If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inflammation is the enemy. Chronic, low level inflammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inflammation is a bad actor. It is something we want to avoid.
Obesity and diabetes are two of the biggest contributors to inflammation, but does diet also play a role? With all the anti-inflammation diets circulating on the internet, you would certainly think so. How good is the evidence that certain foods influence inflammation, and what does an anti-inflammatory diet look like?
The Science Behind Anti-Inflammatory Diets
Let me start by saying that the science behind anti-inflammatory diets is nowhere near as strong as it is for the effect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inflammation.
There are multiple markers of inflammation, and they do not change together. That means that in every study some markers of inflammation are altered, while others are not. There is no consistent pattern from one study to another.
In spite of these methodological difficulties, the studies generally point in the same direction. Let’s start with the strongest evidence and work our way down to the weakest evidence.
Omega-3 fats are anti-inflammatory (I. Reinders et al, European Journal of Clinical Nutrition, 66: 736-741, 2011). The evidence is strongest for the long chain omega-3s found in fish and fish oil, but the shorter chain omega-3s found in foods like walnuts, flaxseeds, chia seeds and flaxseed oil, soybean oil, and canola oil also appear to be anti-inflammatory.
The most straightforward is that refined carbohydrates and sugars (sodas, pastries, and desserts), which have a high glycemic index, increase inflammation. In contrast, complex carbohydrates (whole grains, most fruits and vegetables) decrease inflammation. No surprise there. The second implication is that it is the glycemic index, not the sugar, that is driving the inflammatory response.
That means we need to look more closely at foods than at sugars. Sodas, pastries and desserts are likely to cause inflammation, but sugar-containing foods with a low glycemic index are unlikely to be inflammatory.
Fruits and vegetables are anti-inflammatory. This has been shown in multiple studies. At this point most of the research is centered on identifying the nutrients and phytonutrients from fruits and vegetables that are responsible for the reduction in inflammation. I suspect the investigators are hoping to design an anti-inflammatory supplement and make lots of money. I will stick with the fresh fruits and vegetables.
Saturated fats are inflammatory. At face value, the data on saturated fats appear to be contradictory. Some studies say that saturated fats increase inflammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.
When saturated fats are replaced with refined carbohydrates, sugar and highly processed foods (the standard American low-fat diet), inflammation doesn’t change. This doesn’t mean that a diet high in saturated fat is healthy. It just means that both diets are bad for you. Both are inflammatory.
I would be remiss if I did not address the claims by the low-carb diet proponents that saturated fats do not increase inflammation in the context of a low-carb diet. I want to remind you of two things we have discussed previously:
The comparisons in those studies are generally with people consuming a diet high in simple carbohydrates and sugars.
These studies have mostly been done in the short-term when the participants are losing weight on the low-carb diets. Weight loss decreases inflammation, so the reduction in inflammation on the low-carb diet could be coming from the weight loss.
The one study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009) I have found that compares a low-carb diet (the Atkins diet) with a good diet (the Ornish diet, which is a low-fat, lacto-ovo vegetarian diet) during weight maintenance found that the meat based, low-carb Atkins diet caused greater inflammation than the healthy low-fat Ornish diet.
Red meat is probably pro-inflammatory. Most, but not all, studies suggest that red meat consumption is associated with increased inflammation. If it is pro-inflammatory, the inflammation is most likely associated with its saturated fat, its heme iron content, or the advanced glycation end products formed during cooking.
What Is An Anti-Inflammatory Diet?
Anti-inflammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly different features, but there is a tremendous amount of agreement.
Foods an anti-inflammatory diet includes: In a nutshell, an anti-inflammatory diet includes fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty fish, and fresh herbs and spices. Specifically, your diet should emphasize:
Colorful fruits and vegetables. Not only do they help fight inflammation, but they are a great source of antioxidants and other nutrients important for your health.
Whole grains. They have a low glycemic index. They are also a good source of fiber, and fiber helps flush inflammatory toxins out of the body.
Beans and other legumes. They should be your primary source of protein. They are high in fiber and contain antioxidants and other anti-inflammatory nutrients.
Nuts, olive oil, and avocados. They are good sources of healthy monounsaturated fats, which fight inflammation.
Fatty fish. Salmon, tuna, and sardines are all great sources of long chain omega-3 fatty acids, which are incorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inflammation fighters.
Walnuts, flaxseeds, and chia seeds are good sources of short chain omega-3s. The efficiency of their conversion to long chain omega-3s that can be incorporated into cell membranes is only around 2-5%. If they fight inflammation, it is probably because they replace some of the saturated fats and omega-6 fats you might otherwise be eating.
Herbs and spices. They add antioxidants and other phytonutrients that fight inflammation.
Foods an anti-inflammatory diet excludes: In a nutshell, an anti-inflammatory diet should exclude highly processed, overly greasy, or super sweet foods, especially sodas and other sweet drinks. Specifically, your diet should exclude:
Refined carbohydrates, sodas and sugary foods. They have a high glycemic index, which is associated with inflammation. They can also lead to weight gain and high blood sugar, both of which cause inflammation.
Foods high in saturated fats. This includes fatty and processed meats, butter, and high fat dairy products.
Foods high in trans fats. This includes margarine, coffee creamers, and any processed food containing partly hydrogenated vegetable oils. Trans fats are very pro-inflammatory.
French fries, fried chicken, and other fried foods. They used to be fried in saturated fat and/or trans fat. Nowadays, they are generally fried in omega-6 vegetable oils. A little omega-6 in the diet is OK, but Americans get too much omega-6 fatty acids in their diet. Most studies show that a high ratio of omega-6 to omega-3 fatty acids is pro-inflammatory.
Foods you are allergic or sensitive to. Eating any food that you are sensitive to can cause inflammation. This comes up most often with respect to gluten and dairy because so many people are sensitive to one or both. However, if you are not sensitive to them, there is no reason to exclude whole grain gluten-containing foods or low-fat dairy foods from your diet.
Vegan and vegetarian diets also appear to be anti-inflammatory as well. The anti-inflammatory nature of these diets undoubtedly contributes to their association with a lower risk of heart disease, diabetes, and cancer.
As for the low-carb diets, the jury is out. There are no long-term studies to support the claims of low-carb proponents that their diets reduce inflammation. The few long-term studies that are available suggest that low-carb diets are only likely to be anti-inflammatory if vegetable proteins and oils replace the animal proteins and fats that are currently recommended.
What does this mean for you if you have severe arthritis or other inflammatory diseases? An anti-inflammatory diet is unlikely to “cure” your symptoms by itself. However, it should definitely be a companion to everything else you are doing to reduce inflammation.
The Bottom Line
If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inflammation is the enemy. Chronic, low level inflammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inflammation is a bad actor. It’s something we want to avoid.
Obesity and diabetes are two of the biggest contributors to inflammation, but does diet also play a role? With all the anti-inflammation diets circulating on the internet, you would certainly think so. In this article I review the evidence that certain foods influence inflammation and describe what an anti-inflammatory diet looks like.
For more details read the article above.
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.
Osteoarthritis is not just painful. It is one of the leading causes of disability in this country. And because the joint pain associated with osteoarthritis limits activity levels, it is linked to:
Obesity
The diseases associated with obesity (diabetes and heart disease).
Osteoarthritis increases the risk of heart disease by 50%.
Premature death associated with the increased prevalence of obesity, diabetes, and heart disease.
Osteoarthritis increases the risk of all-cause mortality by 55%.
If osteoarthritis were rare, these statistics would just be an interesting side note. But osteoarthritis is the most common form of arthritis. It affects more than 32 million Americans. And it is costly. It costs the American economy:
$65 billion in health care costs.
$17 billion in lost wages.
$136 billion in total costs.
Conventional therapy for osteoarthritis is treatment with anti-inflammatory drugs, but they have side effects. They may even increase the risk of premature death in some individuals.
What about natural anti-inflammatory nutrients and phytonutrients? Two that have received a lot of press in recent years are omega-3s (fish oil) and curcumin.
There is moderate quality evidence that omega-3s reduce the pain associated with rheumatoid arthritis. Basically, this means that there is strong, but not definitive, evidence that omega-3s reduce the pain of rheumatoid arthritis. Other general conclusions with respect to rheumatoid arthritis were:
The best results were obtained from fish oil preparations with an EPA/DHA ratio of >1.5, suggesting that EPA is more beneficial than DHA.
Early studies suggested that the optimal dose of omega-3s was ≥2.6 g/day for ≥12 weeks.
There was low quality evidence for an effect of omega-3s on osteoarthritis. Only 5 clinical trials have been published on the topic and the results of those studies are conflicting.
The data for an effect of curcumin on osteoarthritis pain are even more limited. There is some evidence it might be beneficial, but the studies are small and are conflicting.
You are probably wondering, “What is an “exploratory study?” Let me start by providing you with a little perspective from my years of heading a cancer research laboratory at the University of North Carolina:
Clinical studies are expensive. And if you are trying to study an approach that has not already proven to be successful, the money needed to fund the study can be hard to come by. It is a “Catch 22” situation. You need to conduct an “exploratory study” to show your project is likely to succeed before the funding agency will give you money to fund your project.
But where do you get the money to fund your exploratory project? One way that investigators overcome that barrier is to use data from a previous study that was originally designed for a different purpose. The study I will describe today is an example of that approach.
The study utilized data collected from a clinical trial designed to measure the effect of omega-3s and curcumin on brain function in older adults. The study recruited 152 older adults (average age = 65) who were overweight to obese (average BMI = 31) and sedentary (˂55 min/week of physical activity) from New South Wales, New Australia.
The participants were randomly divided into 4 groups:
Placebo group. [Note: The fish oil placebo contained 20 mg of fish oil so it would match the odor of the fish oil supplement, and the curcumin placebo contained yellow food dye so it would match the color of the curcumin supplement.]
Fish oil group (2,000 mg DHA & 400 mg EPA per day).
Curcumin group (160 mg/day curcumin).
Fish oil + curcumin group.
Participants were followed for 16 weeks. At the beginning and end of the study participants filled out questionnaires assessing (among other things):
The severity of their chronic osteoarthritis pain.
Disabilities caused by osteoarthritis in the participant’s daily life (physical distress, sleep disturbances, psychological distress, loss of productivity, physical limitations, physical deconditioning due to reduction in physical activity, and financial hardship).
Their physical and mental wellbeing during the past 4 weeks.
Their mood during the past 7 days.
Do Omega-3s Oil Your Joints?
The results were as follows:
Omega-3 supplementation reduced chronic osteoarthritis pain by 42%.
Omega-3 supplementation reduced disability associated with osteoarthritis by 40%.
The reduction in pain and disability in participants supplemented with fish oil was greatest in those who reported the highest pain/disability at the beginning of the study.
The reduction in pain was associated with an improved perception of physical and mental wellbeing.
The reduction in pain was also associated with a decrease in depression and other mood disturbances.
Curcumin did not affect pain or osteoarthritis burden either alone or paired with omega-3s.
The authors concluded, “Our findings indicate potential for fish oil supplementation to reduce mild osteoarthritis pain and burden in sedentary overweight/obese older adults…,which was associated with improved wellbeing.”
What Are The Pros And Cons Of This Study?
Pros:
The results for the effects of omega-3s on osteoarthritis were highly significant. In addition, the questionnaires used were well designed to capture the intensity and location of pain, mood, and feelings of wellbeing.
Cons:
This was an exploratory study using data collected from a study designed to measure the effect of omega-3s and curcumin on brain health in older adults. It was not ideally designed to measure the effect of omega-3s and curcumin on osteoarthritis.
If the original study had been intended for investigating the effect of these supplements on osteoarthritis, it would have been designed differently:
Participants would have been recruited into the study based on the presence and intensity of osteoarthritis pain.
The diagnosis of osteoarthritis would have been confirmed by X-rays.
Participants would have been admitted into the study only if they had moderate to severe osteoarthritis pain. Most of the participants in this study had only mild osteoarthritis pain. That may have limited the ability of this study to find an effect of curcumin on osteoarthritis pain.
The design of the omega-3 supplement would have been different.
