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

Does Vitamin D Prevent Depression?

October 13, 2020 by Dr. Steve Chaney

Why You Can’t Believe Everything You Read

The days are getting shorter and Seasonal Depression, often called the “winter blues”, will soon be upon us. Most of the research on Seasonal Depression has centered on the effect of sunlight on our hormones.

However, sunlight is also responsible for the synthesis of vitamin D in our skin cells. So, some experts have hypothesized that low levels of 25-hydroxyvitamin D, the active form of vitamin D, in our blood also play a role in the winter blues.

If so, that could have important implications for managing depression, especially in older adults. Depression is estimated to affect around 6.5 million of the 49 million adults over the age of 65 in our country. Treatment costs for older adults in this country are estimated at $9 billion/year.

If something as simple and inexpensive as a vitamin D supplement could reduce the risk of depression, it would be a huge boon to our health care system.

Association studies suggest that may be a possibility. For example, one recent meta-analysis of 6 clinical studies (H Li et al, The American Journal of Geriatric Psychiatry, 27: P1192-1202, 2019) reported that every 10 ng/mL increase in 25-hydroxyvitamin D was associated with a 12% decrease in the risk of depression in older adults.

However, association studies do not prove cause and effect.

Unfortunately, randomized, placebo controlled clinical trials have given mixed results. A few studies suggested that vitamin D might reduce depression risk, but most of the studies found no effect of vitamin D on depression risk. However, most of the published studies have been poorly designed They were too small, too short, or did not use validated methods for measuring depression.

This was the genesis of the current study (OI Okerke et al., JAMA, 324: 471-480, 2020). It was designed to be a definitive study that would avoid the defects of previous studies.

The study concluded that vitamin D supplementation does not decrease the risk of depression in older adults, and those were the headlines you have probably seen. But is that conclusion true? Let’s take a peek behind the curtain and analyze the study.

How Was The Study Done?

This study was an offshoot of the VITAL (VITamin D and OmegaA-3 TriaL) clinical study, so let me start by describing the characteristics of that study.

The VITAL study (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403) enrolled 25,871 healthy adults (average age = 67) in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had preexisting cancer or heart disease.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 65% of the participants to determine 25-hydroxyvitamin D levels (a measure of vitamin D status) at baseline and at the end of the first year to assess the effectiveness of vitamin D supplementation. The participants were given either 2,000 IU of vitamin D/day or a placebo and followed for an average of 5.3 years.

This study consisted of 18,353 participants from the VITAL study. Ninety percent of the participants had no previous history of depression. Ten percent had previously been diagnosed or treated for depression but had been depression-free for over 2 years.

The participants filled out annual questionnaires to quantify the onset of depression by three criteria:

A diagnosis of depression by a physician.

Treatment for depression (medications, counseling, or both).

A questionnaire designed to evaluate symptoms of depression. The authors of the study referred to this as an assessment of their mood.

During the 5.3 year follow up period 3.6% of the participants reported the onset of diagnosed depression or a mood consistent with depression. This is consistent with previous studies showing that 1-5% of healthy, non-institutionalized older adults suffer from depression.

Does Vitamin D Prevent Depression?

The results of the study were clear.

Treatment with 2,000 IU of vitamin D3 compared to placebo for 5.3 years did not have a statistically significant effect on:

The incidence or recurrence of depression diagnosis, or…

Treatment for depression, or…

Clinically relevant depressive symptoms.

The authors concluded, “These findings do not support the use of vitamin D3 in adults to prevent depression.”

Why You Can’t Believe Everything You Read

It would be tempting to say, “Case closed. We now know for certain that vitamin D has no effect on depression.”

After all, this was an excellent study. It was large (18,353 participants), lasted a long time (5.3 years), and used well established measures of depression. What’s not to like?

Unfortunately, even well-designed studies can give misleading results. Let’s take a peek behind the curtain and see where this study went astray.

There were two glaring deficiencies in this study.

#1: Most of the participants had adequate vitamin D status at the beginning of the study. The average 25-hydroxyvitamin D level of participants at the beginning of the study was 31 ng/mL (78 nmol/L). The NIH considers 20-50 ng/mL (50-125 nmol/L) to be an adequate level of 25-hydroxyvitamin D for most physiological functions. This means that study participants started in the middle of the adequate range with respect to vitamin D status.

This was not a failure of study design. In fact, the authors of the study are to be commended for measuring the vitamin D status of participants at the beginning of the study. Many previous studies have neglected to do that.

The problem is that vitamin D has become extremely popular. Many Americans are already taking multivitamins or vitamin D supplements. To recruit enough people for the study the authors were forced to allow participants to enter the study even if they were taking vitamin D supplements, as long as the amount did not exceed 800 IU/day.

In short, most of the participants in this study were already supplementing with up to 800 IU/day of vitamin D. If so, they were allowed to continue taking their vitamin D supplements. The 2,000 IU of vitamin D was added to what they were already taking.

The question then becomes, if people are already taking RDA levels of supplemental vitamin D and their blood levels of 25-hydroxyvitamin D are already in the adequate range, do we really expect additional supplemental vitamin D to have a beneficial effect?

The author’s answer to that question was, “The mean baseline 25-hydroxyvitamin D level was 30.8 ng/mL; this value is already at a threshold for extraskeletal health benefits [health benefits other than bone health], and so the ability to observe effects of vitamin D3 supplementation may have been attenuated. [To determine whether vitamin D supplementation reduces the risk of depression] large-scale studies would be required to address the effects of high-dose, long-term vitamin D3 supplementation among those with nutrient deficiency.”

My more direct answer would be, “This study provides no useful information on whether vitamin D3 supplementation reduces the risk of depression. What is needed are studies that start with a population that is deficient in vitamin D.”

An accurate conclusion from this study would have been, “If you are already taking vitamin D supplements and/or have an adequate vitamin D status, supplementation with an extra 2,000 IU of vitamin D3 provides no additional benefit with respect to the risk of developing depression.” But that is not what the headlines said.

#2: The study did not record the reason for the onset of depression. That is important because the top 3 causes of depression in adults 65 and older are:

Loss of a spouse or partner.

Chronic health issues.

Restricted blood flow to the brain.

It is unlikely that vitamin D supplementation would have much of an effect on these issues.

In contrast, seasonal depression, which is more likely to be affected by vitamin D supplementation, was not measured in this study.

The Bottom Line

You may have seen recent headlines saying that vitamin D supplementation has no effect on the risk of developing depression.

The study behind these headlines was a very well-designed study. It was large (18,353 participants), lasted a long time (5.3 years), and used well established measures of depression.

It would be tempting to say, “Case closed. We now know for certain that vitamin D supplementation has no effect on depression.”

Unfortunately, even well-designed studies can give misleading results. This one had a major flaw that made the data almost useless.

The problem is that most Americans are already taking multivitamins or vitamin D supplements. To recruit enough people for the study the authors were forced to allow participants to enter the study even if they were taking vitamin D supplements, as long as the amount did not exceed 800 IU/day.

That meant that most participants already had adequate blood levels of 25-hydroxyvitamin D at the beginning of the study.

Rather than saying that this study definitively shows that vitamin D supplementation has no effect on the risk of developing depression, I feel it would be more accurate to say, “This study provides no useful information on whether vitamin D3 supplementation reduces the risk of depression. What is needed are studies that start with a population that is deficient in vitamin D.”

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.

Do Processed Foods Increase Your Risk Of Diabetes?

October 6, 2020 by Dr. Steve Chaney

Why Do We Keep Eating Processed Foods?

Unless you are Rip Van Winkle and have been asleep for the past 20 years you probably know that the highly processed foods in the typical American diet are bad for your health. But perhaps you didn’t realize just how bad they were.

But first, let’s start with a bit of perspective. Scientists like to be precise. Even healthy foods go through some processing.

The oatmeal you ate this morning was either steel-cut or ground. That is processing.

The almond butter you put on your whole grain toast this morning was made by roasting and grinding. That is processing.

So, scientists have developed the term “ultra-processed food” to describe the worst of the worse. In short, ultra-processed foods:

Usually go through several physical and chemical processes, such as extruding, molding, prefrying, and hydrogenation that can lead to the formation of toxic contaminants. One example you may have heard about recently would be acrylamide in French fries.

Typically contain ingredients of no or little nutritive value, such as refined sugar, hydrogenated oils, emulsifiers, artificial sweeteners, thickening agents, and artificial colors. Some of these ingredients have been linked to cancer, heart disease, and premature death.

Have long shelf-lives because of added preservatives. This allows migration of chemicals such as bisphenol A from the packaging materials into the food.

Examples of ultra-processed foods include:

Sodas
Chips
Candy and packages of cookies or crackers
Most breakfast cereals
Boxed cake, cookie, and pancake mix
Chicken nuggets and fish sticks
Fast food burgers
Hot dogs and other processed meats
Infant formula
Instant noodles
Most store-bought ice cream
Flavored yogurt

In short, ultra-processed foods include sodas and the junk and convenience foods Americans hold so dear. Even things like infant formula and flavored yogurt make the list.

Evidence of the ill effects of ultra-processed foods on our health is becoming overwhelming. In previous issues of “Health Tips From the Professor” I have shared recent studies that have shown that heavy consumption of ultra-processed foods is linked to increased risk of obesity and cancer. Other studies have linked ultra-processed food consumption with increased risk of depression, heart disease, and premature death.

In this issue of “Health Tips From the Professor” I:

Describe a recent study ( B Srour et al, JAMA Internal Medicine, 180: 283-291, 2020) documenting the effect of ultra-processed food consumption on the risk of developing type 2 diabetes.

Ask the important question, “If we know these foods are so bad for us, why do we still keep eating them?”

How Was The Study Done?

The data from this study were taken from an ongoing study in France (the NutriNet-Sante study) looking at associations between nutrition and health. This study began enrolling French adults 18 and older in 2009.

This is a web-based study. Participants are prompted to go to a dedicated website and fill out questionnaires related to things like sex, age, height, weight, smoking status, physical activity, health status, and diet.

With respect to diet, participants filled out a series of 3 nonconsecutive 24-hour dietary records at the time of enrollment and every 6 months. This is a particularly strong feature of this study. Many studies of this type only analyze participant’s diets at the beginning of the study. Those studies have no way of knowing how the participant’s diets may have changed during the study.

Diagnosis of type 2 diabetes for study participants was obtained from the French centralized health records.

The study enrolled 104,708 participants, 20% men and 80% women, and followed them for an average of 6 years. The average age of the participants was 43 years.

Do Processed Foods Increase Your Risk Of Diabetes?

In this study the range of ultra-processed foods in the French diet ranged from 7% to 27% (average = 17%). High intake of ultra-processed foods was associated with:

Younger participants. Simply put, young people were more likely to drink sodas and eat junk food than older adults.

Increased caloric intake. Ultra-processed foods have a higher caloric density than whole, unprocessed foods.

No surprise here. Previous studies have shown that ultra-processed food consumption increases the risk of obesity.

Poorer diet quality. Again, no surprise. Junk foods tend to crowd healthier foods out of the dirt. Specifically, ultra-processed food consumption was associated with:

- Higher intake of sugar and salt.

- Lower intake of fiber.

- Higher intake of sugary drinks, red and processed meats.

- Lower intake of whole grains, yogurt, nuts, fruits, and vegetables.

However, even after statistically correcting for all these factors, there was a significant association between ultra-processed food consumption and the onset of type 2 diabetes in the 6-year follow-up period.

There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.

There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

The authors concluded:

“In this large observational prospective study, a higher proportion of ultra-processed food in the diet was associated with a higher risk of type 2 diabetes. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting ultra-processed food consumption.”

