Dr. Steve Chaney

Does Eating Plant Protein Help You Live Longer?

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Are Whole Grains Heart Healthy?

protein and heart disease nuts and seedsThe 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?

Clinical Study416,104 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?

Animal Protein FoodsLet’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?

Whole GrainsNow, 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”.

EggsEggs

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 Meatfatty steak

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 products and heart diseaseDairy: 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?

dairy products and heart disease questionsA 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

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. 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?

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It’s Time For The Beach

Beach At SunsetThis 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 MuscleLevator 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 MuscleMasseter: 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!

tmj pain treatment reliefPlace 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

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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

Avocado

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.

 

Could Mom’s Stress Affect Her Baby’s Health?

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How Can You Minimize Stress During Pregnancy?

StressIf you are pregnant, the advice you see on the internet can be overwhelming. There are so many things you “must do” and so many things you “must avoid” if you want a healthy baby. It’s enough to stress you out.

As if that weren’t bad enough, we are probably living through the most stressful period in recent memory. So, the last thing you want to hear is that your stress during pregnancy can affect the health of your baby.

Before I go any further, let me make it clear that the studies I will discuss in this issue of “Health Tips From the Professor” are intriguing, but they are preliminary. I don’t want to add to your stress.

Let me start by reviewing the literature:

  • Several studies suggest that stress during pregnancy is associated with preterm birth, low birthweight, and infant mortality.
  • Other studies suggest that stress during pregnancy is associated with suboptimal cognitive development, hyperactivity, and asthma in the offspring.

The big question, of course, is how a mom’s stress during pregnancy can affect the health of her child months or years later. One hypothesis is that stress affects the mom’s gut bacteria, and those gut bacteria are passed along to the child as he or she passes through the birth canal.

We know that stress can affect your gut bacteria, but can it affect your child’s gut bacteria? Studies in mice suggest it can. Today I will discuss the first large clinical study (AK Aatsinki et al, Pyschoneuroendocrinology, 119 (2020) 104754) designed to evaluate that hypothesis in humans.

How Was This Study Done?

Clinical StudyThis study was an offshoot of an ongoing FinnBrain Cohort Project, which aims to study the influence of stress exposures during pregnancy on later childhood development and health outcomes. This particular study was designed to investigate the role of chronic stress during pregnancy on the population of gut bacteria in infants. There were 399 mothers and their babies who completed this study.

All Participants in the FinnBrain Project:

  • Filled out self-reported prenatal questionnaires at gestational weeks 14, 24, and 34. These questionnaires provided background information about the health, weight, age, and education level of the moms, as well as whether they were taking antidepression medications during their pregnancy.
  • Were also asked about breast feeding 2.5 months after giving birth.
  • Duration of gestation, birth weight, and method of delivery information were obtained from Finland’s National Institute for Health and Welfare.

Participants in this study:

  • Were evaluated for depression and anxiety symptoms three times during pregnancy and at 3 months after giving birth. It should be noted that the questionnaires used to evaluate depression and anxiety symptoms did not measure the stressors (events causing the stress). Instead they were measuring the mom’s response to those stressors.
  • Cortisol levels were measured at gestational week 24 as another measure of the mother’s stress level.
  • Fecal samples were obtained from the offspring at the age of 2.5 months and analyzed for the population of gut bacteria.

Could Mom’s Stress Affect Her Baby’s Health?

Bad BacteriaThe results of this study were intriguing:

Infants born to mothers who experienced high levels of stress (such as depression and/or anxiety) during pregnancy had an increased abundance of potentially pathogenic gut bacteria such as:

  • Serratia, Haemophilus, Citrobacter, and Campylobacter from the Proteobacteria group of bacteria.
  • Veillonella and Finegoldia from the Firmicutes group of bacteria.

In addition, infants born to mothers with elevated cortisol levels (another measure of stress) had decreased abundance of potentially health promoting gut bacteria such as Lactobacillus.

In contrast:

  • Infants born to mothers who experienced low levels of stress had increased levels of potentially health promoting gut bacteria, such as Akkermansia.
  • Infants born to mothers with low cortisol levels had an increased abundance of Lactobacillus in their gut.

In short:

  • High levels of stress in the mother during pregnancy are associated with an increased abundance of unhealthy bacteria in their baby’s intestine.
  • Low levels of stress in the mother during pregnancy are associated with an increased abundance of healthy bacteria in their baby’s intestine.

The authors concluded:

“The observed fecal bacteria signature in the infants with exposure to chronic maternal stress, such as increased abundance of potentially inflammatory bacteria from the Proteobacteria group of bacteria, warrant future follow-up of these children, since similar alterations of fecal bacteria have previously been associated with adverse health outcomes such as asthma in children.

The results of this study describe only associations, yet corroborate certain interesting findings reported in earlier literature and offer hypotheses for future mechanistic studies.”

How Can You Minimize Stress During Pregnancy?

Simply put, this study shows that chronic stress during pregnancy increases populations of gut bacteria in the newborn that are associated with adverse health outcomes in children. More studies are needed to confirm and understand this observation, but it raises an issue that is often ignored.

Pregnancy can be a stressful time, especially if you are a first-time mom. Plus, we are living in the most stressful time any of us can remember. So, this study is particularly relevant today.

However, let’s put this into perspective. It’s not the stress in our lives that harms us. It is how we respond to the stress. This study did not measure stress, per se. It measured depression, anxiety, and cortisol levels associated with the stress.

Some of the women in this study had very low levels of all three. It wasn’t that they led stress-free lives. They simply coped better with stress. So, the real question isn’t how to minimize stress. It’s how to better cope with stress. Here are some suggestions.

1) Take time to relax. What you do with this time will be different for each of you. Think about what kind of activity relaxes you the most. Here are some suggestions.

    • Meditation or prayer.
    • Yoga or Tai chi.
    • Watching a comedy.
    • Listening to your favorite music.

2) Make time for hobbies. Again, these would be different for each of you. They should be something that you enjoy and engages your mind. Examples include:

    • Reading.
    • Creating your favorite art. It could be painting, pottery, or knitting, for example.
    • Playing your favorite sport such as golf or tennis.
    • Doing puzzles.
    • Playing cards or board games.
    • Watching a movie.

3) Exercise on a regular basis. Exercise produces endorphins that elevate your mood. It’s even better if you are exercising outdoors so you can enjoy nature or listening to your favorite music while you exercise.

4) Relax your muscles. This is particularly important after you have exercised. Examples include:

    • Do some stretching exercises.
    • Take a luxurious hot bath.
    • Set a regular time to go to bed and get a good night’s sleep.
    • Get a massage.

5) Eat a healthy diet. Studies have shown that people who eat lots of junk and processed foods tend to be depressed and anxious. Aim for a whole food diet with lots of fruits and vegetables. That kind of diet is best for your baby as well.