Because the original study was designed to determine the effect of omega-3s on brain health, the omega-3 supplement chosen had more DHA than EPA.
Had the study been designed to determine the effect on omega-3s on an inflammatory disease like osteoarthritis, the omega-3 supplement would have had more EPA than DHA.
The curcumin supplement was also not ideally designed for this study. The curcumin supplement used in this study contained only 160 mg of curcumin and contained no other ingredients. Well-designed curcumin supplements usually contain around 500 mg curcumin standardized to 95% curcuminoids plus piperine to enhance the absorption of the curcumin.
In the words of the authors, “Further studies are warranted to evaluate the benefits of fish oil, alone or as an adjunct to pharmacotherapy, in patients diagnosed with osteoarthritis who suffer moderate-to-severe pain…” In other words, they now intend to use the data from this exploratory study to apply for funds to conduct a larger study specifically designed to measure the effects of omega-3s on osteoarthritis pain.
The study limitations described above, severely restricted the ability of the study to detect any beneficial effect of curcumin on osteoarthritis pain. The effect of curcumin on osteoarthritis pain is probably less than the effect of omega-3s, but it would be premature to conclude that it has no benefit. However, they obtained no data from their “exploratory study” to justify a follow-up study on the effect of curcumin on osteoarthritis pain.
Fish Oil And Osteoarthritis
This study suggests that 2.4 grams/day of omega-3s may be equally effective at reducing osteoarthritis pain and the effects that osteoarthritis pain has on both physical health and psychological health. However, because this study has several limitations, the evidence cannot be considered definite.
If you have either rheumatoid or osteoarthritis, I recommend trying omega-3 supplementation. Based on the studies described above, you might want to aim for 2-3 g/day of omega-3s with an EPA/DHA ration of 1.5 or greater.
These lifestyle changes should allow you to reduce or eliminate any pain medication you may be taking.
Finally, if you are on blood thinners, consult with your physician before adding omega-3 supplements to your diet. My preference is to incorporate omega-3s and reduce other medications, but that is a discussion you need to have with your doctor.
The Bottom Line
A recent meta-analysis has concluded there is moderate quality evidence that omega-3s reduce the pain associated with rheumatoid arthritis. Basically, this means that there is strong, but not definitive, evidence that omega-3s reduce the pain of rheumatoid arthritis. Other general conclusions with respect to rheumatoid arthritis were:
The best results were obtained from fish oil preparations with an EPA/DHA ratio of >1.5, suggesting that EPA is more beneficial than DHA.
Earlier studies suggested that the optimal dose of omega-3s was ≥2.6 g/day for ≥12 weeks.
However, there have been few studies on the effect of omega-3s on osteoarthritis. A new exploratory study looked at the effect of 2.4 g/day of omega-3s for 16 weeks on the pain and disability associated with osteoarthritis. It found:
Omega-3 supplementation reduced chronic osteoarthritis pain by 42%.
Omega-3 supplementation reduced disability associated with osteoarthritis by 40%.
The reduction in pain and disability in participants supplemented with fish oil was greatest in those who reported the highest pain/disability at the beginning of the study.
The reduction in pain was associated with an improved perception of physical and mental wellbeing.
The reduction in pain was also associated with a decrease in depression and other mood disturbances.
The authors concluded, “Our findings indicate potential for fish oil supplementation to reduce mild osteoarthritis pain and burden in sedentary overweight/obese older adults. Further studies are warranted to evaluate the benefits of fish oil, alone or as an adjunct to pharmacotherapy, in patients diagnosed with osteoarthritis who suffer moderate-to-severe pain…”
If you have either rheumatoid or osteoarthritis, I recommend trying omega-3 supplementation. Based on the studies described above, you might want to aim for 2-3 g/day of omega-3s with an EPA/DHA ration of 1.5 or greater.
As with any natural approach, this will work better for some people that for others. However, don’t forget that omega-3s are also important for heart health, healthy blood pressure, brain health, and a healthy pregnancy. If they also happen to reduce your arthritis pain, that is an extra benefit.
As usual, I recommend a holistic approach. You should also:
Follow an anti-inflammatory diet.
Keep active.
Aim for a healthy weight.
Add antioxidant and polyphenol supplements.
These lifestyle changes should allow you to reduce or eliminate any pain medication you may be taking.
Finally, if you are on blood thinners, consult with your physician before adding omega-3 supplements to your diet. My preference is to incorporate omega-3s and reduce other medications, but that is a discussion you need to have with your doctor.
For more details read the article above.
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.
First, we were told that fats, especially saturated fats, were the problem. Then it was carbohydrates.
Then, we were told not all carbohydrates were equally bad for us. Sugars were the culprit.
Next, we were told not all sugars were bad for us. It was added sugars, especially the sugars added to sodas and other sugary drinks.
In fact, most of the clinical studies on the bad effects of sugar have been done with sugar-sweetened sodas.
If sugar-sweetened sodas are the problem, then surely diet sodas must be the answer.
Maybe not. In a previous issue of “Health Tips From The Professor” I summarized studies showing that consuming diet sodas was just as likely to be associated with obesity and diabetes as consuming sugar-sweetened sodas.
This study is part of a much larger French study on the effect of diet on health outcomes called the NutriNet-Sante cohort. The NutriNet-Sante cohort study was started in 2009 and, as the name suggests, makes extensive use of online questionnaires. For example:
Participants are asked to fill out online questionnaires on physical activity, socioeconomic status, anthropometric data (height, weight, etc.), and major health events on a regular basis.
Every 6 months participants are asked to fill out 3 web-based 24-h dietary records (2 on weekdays and 1 on a weekend).
Major health events were validated based on their medical records and France’s national health insurance system (Yes, Big Brother is definitely watching in France).
Deaths were validated using France’s national mortality registry.
The study included a total of 104,760 participants with an average age of 42.9 and an average BMI of 23.7 (towards the upper end of the normal range) and followed them for 10 years. [Note: The average BMI for Americans at age 40 is 28.6, which is towards the upper end of the overweight category.]
The study compared consumption of diet drinks and sugary drinks with first-time cases of heart disease events (stroke, heart attack, angina, and angioplasty) during a 10-year period.
All first-time cases of heart disease events were combined into a single category for this publication. They will be considered separately in a subsequent publication.
Artificially sweetened beverages (diet drinks) were defined as beverages containing non-nutritive sweeteners. Sugary drinks consisted of all beverages containing ≥ 5% sugar (sodas, syrups, 100% juice, and fruit drinks).
For both categories of beverages, the participants were divided into non-consumers, low consumers, and high consumers.
Do Diet Sodas Hurt Your Heart?
The results were clear. When high consumers were compared with non-consumers:
High consumers of sugary drinks had a 20% increased risk of first-time heart disease events.
High consumers of diet drinks had a 32% increased risk of first-time heart disease events.
The authors concluded, “In this cohort, higher intakes of [both] sugary drinks and diet drinks were associated with a higher risk of heart disease, suggesting that artificially sweetened beverages might not be a healthy substitute for sugary drinks.”
I also might point out that if this study had been done in the United States the increased risk of heart disease might have been greater.
That is because the French drink less sugary drinks and diet drinks than Americans.
High consumers of both sugary drinks and diet drinks in this study averaged 6 ounces per day.
In contrast, the average consumption sugary drinks in the United States is around 17 ounces per day.
Since consumption of sugary drinks is associated with increased incidence of heart disease and we drink more sugary drinks, the increased risk of heart disease in Americans might be greater than the 20% reported in this study.
What Are The Pros And Cons Of This Study?
On the plus side, this was a very large and well-designed study.
For example, many studies of this type take a single assessment of the participant’s diet, either at the beginning or end of the study. They have no idea whether the participants changed their diet during the study. This study did a diet assessment every 6 months.
On the minus side, this was an association study. It measured the association of sugary drink and diet drink consumption with heart disease. Association studies have several limitations. Here are the top three:
#1: Confounding variables. Here are a couple of examples:
People who are overweight tend to drink more diet drinks than people who are normal weight. Obesity increases the risk of heart disease. Therefore, obesity is a confounding variable. You don’t know whether heart disease increased because the participants drank more diet drinks or because they were obese.
People who consume more diet drinks tend also to eat less healthy diets. Unhealthy diets increase the risk of heart disease. Thus, unhealthy diets are also a confounding variable.
The study authors adjusted for confounding variables by statistically correcting the data for:
Age, sex, BMI, sugar intake from other dietary sources, smoking status, physical activity, and family history of heart disease.
Intakes of alcohol, total calories, fruits & vegetables, red & processed meats, nuts, whole grains, legumes, saturated fat, sodium, and proportion of highly processed food in the diet.
Presence of type 2 diabetes, elevated cholesterol or triglycerides, or high blood pressure upon entry into the study.
In short, they did an excellent job of controlling for confounding variables that also affect the risk of heart disease.
#2: Reverse Causation: This is the chicken and egg question. This study measured the association between sugary and diet drink consumption and heart disease. None of the participants in the study had diagnosed heart disease when the 10-year study began.
However, both obesity and sugar consumption have been linked to increased risk of heart disease. What if some participants in the study had been diagnosed with heart disease early in the study and switched to diet drinks to lose weight or reduce sugar intake?
In that case, the diagnosis of heart disease would have caused increased diet drink consumption rather than the other way around. That would be reverse causation.
The study authors took reverse causation into account by excluding participants who experienced a first-time heart disease event in the first 3 years of this 10-year study. In other words, participants had to have been consuming sugary or diet drinks for at least 3 years before their heart disease event for their data to be included in the analysis.
This is considered the gold standard for reducing the influence of reverse causation on the outcome of the study.
#3: Uncertainty About Causation:
Association studies do not provide information on the possible mechanism(s) of the association.
For example, multiple previous studies have shown that people are just as likely to gain weight and develop type 2 diabetes when they consume diet drinks or sugary drinks. However, after years of study, the mechanism(s) of that effect are uncertain.
The mechanism may be physiological. However, many physiological mechanisms have been proposed. None have been proven.
The mechanism may be psychological. We may feel so virtuous for drinking diet drinks that we think it gives us license to eat more junk food. As a former University of North Carolina colleague once put it, “The problem is that we are using our diet drinks to wash down a Big Mac and fries.”
Association studies also do not prove causation. We cannot say with confidence that diet drink consumption increases our risk of heart disease. Nor can we speculate on the mechanism by which this might occur.
However, as the authors of this study concluded, we can say with confidence that there is no evidence that diet drink consumption decreases the risk of obesity, diabetes, or heart disease.
Love Your Heart
Love Your Heart – Drink Water Rather Than Sugar-Sweetened Or Artificially Sweetened Beverages.
If drinking diet drinks does not decrease your risk of heart disease, what can you do to decrease your risk?
The short answer is to fall in love with water. Water has no calories, no sugar, and no artificial sweeteners. In the study described above, it was the non-consumers of sugary beverages and diet beverages that had the lowest risk of heart disease.
Pure water is, of course, the best alternative. However, if plain water is too boring, try herbal teas. If you crave the fizz of sodas, try unsweetened sparkling water, perhaps infused with a little of your favorite fresh fruit. If you crave the caffeine of sodas, coffee or tea might suit you best, preferably without the sugar and cream. There are just two caveats:
Tea and coffee should not be your only source of liquid.
It goes without saying that you want to avoid the 500 calorie Starbucks extravaganzas.
Love Your Heart – What About Artificially Sweetened Foods?
If artificially sweetened drinks have no benefit for preventing obesity, diabetes, or heart disease, what about artificially sweetened foods? Do they also have no benefit?
The short answer is that we don’t know. Most of the studies to date have been with artificially sweetened beverages. However, these studies should make us cautious. We should not automatically assume that artificially sweetened foods are beneficial because they contain fewer calories. They may be just as useless as artificially sweetened beverages.
Love Your Heart – A Holistic Approach
With that in mind, here is what the American Heart Association recommends for reducing your risk of heart disease:
If you smoke, stop.
Choose good nutrition.
Choose a diet that emphasizes vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, nuts, and nontropical vegetable oils (ie, avoid coconut and palm oil).