What Does This Study Mean For You?

You might be tempted to say that a 15% increase in the risk of developing diabetes is a small price to pay for continuing to eat the foods you enjoy. However, you should be alarmed by this study. Here is why.

The French diet is much healthier than the American. Remember that ultra-processed foods only comprised 17% of the French Diet. In contrast, a recent survey found that:

Ultra-processed foods make up 58% of the average American’s diet.

Ultra-processed foods account for 90% of the added sugar in our diet.

It is no wonder that obesity and diabetes are reaching epidemic proportions in our country.

You might also be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. These are diseases that make your life miserable and ultimately kill you.

More importantly, type 2 diabetes is completely reversible if you catch it early enough. Just lose some weight, exercise more, give up the ultra-processed foods, and eat a healthy diet. I recommend a whole food, primarily plant-based diet.

Why Do We Keep Eating Processed Foods?

We all know that ultra-processed foods are bad for us. Study after study show that they make us sick. They kill us prematurely. And, unlike most topics in the field of nutrition, this is not controversial.

For example, there have been lots of bizarre diets that have come and gone over the years. There have been books written on “The Steak Lover’s Diet” and “The Drinking Man’s Diet”. But nobody has written a book on “The Junk Food Lover’s Diet”. It simply would not be believable.

So why do we Americans keep eating such unhealthy foods. Part of the answer is physiological. A preference for sweet, salty, and fatty foods is hardwired into our brain. That’s because they had great survival value in prehistoric times.

If we think back to the time when we were hunters and gatherers:

Fruits are healthy foods. They are a great source of antioxidants, phytonutrients, and fiber, but there were no orchards or grocery stores back then. We had to search for fruits in the wild. Our desire for sweet tasting foods provided the motivation to seek them out.

Game was seasonal and sometimes scarce. We had to be prepared to go for days or weeks without eating except for the leaves and roots we could gather. Our bodies are designed to store fat as the primary energy source to get us through the lean times. Our preference for fatty foods encouraged us to store as much fat as possible in times of plenty so we would be prepared for times of scarcity.

If we fast forward to our early recorded history, salt was scarce. It was worth its weight in gold. Yet some salt is essential for life. Our preference for salty foods encouraged us to search out supplies of salt.

Unfortunately, the food industry has weaponized these food preferences to create the ultra-processed foods we know today. Their ads entice us by associating these foods with youth and good times. And ultra-processed foods have become ubiquitous. There are fast food restaurants on almost every street corner and shopping mall in the country.

Fortunately, we do not have to let the food industry destroy our health. We can retrain our taste buds to appreciate the sweetness of fresh fruits and vegetables. We can substitute healthy fats for the kinds of fat found in most ultra-processed foods. We can also retrain our taste buds to appreciate herbs and spices with just a pinch of salt.

The Bottom Line

Ultra-processed foods, such as sodas, junk foods, and convenience foods have become the biggest food group in the American diet. A recent study found:

Ultra-processed foods make up 58% of the average American’s diet.

Ultra-processed foods account for 90% of the added sugar in our diet.

That is scary because ultra-processed foods are deadly. Previous studies have shown that consumption of ultra-processed foods is linked to obesity, heart disease, cancer, and Alzheimer’s disease.

The study discussed this week looked at the association between ultra-processed food consumption and type 2 diabetes. It showed:

There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.

There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

You might be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. This are diseases that make your life miserable and ultimately kill you.

For more details and a discussion of why Americans continue to eat ultra-processed food even though we know it is bad for us, 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.

The Truth About Vitamin D And Respiratory Diseases

September 29, 2020 by Dr. Steve Chaney

How Should You Prepare For This Winter?

Some health experts are making dire predictions for this fall when COVID-19 overlaps with our annual flu season. People are worried.

When people are worried, hucksters smell a quick buck and start coming out of the woodworks. They are touting all sorts of miracle pills and potions that will keep us safe this winter. The FDA is doing its best to shut them down, but it’s like the “Whack A Mole” game you may remember from the county fair. As soon as the FDA shuts one down, another pops up.

In the meantime, you are left trying to sort through the claims. I could write a whole book on the truth (and lies) about the claims you are seeing on the internet. But this week I will focus on vitamin D. I will give you unbiased answers to three questions.

1) What is the truth about vitamin D and respiratory disease?

2) Will vitamin D help protect you against COVID-19?

3) How should you prepare for this winter?

I am basing today’s “Health Tip” on a recently published study (H Brenner et al, Nutrients 2020, 12, 2488) looking at the effect of vitamin D status on deaths from respiratory disease in older German adults.

How Was The Study Done?

The data from this study were taken from an ongoing study in Germany looking at the effect of diet and lifestyle on health outcomes in older adults. In this case, 9548 adults, ages 50-75, from the region of Saarland in Germany were enrolled in the study between 2000 and 2002 and followed for an average of 15 years.

Blood samples were drawn at the time of enrollment and 25-hydroxyvitamin D levels were determined as a measure of vitamin D status. Deaths and cause of deaths over the 15 year period were obtain from German health records.

The basic characteristics of the study population were:

The gender breakdown was 43.8% men, 52.6% female.

The average age was 62.1 years.

Almost all participants were Caucasians of German or French descent.

8% were vitamin D insufficient (25-hydroxyvitamin D of 30-<50 nmol/L)

1% were vitamin D deficient (25-hydroxyvitamin D of <30 nmol/L)

Note: Almost 60% of this study group had an inadequate vitamin D status. The comparable figures for the US population are 42% with inadequate vitamin D status (34% vitamin D insufficient and 8% vitamin D deficient).

The reasons for this are likely two-fold:

Saarland is at the latitude of Newfoundland, Canada, so sun exposure is less than for most Americans.

Germans are less likely to consume supplements than Americans.

However, the fact that 60% of this study group has inadequate vitamin D status makes it a particularly good group to look at the effect of vitamin D status on health outcomes.

The Truth About Vitamin D And Respiratory Diseases

This study found:

Vitamin D insufficiency (25-hydroxyvitamin D of 30-<50 nmol/L) increased the risk of dying from respiratory disease by 1.9-fold for men and 2.1-fold for women.

Vitamin D deficiency (25-hydroxyvitamin D of <30 nmol/L) increased the risk of dying from respiratory disease by 2.3-fold for men and 3.0-fold for women.

The authors pointed out that this was consistent with a recent meta-analysis of randomized clinical trials showing that supplementation with RDA levels of vitamin D reduced the risk of acute respiratory tract infections by 70% in people who were vitamin D deficient.

The authors concluded:

“Vitamin D insufficiency and deficiency are common and account for a large proportion of respiratory disease mortality in older adults…Our results, along with evidence from meta-analyses from RCTs [Randomized Placebo-Controlled Clinical Trials] regarding results of vitamin D3 supplementation on various outcomes, suggest that vitamin D3 supplementation could contribute to lowering mortality from respiratory and other diseases during and beyond the COVID-19 pandemic, particularly among women.”

How Should You Prepare For This Winter?

Now it is time to answer the three questions I posed at the beginning of this article:

1) What is the truth about vitamin D and respiratory disease?

There have been many studies suggesting that inadequate vitamin D status increases the risk of “catching” respiratory diseases such as the seasonal flu. Some of those studies showed that supplementation with vitamin D3 reduced the risk of catching respiratory diseases. However, most of those were small studies.

This study and the meta-analysis the authors referred to were much larger, better designed studies. Other large, well designed studies are needed. But, taken together, these two studies strongly support the hypothesis that inadequate vitamin D status significantly increases the risk of developing and dying from respiratory diseases.

However, we do need to put this into perspective.

Supplementation with vitamin D primarily protects individuals with inadequate vitamin D status. It doesn’t appear to offer significant benefit for individuals with adequate vitamin D status (>50 nmol/L 25-hydroxyvitamin D).

Supplementation with vitamin D at doses of 2,000 IU or less appears to be sufficient for most people. There is little evidence that megadoses are beneficial unless you are severely vitamin D deficient (more about that below).

2) Will vitamin D help protect you against COVID-19?

The answer to this question is less clear. As we learn more about COVID-19 we have learned that it is much more than just a respiratory disease. On the other hand, cellular studies suggest that vitamin D may interfere with the mechanism by which COVID-19 attacks cells.

What do clinical studies say? We are just learning. Four small clinical trials and one large study have recently been published or posted online as preprints prior to being accepted for publication.

The first study (DO Metzler et al, JAMA Network Open, 2020;3(9):e2019722) found that vitamin D deficiency was associated with an increased risk of testing positive for COVID-19.

The second study (HW Kaufman et al, PLOS One, September 17, 2020) used data from a major national testing center (Quest Diagnostics) and linked COVID-19 test results with 25-hydroxyvitamin D test results for 191,779 patients. This study reported that vitamin D deficiency was associated with a 30% increased risk of testing positive for COVID-19.

The third study found that vitamin D deficiency was associated with hospital admissions for COVID-19.

The fourth study found that vitamin D deficiency was associated ICU admissions for COVID-19.

The fifth study (ME Castillo et al, The Journal of Steroid Biochemistry and Molecular Biology, In Press, online August 29, 2020, 105751) found that supplementation with 25-hydroxyvitamin D (the active form of vitamin D in the blood) upon hospitalization substantially reduced ICU admissions.

Taken together these 5 studies suggest that vitamin D deficiency may increase the risk of being infected by COVID-19 and on the severity of the disease if you are infected.

I should point out that these studies are preliminary. Normally we would say that they need to be confirmed by larger studies before becoming incorporated into the standard of care for COVID-19.

You might be saying to yourself, , “Why is the medical community paying so much attention to preliminary studies?” The answer is simple:

The need is urgent. We need all the tools at our disposal to fight this deadly disease, and we need them now.

Vitamin D3 supplementation at 2,000 IU or less is inexpensive and safe. Plus, even if further studies find that our vitamin D status has no effect on COVID-19 risk, we know that adequate vitamin D has many other potential health benefits.

To summarize:

Preliminary studies suggest that adequate vitamin D status may offer some protection for COVID-19. These studies are not definitive. No reputable scientist is ready to tell you that vitamin D will ward off COVID-19. However, supplementation with 2000 IU/day or less of vitamin D3 is safe and may have multiple health benefits.

Vitamin D should not be considered a “magic bullet”. It is just one aspect of a holistic approach to creating a healthy body that is less susceptible to respiratory diseases like COVID-19.

3) How Should You Prepare For This Winter?

As we approach the winter months, the days are getting shorter and sun exposure is decreasing. This is the time of year when your 25-hydroxyvitamin D levels will be at their lowest.

At the same time, we are likely to see a convergence of the seasonal flu, flu-like illnesses, and COVID-19 this winter. You will need a healthy body, a healthy immune system, and adequate vitamin D status more than ever.

When asked about vitamin D and COVID-19 in a recent interview, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, said, “If you’re deficient in vitamin D, that does have an impact on your susceptibility to infection. I would not mind recommending, and I do it myself, taking vitamin D supplements.”

I recommend supplementation with vitamin D3 to make sure your vitamin D status is adequate. The RDA for vitamin D is 600 IU for adults and 800 IU for seniors over the age of 70. However, because the efficiency with which we convert vitamin D3 to 25-hydroxyvitamin D varies from person to person, many experts recommend supplementing with 1,500-2,000 IU of vitamin D3.

I also recommend that you ask your health provider for a 25-hydroxyvitamin D test. If you are in the vitamin D deficient range, your health provider may recommend more than 2,000 IU/day of vitamin D3.

