The Effect Of Vitamin D On Childhood Development

April 7, 2020 by Dr. Steve Chaney

Is Vitamin D Important During Pregnancy?

If you are parents, you want the best for your child. It can be nerve wracking when your child doesn’t meet the expected developmental milestones. When I saw a recent study titled “Association of maternal vitamin D status in pregnancy and neurodevelopmental outcomes in children” ( AL Darling et al, British Journal of Nutrition, 117: 1682-1692, 2017), I knew you would want to hear about it.

But first a bit of background: 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 inadequate vitamin D status (30-49 nmol/L).

~65% of pregnant women have adequate vitamin D status (50-125 nmol/L).

~ 1% of pregnant women have high vitamin D levels (>125 nmol/L).

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

It is a concern because inadequate vitamin D levels during pregnancy has been associated with gestational diabetes (diabetes during pregnancy), low birthweight babies, and a condition called pre-eclampsia (pre-eclampsia is characterized by the development of high blood pressure during pregnancy and can lead to serious, even fatal, complications for mother and baby).

The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently reviewed the literature and has reported) that vitamin D during pregnancy “probably reduces the risk of pre-eclampsia, gestational diabetes, and the risk of having a low birthweight baby compared to placebo or no intervention.”

In short, this means the evidence is pretty good that inadequate vitamin D increases the risk of significant complications during pregnancy and that supplementation with vitamin D reduces the risk of those complications.

However, what about the effect of inadequate vitamin D during pregnancy on the development of the newborn child? Here the evidence is less clear. This study was designed to answer that question.

How Was The Study Designed?

This study followed neurodevelopmental milestones of 7065 children born to mothers in the Avon region of southwest England between April 1, 1991 and December 31, 1992. Maternal 25-hydroxy vitamin D levels were measured during pregnancy. The distribution of 25-hydroxy vitamin D levels in this population was very similar to that observed for pregnant mothers in the United States.

The children were followed from 6 months to 9 years of age and the following neurodevelopmental milestones were measured:

Gross-motor skills, fine-motor skills, social development, and communication skills were measured at 6, 18, 30, and 42 months.

Behavioral development (socialization, hyperactivity, emotional development, and conduct) was measured at 7 years.

IQ was measured at 8 years.

Reading skill (words/minute, accuracy, and comprehension) was measured at 9 years.

What Is The Effect Of Vitamin D On Childhood Development?

The study compared children of women who had inadequate vitamin D status (<50 nmol/L) during pregnancy to children of women who had adequate vitamin D status (≥50 nmol/L) during pregnancy. Here is what the study found:

The children of mothers with inadequate vitamin D during pregnancy had:

Delayed gross-motor skills at 18 and 30 months.

Delayed fine-motor skills at 30 and 42 months.

Delayed social development at 42 months.

However, when they looked at later years, there was no significant effect of maternal vitamin D status on:

Behavioral development at 7 years.

IQ at 8 years.

Reading skills at 9 years.

This is encouraging because it suggests that the effect of inadequate vitamin D during pregnancy does not have a permanent effect on childhood development. By the time they are 7 or older their nutrition and intellectual stimulation during childhood appears to outweigh the effect of their mother’s nutrition on their development.

In interpreting this information, we need to keep in mind that this study was performed in England, not in a third world country. In particular:

England, like the United States, has supplemental food programs for disadvantaged children.

England has an excellent educational system. So, we can assume these children also received intellectual stimulation as soon as they reached school age.

Is Vitamin D Important During Pregnancy?

If we focus on a healthy pregnancy, there is good evidence that inadequate vitamin D during pregnancy increases the risk of serious complications and that supplementation with vitamin D can reduce these complications. We also know that vitamin D deficiency during pregnancy can affect bone development in the newborn.

Thus, adequate vitamin D is clearly needed for a healthy pregnancy.

However, if we just consider the effect of maternal vitamin D on childhood development, it would be tempting to downplay the importance of vitamin D during pregnancy. This study focused on vitamin D, but studies focusing on other nutritional deficiencies usually give similar results.