Choose a diet that limits sweets, sugar-sweetened beverages, and red meats.
[Note: Don’t substitute artificially sweetened beverages for sugar-sweetened beverages. That doesn’t appear to offer any advantage. Drink water instead.]
Reduce high blood cholesterol and triglycerides.
Reduce your intake of saturated fat, trans fat and cholesterol and get moving.
If diet and physical activity don’t get your cholesterol and triglyceride numbers under control, then medication may be the next step.
[Note: The American Heart Association recommends changing your diet and physical activity first and only resorting to medications if lifestyle changes don’t work. Diet and exercise do not have side effects. Medications do.]
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.
The Bottom Line
Previous studies have shown that people are just as likely to gain weight and develop type 2 diabetes when they consume artificially sweetened and sugar-sweetened drinks. In this issue of “Health Tips From the Professor” I shared a study showing that artificially sweetened drinks are just as bad for your heart as sugar-sweetened drinks.
These are all association studies. Association studies do not provide information on the possible mechanism(s) of the association.
That means we don’t know why artificially sweetened drinks are bad for your heart.
The mechanism may be physiological. However, many physiological mechanisms have been proposed. None have been proven.
The mechanism may be psychological. We may feel so virtuous for drinking diet drinks that we think it gives us license to eat more junk food. As a former UNC colleague once put it, “The problem is that we are using our diet drinks to wash down a Big Mac and fries.”
Association studies also do not prove causation. We cannot say with confidence that diet drink consumption increases our risk of heart disease. Nor can we speculate on the mechanism by which this might occur.
However, we can say with confidence that there is no evidence that diet drink consumption decreases the risk of obesity, diabetes, or heart disease.
The authors of this study concluded, “…higher intakes of [both] sugary drinks and diet drinks were associated with a higher risk of heart disease, suggesting that artificially sweetened beverages might not be a healthy substitute for sugary drinks.”
For more details on the study and information on a holistic approach for reducing heart disease risk 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.
Many of you started 2021 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 2 months ago, but it probably feels like an eternity.
For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.
Perhaps the diet isn’t working as well as advertised…
Perhaps the diet is too restrictive. You are finding it hard to stick with…
Perhaps you are always hungry or constantly fighting food cravings…
Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…
Perhaps you are wondering whether the diet you chose is the wrong one for you…
If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.
Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.
If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2021”. For the full report, click on this link.
How Was This Report Created?
US News & World Report recruited panel of 25 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 39 most popular diets. They rated each diet in seven categories:
How easy it is to follow.
Its ability to produce short-term weight loss.
Its ability to produce long-term weight loss.
its nutritional completeness.
Its safety.
Its potential for preventing and managing diabetes.
Its potential for preventing and managing heart disease.
They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct nine sets of Best Diets rankings:
Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.
Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.
Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.
Best Diabetes Diets is based on averaged diabetes ratings.
Best Heart-Healthy Diets uses averaged heart-health ratings.
Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.
Easiest Diets to Follow represents panelists’ averaged judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.
Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.
Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.
Which Diets Are Best In 2021?
The word WInner in white letters surrounded by a burst of colorful stars in 3d
Are you ready? If this were an awards program I would be saying “Envelop please” and would open the envelop slowly to build suspense.
However, I am not going to do that. Here are the top 5 and bottom 5 diets in each category (If you would like to see where your favorite diet ranked, click on this link). [Note: I excluded commercial diets from this review.]
Best Diets Overall
The Top 5:
#1: Mediterranean Diet
#2: DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)
#3: Flexitarian Diet (A flexible semi-vegetarian diet).
#4: Mayo Clinic Diet
#5: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)
The Bottom 5:
#35: Modified Keto Diet
#36: Whole 30 Diet
#37: GAPS Diet (A diet designed to improve gut health).
#38: Keto Diet
#39: Dukan Diet
Best Weight-Loss Diets
The Top 5:
#1: Flexitarian Diet
#2: Vegan Diet
#3: Volumetrics Diet (A diet based on the caloric density of foods).
#4: Mayo Clinic Diet
#5: Ornish Diet
The Bottom 5:
#35: Fertility Diet
#36: Whole 30 Diet
#37: Alkaline Diet
#38: AIP Diet (A diet designed for people with autoimmune diseases)
#39: GAPS Diet
Best Diabetes Diets
The Top 5:
#1: Flexitarian Diet
#2: Mediterranean Diet
#3: DASH Diet
#4: Mayo Clinic Diet
#5: Vegan Diet
The Bottom 5:
#35: The Fast Diet
#36: AIP Diet
#37: GAPS Diet
#38: Whole 30 Diet (A diet designed for people with autoimmune diseases)
#39: Dukan Diet
Best Heart-Healthy Diets
The Top 5:
#1: DASH Diet
#2: Mediterranean Diet
#3: Ornish Diet (A diet based on the caloric density of foods).
#4: Flexitarian Diet
#5: Vegan Diet
The Bottom 5:
#35: Keto Diet
#36: AIP Diet
#37: Whole 30 Diet
#38: Modified Keto Diet
#39: GAPS Diet
Best Diets for Healthy Eating
The Top 5:
#1: DASH Diet
#2: Mediterranean Diet
#3: Flexitarian Diet
#4: TLC Diet (A diet designed to promote heart health)
#5: MIND Diet
The Bottom 5:
#35: Atkins Diet
#36: Raw Food Diet
#37: Modified Keto Diet
#38: Dukan Diet
#39: Keto Diet
Easiest Diets to Follow
The Top 5:
#1: Mediterranean Diet
#2: Flexitarian Diet
#3: MIND Diet
#4: DASH Diet
#5: Fertility Diet
The Bottom 5:
#35: Keto Diet and Modified Keto Diet (tie)
#36: Whole 30 Diet
#37: Dukan Diet
#38: GAPS Diet
#39: Raw Foods Diet
Best Fast Weight-Loss Diets
The Top 5 (Excluding Commercial Diets):
#1: Atkins Diet
#2: Biggest Loser Diet
#3: Keto Diet
#4: Raw Food Diet
#5: Volumetrics Diet
Which Diets Are Best For Rapid Weight Loss?
Let me start with some general principles:
#1: If you are looking for rapid weight loss, any whole food restrictive diet will do.
The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.
The Biggest Loser diet relies on restrictive meal plan and exercise programs.
The restrictions of the raw food diet are obvious.
The volumetrics diet restricts foods with high caloric density.
The vegan diet, which ranks #7 on this list, is a very low fat diet that eliminates meat, dairy, eggs, and animal fats.
I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.
#2: Restrictive diets ultimately fail.
The truth is 90-95% of people who lose weight quickly on a restrictive diet regain most of that weight in the next two years. The pounds come back and often bring their friends along as well. Many people regain more weight than they lost. This is the famous “Yo-Yo Effect”.
If dieters paid for one of the commercial diets, they may as well have burned their money.
When I talk with people about weight loss, many of them tell me the Atkins diet is the only one they can lose weight on. That would be impressive if they were at a healthy weight, but most are not. They are overweight. I am starting to see the same thing from overweight people who have used the keto diet to lose weight and have regained their weight.
#3: We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.
If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.
If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.
Long term weight loss is possible if you transition to a healthy diet after you have lost the weight. In a recent article in “Health Tips From The Professor” I wrote about an organization called the National Weight Control Registry. These are people who have been successful at keeping the weight off. For purposes of this discussion, two points are important.
They lost weight on every possible diet.
They kept the weight off by following a healthy reduced calorie, low fat diet. (For what else they did, click here).
Which Diet Should You Choose?
With rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:
Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.
Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.
Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.
Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.
Finally, focus on what you have to gain, rather than on foods you have to give up.
On the minus side, none of the diets include sodas, junk foods, and highly processed foods. Teose foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.
On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.
The Bottom Line
For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.
Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories. In the article above I summarize the US News & World Report’s “Best Diets In 2021”.
There are probably two questions at the top of your list.
#1: Which diets are best for rapid weight loss? Here are some general principles:
If you are looking for rapid weight loss, any whole food restrictive diet will do.
Restrictive diets ultimately fail.
We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.
Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.
#2: Which diet should you choose? Here the principles are:
Choose a diet that fits your needs.
Choose diets that are healthy and associated with long term weight loss.
Choose diets that are easy to follow.
Choose diets that fit your lifestyle and dietary preferences.
Finally, focus on what you have to gain, rather than on foods you have to give up.
For more details on the diet that is best for you, 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.
As someone who is not normally a proponent of vaccinations, I have done my best to provide a scientifically accurate evaluation of the vaccines for COVID-19. My purpose has not been to change people’s minds.
If you have already decided to get vaccinated, I applaud you.
If you have decided not to get vaccinated, I respect your opinion.
I have written my articles for those of you who recognize the dangers of COVID-19, want to get vaccinated, but are hesitant because of all the negative chatter about the vaccines you have seen on the internet.
I believe every vaccine should be evaluated on the basis of its risks and benefits.
The benefits are clear. COVID-19 is a deadly disease. It is hard to believe that anyone could look at what has happened in the United States and around the world and not realize COVID-19 is not the common flu. It is the most infectious and deadly disease we have seen in our lifetime. Anything that can help us conquer this deadly disease is tremendously beneficial.
However, every vaccine has risks. The risks are extremely low, but they are not zero. And some past vaccines have had unexpected risks. For that reason, I have evaluated potential risks, including those “risks” you have heard about on the internet, against actual data. I have asked, “Are the risks real?”, “Are they serious?”, and “Do they occur often enough to be of concern?”
The yardstick I use for “Do they occur often enough…?” is the 1 in a million to 1 in 10 million range. The chance of dying in a plane crash is 1 in 10 million. Yet that doesn’t stop us from getting on planes to fly where we want to go.
I think that is an apt analogy. Serious risks from the COVID-19 vaccines are in the 1 in 10 million range. I am willing to take that risk because it will take us to where we want to go – the other side of this pandemic.
I summarized the risks and benefits of the COVID-19 vaccines in a recent “Health Tips From The Professor” article (https://www.chaneyhealth.com/healthtips/the-truth-about-vaccination/). However, science marches on. That article was written just one month ago, but it is time to update the data and also acknowledge what we still don’t know.
Update On The “Truth About Vaccines”
Last week I recorded a talk on the “The Truth About Vaccines”. Part of my motivation was to provide people with audio and video files that would be easier to share. However, I also used that opportunity to update the information on vaccines. Here are the files. Consider them a gift you can use to spread the word about the vaccines.
Note: If you want to share these audio and video files or the “Health Tips From The Professor” article I wrote a month ago, share the link rather than forwarding this email to them.
Similarly, if you would like to share this article with someone, share the link given at the beginning and end of this article rather than forwarding this email to them.
This is because if you forward this email to someone who unsubscribes because they aren’t in favor of vaccinations, it will unsubscribe you from receiving future issues of “Health Tips From the Professor”.
The Four Biggest Unanswered Questions
If you feel like the experts have been “flying by the seat of their pants”, that is because we are. When COVID-19 burst on the scene and spread like wildfire, it was a completely unknown entity. We had no idea what to expect or how effective measures to control it would be.
In fact, much of what we thought we knew was plain wrong. That is why:
We went from “masks are only important for health care workers” to “masks only protect others” to “masks protect us” to “maybe we need double masks”.
That is why a state like California, which has remained mostly locked-down and a state like Florida, which has remained mostly open, have ended up with about the same per capita cases and deaths from COVID-19.
Clearly some mitigation efforts are needed to “flatten the curve” and prevent our hospitals from being overwhelmed. We cannot just let the virus run rampant. But there is no clear agreement among experts as to which mitigation efforts are essential.
So, with perhaps a little humility, let me address the four greatest unanswered questions about COVID-19 and the vaccines. In each case, I will:
Give you the facts as we know them.
Give you my opinion.
Tell you what to watch for and what to do about it.
Here are the questions:
#1: How Long Will Immunity Last? Most headlines you have seen recently are asking this question with regards to the vaccines. But this question is equally important for those of you who have recovered from COVID-19. You also want to know if and how long you are protected from getting infected again.
