas.

The authors concluded, “This … supports an early importance of starch-rich foods in Homo evolution.”

In other words, our paleolithic ancestors likely did eat starchy foods. Their diet may not have contained grains, rice, or beans in significant quantities. However, they consumed whatever starchy roots, fruits, and vegetables they could find.

So, is the Paleo diet based on a myth? It depends on how you phrase the question.

  • If we ask whether our paleolithic ancestors consumed grains, rice, or beans, the answer is probably, “No”. The introduction of these foods in significant quantities probably depended on the agricultural revolution that occurred thousands of years later.
  • If we ask whether our paleolithic ancestors consumed starchy foods, the answer is probably, “Yes”. The foundation of the Paleo diet was based on a myth. Their oral microbiome contained bacterial species that thrived on starchy foods. In fact, starchy foods may have been an important staple in their diet because they are more calorie dense than other fruits and vegetables.
  • If we ask whether our paleolithic ancestors were capable of thriving on a diet that included grains, rice, and beans, the answer is also probably, “Yes”. The oral bacterial species that thrive on starchy foods do so by utilizing the alpha-amylase in human saliva. This means our paleolithic ancestors likely had enough alpha-amylase in their saliva to digest and to thrive on starchy foods like grains, rice, and beans.

Are Starchy Foods Bad For Us?

Starchy FoodsIt is not just the Paleo diet. Many popular diets have villainized starchy foods. Are starchy foods as bad for us as some “experts” would have you believe?

Let’s start by identifying starchy foods. If we think in terms of whole foods, they are:

  • Root vegetables (for example, potatoes, sweet potatoes, beets, carrots, and parsnips).
  • Legumes (for example, beans, peas, and lentils).
  • Grains (for example, wheat, rye, barley, oats, and rice).
  • Winter squash (for example, acorn squash, butternut squash, hubbard squash, and pumpkin).
  • Corn

These foods are good sources of nutrients and phytonutrients. Many of them are also excellent sources of fiber, including a special type of fiber called resistant starch. (I have described the benefits of resistant starch in a previous issue of “Health Tips From the Professor”.) These are foods that definitely deserve to be part of a healthy diet.

The only drawback of starchy vegetables is that they tend to be more calorie dense than other vegetables. While this was a “plus” for our paleolithic ancestors, it is not quite as advantageous in our modern world. If you are trying to watch your calories, my advice is to incorporate these foods into your diet sparingly.

However, there is another class of starchy foods you want to avoid. Of course, I am talking about highly processed foods made from grains, legumes, and corn. They retain all the calories but lose most of the nutrients, phytonutrients, and fiber of the foods they came from.

In short, starchy whole foods are a valuable part of a healthy diet. It is the starchy processed foods made from these whole foods you want to avoid. Of course, I am talking about bread, pasta, and pastries made from refined grains and sugar.

So, how do you know which starchy foods to avoid? My advice is not to become an expert label reader. Just eat foods without labels.

The Bottom Line

One of the founding principles on which the Paleo diet is based is that our paleolithic ancestors ate very few starchy foods, and the human body really isn’t designed to handle these foods. Accordingly, the Paleo diet recommends we should avoid starchy foods like grains and legumes. This has the unfortunate effect of creating an unbalanced diet that overemphasizes meat and animal fats.

But is this founding principle correct, or is it just a myth? When you look beneath the surface, you discover that it is a hypothesis based on the diets of the few primitive hunter-gatherer populations that still exist in our world.

It has been assumed that was as good an estimate of the paleolithic diet as we could get. After all there was no way to directly determine the starch content of the paleolithic diet – until now.

In this issue of “Health Tips From the Professor” I describe a novel approach that allowed scientists to determine the species of bacteria residing in the mouth of our humanoid ancestors based on the DNA extracted from the plaque coating their teeth. (For details on how this was done, read the article above.)

What the scientists found was that all human species, including a Neanderthal who died 100,000 years ago, harbored bacteria in their mouths that thrive on starchy foods.

The scientists concluded, “This … supports an early importance of starch-rich foods in Homo evolution.” In other words, our paleolithic ancestors likely did eat starchy foods. Restricting whole grains and legumes from the Paleo diet is based on a myth. They are an important part of a healthy diet.

For more details about the study and which starchy foods are bad 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.

Do Omega-3s Add Years To Your Life?

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Why Are Omega-3s So Controversial? 

Author: Dr. Stephen Chaney

ArgumentI don’t need to tell you that omega-3s are controversial. Some experts confidently tell you that omega-3s significantly reduce your risk of heart disease and may reduce your risk of cancer and other diseases. Other experts confidently tell you that omega-3s have no effect on heart disease or any other disease. They claim that omega-3 supplements are no better than “snake oil”.