In most of these studies, the effects of inadequate nutrition during pregnancy on childhood developmental milestones appear to be transient. Developmental delays are seen during the first few years of life but disappear as the children get older.

This is incredibly good news. It means that mild nutritional deficiencies during pregnancy do not have to handicap a child for life. If the children are given adequate nutrition and intellectual stimulation as they grow, the poor start they received in life can be erased.

It is also a caution. We already know that poor nutrition during childhood can affect a child’s behavior and intellectual development. If that child also received poor nutrition in the womb, their chances of normal childhood development may be doubly impacted.

In short, if adequate vitamin D during pregnancy improves early developmental milestones in children, that can be viewed as an added benefit.

The only question is how much vitamin D is needed. Fortunately, the present study cast some light on that question.

The study asked whether blood levels of 25-hydroxy vitamin D ≥75 nmol/L were more beneficial than blood levels ≥50 nmol/L. The answer was a clear no. That means an adequate vitamin D status during pregnancy is sufficient to support normal developmental milestones in children.

The current recommendation (DV) of vitamin D3 for pregnant women is 15 mcg (600 IU). Thus, my recommendations are:

If you are pregnant, be sure that your prenatal supplement provides at least 600 IU of vitamin D3.

If you are a woman of childbearing age, be sure that your multivitamin provides at least 600 IU of vitamin D3.

Slightly more is OK but avoid mega doses unless prescribed by a health professional who is monitoring your 25-hydroxy vitamin D status.

Because we all utilize vitamin D with different efficiencies, I would recommend asking for a 25-hydroxy vitamin D test and working with your health professional to keep your levels in the adequate range.

The Bottom Line

A recent study looked at the effect of mild vitamin D deficiency during pregnancy on childhood developmental milestones. The study found that children born to vitamin D-deficient mothers had:

Delayed gross-motor skills at 18 and 30 months.

Delayed fine-motor skills at 30 and 42 months.

Delayed social development at 42 months.

This is concerning. However, when they looked at later years, there was no significant effect of maternal vitamin D status on:

Behavioral development at 7 years.

IQ at 8 years.

Reading skills at 9 years.

The is encouraging. The reasons for this are discussed in the article above.

If we summarize this and previous studies, the bottom line is:

Adequate vitamin D is clearly needed for a healthy pregnancy.

If adequate vitamin D during pregnancy improves early developmental milestones in children, that can be viewed as an added benefit.

For more details and my recommendations on how much vitamin D you need, 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.

Diet And Cancer Risk

March 31, 2020March 31, 2020 by Dr. Steve Chaney

What Can You Do To Reduce Your Risk Of Cancer?

It seems like everyone has a magic pill, essential oil, food, or diet that prevents cancer. It doesn’t take a genius to figure out that all the claims can’t be true. No wonder you are confused. You want to know:

Which of these claims are true?

What can you do to reduce your risk of cancer?

These aren’t trivial questions.

Cancer is the second leading cause of death in this country, and some experts predict it will surpass heart disease as the leading cause of death in the near future.

While cancer treatments have become much more effective in the past few decades, these treatment successes are often associated with severe side-effects, enormous expense, or both.

That is why I was intrigued by a recent study (FF Zhang et al, JNCI Cancer Spectrum (2019) 3(2): pkz034) on diet and cancer that came from the prestigious Friedman School of Nutrition and Public Policy at Tufts University. This study asked two important questions:

How many newly diagnosed cancer cases could have been prevented by changes in the American diet? This is something the authors referred to as the “preventable cancer burden associated with poor diet”.

Which foods increased or decreased the risk of cancer? This, of course, is the most useful information for you and me.

Diet And Cancer Risk

This study estimated that 80,110 new cancer cases among US adults 20 and older could be primarily attributed to poor diet. While poor diet contributes to many more cancers, the authors of this study felt 80,110 represented the number of cancer cases that were clearly preventable by some simple dietary changes.

While all cancers were affected by diet to some degree, the cancers most affected by poor diet were:

Colon cancer (65% of cases)

Mouth and throat cancer (18% of cases)

Endometrial cancer (4.0% of cases)

Breast cancer (3.8% of cases)

When the diet was broken down into individual food groups:

Low intake of whole grains was associated with the largest number of preventable cancer cases (35% of cases). This was followed by.