Studies on this important question have mostly relied on measuring antibodies to COVID-19 in the bloodstream. And the answer appears to be similar for people who have been infected with COVID-19 and people who have been vaccinated, namely:
There are significant individual differences.
In some people, antibody levels decrease after a few months.
In other people, antibody levels appear to remain high for at least 6-8 months.
This is why the CDC is considering recommending a booster shot of the vaccine 6-12 months after you have completed your first round of vaccinations. It is also why some are recommending you get vaccinated even if you have recovered from COVID-19. The theory is that you will need to boost your antibody levels again to maintain full immunity from COVID-19.
But is a booster shot really necessary? As I have written previously:
Both the Pfizer and Moderna vaccines create memory cells as well as circulating antibodies.
Memory cells reside in the bone marrow and retain the blueprint for making more antibody-producing cells if the virus ever reappears. They are responsible for long-term immunity.
For example, many of you may remember a few years ago, a new variant of the flu virus appeared that hit young people much harder than people over 50. The explanation we were given at the time was that the new variant of the virus was similar to a flu virus that had widely circulated 30 years earlier. We had retained significant immunity to the previous virus, and it protected us from the new virus as well.
Because of memory cells, I am optimistic that we will retain significant immunity to COVID-19 even after circulating antibody levels have disappeared. But we won’t know for sure until we have accumulated enough data to know how well the vaccines protect us from COVID-19 a year or two down the road.
However, the data on patients who have recovered from COVID-19 is encouraging. So far, the reinfection rate seems to be around 1-2% and most of the recurring cases are mild.
So, should you get a booster shot? The risk of the vaccines will not change, so we need to look at the benefit side of the ledger.
If I am right and COVID cases are low 6-12 months from now, the benefit of getting a booster shot would be small. I’d give it a pass.
If I am wrong and COVID comes back with a vengeance, getting a booster shot might be prudent.
#2: Do We Need To Fear The Variants? You have seen the hype, “The new variants are highly contagious, and vaccines may not work against them.” The first claim is correct, but existing evidence suggests that the second claim is overblown.
Tests with antibodies from patients who have recovered from COVID-19 and from patients who have been vaccinated find that these antibodies are 70-90% effective at neutralizing the new variants. To put that into context, 70-90% effectiveness is significantly higher than the average flu vaccine.
New data coming out of England, where one of the variants originated, reports that the reinfection rate for people who have recovered from COVID-19 is around 0.7%, and this has not changed since the British variant strain appeared. [If the antibodies produced from the original COVID infection were not effective against the new variant, we would have expected reinfection rates to increase as the new variant became the predominant version of COVID circulating in the country.]
Of course, these data have not deterred the fearmongers. They are telling you that it is only a matter of time until a variant comes along that is unaffected by vaccines. I consider this unlikely, and here is why.
Vaccines are directed against the spike protein of the virus. That is the same protein the virus uses to bind to our cells. Any mutations severe enough to eliminate antibody binding to the spike protein are also likely to prevent the spike protein from binding to our cells. If the spike protein can’t bind to our cells, the virus can’t enter our cells. Such mutant viruses would be non-infectious. They would die out spontaneously.
Because of that, I am optimistic that the current vaccines will retain significant effectiveness against new variants as they arise.
Once again, the CDC may recommend a booster shot to help protect against the variants. The pharmaceutical companies are also working on vaccines that are specific to the new variants.
Should you get one of these shots? Once again, we won’t know for sure until we see how well the vaccines protect us from the new variants.
If I am right and COVID cases are low 6-12 months from now, the benefit of getting a shot would be small. I’d give it a pass.
If I am wrong and a new variant causes a massive surge in COVID cases and deaths in people who have been vaccinated, getting another shot might be prudent.
#3: Can I Get My Life Back After Vaccination? You have probably heard the CDC recommendations that we can still get COVID-19 and pass it on to others after we have been vaccinated. We should, therefore, continue to wear masks and socially distance ourselves.
I have had many people say to me, “If that’s true, why should I even bother to get vaccinated?” Let me start by covering what we know and don’t know about this question. Then I will put it into perspective for you.
The immune cells in the upper respiratory tract are not in perfect sync with the rest of the immune system. That means that after vaccination we may not get quite the level of protection in our upper respiratory track that we do in the rest of our body.
In the initial studies with rhesus monkeys, the animals were vaccinated and subsequently a high titer of live virus was sprayed directly into their noses. Virus was detected in their nasal passages for about 3 days before it disappeared.
The animals did not have detectable levels of virus in their bloodstreams. Nor did they develop any disease symptoms.
However, the brief presence of live virus in their nasal passages led to the suggestion that one might still be able to pass the virus on to others after vaccination.
Small, preliminary studies with a subset of patients enrolled in the vaccine clinical trials suggested that the vaccines might only be around 60% effective at preventing upper respiratory tract infections.
That means if you are exposed to COVID-19, you might have a 40% chance of developing an upper respiratory tract infection. In most cases you will be asymptomatic, but you could pass the virus on to others.
The good news is that you are still 95% protected against severe disease, hospitalization, chronic long-term symptoms, and death. This is the answer to the “Why bother?” question.
However, new data out of Israel gives a more optimistic assessment. The latest study reported that the Pfizer vaccine is 89% effective at preventing even asymptomatic disease.
The bottom line is that the data are still coming in. It may be another 6-12 months before we have an accurate estimate of your risk of developing asymptomatic disease and passing the virus on to someone else if you are exposed to COVID-19 after being vaccinated.
So, what do I recommend? I can’t tell you what you should do, but I will tell you what I plan to do.
I still plan to wear a mask and social distance when I am out and about.
I am comfortable meeting with small groups of close friends and family without a mask, especially if they have also been vaccinated.
I am comfortable going back to church because our church follows an excellent social distancing protocol.
I am comfortable traveling to visit our family in California.
Once the number of COVID-19 cases has reached a low level, I will be comfortable resuming all my previous activities, subject, of course, to any state mandates.
News Flash: Yesterday the CDC updated their guidelines for people who are fully vaccinated. They now say that fully vaccinated people can:
Visit with other fully vaccinated people indoors without wearing masks or physically distancing.
Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physically distancing.
Refrain from quarantining and testing following a known exposure to someone with COVID-19 unless you develop symptoms.
The other CDC guidelines remain in place for now but are likely to change once a larger percentage of the population has been vaccinated.
#4: Why Not Rely On Diet And Supplementation? I have friends who tell me they are not going to get vaccinated. They will rely on diet and supplementation to keep their immune systems strong and protect them from COVID. I respect their choice.
In fact, I have a great deal of sympathy for that choice. When I think of protecting myself from colds and flu, my preference has always been to keep my immune system strong with diet, supplementation, and exercise rather than relying on vaccinations.
However, COVID is different story. It is a far deadlier disease. And even if it doesn’t kill you, it may impact your life for years to come. The long-term health consequences of COVID are perhaps even scarier than the 1% death rate.
Let’s take a realistic look at each of our options to defeat COVID:
In a previous issue of “Health Tips From the Professor” I shared some preliminary clinical studies showing that people with adequate vitamin D status were 60-70% less likely to be infected with COVID, hospitalized with COVID, in the ICU from COVID, and dying from COVID. That is impressive, but it is not 100% protection. And if your vitamin D levels are already adequate, you get no additional benefit from adding extra vitamin D to your diet.
In another issue of “Health Tips From the Professor” I shared a review written by a group of experts on respiratory diseases. They concluded that, in addition to a good diet, supplementation with a multivitamin and extra vitamin C, vitamin D, and omega-3s reduced the risk of dying from respiratory diseases. But they didn’t say it eliminated the risk. It did not guarantee 100% protection.
As for CDC guidelines, wearing a mask gives you somewhere between 30 and 70% protection. Social distancing and handwashing also help, but they don’t offer 100% protection.
Vaccination with the Pfizer and Moderna vaccines gives you at least 60% protection against upper respiratory infections from COVID-19 and 95% protection against severe disease, hospitalization, long term health consequences, and death. It is the single most effective tool we have at our disposal, but it does not give 100% protection. As one of my pessimist friends put it, “95% protection means I have a 1 in 20 chance of getting it.”
COVID-19 is throwing everything it has at us. When faced with a deadly disease and several things I can do that offer partial protection, I choose a holistic approach. I choose to use every tool at my disposal. I choose diet, supplementation, CDC guidelines, and vaccination. Everyone should make their own decision about how best to protect themselves from COVID-19, but my choice is clear. I want to do everything in my power to avoid this disease.
The Bottom Line
In the article above, I have updated my information on vaccines with data from the latest studies, provided you with resources about the vaccines you can share, and have given you updates and perspective on the four biggest unanswered questions about COVID-19 and the vaccines, namely:
How long does immunity last?
Do we need to fear the new variants?
Can I get my life back after vaccination?
Why not rely on diet and supplementation?
For more details, read the article above.
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.
As an expectant mother, you want the best for your child. You want them to be healthy and happy. You probably also want them to be smart.
Your doctor has recommended you take a prenatal supplement. You have probably heard about the importance of folic acid for a successful pregnancy. I have also written about the importance of adequate omega-3s and iodine during pregnancy for the cognitive development of your child.
But what about vitamin D? Vitamin D receptors are expressed in the mammalian brain as early as 12 days into gestation, and vitamin D is thought to be important in neurocognitive development.
Previous studies have shown that vitamin D deficiency during pregnancy is associated with delayed motor-skill and social development during the first few years of childhood. But it is uncertain whether these early deficits translate into long-term deficits in IQ and emotional stability.
This study was designed to answer that question by comparing blood 25-hydroxyvitamin D levels in the mother’s blood during the second trimester and IQ measurements of their children between the ages of 4 and 6.
How Was This Study Done?
This study used data from the CANDLE (Conditions Affecting Neurocognitive Development and Learning in Early Childhood) database. This portion of the study measured blood levels of 25-hydroxyvitamin D during the second trimester of pregnancy of 1503 women from the Memphis area of Tennessee. The 25-hydroxyvitamin D levels were compared with the IQ of their children measured between the ages of 4 and 6.
The average age of the mothers was 26 and 63% of them were black.
Of course, there are many other factors that influence mental development during childhood. Accordingly, the data were corrected for the overall quality of the maternal diet, maternal IQ, maternal education, maternal age, marital status, BMI (a measure of obesity), tobacco use during pregnancy, alcohol use during pregnancy, and household income.
Does Vitamin D Affect IQ?
Here are the results from the study:
The average blood level of 25-hydroxyvitamin D at week 23 of pregnancy was 21.6 ng/mL.
45.6% of the women were vitamin D deficient (<20 ng/mL 25-hydroxyvitamin D).
The average blood level of 25-hydroxyvitamin D in this study was 19.8 ng/mL for Black women and 25.9 ng/mL for White women.
This is consistent with a previous report that 80% of Black pregnant women in this country are vitamin D deficient compared to only 13% of White pregnant women.
After adjusting for other variables known to affect IQ, every 10ng/mL increase in 25-hydroxyvitamin D status during pregnancy resulted in an increase of:
1.17 points in overall IQ.
1.17 points in verbal IQ.
1.03 points in nonverbal IQ.
The effect of vitamin D status during pregnancy on IQ of the offspring at ages 4-6 was the same for both races.
The effect of maternal vitamin D status on childhood IQ plateaued at around 40ng/mL, which is near the top of what is considered an adequate level of 25-hydroxyvitamin D.
The authors of the study concluded: “Gestational vitamin D concentrations were positively associated with IQ at age 4-6, suggesting that vitamin D plays an important role in programming neurocognitive development. Vitamin D status may be an important modifiable factor that can be optimized through appropriate nutritional recommendations and guidance. Vitamin D deficiency was especially prevalent among Black women in this cohort, suggesting a higher need for screening and nutritional intervention in this vulnerable population.”
The authors went on to say: “Vitamin D supplementation may be indicated for women who have poor dietary intake of vitamin D and/or reduced cutaneous synthesis related to skin pigmentation [Simply put, sunlight can catalyze the synthesis of vitamin D in our skin, but skin pigmentation filters out the sunlight and decreases vitamin D synthesis.]…”
The Importance Of Vitamin D During Pregnancy
Let me put this study in perspective by first discussing the pros and cons of the study. Then I will close with what I think is the most important takeaway from the study.