6) Try deep breathing exercises.

7) Ask for support from your family members, especially if they are stressors in your life.

8) Talk with someone. Find a friend or family member who is willing to listen and support you.

In short, take care of yourself. Don’t let stress affect your health and the health of your baby.

The Bottom Line

Pregnancy can be a stressful time, especially if you are a first-time mom. Plus, we are living in the most stressful time any of us can remember. That is why a recent study is particularly relevant.

Simply put, the study showed that chronic stress during pregnancy increases populations of gut bacteria in the newborn that are associated with adverse health outcomes in children. More studies are needed to confirm and understand this observation, but it raises an issue that is often ignored.

However, let’s put it into perspective. It’s not the stress in our lives that harms us. It is how we respond to the stress. This study did not measure stress, per se. It measured depression, anxiety, and cortisol levels associated with the stress.

Some of the women in this study had very low levels of all three. It wasn’t that they led stress-free lives. They simply coped better with stress. So, the real question isn’t how to minimize stress. It’s how to better cope with stress.

For more details and a discussion on how to cope with stress, read the article above.

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

What Is The Truth About Eating Eggs And Heart Disease?

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Have The Dangers Of Eggs Been “Eggagerated”?

egg confusionIt’s no wonder you are confused about whether or not eggs are good for you. The advice you have been given about eggs over the years has been constantly changing.

Eggs are an affordable source of high-quality protein, iron, unsaturated fats, phospholipids like lecithin and choline, and carotenoids. That almost qualifies them as a health food. However, they are also a major source of cholesterol in the American diet. Back when we thought of dietary cholesterol was bad for us, that made eggs the enemy.

Then we discovered that dietary cholesterol has relatively little effect on blood cholesterol levels. It was obesity plus saturated fat and sugar in our diet that raised blood cholesterol levels and increased our risk of heart disease.

Then several studies reported that eggs did not increase our risk of heart disease. A study out of China even found that eggs decreased the risk of heart attack and hemorrhagic stroke. Suddenly, eggs became our best friend.

That only lasted a few years until a study from the United States reported that eggs increased your risk of heart disease, and a study from Europe reported that eggs increased your risk of hemorrhagic stroke. Eggfusion (egg confusion) reigned.

Most of these studies were large studies. They followed their participants for 5-10 years. Why were their results so confusing? A careful analysis of the studies shows that most of them suffered from three major weaknesses.

  • They only measured egg consumption at the beginning of the study. This fails to account for the fact that egg consumption has waxed and waned over the years as eggs have gone from enemy to friend and back to enemy.
  • They did not assess how the overall diet influences the effect of egg consumption on heart disease. If we believe the previous studies, eggs lower the risk of heart disease and hemorrhagic stroke in China and increase the risk of both in the United States and Europe. This suggests that overall diet is important, but this hypothesis has not been tested.
  • They also did not address the question of whether eggs, because of their cholesterol, might have a more adverse effect on heart disease in individuals who already have high blood cholesterol and have difficulty controlling their cholesterol levels.

That is why the study (JP Drouin-Chartier et al, British Medical Journal, 368:m513, 2020) I am reporting on today is so important. It is a huge study, much larger than any previous study on the topic. Plus, it was designed in such a way that it had none of the weaknesses of previous studies.

How Was The Study Done?

Clinical StudyThis 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 173,563 women and 42,055 men and followed them for an average of 32 years. All the participants were free of heart disease, type 2 diabetes, and cancer at the time they were enrolled. The design of these studies was extraordinary.

  • A detailed food frequency questionnaire was administered every 2-4 years. This allowed the investigators to calculate cumulative averages of all dietary variables, including egg intake. This assured that the effects of egg consumption and diet represented the participant’s diet over the 32-year duration of 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 disease and medicine use for each participant during the study. More importantly, 32 years is long enough to measure the onset of diseases like heart disease, diabetes, and cancer – diseases that require decades to develop.
  • The endpoint of the study was “incident heart disease”, which the investigators defined as non-fatal heart attack, death from heart disease, and fatal and non-fatal stroke. During this study, 14,806 participants developed incident heart disease. This was a large enough number for a detailed statistical analysis of the data.
  • For example, statistical analysis showed that the participants with the highest egg intake also were more likely to be obese and more likely to consume red meat, bacon and other processed meats, refined grains, French fries, and sugar-sweetened beverages. These are what we refer to as “confounding variables” because they also increase the risk of heart disease and are likely to confound (confuse) the analysis. Therefore, the investigators statistically corrected the data on egg consumption for these confounding variables. Many previous studies did not have the data or statistical power to correct their egg consumption data for these confounding variables.

In short, this study was much larger, ran far longer, and was better designed that any of the previous studies on egg consumption and heart disease risk. However, the authors did not stop there. They also performed a meta-analysis of 28 previous studies with a total of 1,720,108 participants and 139,195 cardiovascular disease events.

The only weakness in this study is that only 2% of the participants ate more than one egg per day. Consequently, it cannot address the health consequences of eating more than one egg per day on a regular basis.

Before sharing the results of this study with you, I need to provide some background about how our bodies regulate blood cholesterol levels. So, let’s move on to my favorite topic, “Biochemistry 101”.

Biochemistry 101: Cholesterol Metabolism

ProfessorMost people think of cholesterol only as a bad thing – something that can kill us. Nothing could be further from the truth. In fact, cholesterol is essential for life.

  • Our body makes vitamin D and coenzyme Q10 from cholesterol.
  • Our body makes steroid hormones such as cortisol, estrogen, and testosterone from cholesterol.
  • Cholesterol is a vital component of the myelin sheath that coats our nerve cells.
  • And that is just the beginning.

Because cholesterol is essential, our body makes its own cholesterol and has an elegant control system that keeps our blood cholesterol levels right where they should be.

  • When we get lots of cholesterol from our diet, our body makes less and excretes any excess.
  • When we get little cholesterol from our diet, our body makes more and excretes less.

Unfortunately, many Americans muck up this elegant control system. There are several factors that can throw our body’s ability to regulate blood cholesterol levels out of whack, leading to elevated blood cholesterol levels and increased risk of heart disease. For example:

  • Obesity
  • Type 2 diabetes
  • Diets high in saturated fats
  • Diets high in sugar and refined carbohydrates
  • Genetics

And it’s not just elevated cholesterol that is the problem. These same factors are associated with inflammation, which also increases the risk of heart disease.

Of course, we can’t do anything about our genetics, but the other factors are under our control. Let’s keep that in mind as we look at the results of this study.