Finally, we should not rely on vitamin D alone. As I discussed in a previous issue of “Health Tips From The Professor”, I recommend a holistic approach for strengthening our immune systems, and I recommend the CDC guidelines for reducing the risk of catching both the flu and COVID-19.

I would note that social distancing, hand washing, and mask wearing are just as effective at reducing the risk of getting the flu as they are for getting COVID-19. In fact, some Asian countries practice mask wearing in public every flu season.

The Bottom Line

A recent study found that inadequate vitamin D status caused a 2-3-fold increased risk of dying from respiratory illnesses for seniors (ages 50-74).

A previous meta-analysis reported that supplementation with RDA levels of vitamin D reduced the risk of acute respiratory tract infections by 70% in people who were vitamin D deficient.

Taken together, these two studies strongly support the hypothesis that inadequate vitamin D status significantly increases the risk of developing and dying from respiratory diseases.

Preliminary studies suggest that adequate vitamin D status may offer some protection for COVID-19. These studies are not definitive. No reputable scientist is ready to tell you that vitamin D will ward off COVID-19. However, supplementation with 2000 IU/day or less of vitamin D3 is safe and may have multiple health benefits.

Vitamin D should not be considered a “magic bullet”. It just one aspect of a holistic approach to creating a healthy body that is less susceptible to respiratory diseases like COVID-19.

So, how should we prepare for this winter?

As we approach the winter months, the days are getting shorter and sun exposure is decreasing. This is the time of year when your 25-hydroxyvitamin D levels will be at their lowest.

At the same time, we are likely to see a convergence of the seasonal flu, flu-like illnesses, and COVID-19 this winter. You will need a healthy body, a healthy immune system, and adequate vitamin D status more than ever.

I recommend supplementation with vitamin D3 to make sure your vitamin D status is adequate. The RDA for vitamin D is 600 IU for adults and 800 IU for seniors over the age of 70. However, because the efficiency with which we convert vitamin D3 to 25-hydroxyvitamin D varies from person to person, many experts recommend supplementing with 1,500-2,000 IU of vitamin D3.

Finally, we should not rely on vitamin D alone. As I discussed in a previous issue of “Health Tips From The Professor”, I recommend a holistic approach for strengthening our immune systems, and I recommend the CDC guidelines for reducing the risk of catching both the flu and COVID-19.

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.

Does Poverty Affect Nutritional Status?

September 22, 2020 by Dr. Steve Chaney

How Can We Improve Nutrition In Disadvantaged Communities?

Recently there has been increased focus on health disparities in disadvantaged communities. In our discussions of the cause of these health disparities, two questions seem to be ignored.

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

The study (K Marshall et al, PLoS One 15(7):e0235042) I discuss in this week’s “Health Tips From The Professor” attempts to address both of these questions.

Before, I start, let me put this study into context.

Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:

- A permanent reduction in quality of life.

- Immobility, which can lead to premature death.

Inadequate calcium and vitamin D intakes increase the risk of osteoporosis.

While most studies simply report calcium and vitamin D intakes for the general population, this study breaks them down according to ethnicity and income levels. The results were revealing.

How Was The Study Done?

This study drew on data from the 2007-2010 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES). These surveys are conducted by the National Center for Health Statistics, which is part of the CDC. They are designed to assess the health and nutritional status of adults and children in the United States and are used to produce health statistics for the nation.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel. All participants visit a physician. Dietary interviews and body measurements are included for everyone.

This study measured calcium intake, vitamin D intake, and osteoporosis for adults 50 and older. The data were separated by gender, ethnic group and income level. Four different measures of poverty were used. For purposes of simplicity, I will only use one of them, income beneath $20,000, for this article.

Does Poverty Affect Nutritional Status?

The Effect of Ethnicity And Gender On Calcium And Vitamin D Intake:

When the authors looked at the effect of ethnicity and gender on calcium and vitamin D intake, in people aged 50 and older the results were (Note: I am using the same ethnic nomenclature used in the article):

Hispanics:

- 66% (75% for women and 56% for men) were getting inadequate calcium intake.

- 47% (47% for women and 47% for men) were getting inadequate vitamin D intake.

Non-Hispanic Blacks:

- 75% (83% for women and 64% for men) were getting inadequate calcium intake.

- 53% (51% for women and 54% for men) were getting inadequate vitamin D intake.

Non-Hispanic Whites:

- 60% (64% for women and 49% for men) were getting inadequate calcium intake.

- 33% (30% for women and 37% for men) were getting inadequate vitamin D intake.

For simplicity, we can generalize these data by saying:

Gender:

- Women are more likely to be calcium-deficient than men.

- Men are more likely to be vitamin D-deficient than women.

Ethnicity: For both genders and for both calcium and vitamin D:

- The rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites.

The Effect Of Poverty On Calcium Intake, Vitamin D Intake, And Osteoporosis:

When looking at the effect of poverty, the authors asked to what extent poverty (defined as income below $20,000/year) increased the risk of calcium and vitamin D deficiency in adults over 50. Here is a summary of the data

Hispanics:

- For both Hispanic women and Hispanic men, poverty had little effect on the risk of calcium and vitamin D deficiency.

Non-Hispanic Blacks:

- For Non-Hispanic Black women, poverty had little effect on the risk of calcium deficiency, and vitamin D deficiency.

- For Non-Hispanic Black men, poverty increased the risk of both calcium and vitamin D deficiency by 32%.

Non-Hispanic Whites:

- For Non-Hispanic White women, poverty had little effect on the risk of calcium deficiency but increased the risk of vitamin D deficiency by 30%.

- For Non-Hispanic White men, poverty increased the risk of both calcium deficiency and vitamin D deficiency by 18%.

For simplicity, we can generalize these data by saying:

- Poverty increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.

Other statistics of interest:

The SNAP program (formerly known as Food Stamps) had little effect on calcium and vitamin D intake. There are probably two reasons for this:

- In the words of the authors, “While the SNAP program has been shown to decrease levels of food insecurity, the quality of the food consumed by SNAP participants does not meet the standards for a healthy diet.” In other words, the SNAP program ensures that participants have enough to eat, but SNAP participants are just as likely to prefer junk and convenience foods as the rest of the American population. The SNAP program provides no incentive to eat healthy foods.

- We also need to remember that dairy foods are a major source of calcium and vitamin D in the American diet and that Hispanics and Non-Hispanic Blacks are more likely to be lactose-intolerant than the rest of the American population. There are other sources of calcium and vitamin D in the American diet. But without some nutrition education, most Americans are unaware of what they are.

An increased risk of osteoporosis was found in Non-Hispanic Black men, and Non-Hispanic Whites with incomes below $20,000/year.

- This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D. There were other factors involved, but I will focus primarily on the effect of poverty on calcium and vitamin D intake in the discussion below.

How Can We Improve Nutrition In Disadvantaged Communities?

Let’s start with the two questions I posed at the beginning of this article:

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

In terms of calcium intake, vitamin D intake, and the risk of osteoporosis, the answer to both questions appears to be, “Yes”. So, the question becomes, “What can we do?”

It is when we start to ask what we can do to increase calcium and vitamin D intake and decreased the risk of osteoporosis in disadvantaged communities that we realize the complexity of the problem. There are no easy answers. Let’s look at some of the possibilities.

[Note: I am focusing on what we can do to prevent osteoporosis, not to detect or treat osteoporosis. The solutions for those issues would be slightly different.]

1. We could increase funding for SNAP. That would increase the quantity of food available for low income families, but, as noted above, would do little to improve the quality of the food eaten.

2. We could improve access to health care in disadvantaged communities. But unless physicians started asking their patients what they eat and start recommending a calcium and vitamin D supplement when appropriate, this would also have little impact on diet quality.

3. We could improve nutrition education. A colleague of mine in the UNC School of Public Health ran a successful program of nutrition education through churches and community centers in disadvantaged communities for many years. The program taught people how to eat healthy on a limited budget. Her program improved the health of many people in disadvantaged communities.

However, the program was funded through grants. When she retired, federal and state money to support the program eventually dried up. The program she started is a model for what we should be doing.

4. The authors suggested food fortification as a solution. In essence, they were suggesting that junk and convenience foods be fortified with calcium and vitamin D. That might help, but I don’t think it is a good idea.

If we want to improve the overall health of disadvantaged communities, we need to find ways to replace junk and convenience foods with healthier foods. Adding a few extra nutrients to unhealthy foods does not make them healthy.

5. The authors also said that a calcium and vitamin D supplement would be a cheap and convenient way to eliminate calcium and vitamin D deficiencies. Unfortunately, supplements are currently not included in the SNAP program. Unless that is changed, even inexpensive supplements are a difficult choice for families below the poverty line.

As I said at the beginning of this section, there are no easy answers. It is easy to identify the problem. It would be easy to throw money at the problem. But finding workable solutions that could make a real difference are hard to identify.

Yes, we should make sure every American has enough to eat. Yes, we should make sure every American has access to health care. But, if we really want to improve the health of our disadvantaged communities, we also need to:

Change the focus of our health care system from treatment of disease to prevention of disease.

Train doctors to ask their patients what they eat and to instruct their patients how simple changes in diet could dramatically improve their health.

Provide basic nutrition education to disadvantaged communities at places where they gather, like churches and community centers. This would cover topics like eating healthy, shopping healthy on a limited budget, and cooking healthy.

We don’t necessarily need another massive federal program. But those of us with the knowledge could each volunteer to share that knowledge in disadvantaged communities.

Cover basic supplements, like multivitamins, calcium and vitamin D supplements, and omega-3 supplements in food assistance programs like SNAP.

The Bottom Line

Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:

A permanent reduction in quality of life.

Immobility, which can lead to premature death.

We know that inadequate calcium and vitamin D intakes increase the risk of osteoporosis. But most studies simply report calcium and vitamin D intakes for the general population. At the beginning of this article, I posed two questions.

Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

A recent study looked at the effect of gender, ethnicity and income levels on calcium intake, vitamin D intake, and the risk of developing osteoporosis. The results of this study shed some light on those two questions.

When looking at the effect of gender and ethnicity on the risk of inadequate calcium and vitamin D intake, the study found:

Women are more likely to be calcium-deficient than men.

Men are more likely to be vitamin D-deficient than women.

For both genders and for both calcium and vitamin D, the rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites. [Note: Note: I am using the same ethnic nomenclature used in the study.]

Poverty (defined as incomes below $25,000/year) significantly increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.

An increased risk of osteoporosis was also found in Non-Hispanic Black men, and Non-Hispanic White men and women with incomes below $20,000/year.

This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D.

In short, this study suggests that the answer to both questions I posed at the beginning of the article is, “Yes”.

For more information and a discussion of what we could do to correct this health disparity in disadvantaged communities, 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.

You Can Touch Your Toes Again

September 15, 2020 by Dr. Steve Chaney

One more hot month to go! This has been an exceptionally hot summer in many places around the USA. In fact, many times Florida was cooler (mid 90’s) than some of the cities up north. Weird!

I hope you are doing well as this COVID19 problem keeps hanging around to make our lives a challenge. When the shutdown happened back in March, I didn’t know what I was going to do. As you are well-aware, I don’t do relaxing massage, I work with people who are in real pain. How do I tell people to just be in pain until this pandemic passes!

Fortunately for me, and for my clients, the first client I saw after the shutdown was a medical doctor. I asked her about people coming to me and she told me if everyone wears a mask, and I wash my hands before and after treating someone, that it would be fine. So that’s what’s been happening. Plus, I wash everything down with a strong disinfectant after each client, and all is well.