The Cons Of The Study:
The cons are obvious:
This study shows that a 10 ng/mL increase in 25-hydroxyvitamin D during pregnancy is associated with about a 1-point increase in IQ on a 100-point scale? Is that significant? Probably not, especially when you consider all the other dietary and environmental factors that influence intelligence and educational attainment.
2) We don’t know whether this effect of vitamin D status during pregnancy on IQ will persist as the children grow up. It is more likely that socioeconomic and family factors during childhood will play a much larger role in educational attainment.
The Pros Of The Study:
This study is superior to most previous studies on this topic because of its size and duration. It is also a well-designed study.
2) The authors pointed out a previous study has reported that for each decrease of one IQ point:
Lifetime income for men decreases by 1.93%.
Lifetime income for women decreases by 3.23%.
3) The effect of vitamin D status during pregnancy on IQ at age 4-6 plateaued at 40 ng/mL. That means the women in this study would obtain optimal benefit by increasing their 25-hydroxyvitamin D levels by 20 ng/mL. Since each 10 ng/mL increase in 25-hydroxyvitamin D during pregnancy increased IQ by 1.17, this would translate into:
A 4.5% increase in lifetime earnings for men.
A 7.6% increase in lifetime earnings for women.
When you look at it this way, the effect of vitamin D during pregnancy on IQ seems a bit more significant.
The Most Important Takeaway From This Study:
Of all the things you can do during pregnancy to give your kids an advantage in today’s competitive world, supplementation with vitamin D before and during pregnancy is probably the simplest, cheapest, and safest option available to you.
Even if optimizing 25-hydroxyvitamin D levels during pregnancy has no long-term effect on your child’s IQ, we know it has many other benefits for your health and your child’s health.
And, as long as you don’t exceed 50 ng/mL of 25-hydroxyvitamin D, it is perfectly safe.
The authors had this to say about supplementation with vitamin D before and during pregnancy: “Popular prenatal supplements, which typically contain 400-600 IU vitamin D, are likely insufficient to correct 25-hydroxyvitamin D deficiencies. Randomized controlled trials have suggested that daily supplementation of 800 to 1,000 may be needed during pregnancy, and that doses of 4,000 IU may be ideal in cases of severe deficiency.”
The Bottom Line
A recent study looked at 25-hydroxyvitamin D status during the second trimester of pregnancy and the IQ of the offspring at ages 4-6. The study found:
The average blood level of 25-hydroxyvitamin D at week 23 of pregnancy was 21.6 ng/mL.
6% of the women were vitamin D deficient (<20 ng/mL 25-hydroxyvitamin D).
After adjusting for other variables known to affect IQ, every 10ng/mL increase in 25-hydroxyvitamin D status during pregnancy resulted in an increase of 1.17 points in overall IQ.
The effect of maternal vitamin D status on childhood IQ plateaued at around 40ng/mL, which is near the top of what is considered an adequate level of 25-hydroxyvitamin D.
The authors of the study concluded: “Gestational vitamin D concentrations were positively associated with IQ at age 4-6, suggesting that vitamin D plays an important role in programming neurocognitive development. Vitamin D status may be an important modifiable factor that can be optimized through appropriate nutritional recommendations and guidance…”
The authors went on to say: “Vitamin D supplementation may be indicated for women who have poor dietary intake of vitamin D and/or reduced cutaneous synthesis related to skin pigmentation…”
In terms of supplementation, the authors said: “Popular prenatal supplements, which typically contain 400-600 IU vitamin D, are likely insufficient to correct 25-hydroxyvitamin D deficiencies. Randomized controlled trials have suggested that daily supplementation of 800 to 1,000 may be needed during pregnancy, and that doses of 4,000 IU may be ideal in cases of severe deficiency.”
For more details and my perspective of the 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.
What Do The US Dietary Guidelines Say About Your Diet?
Author: Dr. Stephen Chaney
Science is always changing, and nutritional science is no different. As we learn more, our concept of the “ideal diet” is constantly evolving. Because of that, the USDA and the US Department of Health & Human Services produce a new set of Dietary Guidelines for Americans every 5 years.
The 2020-2025 Dietary Guidelines for Americans have just been released. As usual, the process started with a panel of 20 internationally recognized scientists who produced a comprehensive report on the current state of nutritional science and made recommendations for updated dietary guidelines. After a period of public comment, the dietary guidelines were published.
There were two new features of the 2020-2025 Guidelines:
They provided dietary guidelines for every life stage from 6 months of life to adults over 60.
The guidelines also addressed personal preferences, cultural traditions, and budgetary concerns in so that each of us can develop a healthy diet that fits our lifestyle.
What Do The US Dietary Guidelines Say About Your Diet?
Here are the 2020-2025 Guidelines in a nutshell:
Follow a healthy dietary pattern at every life stage.
Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
Focus on meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits. They went on to say, “A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups [emphasis mine], in recommended amounts, and within calorie limits.”
They said, “the core elements that make up a healthy dietary pattern include:”
Vegetables of all types – dark green, red, and orange vegetables; beans, peas, and lentils; starchy vegetables; and other vegetables.
Fruits – especially whole fruits.
Grains – at least half of which are whole.
Dairy – including fat-free or low-fat milk, yogurt, and cheese; lactose-free versions; and fortified soy beverages and soy yogurt as alternatives. [Other plant-based milk and yogurt foods were not recommended because they do not provide as much protein as dairy. So, they were not considered equivalent foods.]
Protein foods – including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products.
Oils – including vegetable oils and oils in food, such as seafood and nuts.
Limit foods and beverages higher in added sugars, saturated fat, and sodium; and limit alcoholic beverages. Their specific recommendations are:
Added sugars – less than 10% of calories/day starting at age 2. Avoid foods and beverages with added sugars for those younger than 2.
Saturated fat – Less than 10% of calories starting at age 2.
Sodium – Less than 2,300 mg per day – even less for children younger than 14.
Alcoholic beverages – Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant.
The US Dietary Guidelines point Americans in the right direction, but they are never as strong as most nutrition experts would like. The 2025 Dietary Guidelines are no exception. They have two major limitations:
#1: The food industry has watered down the guidelines. This happens every time a new set of guidelines are released. The food and beverage lobbies provide their input during the public comment period. And because they fund a significant portion of USDA research, their input carries a lot of weight. Here are the 3 places where they altered the recommendations of the scientific panel:
The scientific panel recommended that Americans decrease the intake of added sugar from 13% of daily calories to 6%. The final dietary guidelines recommended reducing sugar to 10% of daily calories.
The scientific panel recommended that both men and women limit alcoholic drinks to one a day. The final dietary guidelines recommended men limit alcoholic drinks to two a day.
The scientific panel included these statements in their report:
“Dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains are…associated with detrimental health outcomes.”
“Replacing processed or high fat-meats…with seafood could help lower intake of saturated fat and sodium, nutrients that are often consumed in excess of recommended limits.”
“Replacing processed or high-fat meats with beans, peas, and lentils would have similar benefits.”
These statements are included in the final report, but they are buried in portions of the report that most people are unlikely to read. The summary that most people will read recommends shifts in protein consumption to “add variety” to the diet.
#2: The guidelines do not address sustainability and do not explicitly promote a shift to more plant-based diets. Again, this was based on input from food lobby groups who argued that sustainability has nothing to do with nutrition.
If you are concerned about climate change and the degradation of our environment caused by our current farming practices, this is a significant omission.
I have covered this topic in a recent issue of “Health Tips From the Professor”. Here is a brief summary:
In 2019 a panel of international scientists was asked to conduct a comprehensive study on our diet and its effect on both our health and our environment.
The scientific panel carefully evaluated diet and food production methods and asked three questions:
Are they good for us?
Are they good for the planet?
Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.
They developed dietary recommendations popularly known as the “Planetary Diet”. Here are the characteristics of the planetary diet.
It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
It allows the option of adding one serving of dairy a day.
It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.
Unless you are a vegan, this diet is much more restrictive than you are used to. However, if you, like so many Americans believe that climate change is an existential threat, I would draw your attention to one of the concluding statements from the panel’s report.
“Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
In other words, we can do everything else right, but if we fail to change our diet, we cannot avoid catastrophic global warming.
What Do The US Dietary Guidelines Say About Supplementation?
The authors of the 2020-2025 US Dietary Guidelines have relatively little to say about supplementation. However:
They list nutrients that are of “public health concern” for each age group. Nutrients of public health concern are nutrients that:
Are underconsumed in the American diet.
Are associated with health concerns when their intake is low.
They state that “dietary supplements may be useful in providing one or more nutrients that otherwise might be consumed in less than recommended amounts.”
They recommend specific supplements for several age groups.
Here are their nutrients of public health concern and recommended supplements for each age group:
#1: General population.
Nutrients of public health concern are calcium, dietary fiber, and vitamin D. They state that supplementation may be useful for meeting these needs.
#2: Breast Fed Infants.
Supplementation with 400 IU/day of vitamin D is recommended shortly after birth.
#3: Vegetarian Toddlers.
Iron and vitamin B12 are nutrients of concern.
#4: Children & Adolescents.
Calcium and vitamin D are nutrients of concern. Dairy and/or fortified soy alternatives are recommended to help meet these needs.
Iron, folate, vitamin B6, vitamin B12, and magnesium are also nutrients of concern for adolescent females.
#5: Adults (Ages 19-59).
30% of men and 60% of women do not consume enough calcium and 90% of both men and women do not get enough vitamin D.
#6: Pregnant & Lactating Women:
Calcium, vitamin D, and fiber are nutrients of concern for all women in this age group.
In addition, women who are pregnant have special needs for folate/folic acid, iron, iodine, and vitamin D.
Women who are pregnant or thinking of becoming pregnant should take a daily prenatal vitamin and mineral supplement to meet folate/folic acid, iron, iodine, and vitamin D needs during pregnancy. They go on to say that many prenatal supplements do not contain iodine, so it is important to read the label.
All women who are planning or capable of pregnancy should take a daily supplement containing 400 to 800 mcg of folic acid.
#7: Older Adults (≥ 60).
Nutrients of concern for this age group include calcium, vitamin D, fiber, protein, and vitamin B12.
About 50% of women and 30% of men in this age group do not get enough protein in their diet.
My Perspective:
The US Dietary Guidelines use foods of public health concern as the only basis for recommending supplementation. I prefer a more holistic approach that includes increased needs, genetic predisposition, and preexisting diseases as part of the equation (see the diagram on the right). I have discussed this concept in depth in a previousissue of “Health Tips From The Professor”.
I have also taken this concept and made supplement recommendations for various health goals in a free eBook called “Your Design For Healthy Living”.
Some people may feel I should have included more supplements in my recommendations. Others may feel I should have included fewer supplements in my recommendations. No list pf recommend supplements is perfect, but I have tried to include those supplements supported by good scientific evidence in my recommendations.
The Bottom Line
The USDA and Department of Health & Human Services have just released the 2020-2025 US Dietary Guideline. In the article above I have summarized:
Their recommendations for a healthy diet.
Their recommendations for supplementation.
The dark side of the US Dietary Guidelines.
For more details, read the article above.
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.
When I lived up north, February was the worst month of the winter – cold, gloomy, and while it’s only 28 days long, it seemed endless. If you’re in the cold weather, I hope you stay nice and warm, and that you also find some fun outdoor activities to help this month end quickly.
Here in Florida, this is one of our best months! No humidity, no rain, no bugs, and lots of sunshine. We love February!
February is also thought of as a month to show love for another (it should be every month, but we’ll leave that alone for now). Lovers go out to special dinners, sometimes buying expensive gifts or flowers. And many people send sweet cards to friends and family.
But the actual origination of Valentine’s Day isn’t such a loving story. The day is named after St. Valentine, a Christian martyr who was executed in ancient Rome on February 14th in the 3rd century A.D. There was also a pagan ritual that had to do with fertility, and where women put their names into an urn for bachelors to pick from. Somehow the two merged over the years and brought St. Valentine’s Day into the more romantic sphere.