Low intake of dairy foods (22% of cases).

High intake of processed meats (18% of cases).

Low intake of vegetables (16% of cases).

Low intake of fruits (10% of cases).

High intake of red meat (7.1% of cases).

High intake of sugar sweetened beverages (4.0% of cases).

Of the diet-associated cancer cases, the scientists who lead the study estimated that 84% of them represented a direct effect of diet on cancer risk. The dietary factors most likely to directly increase the risk of cancer were:

Low intake of whole grains.
Low intake of dairy foods.
High intake of processed meats.

The scientists estimated that 16% of diet-associated cancer cases were “mediated by obesity”. In layman’s terms, this means that diet increased the risk of obesity and obesity increased the risk of cancer. The dietary factors most likely to increase the risk of obesity-mediated cancers were:

High intake of sugar sweetened beverages.
Low intake of fruits.

The authors concluded: “More than 80,000 new cancer cases [per year] are estimated to be associated with suboptimal diet among US adults…Our findings underscore the need for reducing cancer burden in the United States by improving the intake of key food groups and nutrients of Americans.”

What Does This Mean For You?

These findings aren’t novel. Many previous studies have come to the same conclusions. However, many people find these recommendations to be confusing. Should they increase their intake of certain foods? Should they follow some sort of magic diet?

Perhaps we need to get away from the magic food concept. We need to understand that every time we increase one food in our diet, we exclude other foods. We need to step back and look at the overall diet.

Let me break down the recommendations from this study into three categories: foods we should eliminate from our diet, foods we should include in our diet, and foods we should balance in our diet.

Foods we should eliminate from our diet:

Sugar Sweetened Beverages. They provide no nutritional benefit, and the sugar in most beverages rushes into our bloodstream and overwhelms our body’s ability to utilize it in a healthy way. This leads to obesity, diabetes, and a host of other health issues.

- Public enemy number one is sodas. However, this category also includes fruit juices, sweetened teas and energy drinks, and sugary processed foods.

- This category also includes diet sodas. For reasons we don’t completely understand, diet sodas appear to be just as likely to lead to obesity, diabetes, and heart disease as sugar sweetened sodas. I have discussed the proposed explanations of this phenomenon in a recent issue of “Health Tips From the Professor”.

- Sugar, however, is not the enemy. Sugar found naturally in fruits and other whole foods enters the bloodstream slowly and is metabolized in healthy ways by the body. I have discussed this in another issue of “Health Tips From the Professor”. This is what I mean by restoring balance in our diet. Decreasing the sugar intake from sugar sweetened beverages and increasing sugar intake from fruits is associated with a decreased risk of obesity and obesity-related cancers.

Processed Meats. The evidence is overwhelming at this point that processed meats directly increase the risk of cancer.

- If you have trouble completely eliminating processed meats from your diet, my advice is to minimize them and consume them only in the context of an overall healthy diet. Personally, I still consume bacon occasionally as flavoring for a healthy green salad.

Foods we should include in our diet. I put these in a separate category because Dr. Strangelove and his colleagues have been telling us to eliminate them from our diet, and many Americans are following those recommendations:

Whole grains. We can think of whole grains as the underserving victim of the low-carb craze. The low-carb craze is on the mark when it comes to eliminating added sugars and refined grains from the diet. However, eliminating whole grains from the diet may be doing more harm than good. In fact, this and other studies suggest that whole grains are the most effective foods for reducing cancer risk. Why is that?

- If we assume whole grains are just a good source of fiber and a few vitamins and minerals, it is hard to grasp their importance. We could easily get those nutrients elsewhere.

- However, we are beginning to realize that whole grains play a unique role in supporting certain species of gut bacteria that are very beneficial to our health. In short, whole grains may be essential for a healthy gut.

Dairy Foods. This is another food that has been treated as a villain by Dr. Strangelove and his many colleagues. However, for reasons we don’t completely understand, dairy foods appear to decrease the risk of heart disease and cancer.