I’m seeing less people, but I’m seeing people who are in a lot of pain and are desperate for help. As my clients have told me, I am an essential worker, and I believe they are right.

With that said, I want to tell you about a man who drove 17 hours from southern Texas to work with me for a week. Let’s call him JT for privacy.

You Can Touch Your Toes Again

JT was stiffer than anyone I’d ever seen in the past, and after a 17-hour trip, we knew he needed to come in a LOT. He ended up coming in for 3 hours a day for the first 3 days, and 90 minutes on Thursday and Friday.

When JT arrived, it amazed me at how stiff his pelvis was, every muscle that moved his pelvis, legs and low back were tied up in multiple tight knots. He has given me permission to share his pictures with you so I can explain something really interesting that I found, and how it can help you to release tension in your low back.

Day 1: JT’s hips were so locked that when he bent forward his fingertips only went to 7” above his knees. He couldn’t bend any further than this!

I’ve already shown you how to do the self-treatment for your quadriceps using a 12”x1” length of PVC pipe, and how to use the Perfect Ball on your low back muscle. This is where we started so the muscles that rotate the pelvis down in the front can start to release.

Day 2: First I worked on all of the muscles that insert into his thigh bone where it inserts into his pelvis. Then JT used the Perfect Ball and working on the floor he went deeply into all of the muscles that connect his pelvis to his thigh bone.

At the end of the day his fingers were 5” below his knee joint.

On Day 3 there was a set-back, his fingers were still about 2” below his knee joint but we were questioning what we were missing. When JT bent forward, he had pain in the front of his pelvis, just below the point of his hip bone. That’s an area that definitely shouldn’t be hurting when JT bent forward. I kept looking at my skeleton, Max, and my book of muscles/bones/joints, to try to figure it out, and looking at the muscles of the pelvis. Then suddenly it was so clear!

Your hamstrings originate at the base of your posterior pelvis, and they insert just below the back of your knee. Your thigh bone (femur) inserts into your hip at an area called the acetabulum, it looks like fitting a ball into a curved cup.

This is the part I want to share with you today.

How Your Hamstrings Impact Your Pelvis

On the afternoon of Day 3, I was frustrated at the set-back. After staring at Max and my book of muscles it finally dawned on me that it was JT’s hamstrings that were part of the problem, even though it was his rotating pelvis that was causing his hip joint to be out of alignment.

I had been working on all of the pelvic muscles and they all felt pretty good, and I had done a pass down the back of his thighs, but I hadn’t focused on JT’s hamstrings. And that made all the difference!

An important point to mention when talking about a long-standing problem with tight muscles is to discuss “muscle memory.”

Muscle memory is when a muscle that has been held shortened for an extended time (which could be just a few hours) it will shorten to that new length. The problem is, you release the tension in the muscles and get relief, but the muscle shortens again, and the strain is again placed on your joints.

As JT’s hamstrings shortened, they pulled down of the back of his pelvis, and this twisted the alignment of his hip joint. Because of this misalignment, he was feeling pain in the front of his hip, and that was the piece I’d been missing.

After treating JT’s hamstrings (treatment shown below) he was able to bend almost all the way to his ankles! Only three days before JT could only bend to not even the middle of his thigh, yet here he was almost to his ankles!

Treating Hamstrings To Relax The Pelvis

If you have been to my therapy office, you know that I always teach how to do 1-2 self-treatments. The reason is you need to reverse muscle memory, and the only way to do that is to do the self-treatments frequently – every day is best.

A simple way of treating your hamstrings is to put a Perfect Ball on a wooden chair, or the corner of a desk, and put your hamstrings onto the ball.

Keep moving the ball until you find tender points as these are the knots (spasms) that are putting a strain on your pelvis. Treat each point and then stretch

Stretching Your Hamstrings

Lie on your back and put a rope under your arch. Start with your knee bent and lift your leg up as high as you can go without seriously straining your hamstrings.

Slowly straighten your leg, stretching your hamstrings.

Day 5 – JT is Ready to Go Back to Texas

JT is now only 3” above the top of his foot. He’s not touching his toes yet, but he feels so much better.

The best news is that JT is thoroughly familiar with every self-treatment to release all of the muscles that have an impact on his pelvis. He’s not 100% better yet, but he’s well on his way.

How Does This Affect You?

The important part of this story for you is that you CAN learn how to self-treat, and the odds are excellent that you can get relief from even the most stubborn of chronic pains.

My goal is to help as many people as possible to eliminate chronic pain that is caused by tight muscles, and to show they how to self-treat!

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.

How Much DHA Is Needed To Prevent Alzheimer’s

September 8, 2020 by Dr. Steve Chaney

What Are We Missing?

We are an aging population. As such, issues like cognitive decline, dementia, and Alzheimer’s Disease are of increasing concern. After all, what is the good of reaching your “Golden Years” with a healthy body if you lose your mind?

The ability of the omega-3 fatty acids DHA and EPA to reduce the risk of cognitive decline, dementia, and Alzheimer’s Disease is controversial. Some studies say yes. Others say no.

When studies are conflicting most experts simply conclude the treatment is unproven. I am sympathetic to that viewpoint, but I first like to ask the questions: “Why are the studies conflicting? What are we missing?”

I start by evaluating the strengths and weaknesses of the individual studies.

If the studies claiming the treatment works are weak, I am content to “join the chorus” and consider the treatment unproven.

If the studies claiming the treatment doesn’t work are weak, I am a strong advocate for more well-designed studies before we conclude that the treatment doesn’t work.

If both the “pro” and “con” studies are strong, I want to ask, “What are we missing?”

This is the situation with studies asking whether DHA reduces the risk of Alzheimer’s Disease and other forms of cognitive decline as we age.

Association studies show that greater intake and higher blood levels of the omega-3 fatty acids EPA and DHA are associated with lower risk of Alzheimer’s Disease.

However, most placebo-controlled clinical trials with either DHA alone or DHA + EPA have come up negative. Of course, one can always argue that most of the placebo-controlled clinical trials were too short or too small to show a statistically significant effect. But, my question remains, “What else are we missing?”

One recent study has provided an interesting clue. The authors of the study postulated that B vitamins were required to deliver omega-3 fatty acids to the brain, and their study showed that omega-3 fatty acids were only effective at decreasing the risk of cognitive decline in subjects who also had optimal B vitamin status.

In other words, this study suggested that studies on the effect of omega-3 supplementation and risk of developing Alzheimer’s are doomed to failure if a significant percentage of the subjects have sub-optimal B vitamin status.

The authors of the current study ( IC Arellanes et al, EBioMedicine, doi.org/10.1016/j.ebiom.2020.102883) proposed two additional hypotheses for the negative results of previous clinical trials and designed an experiment to test their hypotheses. Their hypotheses were:

Uptake of DHA and EPA by the brain is very inefficient, and previous studies have not used sufficient doses of DHA or DHA plus EPA to see a significant effect on cognitive impairment.

The APOE4 gene further decreases the uptake of DHA and EPA by the brain.

Before I describe how the study was done, I should probably provide some context by describing how DHA and EPA reach the brain and the role of the apoE protein in the process. It’s time for my favorite topic: “Biochemistry 101”.

Biochemistry 101: What Does The ApoE Protein Do?

If you have ever tried to mix oil and water, it should come as no surprise to you that fats, including DHA and EPA, and cholesterol are not water soluble. That leaves our bodies with a dilemma. How do they get the fat and cholesterol we eat to pass through our bloodstream and get to our cells, where they are needed?

Our body’s solution is to incorporate the fat and cholesterol into particles called lipoproteins. Lipoprotein particles sequester the fat and cholesterol in their interior and surround them with water soluble phospholipids and proteins. Lipoproteins allow our bodies to transport fat and cholesterol through our bloodstream to the tissues that need them.

The next question, of course, is how the lipoproteins know which cells need the fat and cholesterol. This is where apoproteins like apoE come into play. We can think of the apoE protein as a zip code that directs lipoproteins to cells with an apoE receptor.

Our nervous system contains lots of apoE receptors, and binding of the apoE protein to its receptor is instrumental in the delivery of DHA, EPA, and cholesterol to our nervous system.

DHA and cholesterol are both important for brain health. That is because they are major components of the myelin sheath that wraps around our neurons and protects them. EPA may also be important for brain health because its anti-inflammatory effects are thought to prevent the accumulation of the amyloid plaques that are the hallmark of late-onset Alzheimer’s Disease.

There are three major versions of the APOE gene, APOE2, APOE3, and APOE4. Each of them plays slightly different roles in our body. However, it is the APOE4 version that is of interest to us. About 25% of us have the APOE4 version of the APOE gene and it increases our risk of developing Alzheimer’s Disease by a factor of two.

We do not know why this is, but one hypothesis is that lipoproteins with the apoE4 protein have more difficultly delivering much needed DHA, EPA, and cholesterol to the brain. This is one of the hypotheses that the authors set out to study.

How Was The Study Done?

There are two things you should know about this study.

This was a pilot study designed to test the author’s hypotheses and allow them to choose the correct dose of DHA to use for a subsequent study designed to test whether high-dose DHA can reduce the risk of developing Alzheimer’s Disease.

This was a very small study. That’s because the only way to determine how much DHA and EPA reaches the nervous tissue is to perform a lumbar puncture and obtain cerebrospinal fluid at baseline and again at the end of the study. Lumbar punctures are both painful and a bit risky. They were lucky to find 26 individuals who consented to the lumbar punctures.

This was a double-blind, placebo controlled clinical study.

Half the subjects were given 2,152 mg/day of DHA for 6 months, and half were given a daily placebo consisting of corn and soybean oil for 6 months.

Because previous studies have suggested that B vitamins were important for DHA and EPA uptake by nervous tissue, all subjects received a B vitamin supplement.

Levels of DHA and EPA were measured in both plasma and cerebrospinal fluid at baseline and again at the end of 6 months. Note: The subjects were only supplemented with DHA. The investigators were relying on the body’s ability to convert DHA into EPA.

All subjects were screened for APOE4

Other important characteristics of the study subjects were:

Average age was 69. They were 80% female.

All of them had a close family member who had previously been diagnosed with dementia, but none of them had been diagnosed with cognitive impairment at the time of entry into the study.

Around 45% of them had the APOE4 version of the APOE.

In other words, none of them currently had dementia, but most were at high risk of developing dementia.

How Much DHA Is Needed To Prevent Alzheimer’s?

After 6 months of supplementing with over 2,000 mg/day of DHA:

DHA levels in the blood had increased by 200%.

However, DHA levels in cerebrospinal fluid had increased by only 28%.

Moreover, DHA levels in cerebrospinal fluid were 40% lower in subjects who had the APOE4 gene compared to subjects with the APOE2 and APOE3

EPA levels in cerebrospinal fluid averaged about 15-fold lower than DHA levels. When they looked at the effect of DHA supplementation on EPA levels.

EPA levels in plasma had increased by 50%.

EPA levels in cerebrospinal fluid had increased by 43%.

EPA levels in cerebrospinal fluid were 3-fold lower in subjects who had the APOE4 gene compared to subjects with the APOE2 and APOE3

The authors concluded:

“We observed only a modest (28%) increase in cerebrospinal fluid DHA levels with 2152 mg per day of DHA supplementation. This finding has implications for past clinical trials that have used lower doses (e.g. 1 g daily of DHA supplements or less) and were overwhelmingly negative. Using lower doses of omega-3 supplements may have resulted in limited omega-3 brain delivery.”

“Another aspect affecting the response to DHA supplementation is APOE4 status. Subjects with the APOE4 gene showed lower DHA levels and significantly lower EPA levels than subjects with other APOE genes”.