In any case, it’s now a multi billion dollar business that has nothing to do with anything religious but can be fun for loving couples to celebrate.
A Letter From A Reader
This past week I received an email from a reader of this newsletter. I’ve asked people to send me a message if they have any aches or pains that they would like for me to discuss. This is a topic I’ve never discussed before, and since it’s causing this woman distress, I decided it’s the perfect discussion for the month.
Suzie was feeling pain across the front of her shoulder, and she had painful points along the bottom of her clavicle (collarbone). The subclavius muscle is a short muscle that originates on your 1st rib and inserts into the underside of your clavicle. You can look at it on Wikipedia (https://bit.ly/2KV7lT8) if you’d like to see how tiny it is and where to find it when you are self-treating for pain.
As shown in the graphic above, it is interesting to think that such a small muscle can cause so much pain in the front of your shoulder, and down your biceps to your inner elbow. Even more interesting is that most people aren’t aware of this muscle, so they search other places when they are feeling pain across the front of their shoulder. As a result, they don’t get relief, and they may even turn to pain medications.
A Novel Treatment For Shoulder Pain
If your pain starts in the front of your shoulder and radiates down your bicep, the pain may be caused by your subclavius muscle. If, you are in luck. The treatment for this muscle is so simple you can do it any place and at any time.
Simply press your fingertips as shown in this picture. If that exact point isn’t painful, move your fingertips a bit to one side or the other.
It will probably feel like a sharp pain, and you may even feel the tiny bump that is caused by the spasm.
Hold the pressure for a minute or so….
Release the pressure (but don’t move your finger off the point)…
Press deeply again and hold.
Do this several times until it doesn’t hurt to press on the point.
I have been working with people suffering from chronic pain and/or sports injuries since 1989. One thing I have found is that while I can find and successfully treat the muscles causing pain when people come into my office, it’s vital for them to continue their treatment at home.
A phenomenon called “muscle memory” will cause the muscle to begin to shorten as soon as we finish our therapy session. Left untreated the muscle will tighten again in as short as 2-3 days, and you’ll have pain again. However, if you self-treat the muscle you will continue to bring it back to its proper length, and ultimately it will stay, and the pain will be eliminated
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.
Many of you want to get vaccinated against COVID-19, but you are fearful. You have been sending me videos and posts about the risks of COVID vaccines. You have been asking, “Are the vaccines safe?” I don’t have time to respond to all of you personally, so I have decided to combine my responses into a single article in an effort to provide some scientific perspective on the controversies surrounding vaccination.
Let me start by reminding you that I am not someone who automatically endorses every vaccine. I believe every vaccine should be judged on its risk versus benefit. I have discussed this in a previous issue of “Health Tips From The Professor”. In my view, the main benefit of getting the flu shot is to protect others, especially the vulnerable with weak immune systems. Accordingly, the only time I have ever taken the flu shot was the year my granddaughter was born, and that was to protect her.
However, the original strain of COVID-19 is 3-5 times more infectious (the new variants are around 7 times more infectious) and 10 times deadlier than the flu. Even worse, many people never fully recover from COVID. This dramatically changes the risk, benefit equation.
I believe everyone has the right to decide whether they will be vaccinated. I also believe that everyone is entitled to their opinion. I am not writing this article to argue with people who believe vaccines are a bad idea. I am writing this article for those of you who want to get vaccinated but are fearful because of negative messages about vaccines on the internet or from your friends.
In addition, if too many people decline to get vaccinated, the consequences could be catastrophic. This is another powerful motivator for writing this article. I don’t want people refusing the vaccines for the wrong reasons. You deserve to know the pros and cons of vaccinations.
I apologize for the length of this post. There is a lot of negative information about vaccines on the internet. I wanted to respond to as much of it as possible. Here is what I will cover in today’s article:
The public health argument for vaccination.
The personal argument for vaccination.
The risks of vaccination – A perspective.
The claims about existing vaccines.
The good news nobody is talking about.
New vaccines on the horizon.
What questions remain?
What alternatives do we have to vaccination?
The truth about vaccination.
Now, back to the videos and posts. Some are utter nonsense. Others are videos posted by honorable people (some of whom are doctors) who have overstated the risks and understated the benefits of the vaccines. The best analogy I have heard recently is flying in an airplane. If we were to focus on all the horrible things that can happen when a plane crashes, we would never get on an airplane again. However, the risk of a plane crashing is 1 in 10 million, so most of us have no trouble getting on airplanes to take us where we want to go.
I will start by making a science-based comparison of the benefits and risks of the Pfizer and Moderna vaccines. Then I will touch briefly on some on the other vaccines that will soon be available.
To best understand the benefits of vaccination we need to envision what a world without effective COVID vaccines would look like. It drives me crazy when I hear people dismiss the risks of COVID by saying the death rate is only around 1% (1.5% to be exact). That vastly understates the risks of COVID.
The Public Health Argument For Vaccination
Let me start with the public health perspective:
For us to get the pandemic under control and have life to return to normal we need to reach herd immunity. What would that look like without vaccines?
Let’s start with deaths. The best current estimate of the US population is around 340 million. According to the CDC, there have been 26 million cases of COVID-19 in the US to date. That is around 7.7% of the US population. The original estimates were that 40-60% of the population would need to be immune to reach herd immunity. That means an additional 110-178 million Americans would need to be infected with COVID-19 before we achieved herd immunity. With a death rate of 1%, that would require that an additional 1-2 million Americans die before we reached heard immunity.
And this is just a minimum estimate. The % of the population required to reach herd immunity depends on the infectivity of the virus. With the new variants that are now spreading through the US population, 70-90% of the population may need to be infected before we could achieve herd immunity. In either case, are we willing to let millions of Americans die so that we can achieve herd immunity without the vaccine?
Now let’s talk about the 99% who don’t die. The best current estimates are that around 80% of people who were hospitalized with COVID and 20% of those with milder disease suffer from chronic fatigue and/or some degree of lung or heart damage after they have “recovered” from COVID. In some cases, this resolves in a few weeks, but for many it lasts for months, and for some it still has not resolved almost a year later. Are we willing to let millions of Americans suffer from chronic fatigue or worse when this could have been avoided with vaccination?
Obviously, these are worst case scenarios. We have already seen 20 million Americans be vaccinated. Many more are eagerly awaiting their turn to be vaccination. However, the concern of the public health community is that unfounded fears of vaccination will prevent us from reaching herd immunity through vaccinations. That would mean that many Americans would die needlessly from COVID. And many more would suffer needlessly from chronic fatigue or worse for months after “recovering” from COVID.
In summary, the public health argument for you getting vaccinated is clear. You are protecting your fellow Americans (and perhaps your vulnerable loved ones) from dying from COVID-19 or suffering long term health consequences from COVID-19. Whether you are protecting 10’s of thousands, 100’s of thousands, or millions of Americans depends on the percent of the population that gets vaccinated.
2) What about lockdowns? Here the data are clear. Lockdowns are effective at temporarily slowing the spread of the virus, so that hospitals are not overwhelmed. But they are not effective for much else. They don’t kill off the virus. And it surges again when the lockdown is lifted. We could lurch from lockdown to lockdown until we have achieved herd immunity, but I don’t think anyone wants that.
The Personal Argument For Vaccination
What about the benefits for you as an individual? Perhaps the best way of answering that question is to
white mask
address the recent announcement that you will still need to wear a mask after you have been vaccinated because you can still catch the virus and still spread it. I have seen some of you say, “If that’s true, why bother getting vaccinated?” I am as bummed as any of you that I will still need to wear a mask and socially distance after getting vaccinated but let me put that into perspective for you.
Let’s start with the science. While we often talk as if we have a single immune system, we actually have several semi-independent immune defense systems. For airborne viruses like COVID-19, our first line of defense is our upper respiratory tract. We have immune cells that line our nose, throat, and upper respiratory track that can slow or stop the viral infection. If the virus takes up residence in our upper respiratory tract, it can cause mild flu-like symptoms. Once the virus escapes the upper respiratory tract, it can invade the lower respiratory tract and our bloodstream. This is where all the bad things happen.
The Pfizer and Moderna vaccines are 60% effective at preventing COVID-19 from infecting our upper respiratory tract and 95% effective at preventing COVID-19 from infecting our lower respiratory tract and bloodstream.
This means after we have been vaccinated, we still have a 40% chance of being infected with COVID-19 and suffering mild flu-like symptoms. If we have been infected, we can still spread it to others. However, we have 95% protection against experiencing severe COVID-19 symptoms, being hospitalized, dying, and suffering from long term complications from COVID-19. This is the most compelling personal benefit of vaccination.
Finally, I should speak to the 40% risk of being infected. That is only a concern while the virus is widely circulating in the community. When we reach herd immunity and the virus levels are low, the probability of infection will also be low.
2) There is one other personal consideration. A recent study has confirmed what we already expected, namely that there is a considerable variation in immune response at every age. However, the surprising result was the study could not find any reliable predictor for the variation in immune response. In the words of one of the authors, “If you get infected with COVID-19, there is no way of telling whether it will be a mild cold or a trip to the ICU.” There have even been reports of young, healthy athletes dying from COVID-19. This does not happen often enough for it to affect the statistics. But if it were to happen to you or someone you loved, it would be important to you.
In summary, the personal argument for you getting vaccinated is that the Pfizer and Moderna vaccines give you 95% protection from severe disease, hospitalization, death, and long-term health consequences caused by COVID-19. This protection can be important even for people who are young and healthy.
The Risks Of Vaccinations
Now let’s turn to the risks of vaccination. The risks are real, but let’s put them into perspective.
The risks of vaccination need to be compared with the risks of attempting to reach herd immunity without vaccination that I have described above.
2) The risks of adverse events occurring after vaccination also need to be compared with the risk of those same adverse events occurring after infection with COVID-19, flu, or the common cold. This is something that has been completely ignored in most online discussions of vaccination risks. Every time something triggers our immune system, there is a small chance of it going haywire and triggering things like autoimmune responses and Bell’s palsy. It doesn’t matter if the trigger is a viral infection, a bacterial infection, or a vaccine. Simply put, you are equally likely to suffer from some of these adverse events if you get vaccinated or if you decline vaccination and become infected with COVID-19.
3) Some of the reports circulating on the internet are based on the Vaccine Adverse Effects Reporting Site (VAERS) despite the clear warning that these reports are unverified and may be inaccurate. Once the reports have been posted on VAERS, the CDC contacts the person reporting the event and obtains a complete medical history for the patient. If the patient died, the CDC obtains the death certificate and, if available, the autopsy report. They then use a sophisticated algorithm to determine whether the event was unexpected based on the patient’s age, health, and underlying diseases. Rather than using the unverified VAERS data, I have based my analysis on the CDC’s January 27 COVID-19 Safety Update which summarized the data collected from the first 20 million vaccinations.
The Claims About Existing Vaccines
Pinochio
Now, let’s turn to some of the claims you may have heard about the Pfizer and Moderna vaccines. There is a kernel of truth to each of the claims. However, the people sharing these claims are not sharing the full truth. As Paul Harvey used to say, they are not sharing “the rest of the story.”
I suppose I should start by addressing the oft-repeated statements that these vaccines are not FDA approved, but have received Emergency Use Authorization instead. They are experimental. There is no data on safety. They haven’t been studied in animals. We have never had an mRNA vaccine before.
In an ideal world clinical studies on the vaccines would have continued another year or two so they could have received full FDA approval. We would have found out things like how long immunity lasts and whether we could space the shots further apart. However, we don’t live in an ideal world. Thousands of Americans are dying every day. Fast action was needed. That is what Emergency Use Authorization was created for. Clinical studies are still ongoing to resolve questions like how long immunity lasts. Things like that are nice to know, but they are not essential for stopping the pandemic.
They have been studied in animals. I suspect this hasn’t been discussed publicly because many people oppose animal testing.