Foods we should balance in our diet.

Red Meat. Diets high in red meat are consistently associated with a slight increase in cancer risk. The World Health Organization lists red meat as a probable carcinogen, but that has proven to be controversial.

- Much of the research has centered on why red meat causes cancer. Several mechanisms have been proposed, but none of them have been proven.

- In contrast, very little consideration has been given to what red meat is displacing from the diet. Diets high in red meat are often low in whole grains, fruits and/or vegetables.

- Perhaps instead of eliminating red meat from our diets we should be talking about balancing red meat in our diets by consuming less red meat and more whole grains, fruits, and vegetables.

What Can You Do To Reduce Cancer Risk?

You may have been thinking that 80,110 cases/year represents a small percentage of new cancer cases. That’s because diet is only one component of a holistic cancer prevention strategy. Here is what the American Cancer Society recommends for reducing cancer risk:

Avoid tobacco.

Limit sun exposure.

Achieve and maintain a healthy weight.

Eat a healthy diet, with an emphasis on plant foods (Their recommendations are in line with this study).

Be physically active.

Limit alcohol use.

Get vaccinated against HPV.

Get regular medical checkups.

Doing any of these things will reduce your cancer risk. But the more of these you can incorporate into your lifestyle, the lower your risk.

The Bottom Line

A recent study looked at diet and cancer risk. The authors reported that 80,110 new cancer cases among US adults 20 and older could be primarily attributed to poor diet.

When the diet was broken down into individual food groups:

Low intake of whole grains was associated with the largest number of preventable cancer cases. This was followed in descending order by.

Low intake of dairy foods.

High intake of processed meats.

Low intake of vegetables.

Low intake of fruits.

High intake of red meat.

High intake of sugar sweetened beverages.

For more details, read the article above. For example, I discuss which foods we should eliminate, which foods we should eat more of, and which foods we should balance in our diet. To add a more holistic perspective, I also discuss the American Cancer Society’s recommendations for reducing cancer risk.

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 Foods Affect Stroke Risk?

March 24, 2020 by Dr. Steve Chaney

Why Is Diet And Stroke Risk So Confusing?

One day we are told vegetarian diets reduce our stroke risk. The next day we are told they increase stroke risk. It’s the same with red meat, dairy, and eggs. We keep getting mixed messages. It’s enough to make your head spin. Why is diet and stroke risk so confusing?

Part of the problem is that there are two distinct types of stroke. The technical names for them are ischemic stroke and hemorrhagic stroke.

An ischemic stroke occurs when an artery in the brain becomes blocked, shutting off blood flow and damaging part of the brain. This is usually caused by the gradual buildup of fatty deposits and cholesterol plaques in the arteries. When a blood clot forms and lodges in one of the narrowed arteries leading to the brain, an ischemic stroke occurs.

Ischemic strokes account for 87% of all strokes.

Ischemic strokes are associated with obesity, elevated cholesterol, diabetes, high blood pressure, and smoking.

A hemorrhagic stroke occurs when a weakened blood vessel bursts and bleeds into the surrounding region of the brain. Because our brains are surrounded by a protective skull, that blood has nowhere to go. Pressure from the buildup of blood damages brain cells in the vicinity of the bleed.

Hemorrhagic strokes account for only for only 15% of strokes but are responsible for 40% of stroke deaths.

The most common cause of a hemorrhagic stroke is the localized enlargement of a blood vessel due to chronic high blood pressure. This weakens the wall of the blood vessel, making it prone to rupturing.

Part of the confusion about diet and stroke risk is because many earlier studies did not distinguish between the two types of stroke.

If the studies just measured the incidence of stroke, the data were dominated by ischemic strokes (87% of strokes are ischemic).

However, if the studies focused on stroke deaths, hemorrhagic stroke made a larger contribution to the data set (40% of stroke deaths are hemorrhagic).

Fortunately, recent studies have started to focus on the effect of diet on ischemic and hemorrhagic strokes separately. However, many of those studies have been too small to accurately assess the effects of diet on hemorrhagic stroke.