“In summary, our study suggests that higher doses of omega-3 fatty acids (2 or more g of DHA) are needed to ensure adequate brain delivery, particularly in APOE4 carriers…Past low dose (1 g per day or less) omega-3 supplementation trials in dementia prevention may not have provided adequate brain levels to fully evaluate the efficacy of omega-3 supplementation on cognitive outcomes.”

Based on the results from this study the authors are currently testing the effect of B vitamins and high dose DHA supplementation on cerebrospinal fluid fatty acid levels, brain imaging, and cognitive outcomes in a larger ongoing clinical trial.

What Does This Study Mean For You?

The ability of the omega-3 fatty acids DHA and EPA to reduce the risk of cognitive decline, dementia, and Alzheimer’s Disease is confusing. Studies disagree.

In situations like this, most experts dismiss the hypothesis as “unproven”. However, I like to ask, “What are we missing?”

One recent study provided a clue. It suggested that omega-3s and B vitamins were interdependent. We need both to reduce cognitive decline. However, that might not be the complete answer.

This study gave both DHA and B vitamins to subjects and discovered another interesting clue. The study suggests we may not have been giving subjects enough omega-3s to see a significant effect on cognitive decline.

Let me start by saying this study did not test whether or not DHA supplementation prevents cognitive decline, dementia, and Alzheimer’s Disease. Nor does it tell us how much DHA is needed to prevent Alzheimer’s Disease, other than to show that anything less than 2 g per day is likely to be inadequate.

However, the study did make two important advances:

#1: It showed just how difficult it is to deliver adequate amounts of DHA and EPA to the brain. This is important because it shows:

Most previous studies have not used high enough doses of DHA or DHA plus EPA to evaluate the effect of omega-3 fatty acids on cognitive decline. Those studies were not simply negative. They were doomed to failure. The studies were worthless.

That means we should stop saying that the ability of omega-3s to prevent cognitive decline and diseases like Alzheimer’s is unproven. Instead, we should say that hypothesis has not adequately been tested.

That also means future studies of the ability of DHA to reduce the risk of cognitive decline, dementia, and/or Alzheimer’s will need to use much higher doses or a better delivery system to get adequate amounts of DHA and EPA into the brain.

#2: It showed that the APOE4 gene significantly decreases the ability of the brain to accumulate DHA and EPA. This has several important implications.

Because both DHA and EPA are vital for brain health, this may explain why the APOE4 gene increases the risk of Alzheimer’s Disease.

It also means those at highest risk for Alzheimer’s Disease are the ones who are most likely to have difficulties accumulating DHA and EPA in their brain.

Once again, it means future studies of the ability of supplemental DHA to reduce the risk of Alzheimer’s Disease will need to use much higher doses of DHA.

The Bottom Line

The ability of the omega-3 fatty acids DHA and EPA to reduce the risk of cognitive decline, dementia, and Alzheimer’s Disease is controversial.

Association studies show that greater intake and higher blood levels of the omega-3 fatty acids EPA and DHA are associated with lower risk of Alzheimer’s Disease.

However, most placebo-controlled clinical trials with either DHA alone or DHA + EPA have come up negative.

In situations like this, most experts dismiss the hypothesis as “unproven”. However, I like to ask, “What are we missing?”

One recent study provided a clue. It suggested that omega-3s and B vitamins were interdependent. We need optimal amounts of both to reduce dementia. However, that might not be the complete answer.

This study gave both DHA and B vitamins to participants and discovered another interesting clue. The study suggests we may not have been giving subjects enough omega-3s to see a significant effect on cognitive decline.

The authors of the study hypothesized:

Uptake of DHA and EPA by the brain is very inefficient, and previous studies have not used sufficient doses of DHA or DHA plus EPA to see a significant effect on cognitive impairment.

The APOE4 gene, which is known to increase the risk of Alzheimer’s Disease, further decreases the uptake of DHA and EPA by the brain.

Their study confirmed their hypotheses and made two important advancements:

#1: It showed just how difficult it is to deliver adequate amounts of DHA and EPA to the brain. This is important because it shows:

Most previous studies have not used high enough doses of DHA or DHA plus EPA to evaluate the effect of omega-3 fatty acids on cognitive decline. Those studies were not simply negative. They were doomed to failure. The studies were worthless.

That means we should stop saying that the ability of omega-3s to prevent cognitive decline and diseases like Alzheimer’s is unproven. Instead, we should say that hypothesis has not adequately been tested.

That also means future studies of the ability of DHA to reduce the risk of cognitive decline, dementia, and/or Alzheimer’s will need to use much higher doses or a better delivery system to get adequate amounts of DHA and EPA into the brain.

#2: It showed that the APOE4 gene significantly decreases the ability of the brain to accumulate DHA and EPA. This has several important implications.

Because both DHA and EPA are vital for brain health, this may explain why the APOE4 gene increases the risk of Alzheimer’s Disease.

It also means those at highest risk for Alzheimer’s Disease are the ones who are most likely to have difficulties accumulating DHA and EPA in their brain.

Once again, it means future studies of the ability of supplemental DHA to reduce the risk of Alzheimer’s Disease will need to use much higher doses of DHA.

Based on the results from this study the authors are currently testing the effect of B vitamins and high dose DHA supplementation on DHA and EPA levels in the brain, brain imaging, and cognitive outcomes in a larger ongoing clinical trial.

For more details, read the article above. For a better understanding of the roles of DHA, EPA, and the APOE gene in brain health, you may want to read my “Biochemistry 101” section above.

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

Are Nuts Good For Your Heart?

September 1, 2020 by Dr. Steve Chaney

Which Nuts Are Best?

Last week I shared an important study about the benefits of replacing some of the animal protein in your diet with plant protein from whole grains. In case you have forgotten, the study showed replacing just 15 grams of the animal protein in your diet with an equivalent amount of protein from whole grains significantly decreased the risk of premature death from cardiovascular disease, stroke, and from all causes.

This was an important study because whole grains have been maligned in recent years. Low carb diets, keto diets, paleo diets, and low-lectin diets all recommend cutting whole grains out of your diet. Dr. Strangelove and his friends have been telling us to avoid whole grains, and too many Americans have been doing just that.

The study I shared last week reminds us that whole grains are good for our hearts. They are a great source of antioxidants, B vitamins, minerals, and phytonutrients. More importantly, they contain a unique type of fiber called resistant starch that supports the growth of heart-healthy gut bacteria. There are a few other foods that are a good source of resistant starch, but they are also on Dr. Strangelove’s “naughty list” of foods to avoid.

Unfortunately, you might have come away from last week’s article thinking that other plant protein sources, like beans, legumes, nuts, and seeds, weren’t important for reducing your risk of heart disease. However, the fact that they didn’t reduce the risk of premature death from heart disease in that study was likely an artifact of the way the study was designed.

The study asked what happens when you change 15 grams of the protein in your diet from red meat protein to different kinds of plant protein. That question was easy to answer for grains because they are a major source of protein in the American diet. However, Americans don’t get enough protein from either beans and legumes or nuts and seeds to provide a statistically valid answer to that question.

To correct any misconceptions from last week’s article I thought it might be valuable to review a study (M Guasch-Ferré et al, Journal Of The American Journal Of Cardiology, 70: 2519-2532) from a few years ago that looked at the effect of nut consumption on the risk of heart disease.

How Was The Study Done?

This study started by combining the data from three major clinical trials:

The first Nurse’s Health Study, which ran from 1980 to 2012,

The second Nurse’s Health Study, which ran from 1991-2013, and

The Health Professional’s Follow-Up Study, which ran from 1986-2012.

These studies combined enrolled 169,310 women and 41,526 men and followed them for an average of 32 years. All the participants were free of heart disease and cancer at the time they were enrolled. The design of these studies was extraordinary.

A detailed food frequency questionnaire was administered every 4 years. This allowed the investigators to calculate cumulative averages of all dietary variables, including nuts. This assured that the effects of nut consumption and diet represented the participant’s average diet over the 32-year duration of the study, not just their diet when they entered the study.

Participants also filled out questionnaires that captured information on disease diagnosis, disease risk factors, medicines taken, weight, and lifestyle characteristics every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of heart disease for each participant during the study. More importantly, 32 years is long enough to measure the onset of diseases like heart disease, which requires decades to develop.

The primary endpoint of the study was “cardiovascular disease”, which the investigators defined as fatal and non-fatal heart attacks, fatal and non-fatal strokes, and deaths from all types of heart disease. During this study, 14,136 participants developed cardiovascular disease. This was a large enough number for a detailed statistical analysis of the data.

Secondary endpoints were heart disease (fatal and non-fatal heart attacks) and stroke (fatal and non-fatal strokes).

Are Nuts Good For Your Heart?

When the authors compared people who consumed 5 or more one ounce servings of nuts per week with people who never or almost never consumed nuts, they found that nut consumption decreased:

Cardiovascular disease by 14%.

Heart attacks by 20%.

Strokes by a non-significant 2%.

This part of the study merely confirms what other studies have shown. What makes this study unique is that it identifies the relative heart health benefits of different kinds of nuts.

Which Nuts Are Best?

Nuts are an excellent source of vitamins, minerals, phytonutrients, and fiber. But what makes them particularly heart healthy is the healthy fats they provide.

Peanuts (which are actually legumes rather than true nuts) are rich in monounsaturated fats.

Tree nuts in general are an excellent source of polyunsaturated fats.
Walnuts

Walnuts are particularly rich in omega-3 polyunsaturated fats.

When they looked at individual nuts:

Consuming a serving of peanuts (35 peanuts) 2 or more times per week decreased:

- Cardiovascular disease by 13%.

- Heart attacks by 15%.

- Stroke by 10%.

- Peanut butter had no effect on cardiovascular outcomes, probably because many commercial brands of peanut butter add saturated fats to reduce separation of the oil and make their product creamier.

Consuming a serving of tree nuts (12-15 nuts) 2 or more times per week decreased:

- Cardiovascular disease by 15%.

- Heart attacks by 23%.

Consuming a serving of walnuts (14 walnut halves) one or more times per week decreased:

- Cardiovascular disease by 19%.

- Heart attacks by 21%.

- Stroke by 17%.

In case you missed it, walnuts were the superstars of the nut family. One serving/week of walnuts was more effective than two or more servings/week of peanuts or other tree nuts at reducing the risk of heart attacks, stroke, and overall cardiovascular disease. This is probably because walnuts are a particularly good source of omega-3 fats.

[Professor’s note: I include a serving of walnuts with my breakfast every morning.]

The authors concluded: “Findings from 3 large prospective cohort studies indicate that frequent intake of nuts, tree nuts, peanuts, and walnuts was associated with a lower risk of cardiovascular disease, independently from other cardiovascular risk, lifestyle, and dietary factors. Our findings support recommendations of increasing the intake of a variety of nuts as part of healthy dietary patterns to reduce the risk of chronic diseases in the general population.”

What Does This Study Mean For You?

I have consistently shared the evidence that primarily plant-based diets are associated with the best long-term health outcomes, especially when we look at chronic diseases like heart disease, diabetes, and cancer.

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

Unfortunately, Dr. Strangelove and his friends have been telling us that whole grains are bad for us. We should eliminate them from our diet. And too many Americans have been following that advice. That’s why last week’s “Health Tips From the Professor” article reviewed the evidence for heart health benefits from whole grain consumption.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits from nut consumption. Here is the take home message I hope you get from this article:

Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.

Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.

This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.

Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.

All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.

I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.

Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

The Bottom Line

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits of nut consumption. Here is the take home message I hope you get from this article:

Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.

Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.

This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.

Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.

All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.

I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.

Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

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.

Does Eating Plant Protein Help You Live Longer?

August 25, 2020 by Dr. Steve Chaney

Are Whole Grains Heart Healthy?

The diet wars continue. Dr. Strangelove and his colleagues are still trying to convince you that you can eat all the red meat you want. It is those deadly whole grains, beans, and fruits you need to avoid.

However, as the benefits of primarily plant-based diets continue to accumulate, it is becoming harder for them to maintain these preposterous claims.

For example, several recent studies have shown that replacing animal protein with plant protein in your diet results in better health.

The Iowa Women’s Health Study found that plant protein substitution for animal protein is associated with reduced risk of dying from heart disease.

The Nurse’s Health Study and Health Professionals Follow-up Study found that greater plant protein intake was associated with reduced risk of dying from heart disease and reduced risk of dying from all causes.

The Japan Public Health Center-Based Prospective Cohort Study found a reduced risk of dying from heart disease, cancer, and all causes with substitution of plant protein for red meat protein.

These were all very large studies in which populations were followed for long periods of time. You might be thinking that with such overwhelming evidence no further studies are needed.

However, these studies did not examine which plant protein sources were most beneficial and which animal protein sources were most detrimental. The study (J. Huang et al, JAMA Internal Medicine, published online July 13, 2020) I describe in today’s “Health Tips From The Professor” was designed to answer that question.

How Was The Study Done?

416,104 participants from the NIH-AARP Diet and Health Study were enrolled in this study in 1995 and 1996 and were followed for 16 years. At the time of enrollment, the participants filled out a comprehensive Diet History Questionnaire. The participants also completed questionnaires about their health, lifestyle, and socio-economic status.

Deaths were obtained from the Social Security Death Master File. Causes of death were obtained from the National Death Index Plus.

The basic characteristics of the study population were:

Gender: 57% men, 43% women.
Racial identification: 90% non-Hispanic white.
Average age 61 (range 50-71).
Average BMI = 27 (in the overweight range).
Participants were excluded from the study if they had pre-existing cancer, heart disease, stroke, or end-stage kidney disease.

In terms of protein intake:

Average protein intake was 15.3% of calories.

Plant protein contributed 40% (range 27% – 57%) to the total protein intake.

Animal protein contributed 60% (range = 43% to 63%) of the total protein intake.

The major sources of animal protein in the diet were:

Dairy products = 31.6%

White meat (poultry, fish, and processed white meat) = 31.3%

Red meat (both fresh and processed) = 30.6%

Eggs = 4.0%

The major sources of plant protein in the diet were:

Grains (bread, cereal, and pasta) = 45.8%

Beans and legumes = 8.0%

Nuts and seeds = 4.5%

Other plant protein (including plant protein from supplements) = 41.7%

All these protein intake figures are normal for the American diet.

I should note that beans, nuts, and seeds are among the best sources of plant protein. However, they are only a minor part of the typical American diet, so they contribute relatively little to our plant protein intake.

Does Eating Plant Protein Help You Live Longer?

In terms of overall protein intake, this study mirrored previous studies.

There was an inverse association between plant protein intake and premature death from heart disease, stroke, and all causes. Put another way, the more plant protein people in this study ate, the lower was their risk of premature death.

To quantify the effect, the investigators asked what happened when 3% of calories came from plant protein instead of animal protein. I recognize, however, that 3% of calories is a rather abstract concept, so let me break it down for you so you can apply it to your lives.

For participants in this study, protein was 15% of their total calories. That means when the investigators were talking about shifting 3% of total calories from animal protein to plant protein, they were talking about 20% of the protein in the diet coming from plant protein rather animal protein.

Based on the average caloric intake of participants in this study, that corresponds to 15 grams of protein for men and 12 grams of protein for women.

With that in mind, let’s look at the results:

Changing just 3% of calories from animal protein to plant protein:

Lowered the risk of premature death from all causes by 10% for both men and women.

Lowered the risk of premature death from cardiovascular disease by 11% for men and 12% for women.

Lowered the risk of premature death from stroke by 22% for men and 19% for women.

These findings are consistent with previous studies. By now, it should be apparent that primarily plant-based diets are best for your overall health. Primarily plant-based diets also appear to reduce your risk of dying prematurely from heart disease and from all other diseases combined.

The authors concluded: “This large cohort investigation showed small but significant associations between higher intake of plant protein and lower overall and cardiovascular mortality…Findings from this and previous studies provide evidence that dietary modifications in choice of protein sources may promote health and longevity.”

However, this part of the study merely confirms what other studies have shown. What makes this study unique is that it identifies which animal proteins are worst for us and which plant proteins are best for us.

Which Animal Proteins Are Least Heart Healthy?

Let’s start with the animal proteins (Note: To simplify a complex set of data, I am going to average the results for men and women).

Changing 3% of calories from egg protein to plant protein:

- Lowered the risk of premature death from all causes by 23%.

- Lowered the risk of premature death from cardiovascular disease by 27%.

- To put this into perspective, 3% of calories from egg protein corresponds to around 2.5 eggs/day. So, talking about replacing 3% of calories of egg protein creates a false narrative. The average egg consumption in this study was 0.5 eggs/day and very few participants consumed even 2 eggs every day. If we make a more reasonable comparison, replacing one egg/day with an equivalent amount of plant protein:

- - Lowers the risk of premature death from all causes by 9%.

- - Lowers the risk of premature death from cardiovascular disease by 11%.

Changing 3% of calories from red meat protein to plant protein:

- Lowered the risk of premature death from all causes by 14%.

- Lowered the risk of premature death from cardiovascular disease by 12%.

- Lowered the risk of premature death from stroke by 21%.

- To put this into perspective, 3% of calories from red meat protein corresponds to around 2 ounces/day.

Changing 3% of calories from dairy protein to plant protein:

- Lowered the risk of premature death from all causes by 8%.

- Lowered the risk of premature death from cardiovascular disease by 11%.

- Lowered the risk of premature death from stroke by 21%.

- To put this into perspective, 3% of calories from dairy protein corresponds to around 1.7 8-ounce glasses of milk, 2 ounces of cheese, or 1 cup of yogurt (most yogurt “cups” sold commercially are less than an 8-ounce cup).

Changing 3% of calories from white meat protein to plant protein had no effect on premature death from any disease in this study. I will discuss the reasons for that below.

Are Whole Grains Heart Healthy?

Now, let’s look at the flip side. What happens when you replace 3% of calories from red meat protein with various kinds of plant protein?

Changing 3% of calories from red meat protein to plant protein from whole grains:

- Lowered the risk of premature death from all causes by 28%.

- Lowered the risk of premature death from cardiovascular disease by 32%.

- Lowered the risk of premature death from stroke by 32%.

- To put this into perspective, 3% of calories from whole grain protein corresponds to around 2.5 slices of whole grain bread, 2 cups of oatmeal, or 2.5 cups of brown rice or whole grain pasta – or any combination of them during the day.

The results were similar for replacing egg protein with whole grain protein.

Changing 3% of calories from red meat protein or egg protein to other types of plant protein had no effect on premature death from any disease. The reasons for that will be discussed below.

The authors concluded “…this investigation showed prominent inverse associations between overall and cardiovascular mortality and the replacement of egg protein and red meat protein with plant protein, particularly for plant protein derived from bread, cereal, and pasta…”

Why Do Animal Proteins Increase Your Risk Of Premature Death?

Let me take a deep dive into the data. If you like, you can skip to “What Does This Study Mean For You?”

To help you gain a better understanding of these results, I will answer two questions for you:

Mechanism: What is/are the metabolic explanation(s) for these results?

Perspective: How can you apply this information to your own life?

Reminder: This section is for those of you who want the details. I will give the Cliff Notes summary in the section “What Does This Study Mean For You”.

Eggs

Mechanism:

The bad effect of eggs on cardiovascular mortality and all-cause mortality is thought to be almost exclusively due to their high cholesterol content.

On the flip side, eggs are an excellent source of low-fat animal protein and provide nutrients like choline and carotenoids that are often insufficient in the American diet.

Perspective:

Our bodies have a beautifully designed system for regulating blood cholesterol levels. This means under ideal conditions dietary cholesterol has very little effect on blood cholesterol levels. However, as I have pointed out in a previous issue of “Health Tips From the Professor”, conditions are often far from ideal.

Diet context matters. Obesity, saturated fat, and sugar all interfere with our ability to regulate blood cholesterol levels. People consuming the typical American diet, like the ones in this study, have more difficulty regulating their blood cholesterol levels and are more likely to be adversely affected by dietary cholesterol from eggs and other high-cholesterol foods.

- Previous studies suggest that adding eggs to the typical American diet may increase risk of cardiovascular disease and premature death.

- In contrast, adding eggs to a primarily plant-based diet, such as found in China and Japan, appears to decrease risk of heart disease and premature death.

Red Meat

Mechanisms: The mechanism(s) associated with the bad effects of red meat are less clear. Here are the potential mechanisms discussed by the authors of this study.

Red meat is high in cholesterol. While many experts have downplayed the importance of dietary cholesterol in recent years, it still may be of concern in the context of the typical American diet because of our body’s inability to regulate cholesterol metabolism normally.

Red meat is high in saturated fat. While some experts have downplayed the importance of reducing saturated fat intake, I pointed out in a previous issue of “Health Tips From the Professor” that it depends on what the saturated fat is replaced with.

- When saturated fats are replaced with sugar and refined carbohydrates in the typical American diet, reducing saturated fat is of no benefit.

- When saturated fats are replaced with polyunsaturated fats in the context of a primarily plant-based diet, such as the Mediterranean diet, reducing saturated fats leads to a substantial reduction in the risk of heart disease and premature death.

Red meat also contains heme iron which is associated with 57% increased risk of cardiovascular disease.

Diets high in red meat result in populations of gut bacteria that are associated with increased risk of cardiovascular disease. This is most likely because red meat is displacing plant foods that support the growth of healthy bacteria.

As discussed in a recent issue of “Health Tips From the Professor”, the gut bacteria associated with red meat consumption convert the L-carnitine in red meat to a metabolite called trimethylamine N-oxide (TMAO) which appears to significantly increase the risk of cardiovascular disease.

Finally, a recent study suggests that foods high in sulfur-containing amino acids significantly increase risk of cardiovascular disease. However, this mechanism is not specific for red meat. White meat, beans, and legumes are also high in sulfur-containing amino acids.

Perspective:

While the exact mechanism(s) is/are uncertain, there is substantial evidence from multiple studies that red meat consumption increases the risk of premature death from cardiovascular disease and from all causes.

Grass fed beef is not a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

However, those of you who, like me, enjoy red meat should not consider this to be an absolute “red meat should never touch your lips” edict. As I have discussed in a previous issue of “Health Tips From the Professor”, the health effects of red meat are a matter of quantity and diet context.

- If you are thinking in terms of a juicy 8-ounce steak with a baked potato and sour cream, red meat is probably not a healthy choice.

- However, if you are thinking of 2-3 ounces of lean steak in a vegetable stir fry or a green salad, red meat may be a healthier choice.

Dairy: I have reported on the health risks and benefits of dairy foods in a previous issue of “Health Tips From the Professor”, so I will just give you a brief summary here.

Perspective:

Eating dairy foods, even high-fat dairy foods, has relatively little effect on cardiovascular disease risk in the context of the typical high-fat, high-sugar American diet.

Eating dairy foods, even high-fat dairy foods, in the context of a healthy plant-based diet appears to lower cardiovascular disease risk.