What Is The Truth About Eating Eggs And Heart Disease?

the truth signWhen the investigators looked at their combined data from the Nurse’s Health Studies and the Health Professional’s Study:

  • There was no difference in heart disease outcomes for participants consuming an average of one egg/day and participants consuming less than one egg/month.
  • When the investigators examined heart attack and stroke separately, there was no difference in either outcome for participants consuming an average of one egg/day and participants consuming less than one egg/month.
  • As mentioned above the participants who consumed the most eggs weighed more; were less physically active; were more likely to be current smokers; and were more likely to consume red meat, processed meats, refined grains, potatoes (think French fries and potato chips), full fat milk, and sugar-sweetened beverages.
    • Without correcting for these factors eating one egg/day resulted in a 10% increase in heart disease risk.
    • After correcting for these factors, eating one egg/day resulted in a 7% decrease in heart disease risk.
    • In both cases the differences were statistically non-significant. However, they were in line with the previous studies mentioned above.

When they looked at the data generated by their meta-analysis of 28 studies:

  • There was no association between heart disease risk and egg consumption.
    • In Asian countries where the diet was primarily unrefined, plant-based foods, egg consumption decreased heart disease risk.
    • In people with type 2 diabetes, egg consumption increased heart disease risk.

The authors concluded “…moderate egg consumption (up to one egg/day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.”

The authors also noted that their data did not allow them to evaluate the effect of consuming more than one egg/day.

Have The Dangers Of Eggs Been “Eggagerated”?

are eggs good for youThis study clears up a lot of confusion about egg consumption and heart disease risk. The problem is that the scientific and medical communities have been looking for a “one size fits all” recommendation about egg consumption. This study shows us that the reality is much more complicated. Let me describe my interpretation of the data.

I think the results of this and previous studies are best described by the phrase, “Eggs are a healthy part of a healthy diet”. Here is what I mean by that.

  • If you are consuming a primarily plant-based diet, your body is fully able to regulate your blood cholesterol levels. Then, you can reap the full benefits of the egg, namely the protein, iron, unsaturated fats, lecithin, choline, and carotenoids it provides. Under these conditions, eating up to one egg/day reduces your risk of heart disease.
  • If you are consuming a diet that contains primarily chicken or fish and unprocessed plant foods, egg consumption is neutral. It neither increases nor decreases your risk of heart disease.
  • If you are consuming a diet that contains sugar-sweetened beverages, red and processed meats, high fat dairy products, refined grains, and junk foods (ie, the typical American diet), your body is no longer able to regulate blood cholesterol levels well. Now the cholesterol content of eggs becomes an issue and consuming one egg/day slightly increases your risk of heart disease.
  • If you are overweight and have developed type 2 diabetes, your body has become insulin resistant. This also interferes with your body’s ability to regulate blood cholesterol levels. In this situation, consuming one egg/day also increases your risk of heart disease.

The caveat is, of course, that these conclusions are based averages, and none of us are average.

The Bottom Line

You are probably aware that the effect of egg consumption on heart disease risk is controversial. Some studies report that egg consumption has no effect on heart disease risk. Other studies report egg consumption decreases heart disease risk. Still other studies report that egg consumption increases heart disease risk. No wonder you are confused.

A recent study has cleared up much of the confusion. This was not just another study. This study was much larger, ran far longer, and was better designed that any of the previous studies.

If you look at this and previous studies, it becomes clear that the effect of egg consumption on heart disease risk is strongly influenced by your overall diet and lifestyle.

  • If you are consuming a primarily plant-based diet, your body is fully able to regulate your blood cholesterol levels. Then, you can reap the full benefits of the egg, namely the protein, iron, unsaturated fats, lecithin, choline, and carotenoids it provides. Under these conditions, eating up to one egg/day reduces your risk of heart disease.
  • If you are consuming a diet that contains primarily chicken or fish and unprocessed plant foods, egg consumption is neutral. It neither increases nor decreases your risk of heart disease.
  • If you are consuming a diet that contains sugar-sweetened beverages, red and processed meats, high fat dairy products, refined grains, and junk foods (ie, the typical American diet), your body is no longer able to regulate blood cholesterol levels well. Now the cholesterol content of eggs becomes an issue and consuming one egg/day slightly increases your risk of heart disease.
  • If you are overweight and have developed type 2 diabetes, your body has become insulin resistant. This also interferes with your body’s ability to regulate blood cholesterol levels. In this situation, consuming one egg/day also increases your risk of heart disease.

In short, eggs are a healthy part of a healthy diet.

For more details, read the article above. You may also want to read the section “Biochemistry 101: Cholesterol Metabolism” to gain a better understanding of the mechanism behind these statements.

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

Can Vitamin C Prevent Heart Disease?

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Where Should I Get My Vitamin C?

vitamin CThe vitamin C controversy continues. Some people call vitamin C a “miracle” nutrient. Others consider it little more than “fairy dust”. What is the truth?

Let’s look at the effect of vitamin C on heart disease risk as an example of why it is so difficult to resolve questions like this.

Association studies are ideal for measuring long-term effects of nutrient consumption on health outcomes. These studies have consistently found an inverse association between dietary vitamin C and plasma vitamin C levels with the risk of heart disease. Simply put, the more vitamin C from dietary sources, the lower the risk of heart disease.

However, association studies do not prove cause and effect. The primary reason for this is that association studies are complicated by “confounding variables”. For example, most vitamin C in the diet comes from fruits and vegetables. So, the question arises, “Is it the vitamin C in fruits and vegetables that is responsible for the decreased heart disease risk, or is it the fiber that is also present in fruits and vegetables?” Previous studies have not been designed to answer this question.

Placebo-controlled clinical trials solve the confounding variable issue because they involve supplementation with pure vitamin C or a placebo. There is only a single variable. However, placebo-controlled clinical trials only last for a short time. That means they can measure biological markers that may affect heart disease risk but seldom last long enough to directly measure the effect of vitamin C on heart disease risk.

For example, previous studies have shown that high-dose (500 to 4,000 mg/day) supplementation with vitamin C improves the function of the endothelial lining of our blood cells and reduces blood pressure. These are biological markers that might be expected to reduce heart disease risk.

However, heart disease takes decades to develop. No studies of vitamin C supplementation have lasted long enough to show an actual decrease in heart disease outcomes.

In today’s issue of “Health Tips From The Professor” I would like to address three questions:

1) Does dietary vitamin C reduce heart disease risk?

2) How much of the risk reduction is due to the fiber content of fruits and vegetables rather than their vitamin C content?

3) Does supplementation with vitamin C reduce heart disease risk?

I will focus on a recent study (N Martin-Calvo and MA Martinez-Gonzalez, Nutrients, 9: 954, 2017, doi.org/10.3390/nu909054) that was designed to answer these questions.

How Was The Study Done?

Heart Health StudyThis study was an offshoot of an ongoing Spanish research program called Seguimiento Universidad de Navarra (SUN) follow-up study. This program is following graduates of the University of Navarra to gauge the effect of diet and lifestyle on health outcomes.