The latest study (TYN Tong et al, European Heart Journal, ehaa007, published February 24, 2020) is one of the largest studies to look at the effect of diet on both kinds of stroke. It has enough patients in the hemorrhagic group to get an accurate estimate of the effect of diet on hemorrhagic stroke.

How Was The Study Done?

This study analyzed data on diet and stroke from 418,329 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition). Although the study has cancer in the title, it actually investigated the effect of nutrition on multiple diseases (Presumably, the study title was chosen because EPIC is a more appealing acronym than EPID (European Prospective Investigation into Diseases and Nutrition)).

The participants were recruited from 9 European countries (Denmark, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). The average age of participants was 50, and they were followed for an average of 12.7 years.

At the beginning of the study participants completed country-specific dietary and lifestyle questionnaires.

The dietary assessment was a food frequency questionnaire that asked participants about their dietary intake for the year prior to enrollment in the study. The food frequency data were used to estimate daily intake of red meat, processed meat, poultry, fish, dairy products, eggs, grains, fruits, vegetables, legumes, nuts, seeds, and dietary fiber (It measured total fiber and fiber from grains, fruits and vegetables individually).

The outcome measured was the incidence of ischemic and hemorrhagic strokes during the 12.7-year follow-up.

Which Foods Affect Stroke Risk?

For ischemic stroke:

Each 200 gram/day increase in consumption of fruits and vegetables decreased ischemic stroke risk by 13% (200 grams roughly corresponds to one large apple or one large orange without the skin).

Each 10 gram/day increase in consumption of fiber decreased ischemic stroke risk by 23%. Most of this decreased stroke risk was due to fiber from whole grains, fruits, and vegetables.

- Each 4 gram/day increase in fiber from whole grains decreased ischemic stroke risk by 10%.

- Each 4 gram/day increase in fiber from fruits and vegetables decreased ischemic stroke risk by 12%.

Dairy foods decreased ischemic stroke risk with the following breakdown:

- Each cup of milk decreased ischemic stroke risk by 5%.

- Each half cup of yogurt decreased ischemic stroke risk by 9%.

- Each ounce of cheese decreased ischemic stroke risk by 12%.

Each 50 grams/day (2 ounces) of red meat increased ischemic stroke risk by 14%.

- However, red meat was only half as likely to increase risk of ischemic stroke when the diet was also rich in fruits, vegetables, whole grains, and legumes.

For hemorrhagic stroke:

Each 20 gram/day increase in consumption of eggs increased hemorrhagic stroke risk by 25% (20 grams roughly corresponds to about 1/2 of a small egg or 1/3 of a jumbo egg).

This study did not measure the effect of salt intake on hemorrhagic stroke risk.

No other foods measured in this study had a significant effect on hemorrhagic stroke risk.

However, hemorrhagic stroke is highly associated with high blood pressure. When we look at the influence of foods on high blood pressure, here are the Harvard School of Medicine recommendations for keeping blood pressure low:

Eat more fish, nuts and beans in place of high-fat meats.

Choose fruits and vegetables instead of sugary, salty snacks and desserts.

Select whole grains rather than refined grains.Eat fruit instead of drinking fruit juice.

Use unsaturated fats like olive, canola, soybean, peanut, corn or safflower oils instead of butter, coconut oil, or palm-kernel oil.

Use herbs, spices, vinegar, and other low-sodium flavorings instead of salt; Choose low-sodium foods whenever possible.

Why Is Diet And Stroke Risk So Confusing?

As I mentioned at the start of this article, part of the reason that the headlines about diet and stroke risk are so confusing is:

Many studies did not distinguish between the two types of stroke.

Other studies were too small to reliably estimate the effect of food on hemorrhagic stroke risk.

However, there are still some unexplained inconsistencies among recently published studies. It is these inconsistencies I would like to address. For example:

1) In a recent issue of Health Tips From the Professor I reported on a major study (500,000 people followed for 8.9 years) in China. That study came to the opposite conclusion about eggs and risk of hemorrhagic than the EPIC study I discussed above. It found:

People consuming one egg per day had a 26% decrease in hemorrhagic stroke risk and a 28% decrease in hemorrhagic stroke deaths compared to people who never or rarely consumed eggs.