Safety was evaluated carefully in the vaccine clinical trials. No major safety issues were seen in the Pfizer and Moderna clinical trials with about 50,000 participants. With any drug or vaccine, you never know about rare side effects until millions of people have received the treatment. At this point, more than 20 million people have been vaccinated and very few unexpected side effects have been reported (more about that below). The safety of these vaccines is well established at this point.
mRNA vaccines are not an untested technology. They have been in development for at least 10 years. Personally, I prefer the mRNA vaccines because they are cleaner than earlier vaccines. They have fewer components and there are, therefore, fewer things that can go wrong.
2) Now, let me address the claim that large numbers of people get sick after receiving the vaccine, and are unable to go to work. That sounds scary but let me tell you “the rest of the story”.
Short term side effects of the Pfizer and Moderna vaccines include pain at the site of injection, fatigue, headache, generalized muscle pain, chills, fever, swelling, and joint pain, particularly after the second shot. These are common symptoms for almost any vaccine. Not everyone experiences these symptoms, and for some people the symptoms are mild. However, the symptoms are severe enough for some people that it keeps them out of work. This is the kernel of truth.
However, what people spreading this claim aren’t telling you is that the symptoms are temporary. They generally clear up within 24-48 hours. And people who do have severe symptoms usually miss only a day or two of work.
The bottom line is you may feel lousy for a day or two after the shot (especially the second shot). You may miss a day or two of work. But you will recover in a day or two. You will be fine, and the temporary discomfort will be worth it because you have achieved 95% protection from COVID-19.
3) Next, let me address the claim that some people have required medical attention and hospitalization after being vaccinated. That sounds even scarier, but here is “the rest of the story”.
What they are referring to are severe allergic reactions to the vaccine. In most cases, severe allergic reactions can be handled with an injection of epinephrine (Most people who are prone to severe allergic reactions carry an epi-pen with them at all times). However, severe allergic reactions can require medical attention and occasionally a brief visit to the hospital. Again, this is the kernel of truth, but here is “the rest of the story”.
The chance of a severe allergic reaction occurring is 1 in 100,000. That is about the same as your chance of being struck by lightning.
These are not random occurrences. 81% of the cases occur in people who have previously had severe allergic reactions to foods, medicines, vaccines, or insect bites, especially those people who have required medical attention or hospitalization in the past. In other words, most people know they are at risk ahead of time. If you have never had a severe allergic reaction to anything before, your chance of experiencing a severe allergic reaction to these vaccines is around 1 in a 100 thousand.
The bottom line is that if you have never experienced severe allergic response in the past, your chances of experiencing it following vaccination are slight. As a precaution vaccination sites ask you to wait for 15’ before leaving so you can be observed for allergic reactions.
If you have suffered from severe allergic reactions in the past, your chances of having a severe allergic reaction to the vaccine are greater. This could require medical attention or a brief hospitalization. My recommendation for you is to consult with your physician before signing up for the vaccine. If you and your physician decide vaccination is right for you, get your vaccination from a medical center or clinic where physicians are available should severe allergic responses arise.
The CDC has been following this side effect very carefully during the rollout of the Pfizer and Moderna vaccines. The good news is that most people fully recover within 24-48 hours. This is also a transient side effect.
4) Another claim is that the vaccine will, in effect, sterilize women taking it so that they cannot become pregnant.
Let’s start with the kernel of truth. Early last year, two scientists who had formerly worked for Pfizer released a sent a letter to vaccine experts across the world warning that the Pfizer vaccine could cause sterilization. That sounds super-scary, but here is the “rest of the story”.
That letter was part of what is called “the scientific method”. Scientists are continually challenging existing paradigms. This constant challenging and testing of ideas is the true strength of the scientific method.
Scientists understand this. When someone challenges an existing paradigm, we ask, “Is it true? What do the data show?” Here are the data.
The Pfizer study excluded pregnant women from the study. However, 23 women became pregnant and gave birth during the study. Twelve of them were in the vaccine group and eleven in the placebo group. This is a small number, but…
The mechanism proposed for the vaccine causing sterility also applies to infection with the live virus. At this point, more than 100 million people have had COVID worldwide and there has been no decrease in fertility.
The bottom line is that the hypothesis proposed by the former Pfizer scientists has been tested and disproved. There is no detectable risk of infertility associated with either COVID-19 exposure or the vaccines.
Unfortunately, most bloggers and many medical doctors don’t fully understand the scientific method. They don’t realize that things like the letter by the former Pfizer scientists are simply hypotheses and they don’t look at existing data to see whether the hypotheses are true or false.
5) Finally, there are claims that lots of people are dying after receiving the vaccine. This is based on misuse of the VAERS database. They are ignoring the warning that the data have not been verified. If you simply refer to the unverified VAERS database, 196 people have died following the first 20 million vaccinations. It sounds scary, but here is the rest of the story.
Every time one of these deaths is reported to the VAERS database, the CDC obtains the medical records and cause of death. Then they calculate whether the death was unexpected for someone with that medical condition. For example, 81% of the deaths have occurred in long term care facilities. When you read the medical records of these patients you find entries like “…in and out of hospice…” or “…has congestive heart failure and was in declining health…”
In the words of the CDC, the death of these patients was expected. They called these deaths “temporally-associated coincidental events.” I would word it a bit differently. These were patients on the brink of death. Anything could push them over the edge. It just happened to be the vaccination that did it.
When the CDC had completed their data analysis, they could only identify two unexpected deaths in healthy patients following vaccination. That is 1 out of 10 million – the same chance you have of dying in a crash the next time you get on a plane. When you compare that with a 1 in a hundred chance of dying and a 20% chance of having long term complications from COVID-19, the choice of getting vaccinated sounds a lot less scary.
6) I suppose I should close this section by addressing some of the videos you have shared with me of people claiming they have serious side effects from the Pfizer and Moderna vaccines. Unfortunately, these claims have not been submitted to the VAERS database, so they can be verified by the CDC. At this point they seem to be in the 1 in 10 million category, but I won’t know for sure until they have been submitted and verified. As a scientist, I deal with data, not speculation.
The Good News Nobody Is Talking About
The good news nobody is talking about is that the Pfizer and Moderna vaccines may trigger fewer autoimmune diseases than previous vaccines.
Whenever the immune system is triggered by either viral infection or vaccines, there is a small chance it will go haywire and trigger autoimmune responses, with Bell’s palsy and Guillain-Barre syndrome being the two most common. Typically, this occurs in at the rate of about 1 in a million vaccinations, with the exception of the swine flu vaccine a few years ago when it was 1 in 100,000.
At the 20 million mark with the Pfizer and Moderna vaccines there have been zero cases of Guillain-Barre syndrome and 4 cases of Bell’s palsy. The CDC considered the Bell’s palsy cases as coincidental given the medical history of the patients. However, even if the Bell’s palsy cases were caused by the vaccination, that would translate into a rate of 1 in 5 million vaccinations. This is about the same as your risk of developing Bell’s palsy after you have had the flu.
New Vaccines On The Horizon
Now, let me speak briefly about the Johnson & Johnson and AstraZeneca vaccines that are likely to be available in the US shortly.
Both vaccines utilize a weakened common cold virus with the gene for the COVID-19 spike protein spliced in. This is a vaccine delivery system that has been used for decades and has a well characterized safety profile.
The Johnson & Johnson vaccine is a single shot vaccine that is 66% effective against moderate to severe disease and 85% effective against hospitalization and death.
The AstraZeneca vaccine requires two shots for maximum effectiveness. Unlike the Pfizer and Moderna vaccines, clinical trials have determined the optimal time (3 months) between the first and second dose. The AstraZeneca vaccine is 76% effective after the first dose and 82% effective after the second dose.
In summary, both vaccines are slightly less effective than the Pfizer and Moderna vaccines. Their safety appears to be comparable to the Pfizer and Moderna vaccines, but we will know much more about their safety after the first 10 or 20 million doses have been administered in the US.
What Questions Remain?
What about the future? There are three big question marks at present.
Will the residual effects of COVID-19 (chronic fatigue, loss of heart and lung function) resolve or are they permanent? That is a scary thought, but we won’t really know the answer to this question for another year or two.
2) How long will vaccine protection last? You have been hearing that immune protection may only last a few months. If that were true, it would be very discouraging. I could understand you thinking, “Why bother?” However, once again we need to look at “the rest of the story”.
If we just look at levels of circulating antibodies, there is a great deal of individual variation. In some individuals, circulating antibodies disappear in a couple of months. For others, they last much longer. If circulating antibodies were the sole measure of our resistance to infection from COVID-19, it would appear the immune protection from vaccinations is short lived.
However, both the Pfizer and Moderna vaccines create memory cells as well as circulating antibodies. Memory cells reside in the bone marrow and retain the blueprint for making more antibody-producing cells if the virus ever reappears. They are responsible for long-term immunity. For example, many of you may remember that a few years ago, a new variant of the flu virus appeared that hit young people much harder than people over 50. The explanation we were given at the time was that the new variant of the virus was similar to a flu virus that had widely circulated 30 years earlier. We had retained significant immunity to the previous virus, and it protected us from the new virus as well.
Because of memory cells, I am optimistic that we will retain significant immunity to COVID-19 even after circulating antibody levels have disappeared. But we won’t know for sure until we have accumulated enough data to know how well the vaccines protect us from COVID-19 a year or two down the road.
The CDC may recommend a booster shot a year from now. Hopefully, by then we will know if it is necessary.
3) Will the vaccines protect us from new variants of the virus? Preliminary data suggest that the existing vaccines are likely to offer significant (70-80%) protection against the new variants.
However, I know you are seeing doomsday predictions that new variants of COVID-19 will emerge that will be unaffected by the vaccines. If that were to happen, we would be back to square one. We would need to create a new vaccine. However, before you panic, you need to hear “the rest of the story”.
Vaccines are directed against the spike protein of the virus. That is the same protein the virus uses to bind to our cells. Any mutations severe enough to eliminate antibody binding to the spike protein are also likely to prevent the spike protein from binding to our cells. If the spike protein can’t bind to our cells, the virus can’t enter our cells. Such mutant viruses would be non-infective. They would die out spontaneously.
Because of that, I am optimistic that the current vaccines will retain significant effectiveness against new variants as they arise. Again, we won’t know for sure until we have data on whether people who have been vaccinated are resistant to the new variants.
Once everyone has been vaccinated the first time around, the CDC may recommend a booster shot to protect against the new variants. Hopefully, by then we will know if it is necessary.
What Alternatives Do We Have To Vaccination?
Let me close by asking whether there are alternatives to vaccinations. Are there other things we could be doing to prevent COVID-19?
I should probably start with hydroxychloroquine. You have probably seen the video by a medical doctor saying that we should be using hydroxychloroquine rather than relying on the vaccines. She claims that hydroxychloroquine is safe and effective at preventing serious disease when given when someone is exposed or after the first symptoms of COVID appear. I am sympathetic to her viewpoint. If hydroxychloroquine had been proven to be safe and effective and it were readily available to the American public, I might feel differently about the importance of vaccination. But here is the “rest of the story” the doctor isn’t telling you.
This doctor who wants exhaustive clinical trials for the vaccines is willing to accept a couple of small, preliminary studies on the effectiveness of hydroxychloroquine. More importantly, the pushback was not about the general safety of hydroxychloroquine, as she states. It was based on published studies suggesting that hydroxychloroquine increases the risk of death when it is given late in COVID treatment to an old and sick population group. We don’t know whether hydroxychloroquine increased deaths because it was given late in the infection or because of certain underlying health conditions those patients had.
In a rational world the government would have funded a larger “Warp Speed” study to determine who benefits from hydroxychloroquine and who is endangered by hydroxychloroquine. But we don’t live in a rational world.
In a rational world a drug as cheap and readily available as hydroxychloraquine would be available to doctors who wanted to prescribe it for their COVID patients. We don’t live in a rational world.
2) Finally, there is my favorite topic, a healthy diet and supplementation. In previous issues of “Health Tips From the Professor” I have shared studies showing that adequate vitamin D status may reduce the risk of getting COVID. It also appears to reduce the risk of hospitalizations, ICU admissions, and deaths from COVID. I should emphasize that these studies suggest that adequate D status reduces the risk of getting COVID. None of the studies said it eliminated the risk of getting COVID.