Health, lifestyle, and diet information is collected when graduates enroll in the program and by mailed questionnaires every two years thereafter.

Graduates who were enrolled in the SUN program in 2014 or earlier were invited to participate in this vitamin C and heart disease study.

  • Vitamin C intake from diet and from supplements was assessed from the dietary analysis.
  • A diagnosis of heart disease was obtained from the Health questionnaire and confirmed by physician follow-up.
  • Deaths due to heart disease were obtained from the Spanish National Death Index cross-referenced to participants in the study and were confirmed by participants next of kin, work associates, or postal authorities.

The study excluded:

  • Participants with pre-existing heart disease at the beginning of the study.
  • Participants who were younger than 40 at the beginning of the study.
  • Participants with either very high or very low vitamin C intake.

That left 13,421 participants who were young (average age = 42), at a healthy weight (average BMI = 24), healthy, and taking few medications.

Can Vitamin C Prevent Heart Disease?

Healthy HeartThe 13,421 participants in this study were followed for an average of 11 years.

They were divided into three groups based on their vitamin C intake.

  • Group 1 averaged 148 mg/day.
  • Group 2 averaged 257 mg/day.
  • Group 3 averaged 445 mg/day.

There are two noteworthy observations about their vitamin C intake:

  • None of the groups were vitamin C deficient. All three groups were getting well above the RDA for vitamin C (75 mg/day for women and 90 mg/day for men).
  • Most of the vitamin C came from fruits and vegetables in the diet. The group with the highest vitamin C intake (445 mg/day) only averaged about 10 mg/day from supplements.

The results of the study were intriguing. When the investigators compared the group with the highest vitamin C intake to the group with the lowest vitamin C intake:

  • Vitamin C significantly decreased both the risk of developing heart disease and the risk of dying from heart disease.
    • Statistically adjusting the data for age, gender, weight, lifestyle, and medicine use did not affect the outcome.
    • Statistically adjusting the data for fiber from sources other than fruits and vegetables did not affect the outcome.
    • Statistically adjusting the data for adherence to a healthy diet (the Mediterranean diet) did not affect the outcome.

However, when the data were statistically adjusted for total fiber (including fiber from fruits and vegetables) the high fiberresults painted a slightly different picture. With this adjustment:

  • Vitamin C decreased the risk of developing heart disease by 26%, but this decrease was not statistically significant.
  • Vitamin C decreased the risk of dying from heart disease by 70%, and this decrease was highly significant.

This was the first study to consider the relative importance of vitamin C from fruits and vegetables and fiber from fruits and vegetables on heart disease outcomes and the results were interesting. Here are the important conclusions.

1) Both the fiber and the vitamin C from fruits and vegetables contributed to a decreased risk of developing heart disease. This study was unable to separate their contributions.

Of course, it is important to note that this was a young, healthy population, none of whom were deficient in vitamin C. It would be interesting to repeat this study with an older, sicker population with a more restrictive diet.

2) Vitamin C from fruits and vegetables reduced the risk of dying from heart disease independent of the beneficial effects of fruit and vegetable fiber.

3) This study was not able to address the effect of vitamin C supplementation on heart disease risk. That is because the Spaniards supplement much less frequently than Americans and this study excluded anyone with unusually high vitamin C intake. The average supplemental vitamin C in the 3 groups ranged from 0.56 mg/day to 9.6 mg/day.

4) This study also emphasizes the importance of getting fiber from a variety of food sources. It showed that fiber from fruits and vegetables was more beneficial at reducing heart disease risk than fiber from other food sources. That means restrictive diets that eliminate fruits and/or vegetables may be bad for your heart.

Where Should I Get My Vitamin C?

Vegan FoodsThis study reinforces the importance of getting lots of fresh fruits and vegetables in your diet.

  • You could make a list of all the vitamin C-rich fruits and vegetables like citrus fruits, red & green peppers, broccoli, etc. and make sure you are including them in your diet.
  • You could total up the vitamin C in each food you eat and try to reach the 445 mg/day in the group with the highest vitamin C in this study.

However, it doesn’t have to be that complicated. If you eat a primarily plant-based diet, aim for 5-9 servings of fruits and vegetables a day, and “eat the rainbow” you will get plenty of vitamin C from your diet.

Also, don’t worry about whether the benefits of fruit and vegetable consumption come from their vitamin C or from their fiber. That’s the beauty of eating whole foods. You get both in the same package.

Of course, you are probably also wondering whether vitamin C supplementation will reduce your risk of heart disease. As I described earlier, there are lots of reasons for thinking that vitamin C supplementation might decrease heart disease risk.

  • Several studies show that higher vitamin C intake and higher vitamin C levels in the blood are associated with lower heart disease risk.
  • This study showed that vitamin C reduces the risk of dying from heart disease independent of fiber from fruits and vegetables and independent of an overall healthy diet. This suggests that vitamin C plays an independent role in reducing heart disease risk.
  • Placebo controlled clinical trials show that vitamin C supplementation reduces risk factors that contribute to heart disease.

However, none of these studies prove that vitamin C supplementation reduces heart disease risk. That requires placebo-controlled clinical trials measuring the effect of vitamin C supplementation on heart disease outcomes. Unfortunately, these studies are usually doomed to failure.

Chronic diseases like heart disease takes decades to develop. Placebo-controlled, randomized studies are almost never large enough or last long enough to show an effect of supplementation on chronic diseases.

The best we can say at present is that vitamin C supplementation along with a primarily plant-based diet with lots of colorful fruits and vegetables may reduce your risk of heart disease.

The Bottom Line

A recent study in Spain followed 13,421 healthy college graduates with an average age of 42 for 11 years and looked at the effect of vitamin C intake on the risk of developing heart disease and the risk of dying from heart disease.

This was the first study to consider the relative importance of vitamin C from fruits and vegetables and fiber from fruits and vegetables on heart disease outcomes and the results are intriguing. Here are the important conclusions.

1) Both the fiber and the vitamin C from fruits and vegetables contributed to a decreased risk of developing heart disease. This study was unable to separate their contributions.

Of course, it is important to note that this was a young, healthy population, none of whom were deficient in vitamin C. It would be interesting to repeat this study with an older, sicker population with a more restrictive die

2) Vitamin C from fruits and vegetables reduced the risk of dying from heart disease by 70%, and this effect was independent of the beneficial effects of fruit and vegetable fiber.

3) This study was not able to address the effect of vitamin C supplementation on heart disease risk. That is because the Spaniards supplement much less frequently than Americans and this study excluded anyone with unusually high vitamin C intake. The average supplemental vitamin C in the 3 groups ranged from 0.56 mg/day to 9.6 mg/day.