As this study suggests, moving towards a more plant-based diet by substituting some plant protein for dairy protein in the diet will also decrease your risk of cardiovascular disease

White Meat: This and previous studies suggest that white meat is less likely than red meat to increase the risk of cardiovascular disease and premature death. I have discussed the differences between red and white meat in a previous issue of “Health Tips From the Professor”. However, I can summarize the differences best here by going back to the mechanisms associated with the link between red meat and cardiovascular diseases and highlight those that do not apply to white meat.

Mechanisms:

Saturated fat. Many fish are much lower in saturated fat and are excellent sources of heart-healthy omega-3 fats. Chicken and turkey breast with the skin removed are also much lower in saturated fat than red meat.

Heme iron. Chicken breast is lower in heme iron than red meats.

TMAO. White meats contain 10-50 times less L-carnitine than red meats. Since L-carnitine is the precursor of TMAO, they are much less likely to cause TMAO production.

Why Do Plant Proteins Decrease Your Risk Of Premature Death?

Whole Grains: Whole grains have been much maligned in recent years. They have been lumped in with sugar and refined grains and have been added to everyone’s “naughty list”.

If you are following a low-carb diet, you are told to avoid all grains.

If you are following a Paleo diet, you are told our paleo ancestors ate no grains.

If you are trying to avoid lectins…you get the point.

That’s unfortunate, because whole grains are very healthy. In a recent issue of “Health Tips From the Professor” I shared a study showing that whole grain consumption reduced the risk of premature death from heart disease, cancer, and all causes. The current study shows essentially the same thing.

The only question is why whole grains are uniquely effective at decreasing premature death from cardiovascular disease and all causes in this study. Why aren’t all plant proteins equally effective? I will share both a suggested mechanism and perspective.

Mechanism:

In a recent issue of “Health Tips From The Professor” I reported a study showing that grains and a few other foods contain a unique type of fiber called resistant starch that suppress growth of the gut bacteria which convert L-carnitine to TMAO. This may be why whole grains are uniquely effective at reducing the risk of cardiovascular disease and premature death.

Some refined grains are also good sources of resistant starch. However, I don’t recommend them because they lack the antioxidants, vitamins, phytonutrients, and insoluble fiber found in whole grains.

Perspective:

The fact no other plant protein source significantly reduced heart disease risk in this study is most likely an artifact of the study.

The study asked what happens when you change 15 grams of the protein in your diet from red meat protein to different kinds of plant protein. That question was easy to answer for grains because they are a major source of protein in the American diet. However, Americans don’t get enough protein from other high protein plant foods like beans and legumes or nuts and seeds to provide a statistically valid answer to that question.

However, all plant foods have their own health benefits. They are excellent sources of antioxidants and phytonutrients that provide heart health benefits.

In addition, each plant food provides a different blend of fibers and supports different populations of gut bacteria with different health benefits. For example, fiber from fruits and vegetables is associated with a lower risk of cancer.

What Does This Study Mean For You?

A recent study has shown that changing as little as 20% of the protein in our diet from animal protein to plant protein significantly reduces our risk of premature death from cardiovascular disease, stroke, and from all causes.

The effect of replacing 2 ounces of red meat, 1 egg, or 2 servings of dairy with an equivalent amount of plant protein was equally beneficial.

Previous studies show that diet context is important. A small amounts of animal protein in the context of a whole food, primarily plant-based diet is much less likely to cause harm and may provide benefit. For example:

Eggs are high in cholesterol but are also excellent sources of low-fat protein and nutrients that may be missing in a plant-based diet.

- Previous studies suggest that adding eggs to the typical American diet may increase risk of cardiovascular disease and premature death.

- In contrast, adding eggs to a primarily plant-based diet, such as found in China and Japan, appears to decrease risk of cardiovascular disease and premature death.

Dairy foods are high in saturated fat but are excellent sources of calcium, vitamin D, and other nutrients that may be missing in a plant-based diet.

- Eating dairy foods, even high-fat dairy foods, has relatively little effect on cardiovascular disease risk in the context of the typical high-fat, high-sugar American diet.

- Eating dairy foods, even high-fat dairy foods, in the context of a healthy plant-based diet appears to lower cardiovascular disease risk.

Red meat has multiple suggested mechanisms for it increasing the risk of death from cardiovascular disease. However, diet context still matters.

- If you are thinking in terms of a juicy 8-ounce steak with a baked potato and sour cream, red meat is probably not a healthy choice.

- However, if you are thinking of 2-3 ounces of lean steak in a vegetable stir fry or a green salad, red meat may be a healthier choice.

- Grass fed beef should not be considered a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

White meat does not appear to affect your risk of developing cardiovascular disease.

Whole grains significantly decreased the risk of premature death from cardiovascular disease and death from all causes. This may be because whole grains contain a unique type of fiber called resistant starch that suppresses the growth of the gut bacteria which convert L-carnitine to a heart-damaging compound called TMAO.

- Notice that I specified “whole grain”. While some refined grains are also a good source of resistant starch, they lack the other heart healthy nutrients and phytonutrients found in whole grains.

- - Wonder Bread, Frosted Flakes, Honey Bunches of Oats, and white-flour pasta are not on my approved list. I agree with low-carb enthusiasts about eliminating them from our diets.

- - You should also be aware that “whole grain” on the label means nothing. You want to choose foods that say “100% whole grain”.

- Finally, this study only focused on plant protein sources. It is important to remember that other plant foods are an excellent source of antioxidants, phytonutrients, and fiber. Each plant food provides unique heart health benefits.

The Bottom Line

The effect of replacing 2 ounces of red meat, 1 egg, or 2 servings of dairy with an equivalent amount of plant protein was equally beneficial. White meat did not affect the risk of cardiovascular disease or premature death.

Grass fed beef should not be considered a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

Diet context is important. Small amounts of animal protein in the context of a whole food, primarily plant-based diet appear to be much healthier for us than large amounts of animal protein in the context of the high-fat, high-sugar American diet.

On the flip side of the equation, whole grains significantly decreased the risk of premature death from cardiovascular disease and death from all causes. This has also been seen in other recent studies.

Notice that I specified “whole grain”. Wonder Bread, Frosted Flakes, Honey Bunches of Oats, and white-flour pasta are not on the list.

You should also be aware that “whole grain” on the label means nothing. You want to choose foods that say “100% whole grain”.

Finally, this study only focused on plant protein sources. It is important to remember that other plant foods are an excellent source of antioxidants, phytonutrients, and fiber. Each plant food provides unique heart health benefits.

For more details, read the article above, especially the “What Does This Study Mean For You?” section.

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

Which Muscles Are Affected By Stress?

August 18, 2020 by Dr. Steve Chaney

It’s Time For The Beach

This is a perfect time to go to the beach – August is hot and humid, and the water feels so refreshing. Of course, we now need to socially distance ourselves from each other, but for those of us in Florida that is possible when we have so many beautiful beaches close to our homes.

Most of us are sticking close to home, and summer sure isn’t what it has been in years past. The baseball season was on – then off – and as of right now, who knows! Most of the people I know are getting through this okay, I hope you are too!

Which Muscles Are Affected By Stress?

We are living in stressful times, and chronic stress can cause your muscles to tighten. When that happens, it can lead to pain in unexpected places. When you visit your doctor, they may recommend drugs or aggressive treatments.

Unfortunately, many doctors are unaware tight muscles can be the real cause of your pain. They don’t know that there are simple treatments that can release your tight muscles and relieve the pain – without resorting to drugs.

This week I will address the top 3 muscles that are affected by chronic stress and how to treat those muscles when they cause you pain.

Levator Scapulae: This is, in my opinion, the #1 muscle that gets involved when we are under stress. The nickname for the Levator Scapulae is “the shrug muscle” because when it contracts normally you lift your shoulders up….you shrug.

The problem is, the muscle originates on your first four cervical vertebrae, and inserts into your shoulder blade. When you are under stress it is common for your shoulders to lift up. The muscle is held tightly, and a phenomenon called “muscle memory” keeps the muscle in the shortened position. Once the levator scapulae is “stuck” in a shortened position, when you either bend your neck to the side (bringing your ear closer to your shoulder), or you lift something heavy with your arm, pulling your shoulder down, it pulls on your cervical vertebrae.

This causes your cervical vertebrae to move and puts pressure on your spinal cord right at the base of your brain. The Levator Scapulae has been proven, in my clinical practice, to be the #1 reason for severe headaches. When it gets tight it will pull the insertions at your neck and pull them to the side and down. This causes the bones to press into your spinal cord, right at the base of your brain, and you get a severe headache!

Last month I shared self-treatment techniques to release the tightness in your Levator Scapulae muscles and relieve your tension headaches. If you are suffering from tension headaches, these techniques can work wonders.

Intercostals: The Intercostal muscles are between each rib. When you breath in, they expand, and when they contract, you breath out. The problem is, when you are under stress you may hold your breath longer than normal, and muscle memory sets in, and they stay in the shortened position.

As this happens you lose the ability to take a good, deep breath. This lessens the amount of oxygen that is in your blood and that goes out to your cells. This can cause problems all over your body.

The solution to this problem is deep breathing exercises. A friend of mine, Tara Clancy, is an expert on breathing and how it affects your entire body. You can check her out at http://www.o2tara.org.

Masseter: Do you clench your teeth when you are under stress? The muscle that causes you to clench your teeth is called the masseter muscle. If you put your fingertips onto your cheeks, pressing into your back teeth you are on your masseter muscle. Clench your teeth, you will feel the muscle bulge as it contracts.

The masseter muscle (circled on graphic) is the muscle that contracts to enable you to chew your food. Normally, as you chew the muscle shortens, and then lengthens as you put more food into your mouth. However, if you are under chronic stress, and your teeth stay clenched, your masseter will shorten from muscle memory and put a strain on your jaw joint. This is the cause of a condition called TMJ.

TMJ is a condition where your jawbone rubs, or “clicks,” over the bone that is just in front of your ear. It is painful, and over time it will damage the bones. When you are under stress and constantly clenching your teeth, you are shortening your masseter muscle. The now-shorter muscle prevents you from opening your jaw completely, for example, when you yawn. As you are trying to yawn your jaw flips over the bone, and it hurts.

Self-Treatment For TMJ

Several years ago, I had a client who had such tight masseter muscles that a dental surgeon was going to sever them so she could open her mouth. This is a terrible solution because it would mean her mouth would hang open for the rest of her life. Fortunately for this client she had to get medical approval before she could have the surgery. When Dr. Cohen (the doctor I worked with) felt her masseter muscles, he refused to sign the permission form. He told her that she had to see me first, and fortunately I was there at the time. It took just 30 minutes for me to release the spasms and teach her how to do the treatment. At the end of the session she was pressing into both masseter muscles and opening her mouth. She did it easily and without pain! She started to cry because she came within one day of having this unnecessary surgery. Her life was changed by just a simple self-treatment!

Place your fingers as shown in the picture to the left. Clench your teeth so you can feel the muscles bulge.

Apply deep pressure on just one side for 5 seconds. Then release that pressure and apply deep pressure to the opposite side for 5 seconds. Go back and forth until it doesn’t hurt anymore. Then find a different “hot spot,” and repeat. Continue doing this until you can’t find any more tender points on your muscle and jaw.

To stretch the masseter muscle just press deeply into the original point on the muscle and slowly open your mouth wide.

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.

It’s Buyer Beware In The Food And Supplement Industries

August 11, 2020 by Dr. Steve Chaney

How Can You Identify High Quality Products?

When it comes to the food and supplement industries a paraphrase of the famous introduction to “A Tale Of Two Cities” comes to mind; “It is the best of worlds, it is the worst of worlds.”