The problem is that each camp of experts can cite published clinical studies to support their claims. How can that be? How can clinical studies come to opposite conclusions on such an important topic? The problem is that it is really difficult to do high quality clinical studies on omega-3s. I will discuss that in the next section.

The question of whether omega-3s affect life span has also been controversial. Heart disease and cancer are the top two causes of death in this country. So, if omega-3s actually reduced the risk of heart disease and cancer, you might expect that they would also help us live longer. Once again, there are studies on both sides of this issue, but they are poor quality studies.

We need more high-quality studies to clear up the controversies surrounding the health benefits of omega-3s. I will report on one such study in this issue of “Health Tips From The Professor”. But first let me go into more depth about why it is so difficult to do high-quality studies with omega-3 fatty acids.

Clinical Studies 101: Why Are Omega-3s So Controversial?

professor owlI have covered this topic in previous issues of “Health Tips From the Professor”, but here is a quick summary.

  1. Randomized, placebo controlled clinical trials (RCTs) are considered the gold standard for evidence-based medicine, but they ill-suited to measure the effect of omega-3s on health outcomes.
    • Heart disease and cancer take decades to develop. Most RCTs are too small and too short to show a meaningful effect of omega-3s on these diseases.
    • To make up for this shortcoming, some recent RCTs have started with older, sicker patients. This way enough patients die during the study that it can measure statistically significant outcomes. However, these patients are already on multiple medications that mimic many of the beneficial effects of omega-3s on heart disease.

These studies are no longer asking whether omega-3s reduce the risk of heart disease. They are really asking if omega-3s have any additional benefits for patients who are already taking multiple medications – with all their side effects. I don’t know about you, but that is not the question I am interested in.

    • Until recently, most RCTs did not measure circulating omega-3 levels before and after supplementation, so the investigators had no idea whether omega-3 supplementation increased circulating omega-3 levels by a significant amount.

And for the few studies where omega-3 levels were measured before and after supplementation, it turns out that for many of the participants, their baseline omega-3 levels were too high for omega-3 supplementation to have a meaningful effect. Only participants with low omega-3 levels at the beginning of the study benefited from omega-3 supplementation.Supplementation Perspective

These studies are often quoted as showing omega-3 supplementation doesn’t work. However, they are actually showing the true value of supplementation. Omega-3 supplementation isn’t for everyone. It is for people with poor diet, increased need, genetic predisposition, and/or pre-existing disease not already treated with multiple medications.

2) Prospective cohort studies eliminate many of the shortcomings of RCTs. They can start with a large group of individuals (a cohort) and follow them for many years to see how many of them die or develop a disease during that time (this is the prospective part of a prospective cohort trial). This means they can start with a healthy population that is not on medications.

This also means that these studies can answer the question on most people’s minds, “Are omega-3s associated with reduced risk of dying or developing heart disease?” However, these studies have two limitations.

    • They are association studies. They cannot measure cause and effect.
    • Ideally, omega-3 levels would be measured at the beginning of the study and at several intervals during the study to see if the participant’s diet had changed during the study. Unfortunately, most prospective cohort studies only measure omega-3 levels at the beginning of the study.

3) Finally, a meta-analysis combines data from multiple clinical studies.

    • The strength of a meta-analysis is that the number of participants is quite large. This increases the statistical power and allows it to accurately assess small effects.
    • The greatest weakness of meta-analyses is that the design of the individual studies included in the meta-analysis is often quite different. This introduces variations that decrease the reliability of the meta-analysis. It becomes a situation of “Garbage in. Garbage out”

The study (WS Harris et al, Nature Communications, Volume 12, Article number: 2329, 2021) I am discussing today is a meta-analysis of prospective cohort studies. It was designed to determine the association between blood omega-3 fatty acids and the risk of:

  • Death from all causes.
  • Death from heart disease.
  • Death from cancer.
  • Death from causes other than heart disease or cancer.

More importantly, it eliminated the major weakness of previous meta-analyses by only including studies with a similar design.

How Was This Study Done?

Clinical StudyThis study was a meta-analysis of 17 prospective cohort studies with a total of 42,466 individuals looking at the association between omega-3 fatty acid levels in the blood and premature death due to all causes, heart disease, cancer, and causes other than heart disease and cancer.

Participants in the 17 studies were followed for an average of 16 years, during which time 15,720 deaths occurred. This was a large enough number of deaths so that a very precise statistical analysis of the data could be performed.

The average age of participants at entry into the studies was 65, and 55% of the participants were women. Whites constituted 87% of the participants, so the results may not be applicable to other ethnic groups. None of the participants had heart disease or cancer when they entered the study.