4) This study also emphasizes the importance of getting fiber from a variety of food sources. It showed that fiber from fruits and vegetables was more beneficial at reducing heart disease risk than fiber from other food sources. That means restrictive diets that eliminate fruits and/or vegetables may be bad for your heart.

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.

Is Stress Causing My Headaches?

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“It’s Summertime, and the Living Is…Stressful”

headacheIt’s hot out, the birds are chirping, the air is pretty still, and the rains are often torrential.  It’s summer and under normal circumstances things slow down as people take vacations or just go to sit at the beach or pool.  Normally, we would be singing that old favorite, “It’s summertime and the living is easy”.

But this year is different! This summer’s song could be, “It’s summertime and the living is stressful.

We’ve all been affected by COVID19 in some manner, life is more complicated for most of us, and stress-levels have increased for a lot of people. Since stress often causes headache pain, today’s newsletter is going to focus on relieving stress headaches.

Stress Can Tighten Your Muscles

Constant stress can tie your muscles into knots.   It is important to do things to relieve the stress that the current events are placing on your body.  Maybe you aren’t going to the gym, but you can go out for a long, fast walk.  You could even bring some light hand weights and be pumping your arms as you walk.  If you have access to a pool, swimming is a great way to get exercise without stressing the body – with social distancing, of course.

There are several muscles that cause headaches. Unfortunately, it’s rare that anyone in the medical field will check out muscles while looking for the source of headache pain.

Is Stress Causing My Headaches?

As I said above, chronic stress can cause your muscles to tighten, and tight muscles can cause headaches. I will discuss two of the main offenders today.

Treating Temporalis MuscleOne muscle that causes headaches is called the Temporalis.  This muscle is the shape of a fan and is at the temples of your skull, behind your eyes and above your ears.  It not only causes headaches. It also causes pain into your top teeth!

To treat your Temporalis muscle, take your three middle fingers and press on the muscle as shown in the picture to the left.

Find the tender point, only pressing enough to feel it, but not so much that you want to faint. Hold the pressure for a minute and then move your fingers slightly up and down, without sliding on your skin.

Release the pressure for about 15 seconds and repeat this sequence until the pain is gone.

Do this treatment on both sides of your skull.  Stay still on any “hot spots” as they are the actual spasm that is causing the problem. You’ll be surprised at how the pain and tenderness will diminish as you continue to do the whole treatment for just a few minutes.

Levator Scapulae MuscleAnother key headache muscle is the Levator Scapulae, a muscle that originates on your cervical vertebrae and inserts into your shoulder blade.  When this muscle is in spasm it will pull your cervical vertebrae to the side and down and press the bone into your spinal cord at the base of your brain.  

Looking at how the levator scapulae muscle attaches to the vertebrae in your neck will explain why it is an important cause of stress headaches.

The levator scapulae originates on the top four cervical vertebrae (see small box) and inserts into the top of your shoulder blade.  When the muscle contracts normally you lift up your shoulders. The nickname for this muscle is “the shrug muscle” because of its action.

However, when it gets tight it will pull the insertions at your neck 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!

Fortunately, you can treat the levator scapulae muscle, release the tension on the cervical vertebrae, and by treating the muscles in the back of your neck that become involved as the vertebrae move, you can stop the headache. It usually takes a while, maybe even two days. I wish I could tell you it’s immediate, but the important thing is you can stop the pain.

If you have suffered from headaches and your doctor has tested you to be sure it isn’t something more serious, then you’ll be pleased with the results of the Julstro™ self-treatments.

Relief From Stress Headaches Caused By A Tight Levator Scapula Muscle

Let me take you through the treatment step by step.

Relaxing Levator Scapulae MuscleStep 1: Relaxing the Spasms in Your Shoulders 

 You start by relaxing the spasms in your shoulders. While it can be awkward at first, you can very effectively treat your levator scapulae muscle by using a ball and pressing into the corner of a wall.

Put the Julstro Perfect ball directly on the top of your shoulder. Then lean straight into the corner of a wall.

Move slightly until you feel the pressure being focused on the knot at the top of your shoulder.

This treatment is for both your levator scapulae muscle and your trapezius muscle.

Step 2: Treating Your Levator Scapulae Muscle. 

Once you have loosened up the spasms in your shoulders, continue working on the levator scapulae muscle. You can also treat both by squeezing them with your fingers. We’ll demonstrate by treating your right shoulder. Naturally, you can do the same treatment on the opposite shoulder.

Bend your left arm and support you elbow with your right hand. Put your left three middle fingers on your right Treating Levator Scapulae Muscle shoulder at the point where the shoulder and neck meet. It helps if you place it so your thumb and pointer finger are close to your neck with the middle finger being the working finger right on the junction, just a bit toward the back. Your four fingers should be crooked at each joint of the hand and your palm should be flat against your body.

Staying in the same spot, relax your arm with your elbow close to the middle of your chest. In this position you will probably have your middle finger directly on the spasm point. All the strength from this move is coming from your upper arm, not from your fingers. To do that you will simply make sure that your middle finger is on the sore spot and then pull your elbow down toward the floor. Your finger will be like a hook that presses into the spasm.

If you feel your fingers getting tired, you are using your hand to give strength and not your arm. Once you feel the difference, it will be easy to do again. After you have found the trigger point and you are adding pressure to it, continue pressing into the knot.

Treating Levator Scapulae Muscle 2Next, keep your hand in the same spot, still pressing on the knot. Take your thumb, flip over onto the front of your shoulder, and push it straight into the muscle. This will move your thumb to a place that will now cause you to be pinching the knot.

You’ll feel if you have it right. You should have a fairly thick piece of muscle between the middle finger and the thumb. You can inch your three middle fingers back a bit if you find you aren’t gripping the entire thickness of the muscle.

If all you are feeling is skin between your fingertips, go back and try again. When you know you have a thick piece of muscle, grip tightly and release. Do this four times for 15 seconds each time.

 

Step 3: Stretching the Muscles in Your Shoulder

Now that you have worked out the knots, you are ready to stretch your shoulder muscles. Rotate your head a bit Stretching Levator Scapulae Muscleso your ear is angled toward the front of your chest. By doing this you will be adding additional stretch to the trigger point and releasing it at the same time.

Finally, continue holding the muscle and move your head as shown. Hold this for 15 seconds and release the pressure. When you finish, release your grip and shake out your shoulders. Then do it again, three more times, holding each stretch for 15 seconds.

You will really feel a great deal of relief when you ease the tension in this muscle.  This process will become easy after you play with it for a while and get the hang of squeezing the ball of knots that are on the top of your shoulder.

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.

Should I Avoid Whole Grains?

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Will Whole Grains Kill Me?