There are companies who value your health more than their bottom line. They insist on the highest quality ingredients, verify the purity of their ingredients, and run extensive quality controls on their final product. It’s an expensive process, but you are worth it.

I wish I could tell you that all companies cared enough about your health to produce products that are pure and potent. Unfortunately, I cannot.

Some products don’t contain the amount of active ingredient claimed on the label. Some products contain potentially toxic contaminants. These errors are usually due to poor manufacturing processes and/or lack of proper quality controls.

Even worse, some products are adulterated. That means the manufacturer substituted a cheaper ingredient for the active ingredient. That cannot be accidental. Adulteration is a willful act to deceive the consumer.

I also wish I could tell you the USDA and the FDA are protecting you by making sure food and supplement products are pure and potent. Unfortunately, I cannot.

It’s not that they aren’t trying. They are simply overwhelmed.

There are hundreds of charlatans in the marketplace.

It often takes 2 to 5 years of litigation to put bad actors out of business.

And, as soon as they put one out of business, another one pops up. It’s like that “Whack A Mole” game at the county fair.

Normally, I see reports of poor quality products every few months. But when five product horror stories crossed my desk in a few weeks, it is time to speak up. This week I will share reports on quality control and adulteration issues with:

Turmeric supplements.

Lavender essential oils.

Bitter orange supplements.

Avocado oil.

CBD products.

Adulteration Of Turmeric Supplements

Turmeric supplements are “hot” right now. Their sales have almost doubled in the last couple of years. Whenever a product becomes this popular, unscrupulous manufacturers are tempted to jump into the market. Looking to make a quick buck they substitute inactive, less expensive ingredients for the active ingredients – a process called “adulteration”.

To better understand how turmeric supplements are adulterated, let’s look at how turmeric supplements are made. The active ingredients in turmeric supplements are a class of compounds called curcuminoids that come from the root of the Curcuma longa plant.

1) The simplest way to create a turmeric supplement is to simply grind the root into a powder and put the resulting turmeric powder into a capsule or tablet.

- However, turmeric powder is often adulterated by substituting the less expensive Curcuma zeodoria root (from wild turmeric) for the Curcuma longa

2) The more potent turmeric supplements extract the active curcuminoids from turmeric powder.

- However, turmeric extracts are often adulterated by substituting synthetic curcumin for the natural extract.

Fortunately, the American Botanical Council has created a program called Botanical Adulterants Prevention Program (BAPP) to identify bad players in the botanicals (meaning anything coming from plants) market. In a recent bulletin on turmeric adulteration, they reported:

In one test of turmeric powder, all the samples tested had more Curcuma zeodoria powder than Curcuma longa

In another test of turmeric powder, 4 out of 6 samples were adulterated with Curcuma zeodoria

In a test of turmeric extracts, 4 out of 5 samples were adulterated with synthetic curcumin.

Is Curcuma zeodoria powder as safe and effective as Curcuma longa powder? Nobody knows.

Curcuma zeodoria root has a different mix of curcuminoids than Curcuma longa root, and some concerns have been raised about the safety of Curcuma zeodoria

Is synthetic curcumin as safe and effective as natural turmeric extract? Nobody knows.

The FDA views synthetic versions of natural botanical compounds as different from the botanical itself, Thus, if a supplier correctly identified their extract as containing synthetic curcumin, they would be required to file an NDI notification with FDA, including proof of safety, for products containing their extract to be legally sold in the US.

The use of synthetic curcumin may replace the other curcuminoids found in natural turmeric extracts. In other words, you would not be getting the full spectrum of curcuminoids you would find in a natural extract standardized to 95% curcuminoids.

Note: The American Botanical Council Bulletin did not address turmeric products that are available on the marketplace. They reported on the major suppliers of the raw materials that manufacturers purchase to make their turmeric products. This has two important implications for consumers like you and me:

Many companies base their label claims on the specifications provided by the supplier of their raw ingredients. However, unless they run independent quality control tests on the raw ingredients, they actually have no idea what is in their product.

That means when comparing turmeric products, we should not rely on label claims or price alone. We should ask about the company’s quality control process, particularly whether they run independent quality control tests on the ingredients they use.

Adulteration Of Lavender Essential Oil

Lavender oil has been around for hundreds of years. It has long been prized for its calming effect. It has traditionally been used in aromatherapy for relief of stress, anxiety, depression, and to improve sleep.

With the recent “essential oil” craze, it has been reclassified as an essential oil with an impressive list of additional “benefits” – such as relieving headaches, getting rid of acne and eczema, reducing menstrual cramps, and reducing inflammation to name a few.

As you might expect, the market for lavender essential oil is exploding. It is expected to almost double between 2016 and 2024.

However, lavender oil is hard to come by. The lavender flowers are steamed to release the volatile components, and the oil is then distilled. Only a tiny fraction of the lavender plant ends up in the final product. You might suspect that manufacturers would be tempted to cut corners. You would be correct.

Once again, the American Botanical Council’s Botanical Adulterants Prevention Program (BAPP) comes to the rescue. Recently BAPP tested lavender essential oils in the marketplace. Their newly-released bulletin reported that 82% of lavender products on the market were adulterated.

Some of the adulterated products used oils from related plant species.

Some products used oils from unrelated plant species like rosemary.

Other products used synthetic oils.

All the adulterated products used oils that were less expensive than genuine lavender oil. To the untrained consumer the adulterated products may smell like lavender oil, but there is no evidence that the oils substituted for lavender oil have the same benefits as lavender oil.

This is not simply a quality control issue. It was not accidental. You don’t start with plant species other than lavender and expect to end up with lavender oil. And you really don’t start with synthetic oils and expect to end up with natural lavender oil. This is deception, pure and simple.

Poor Quality Control Of Bitter Orange Supplements

Bitter orange is another name for the Seville Oranges you may have seen in your local market. Unripe Seville Oranges are quite bitter, and this is the form used in supplements.

Traditionally, bitter oranges have been used as a digestive aide. More recently, some unscrupulous manufacturers have advertised bitter orange as a fat burning supplement and have marketed it as a sports nutrition and weight management supplement.

Any supplement marketed as “fat burning” attracts a lot of attention. Once again, sales have skyrocketed, and manufacturers have been tempted to cut corners. This attracted the attention of the USDA, who recently published a study assessing the quality of supplements containing bitter orange.

The USDA purchased 59 products available in the US that either contained bitter orange as the primary ingredient or as one of the major ingredients in a proprietary formula. They tested these products using state-of-the-art analytical techniques. What they found wasn’t pretty.

Only 5 of the products had the amount of active ingredient claimed on the label. This could be a quality control issue, but it is not reassuring to you, the consumer.

Some of the products had higher amounts of minor compounds found in the bitter orange than they did of the active ingredient. It is hard to imagine how this occurred unless those manufacturers used what was left over after other companies had extracted the active ingredient. And there is no research on the effects of these minor compounds in humans.

7 of the products had synthetic ingredients that had never seen a bitter orange. Once again, there is no evidence these compounds are either safe or effective.

Poor Quality & Adulterated Avocado Oil

Avocados are in. They are prized as a source of antioxidants and healthy monounsaturated fats. Avocado oil has all the benefits of raw avocados, plus it has an extremely high smoke point, making it ideal for high temperature cooking.

It’s no wonder that sales of avocado oil have soared by 52% in the last couple of years alone. Once again, there will be manufacturers who are tempted to cut corners.

Fortunately, scientist at University of California, Davis recently published a study on the quality of avocado oil. Unfortunately, they found that most of the avocado oil sold in the US was oxidized, mislabeled, or misbranded.

The scientists purchased 14 brands of avocado oil from local markets and purchased an additional 8 brands online. Here is what they found:

82% of the 22 brands they tested were either oxidized or mixed with other oils. Specifically:

- 15 of the brands were oxidized, which compromises both the taste and the health benefits of avocado oil.

- 6 of the brands were adulterated with cheaper oils, including sunflower, safflower, and soybean oil.

- 3 of the brands contained little or no avocado oil. They were mixtures of other oils. This is even worse than simple adulteration. These products should not have even been labeled as avocado oil.

- - Interestingly, 2 of the 3 brands with no avocado oil were labeled “extra virgin” avocado oil, which is supposed to indicate the highest quality oil. Did I mention “buyer beware”?

CBD Horror Stories

I don’t need to tell you that the CBD industry has taken off in recent years. Most of the claims for CBD products are unproven, but that is another story for another time.

Even more worrisome are quality control issues for CBD products. In fact, it is so worrisome that congress asked the FDA to study quality controls in the CBD industry and report back to them, which they did last month.

Let me start with a little history. Congress has asked the FDA to set safety, efficacy (product claims), and quality standards for CBD products.

1) The FDA is farthest along with product claims. They have rejected most product claims for CBD products and have initiated legal actions against several companies that have refused to stop making these product claims.

2) With respect to safety they have specified that CBD products should contain less than 0.3% THC (marihuana) but have not yet completed safety studies on other CBD ingredients.

3) With respect to quality controls, they have started by surveying the quality of CBD products currently available in the US. They tested 147 products, and the results weren’t pretty. As described in their report to congress:

- 9 CBD products contained no CBD.

- 18 products were less potent than advertised. They contained less than 80% of the amount claimed on the label.

- 38 products were more potent than advertised. They contained more than 120% of the amount claimed on the label.

- 72 products (49% of the total) contained impermissible levels of THC.

How Can You Identify High Quality Products?

As I said in my book “Slaying The Supplement Myths” there are ethical supplement companies that care about your wellbeing and produce high quality products. However, there is also a dark underbelly of the food and supplement industries.

In the article above I have shared examples of products that:

Contained little or no active ingredient.

Contain less or more of the active ingredient than claimed on the label.

Contain potentially harmful contaminants.

Are adulterated by substituting cheaper ingredients which may not be effective for the active ingredient.

At this point you are probably asking, “How do I protect myself? How do I make sure that I am not wasting my money and jeopardizing my health when I buy a supplement? I cover the answer to this question in my book, “Slaying The Supplement Myths“. Here is a shortened version:

Ignore the slick marketing.

Don’t base your decision on price alone. That can be a trap.

Do your research. Ask questions. Only choose reputable companies that do quality
controls on both the raw ingredients and the finished product.

The problem, of course, is that every company claims to run stringent quality control tests. My
suggestion is to ask them about their quality control process. Here are the questions to ask (you will find more in my book):

1) Do you run tests to confirm the purity of your raw ingredients, or do you accept the claims of your suppliers?

2) How many quality control tests do you run on your final product? If it is a single nutrient product, the number should be in the dozens. If it is a multivitamin, the number should be in the hundreds. For more complex products, you should expect a thousand or more quality control tests.

3) Do you run quality controls on every batch…or, put another way…How many quality controls do you run each year? Those should run into the tens of thousands.

4) What kind of analytic methods do you use?

These are tough questions, but they are the right questions to ask before you pick a supplement company. After all, you are entrusting your health to their products.

The Bottom Line

There are ethical food and supplement companies that care about your wellbeing and produce high quality products. However, there is also a dark underbelly of both the food and supplement industries.

In the article above I have shared examples of products that:

Contained little or no active ingredient.
Contain less or more of the active ingredient than claimed on the label.
Contain potentially harmful contaminants.
Are adulterated by substituting cheaper, less effective ingredients for the active ingredient.

I shared reports of quality control and adulteration horror stories with:

Turmeric supplements.

Lavender essential oils.

Bitter orange supplements.

Avocado oil.

CBD products.

I also shared how to find companies that make high quality products you can trust.

For more details, read the article above.

To find which supplements I recommend, click here.

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.