Finally, the associations were corrected for a long list of variables that could have influenced the outcome (Read the publication for more details).

A strength of this meta-analysis is that all 17 studies were conducted as part of the FORCE (Fatty Acids & Outcomes Research Consortium) collaboration. The FORCE collaboration was established with the goal of understanding the relationships between fatty acids (as measured by blood levels of the omega-3 fatty acids) on premature death and chronic disease outcomes (cardiovascular disease, cancer, and other conditions).

Each study was designed using a standardized protocol, so that the data could be easily pooled for a meta-analysis. In the words of the FORCE collaboration founders:

  1. The larger sample sizes of [meta-analyses] will substantially increase statistical power to investigate associations…enabling the [meta-analyses] to discover important relationships not discernible in any individual study.

2) Standardization of variable definitions and modeling of associations will reduce variation and potential bias in estimates across cohorts.

3) Results will be far less susceptible to publication bias.

Do Omega-3s Add Years To Your Life?

Omega-3sThe meta-analysis divided participants into quintiles based on blood omega-3 levels. When comparing participants with the highest omega-3 levels with participants with the lowest omega-3 levels:

  • Premature death from all causes was decreased by 16%.
    • When looking at the effect of individual omega-3s, EPA > EPA+DHA > DHA.
  • Premature death from heart disease was decreased by 19%.
    • When looking at the effect of individual omega-3s, DHA > EPA+DHA > EPA.
  • Premature death from cancer was decreased by 15%.
    • When looking at the effect of individual omega-3s, EPA > DHA > EPA+DHA.
  • Premature death from causes other than heart disease and cancer was decreased by 18%.
    • When looking at the effect of individual omega-3s, EPA > EPA+DHA > DHA.
  • The differences between the effects of EPA, DHA, and EPA+DHA were small.
  • ALA, a short chain omega-3 found in plant foods, had no effect on any of these parameters.

In the words of the authors: “These findings suggest that higher circulating levels of long chain omega-3 fatty acids are associated with a lower risk of premature death. Similar relationships were seen for death from heart disease, cancer, and causes other than heart disease and cancer. No associations were seen with the short chain omega-3, ALA [which is found in plant foods]”.

What Does This Study Mean For You?

confusionIf you are thinking that 15-19% decreases in premature death from various causes don’t sound like much, let me do some simple calculations for you. The average lifespan in this country is 78 years.

  • A 16% decrease in death from all causes amounts to an extra 12.5 years. What would you do with an extra 12.5 years?
  • A 19% decrease in death from heart disease might not only allow you to live longer, but it has the potential to improve your quality of life by living an extra 15 years free of heart disease.
  • Similarly, a 15% decrease in death from cancer might help you live an extra 12 years cancer-free.
  • In other words, you may live longer, and you may also live healthier longer, sometimes referred to as “healthspan”.

Don’t misunderstand me. Omega-3s are not a magic wand. They aren’t the fictional “Fountain of Youth”.

  • There are many other factors that go into a healthy lifestyle. If you sit on your couch all day eating Big Macs and drinking beer, you may be adding the +12.5 years to a baseline of -30 years.
  • Clinical studies report average values and none of us are average. Omega-3s will help some people more than others.

I will understand if you are skeptical. It seems like every time one study comes along and tells you that omega-3s are beneficial, another study comes along and tells you they are worthless.

This was an extraordinarily well-designed study, but it is unlikely to be the final word in the omega-3 controversy. There are too many poor-quality studies published each year. Until everyone in the field agrees to some common standards like those in the FORCE collaboration, the omega-3 controversy will continue.

The Bottom Line 

A recent meta-analysis looked at the association between omega-3 fatty acid levels in the blood and premature death due to all causes, heart disease, cancer, and causes other than heart disease and cancer.

The meta-analysis divided participants into quintiles based on blood omega-3 levels. When comparing participants with the highest omega-3 levels with participants with the lowest omega-3 levels:

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

In the words of the authors: “These findings suggest that higher circulating levels of long chain omega-3 fatty acids are associated with a lower risk of premature death. Similar relationships were seen for death from heart disease, cancer, and causes other than heart disease and cancer.”

For more details about study 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.

 

 

Are Vegan Diets Bad For Your Bones?

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The Secrets To A Healthy Vegan Diet

Author: Dr. Stephen Chaney

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

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

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

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

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

How Was This Study Done?

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

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

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

Are Vegan Diets Bad For Your Bones?

Here is what the investigators found:

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

Lumbar spine:

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

Femoral neck:

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

Whole body:

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

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

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

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

The Secrets To A Healthy Vegan Diet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Bottom Line 

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

  1.     Do vegans have lower bone density than omnivores?

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

The study found that:

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

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

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

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

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

Health Tips From The Professor