Whole GrainsIt seems like just yesterday that health experts all agreed that whole grains were good for us. After all:

  • They are a good source of fiber, B vitamins, vitamin E, and the minerals magnesium, iron, zinc, manganese, and selenium.
  • Their fiber fills you up, so you are less likely to overeat. This helps with weight control.
  • Their fiber also supports the growth of friendly bacteria in your gut.

In fact, the USDA still recommends that half of the grains we eat should be whole grains. And, outside experts, not influenced by the food industry, feel this recommendation is too low. They feel most of the grains we eat should be whole grains. Foods made from refined grains should be considered as only occasional treats.

Then the low-carb craze came along. Diets like Paleo and Keto were telling you to avoid all grains, even whole grains. Even worse, Dr. Strangelove and his colleagues were telling you whole grains contained something called lectins that were bad for you. Suddenly, whole grains went from being heroes to being villains.

You are probably asking, “Should I avoid whole grains?” What is the truth? Perhaps the best way to resolve this debate is to ask, how healthy are people who consume whole grains for many years? This week I share a recent study (G Zong et al, Circulation, 133: 2370-2380, 2016) that answers that very question.

How Was The Study Done?

This study was a meta-analysis of 14 clinical trials that:

  • Enrolled a total of 786,076 participants.
  • Obtained a detailed diet history at baseline.
  • Followed the participants for an average of 15 years (range = 6-28 years).
  • Determined the effect of whole grain consumption on the risk of death from heart disease, cancer, and all causes.

Will Whole Grains Kill Me?

deadDr. Strangelove and his colleagues are claiming that whole grains cause inflammation, which increases your risk of heart disease and cancer. Heart disease and cancer are the leading causes of death in this country. In fact, according to the CDC, heart disease and cancer accounted for 44% of all deaths in the US in 2017.

Therefore, if Dr. Strangelove and his colleagues were correct, consumption of whole grains should increase the risk of deaths due to heart disease and cancer – and increase the risk of death due to all causes.

That is not what this study showed.

When the highest whole grain intake (5 servings/day) was compared with the lowest whole grain intake (0 servings/day), whole grain consumption reduced the risk of death from:

  • Heart disease by 18%.
  • Cancer by 12%.
  • All causes by 16%.

Furthermore, the effect of whole grains on mortality showed an inverse dose response. Simply put, the more thumbs upwhole grains people consumed, the lower the risk of deaths from heart disease, cancer, and all causes.

However, the dose response was not linear. Simply going from 0 servings of whole grains to one serving of whole grains reduced the risk of death from.

  • Heart disease by 9%.
  • Cancer by 5%.
  • All causes by 7%.

The authors concluded: “Whole grain consumption was inversely associated with mortality in a dose-response manner, and the association with cardiovascular mortality was particularly strong and robust. These observations endorse current dietary guidelines that recommend increasing whole grain intake to replace refined grains to facilitate long-term health and to help prevent premature death.”

The authors went on to say: “Low-carbohydrate diets that ignore the health benefits of whole grain foods should be adopted with caution because they have been linked to higher cardiovascular risk and mortality.”

Should I Avoid Whole Grains?

Question MarkAs for the original question, “Should I avoid whole grains?”, the answer appears to be a clear, “No”.

The strengths of this study include the large number of participants (786,076) and the demonstration of a clear dose-response relationship between whole grain intake and reduced mortality.

This study is also consistent with several other studies that show whole grain consumption is associated with a lower risk of heart disease, diabetes, cancer – and appears to lead to a longer, healthier life.

In short, it appears that Dr. Strangelove and the low-carb enthusiasts are wrong. Whole grains aren’t something to avoid. They reduce the risk of heart disease, diabetes, and cancer. And they reduce the risk of premature death. We should be eating more whole grains, not less.

However, the authors did point out that this study has some weaknesses:

  • It is an association study, which does not prove cause and effect.
  • Study participants who consumed more whole grains also tended to consume more fruits and vegetables – and less red meat, sodas, and highly processed foods.

However, I would argue the second point is a strength, not a weakness. We need to give up the idea that certain foods or food groups are “heroes” or “villains”. We know that primarily plant-based diets like the Mediterranean and DASH diets are incredibly healthy. Does it really matter how much of those health benefits come from whole grains and how much comes from fruits and vegetables?

The Bottom Line

Dr. Strangelove and low-carb enthusiasts have been telling us we should avoid all grains, including whole grains. Is that good advice?

If Dr. Strangelove and his colleagues were correct, consumption of whole grains should increase the risk of deaths due to the top two killer diseases, heart disease and cancer. Furthermore, because heart disease and cancer account for 44% of all deaths in this country, whole grain consumption should also increase the risk of death due to all causes.

A recent study showed the exact opposite. The study showed:

When the highest whole grain intake (5 servings/day) was compared with the lowest whole grain intake (0 servings/day), whole grain consumption reduced the risk of death from:

  • Heart disease by 18%.
  • Cancer by 12%.
  • All causes by 16%.

Furthermore, the effect of whole grains on mortality showed an inverse dose response. Simply put, the more whole grains people consumed, the lower the risk of deaths from heart disease, cancer, and all causes.

However, the dose response was not linear. Simply going from 0 servings of whole grains to one serving of whole grains reduced the risk of death from.

  • Heart disease by 9%.
  • Cancer by 5%.
  • All causes by 7%.

The authors concluded: “Whole grain consumption was inversely associated with mortality in a dose-response manner, and the association with cardiovascular mortality was particularly strong and robust. These observations endorse current dietary guidelines that recommend increasing whole grain intake to replace refined grains to facilitate long-term health and to help prevent premature death.”

The authors went on to say: “Low-carbohydrate diets that ignore the health benefits of whole grain foods should be adopted with caution because they have been linked to higher cardiovascular risk and mortality.”

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 Maternal Vitamin D Affect Childhood ADHD?

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Can ADHD Be Prevented?

vitamin dIf you are pregnant, or of childbearing age, should you be supplementing with vitamin D? Increasingly, the answer appears to be yes.

1) Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

    • 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).
    • 25% of pregnant women have insufficient vitamin D status (30-49 nmol/L).

In short, that means around 1/3 of pregnant women in the US have insufficient or deficient levels of vitamin D. The effect of inadequate vitamin D during pregnancy is not just an academic question.

2) The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently concluded that supplementation with vitamin D reduces the risk of significant complications during pregnancy.

3) Another recent study found that inadequate vitamin D status during pregnancy delayed several neurodevelopmental milestones in early childhood, including gross motor skills, fine motor skills, and social development.

If neurodevelopmental milestones are affected, what about ADHD? Here the evidence is not as clear. Some studies have concluded that vitamin D deficiency during pregnancy increases the risk of ADHD in the offspring. Other studies have concluded there is no effect of vitamin D deficiency on ADHD.

Why the discrepancy between studies?