I also have shared a major study that recommended supplementation to strengthen our immune systems and help protect us from respiratory diseases like COVID. Again, the authors said that supplementation reduced the risk of respiratory diseases. They did not say that supplementation eliminated the risk.
If you wish to strengthen your immune system with a healthy diet and supplementation and rely on that to protect you from COVID, I respect your decision. However, I caution you not to think of it as complete protection. It is partial protection. It won’t make you immune to COVID.
The Truth About Vaccination
COVID-19 is the deadliest disease we have seen in our lifetime. It attacks your lungs and every other organ in your body. It kills 1 out of every 100 people it infects. It even attacks and kills young healthy adults. Even worse, between 20% and 80% of its survivors may never fully recover. Their life may never be the same again.
The current vaccines offer 60% protection against mild disease and 95% protection against severe disease, hospitalization, death, and long-term complications from COVID-19 infection. The vaccines are not perfect. They do have some risks. There are still some unanswered questions. But the risks of vaccination are orders of magnitude less than the risks associated with COVID-19.
Good nutrition, mask wearing, social distancing, and hand washing also offer some protection against COVID-19. Here is my perspective.
COVID-19 is throwing everything it has at us. We need to respond with every resource at our disposal. Supplementation, vaccination, wearing masks, hand washing, and social distancing all provide partial protection. However, in combination they provide much more protection than they do individually. For example, good nutrition strengthens our immune system and makes vaccines more effective. Vaccines give our immune system the ammunition they need to fight COVID-19. Thus, vaccines make good nutrition more effective at protecting us.
I choose and recommend a holistic approach. COVID-19 is a deadly foe. I choose to arm myself with every defensive weapon I have at my disposal. I choose good nutrition, supplementation, vaccination, mask wearing, hand washing and social distancing.
The Bottom Line
COVID-19 is the deadliest disease we have seen in our lifetime. It attacks your lungs and every other organ in your body. It kills 1 out of every 100 people it infects. It even attacks and kills young healthy adults. Even worse, between 20% and 80% of its survivors may never fully recover. Their life may never be the same again.
The current vaccines offer 60% protection against mild disease and 95% protection against severe disease, hospitalization, death, and long-term complications from COVID-19 infection. The vaccines are not perfect. They do have some risks. There are still some unanswered questions. But the risks of vaccination are orders of magnitude less than the risks associated with COVID-19.
Good nutrition, mask wearing, social distancing, and hand washing also offer some protection against COVID-19. Here is my perspective.
COVID-19 is throwing everything it has at us. We need to respond with every resource at our disposal. Supplementation, vaccination, wearing masks, hand washing, and social distancing all provide partial protection. However, in combination they provide much more protection than they do individually.
For example, good nutrition strengthens our immune system and makes vaccines more effective. Vaccines give our immune system the ammunition they need to fight COVID-19. Thus, vaccines make good nutrition more effective at protecting us.
I choose and recommend a holistic approach. COVID-19 is a deadly foe. I choose to arm myself with every defensive weapon I have at my disposal. I choose good nutrition, supplementation, vaccination, mask wearing, hand washing and social distancing.
In the article above I have covered the following topics:
The public health argument for vaccination.
The personal argument for vaccination.
The risks of vaccination – A perspective.
The claims about existing vaccines.
The good news nobody is talking about.
New vaccines on the horizon.
What questions remain?
What alternatives do we have to vaccination?
The truth about vaccination.
For more information, 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.
Should You Avoid Supplement Use During Chemotherapy?
Since much of my research career was devoted to cancer research, specifically developing new chemotherapeutic drugs for treating cancer, many of you have asked me the question: “Do food supplements interfere with chemotherapy?”
My answer has always been that it is theoretically possible, but that we don’t really know the answer because the necessary studies have not been done.
However, I do know that most cancer drugs are retained in the body for a short period of time. So, my pragmatic advice has always been to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. That is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.
That is why I was interested when I saw the recent headlines claiming certain supplements may interfere with chemotherapy for breast cancer. I wanted to find out if someone had finally done a definitive study on the effect of supplementation on chemotherapy.
This study was an offshoot of a much larger Phase III clinical trial designed to determine the best schedule for administering three drugs (doxorubicin, cyclophosphamide, and paclitaxel) to patients with high-risk early-stage breast cancer.
The 1,134 patients enrolled in this study were given questionnaires on their use of supplements when they registered for the study to determine supplement use prior to the study. They were also given questionnaires when they completed chemotherapy to determine supplement use during chemotherapy.
The questionnaires documented use of:
Multivitamins
The antioxidants vitamin C, vitamin A, vitamin E, carotenoids, and coenzyme Q10.
Vitamin D.
The B vitamins vitamin B6, vitamin B12, and folic acid.
The minerals iron and calcium.
Omega-3 fatty acids.
Glucosamine, melatonin, and acidophilus.
Recurrence of the breast cancer and death from breast cancer were measured 6 months after chemotherapy ended.
Do Supplements Interfere With Chemotherapy?
The study reported:
The number of patients using individual antioxidant supplements was too low to determine whether individual antioxidants had any effect on treatment outcomes.
When the patients using any antioxidant supplement were pooled into a single group, there was a nonsignificant association between antioxidant supplement use during chemotherapy and an increased risk of breast cancer recurrence and death from breast cancer.
Iron use during chemotherapy was significant associated with an increased risk of breast cancer recurrence.
Vitamin B12 use during chemotherapy was significantly associated with increased risk of breast cancer recurrence and death from breast cancer.
Multivitamin use was not associated with either recurrence or death from breast cancer.
The number of patients using the other supplements was too low to determine whether those supplements had any effect on treatment outcomes.
The authors concluded: “Associations between survival outcomes and use of antioxidant and other dietary supplements are consistent with recommendations for caution among patients when considering the use of supplements, other than a multivitamin, during chemotherapy.”
This is the conclusion that generated the headlines you may have seen.
However, in their discussion the authors conceded that a previous review concluded that, “…insufficient evidence existed with regard to the safety of dietary supplements [during chemotherapy] to make recommendations, and that still may be the case.”
I will discuss the reasons for their disclaimer below. However, I will point out that disclaimers like this never seem to make it into the headlines you read.
What Are The Strengths And Weaknesses Of This Study?
The only strength of this study is that it was performed in the context of an ongoing clinical trial, with surveys conducted before chemotherapy and during chemotherapy to assess supplement use.
However, the study had multiple weaknesses that limit the ability to draw any firm conclusions from the study.
#1: The number of people using supplements in this study was very small. For example:
Only 200 people took any antioxidants during chemotherapy.
Only 137 people took a vitamin B12 supplement during chemotherapy.
Only 109 people took an iron supplement during chemotherapy.
To put this into perspective, if a drug company were submitting a new drug for approval to the FDA, they would be required to submit data from ~50-100-fold more cancer patients to prove that the drug was effective.
With this small number of supplement users, even “statistically significant” observations are questionable.
In contrast, the number of people taking a multivitamin during chemotherapy was 497. Thus, those data were a little stronger than the data for individual supplements.
#2: They did not ask why people were taking supplements. It turns out that the patients who used supplements were older and sicker. They were more likely to be overweight and to have type 2 diabetes.
These are patients who are also more likely to have poor outcomes from chemotherapy. The authors tried to correct for that, but it is virtually impossible to make these corrections when the number of patients taking supplements is so low.
#3: They did not ask about the dose of supplements people were taking.
Multivitamins typically contain RDA levels of antioxidants and vitamin B12, so it would be safe to assume that RDA levels of antioxidants and vitamin B12 are safe during chemotherapy.
Approximately 50% of the women in the study were premenopausal, so it is likely that they were taking a multivitamin with iron. That suggests that RDA levels of iron are safe during chemotherapy for premenopausal women.
In short, the association between supplement use and poorer outcomes from chemotherapy is tenuous. If there is any association, it is likely with high dose individual supplements rather the lower levels of the same nutrients found in a multivitamin.
Is An Effect Of Supplement Use On Chemotherapy Plausible?
As a biochemist, the next question I ask is whether there is a plausible mechanism for an effect of any of these supplements on chemotherapy outcomes.
For two of the drugs in the regimen (paclitaxel and cyclophosphamide), free radical formation may contribute to their effectiveness, but it is not their main mechanism of action. Thus, it is plausible that high dose antioxidant supplements could make these drugs less effective, but the effect should be relatively small.
Tumors require high amounts of iron for proliferation, so it is plausible that excess iron could make tumors more resistant to chemotherapy. However, for premenopausal women, multivitamins with iron did not interfere with the drugs used in this study. Thus, it appears likely that RDA levels of iron, where appropriate, do not interfere with chemotherapy.
The authors said that the reason for the observed effects of vitamin B12 on chemotherapy in their study “remains to be understood”. However, the answer might be found in the dosage of vitamin B12. A previous study reported that doses of vitamin B12 that were greater than 20 times the RDA increased the risk of lung cancer.
If people in this study were taking doses of vitamin B12 in excess of 20 times the RDA, it would provide a plausible explanation for B12 interfering with chemotherapy. If not, there is no known explanation. In any case, I do not recommend taking such high doses of any supplement.
Should You Avoid Supplement Use During Chemotherapy?
Now, let’s get back to the original question: “Should you avoid supplement use during chemotherapy?” If you read the headlines saying, “Supplement Use During Chemotherapy May Be Risky”, you might think that the answer is an unqualified yes. That is also what your doctor is likely to think.
However, when you analyze the study behind the headlines you realize that the evidence supporting the headlines is very weak.
So, that puts us back to where we were before the study was published. Simply put:
It is theoretically possible that supplements interfere with chemotherapy, but we don’t know for sure.
A pragmatic approach is to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. This is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.
Note: This is generic advice. I am not a medical doctor, so it would be unethical for me to provide individualized advice on how to minimize interactions between supplements and chemotherapy. What I recommend is that you ask your doctor whether my generic recommendations make sense for your cancer and your drug regimen.
If this study advanced our knowledge at all, it would be that:
The supplements most likely to interfere with chemotherapy appear to be high dose antioxidants, vitamin B12, and iron supplements.
Multivitamins, even multivitamins with iron when appropriate, are unlikely to interfere with chemotherapy.
The Bottom Line
Recent headlines have warned, “Supplement Use During Chemotherapy May Be Risky”. Is that true?
However, when you analyze the study behind the headlines you realize that the evidence supporting the headlines is very weak.
So, that puts us back to where we were before the study was published. Simply put:
It is theoretically possible that supplements interfere with chemotherapy, but we don’t know for sure.
A pragmatic approach is to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. This is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.
Note: This is generic advice. I am not a medical doctor, so it would be unethical for me to provide individualized advice on how to minimize interactions between supplements and the chemotherapy drugs you are on. What I recommend is that you ask your doctor whether my generic recommendations make sense for your cancer and your drug regimen.
If this study advanced our knowledge at all, it would be that:
The supplements most likely to interfere with chemotherapy appear to be high dose antioxidants, vitamin B12, and iron supplements.
Multivitamins, even multivitamins with iron when appropriate, are unlikely to interfere with chemotherapy.
For more details read the article above.
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.
If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inflammation is the enemy. Chronic, low level inflammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inflammation is a bad actor. It is something we want to avoid.
Let me start by saying that the science behind anti-inflammatory diets is nowhere near as strong as it is for the effect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inflammation.
studies say that saturated fats increase inflammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.
Anti-inflammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly different features, but there is a tremendous amount of agreement. 
incorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inflammation fighters.
In case you didn’t notice, the recommendations for an anti-inflammatory diet closely match the other healthy diets I have discussed previously. It should come as no surprise then that both the Mediterranean (L. Gallard, Nutrition in Clinical Practice, 25: 634-640, 2010; L. Schwingshackl and G. Hoffmann, Nutrition Metabolism and Cardiovascular Diseases, 24: 929-939, 2014) and DASH (D.E. King et al, Archives of Internal Medicine, 167: 502-506, 2007) diets are anti-inflammatory.