  • Most of the previous studies have been small. Simply put, there were too few children in the study to make statistically reliable conclusions.
  • Most of the studies measured maternal 25-hydroxyvitamin D levels in the third trimester or in chord blood at birth. However, it is during early pregnancy that critical steps in the development of the nervous system take place.

Thus, there is a critical need for larger studies that measure maternal vitamin D status in the first trimester of pregnancy. This study (M Sucksdorff et al, Journal of the American Academy of Child & Adolescent Psychiatry, 2020, in press) was designed to fill that need.

How Was The Study Done?

Clinical StudyThis study compared 1,067 Finnish children born between 1998 and 1999 who were subsequently diagnosed with ADHD and 1,067 matched controls without ADHD. There were several reasons for choosing this experimental group.

  • Finland is among the northernmost European countries, so sun exposure during the winter is significantly less than for the United States and most other European countries. This time period also preceded the universal supplementation with vitamin D for pregnant women that was instituted in 2004.

Consequently, maternal 25-hydroxyvitamin D levels were significantly lower than in most other countries. This means that a significant percentage of pregnant women were deficient in vitamin D, something not seen in most other studies. For example:

    • 49% of pregnant women in Finland were deficient in vitamin D (25-hydoxyvitamin D <30 nmol/L) compared to 8-11% in the United States.
    • 33% of pregnant women in Finland had insufficient vitamin D status (25-hydroxyvitamin D 30-49.9 nmol/L) compared to 25% in the United States.
  • Finland, like many European countries, keeps detailed health records on its citizens. For example:
    • The Finnish Prenatal Study collected data, including maternal 25-hydroxyvitamin D levels during the first trimester), for all live births between 1991 and 2005.
    • The Care Register for Health Care recorded, among other things, all diagnoses of ADHD through 2011.

Thus, this study was ideally positioned to compare maternal 25-hydroxyvitamin D levels during the first trimester of pregnancy with a subsequent diagnosis of ADHD in the offspring. The long-term follow-up was important to this study because the average age of ADHD diagnosis was 7 years (range = 2-14 years).

Does Maternal Vitamin D Affect Childhood ADHD?

Child With ADHDThe answer to this question appears to be a clear, yes.

If you divide maternal vitamin D levels into quintiles:

  • Offspring of mothers in the lowest vitamin D quintile (25-hydroxyvitamin D of 7.5-21.9 nmol/L) were 53% more likely to develop ADHD than offspring of mothers in the highest vitamin D quintile (49.5-132.5 nmol/L).

When you divide maternal vitamin D levels by the standard designations of deficient (<30 nmol/L), insufficient (30-49.9 nmol/L), and sufficient (≥50 nmol/L):

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

Can ADHD Be Prevented?

Child Raising HandI realize that this is an emotionally charged title. If you have a child with ADHD, the last thing I want is for you to feel guilty about something you may not have done. So, let me start by acknowledging that there are genetic and environmental risk factors for ADHD that you cannot control. That means you could have done everything right during pregnancy and still have a child who develops ADHD.

Having said that, let’s examine things that can be done to reduce the risk of giving birth to a child who will develop ADHD, starting with vitamin D. There are two aspects of this study that are important to keep in mind.

#1: The increased risk of giving birth to a child who develops ADHD was only seen for women who were vitamin D deficient. While vitamin D deficiency is only found in 8-11% of pregnant mothers in the United States, that is an average number. It is more useful to ask who is most likely to be vitamin D deficient in this country. For example:

  • Fatty fish and vitamin D-fortified dairy products are the most important food sources of vitamin D. Fatty fish are not everyone’s favorite and may be too expensive for those on a tight budget. Many people are lactose intolerant or avoid milk for other reasons. If you are not eating these foods, you may not be getting enough vitamin D from your diet. This is particularly true for vegans.
  • If you have darker colored skin, you may have trouble making enough vitamin D from sunlight. If you are also lactose intolerant, you are in double trouble with respect to vitamin D sufficiency.
  • Obesity affects the distribution of vitamin D in the body. So, if you are overweight, you may have low 25-hydroxyvitamin D levels in your blood.
  • The vitamin D RDA for pregnant and lactating women is 600 IU, but many multivitamin and prenatal supplements only provide 400 IU. If you are pregnant or of childbearing age, it is a good idea to look for a multivitamin or prenatal supplement that provides at least 600 IU, especially if you are in one of the high risk groups listed above.
  • Some experts recommend 2,000 to 4,000 IU of supplemental vitamin D. I would not recommend exceeding that amount without discussing it with your health care provider first.
  • Finally, for reasons we do not understand, some people have a difficult time converting vitamin D to the active 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in their bodies. If you are pregnant or of childbearing age, it is a good idea to have your blood 25-hydroxyvitamin D levels determined and discuss with your health care provider how much vitamin D you should be taking. Many people need more than 600 IU to reach vitamin D sufficiency status.

#2: Maternal vitamin D deficiency has a relatively small effect (34%) on the risk of the offspring developing ADHD. That means assuring adequate vitamin D status during pregnancy should be part of a holistic approach for reducing ADHD risk. Other factors to consider are:

  • Low maternal folate and omega-3 status.
  • Smoking, drug, and alcohol use.
  • Obesity.
  • Sodas and highly processed foods.

Alone, each of these factors has a small and uncertain influence on the risk of your child developing ADHD. Together, they may play a significant role in determining your child’s risk of developing ADHD.

In closing, there are three take-home lessons I want to leave you with:

1) The first is that there is no “magic bullet”. There is no single action you can take during pregnancy that will dramatically reduce your risk of giving birth to a child who will develop ADHD. Improving your vitamin D, folate, and omega-3 status; avoiding cigarettes, drugs, and alcohol; achieving a healthy weight; and eating a healthy diet are all part of a holistic approach for reducing the risk of your child developing ADHD.

2) The second is that we should not think of these actions solely in terms of reducing ADHD risk. Each of these actions will lead to a healthier pregnancy and a healthier child in many other ways.

3) Finally, if you have a child with ADHD and would like to reduce the symptoms without drugs, I recommend this article.

The Bottom Line

A recent study looked at the correlation between maternal vitamin D status during the first trimester of pregnancy and the risk of ADHD in the offspring. The study found:

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

In the article above I discuss what this study means for you and other factors that increase the risk of giving birth to a child who will develop ADHD.

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.

 

Can DNA Testing Help You Lose Weight?

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How Does DNA Testing Work Best?

Genetic TestingGenomics (DNA testing) is hot. You are being told that if you just knew your genes, you could lose weight successfully, be healthier, be happier, leap tall buildings in a single bound (Actually, I haven’t heard the last claim, but it’s about the only claim that genomics marketers haven’t made). Which of these claims are true, and which are just hot air?

The experts agree that the benefits of DNA testing have been greatly oversold. As I said in a recent article on DNA testing, the idea that genes control our destiny is no longer considered valid. There are 3 reasons for this. I will start with the scientific term for each and then give you the non-scientific explanation.

  • Penetrance simply means that the severity of most gene mutations is influenced by our genetic background. Simply put, the same mutation can have a significant effect in one individual and a trivial effect in another individual.
  • Epigenetics refers to modifications of the DNA that influence gene expression. These DNA modifications are, in turn, influenced by diet and lifestyle.
  • Microbiome refers our gut bacteria. In many cases, our microbiome has just as much influence on our health as our genes. And our microbiome is influenced by diet and lifestyle.

Now you know the complexity of DNA testing, it is easy to see why experts feel that it is premature to use DNA testing to predict the best diet for either weight loss or health.

As an example, one recent study used DNA testing to predict whether study participants were more likely to lose weight on a low-carb or low-fat diet. The participants were then randomly assigned to low-carb and low-fat diets. At the end of 12 months:

  • There was no significant difference in weight loss for those on low-fat and low-carb diets. This has been reported in multiple previous studies but is an inconvenient truth that most low-carb enthusiasts tend to ignore.
  • DNA testing offered no predictive value as to whether a low-carb or low-fat diet was more effective for weight loss.

However, DNA testing may have one benefit that is overlooked by many experts. What if the DNA test results motivated people to do better? After all, most diet advice is generic. People feel it may or may not apply to them. Does personalized diet advice based on their genetic makeup motivate people to stick with the diet better?

Some studies have suggested that people may follow personalized diet plans based on their DNA more faithfully. However, most of those studies have been short-term.

That is why I have chosen today’s study (J Horne et al, BMJ Nutrition, Prevention & Health, 2020) to discuss. It is a very well-designed study and it lasted for a full year.

How Was The Study Done?

Clinical StudyThis was an extremely well-designed study. In fact, it was so well designed that it probably needs the “Results are not typical” designation the FDA requires when some diet companies make claims about weight loss success. Here are the details:

  • The study participants were highly motivated, college educated, middle-aged (average age = 55), obese (average weight = 216 pounds) Caucasian women who had a positive attitude about their ability to change what they ate. In case you weren’t counting, there were four characteristics of this group that might be considered atypical for the average American.
  • The participants volunteered for a highly structured weight loss program called the “Group Lifestyle Balance”, or GLB, program.
    • Participants were given a detailed calorie-controlled nutrition plan at the beginning of the program.
    • They were asked to track their daily food and beverage intake for the first 2-3 months of the program.
    • In the second week of the program participants were educated on how to count and track calories and nutrients such as total fat or saturated fat.
    • There were weekly meetings with dietitians the first 3 months and monthly meetings for the remainder of the 12-week program to provide the guidance and support needed to stick with their nutrition plan.
  • The plan also incorporated a behavior change program called Theory of Planned Behavior (TPB) that evaluates and influences attitudes, subjective norms, and behavioral control that are key to behavior change. During the regular meetings:
    • The participants were informed about of the health benefits associated with a healthy lifestyle.
    • They were educated on positive mindsets and mindfulness.
    • They were taken through a stepwise, goal setting approach designed to positively impact behavioral change.

In short, this is a gold standard diet program that provided the nutritional support needed to stick with the diet program and the psychological support needed to change eating behavior. Unfortunately, this is also atypical. Very few diet programs provide this level of support.

Everyone in the study participated in this program. However, the participants were divided into two groups.

  • Both groups were advised to follow a standard calorie-controlled, moderately low-fat (25% of total calories) nutrition plan.
  • In addition, the second group was put on a plan that was either high protein or low saturated fat (<10% of total calories) based on their DNA test results.
  • The nutritional support was identical except that the second group was told that their nutrition plan was specific for them, based on their DNA analysis.
  • The dietary intake of both groups was assessed with a 3-day dietary recall (2 week days and 1 weekend day) at baseline (before the program began) and at 3, 6, and 12 months to assess the participants adherence to their diet plan.

Can DNA Testing Help You Lose Weight?

Happy woman on scaleI hate to disappoint you, but the short answer to this question, is no. Both groups lost the same amount of weight, which is not surprising considering the comprehensive nature of the diet program that both groups were enrolled in.

However, the group given advice based on their DNA test were more motivated to stick with their personalized nutrition goals. Specifically:

  • Long-term adherence to reductions in saturated fat intake was significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.
    • The control group reduced their saturated fat intake by 12% at 3 months, but only by 4% at 6 months, and 2.5% at 12 months.
    • The group with the personalized diet plan reduced their saturated fat intake by 14% at 3 months, 18% at 6 months, and 22% at 12 months.
  • Long-term adherence to reductions in total fat intake was also significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.
    • The control group reduced their total fat intake by 18% at 3 months, but only by 4% at 6 and 12 months.
    • The group with the personalized diet plan reduced their total fat intake by 11% at 3 months, 13% at 6 months, and 16% at 12 months.
    • It is important to remember that both groups had been advised to reduce their total fat intake to 25% of calories and had received nutritional and psychological support to achieve that goal. The only difference was that the second group had been told that advice was based on their DNA test.

The authors of the study concluded: “Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.”

How Does DNA Testing Work Best?

DNA TestingThere remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, this and other studies suggest that DNA testing may provide one valuable asset for weight loss programs. It appears that people are more likely to stick with a program they believe has been personalized for them.

There are, however, several caveats to this conclusion.

  • Participants in this study received nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.
  • Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.
  • This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.
  • Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

For example, DNA test results consistent with reduced carbohydrate intake are sometimes used to recommend unhealthy diets that eliminate one or more food groups rather than low-carb versions of healthy diets like the Mediterranean diet.

The Bottom Line

There remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, DNA testing may provide one valuable asset for weight loss programs. Some studies have suggested that people are more likely to stick with a program they believe has been personalized for them.

However, most of these studies have been short term. A recent study asked whether the improvement in motivation lasted for 12 months.

Two matched groups of well-educated, highly motivated women were enrolled in a “gold-standard” weight loss program that provided both nutritional and psychological support for 12 months.

Both groups were given a diet plan that restricted total calorie intake and advised reducing fat intake to 25% of total calories. However, based on their DNA test results one group was given a personalized diet plan that also advised them to reduce their saturated fat intake to less than 10% of total calories.

  • The group receiving personalized diet advice did a better job of reducing both saturated and total fat intake and maintaining that change for 12 months compared to the group that just received a set diet plan.
  • These results suggest that personalization of diet advice may improve long-term adherence to healthy dietary changes.

The authors of the study concluded: “Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.”

There are, however, several caveats to this conclusion.

  • Participants in this study received both nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.
  • Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.
  • This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.
  • Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

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.

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