In other words, the two studies came to opposite conclusions. In the China study eggs decreased risk of hemorrhagic stroke. In the European study (EPIC) eggs increased risk of hemorrhagic stroke. The reason for this discrepancy is not clear, but one can speculate it might be explained by differences in the underlying diets of the two countries:

In China the diet is primarily plant-based. The addition of an egg/day may provide needed protein, fat, and cholesterol (Some cholesterol is essential. We just overdo it in this country).

In Europe the diet is already high in protein, saturated fat, and cholesterol. Getting more of them from eggs may not be such a good thing.

In short, if your diet is primarily plant-based, the addition of an egg/day may be a good thing. However, if your diet is already high in meat, saturated fat, and cholesterol, the addition of an egg/day may not be a good thing.

2) In another recent issue of Health Tips From the Professor I reported on the EPIC-Oxford study that claimed vegetarians had 20% increased risk of hemorrhagic stroke compared to meat eaters.

Interestingly, the EPIC-Oxford study represented a very small portion (~10%) of the overall EPIC study and differed from the rest of the EPIC study in two important ways.

It looked at the effect of diets rather than foods on stroke risk.

Oxford was the only one of the 22 research centers involved in the EPIC study to invite people following a vegetarian diet to enroll in the study, so it had a much higher proportion of vegetarians than other centers that participated in the study.

The current study did not find any evidence that fruits, vegetables, nuts, seeds, beans, or whole grains influenced the risk of hemorrhagic stroke. In other words, in this much larger data set there was no evidence that the foods associated with a vegetarian diet increased hemorrhagic stroke risk.

However, most of the participants in larger EPIC study were also eating meats. They were not following a pure vegetarian diet.

As I said previously, “If the data on hemorrhagic stroke risk in the EPIC-Oxford study are true, it suggests it may not be a good idea to completely eliminate meat from our diet. However, you don’t need to add much meat to a vegetarian diet. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of hemorrhagic stroke.”

What Does This Mean For You?

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

In terms of an overall take-home lesson on diet and stroke risk, my advice is: “A primarily plant-based diet is a good idea, but you don’t need to become a vegan purist. Nor do you want to follow fad diets that eliminate whole food groups. We have 5 food groups for a reason. Eliminating any of them may not be a good idea.”

The Bottom Line

A recent study examined the effect of various foods on the risk of the two major forms of stroke.

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

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.

Relief From Pain Between Your Shoulder Blades

March 17, 2020 by Dr. Steve Chaney

Happy St. Patrick’s Day

Even if you’re not Irish, Happy St. Patrick’s Day! I think it’s one of those days that really isn’t necessarily an ethnic holiday anymore, it’s an “everybody” holiday.

I’m from New York and St. Patty’s Day is a HUGE day, with a big parade (I walked in it when I was in high school) and a LOT of partying! The first recorded St. Patrick’s Day parade was held not in Ireland but in New York City in 1762 because there were so many Irish immigrants.

I wasn’t too thrilled with aspects of the party part, but it’s still fun to wear green and have all the trappings of the day. My favorites are green cookies and cupcakes (you can tell where my weakness lies – LOL).

Here are 10 fun facts about St. Patrick’s Day, Thanks to https://www.proflowers.com/blog/interesting-st-patricks-day-facts

The first St. Patrick’s Day celebration in the United States was held in Boston (1737).

Shamrocks are the national flower/emblem of Ireland.
Legend says that each leaf of the clover has a meaning: Hope, Faith, Love and Luck.
Your odds of finding a four-leaf clover are about 1 in 10,000 (I don’t know about this one. I must be pretty lucky because when I was a kid, we used to always find them in the grass).
The color of St. Patrick’s Day was originally blue.

There are 34.7 million U.S. residents with Irish ancestry. This number is more than seven times the population of Ireland itself

The real St. Patrick wasn’t Irish. He was born in Britain around A.D. 390 to an aristocratic Christian family

Patrick never got canonized by a pope, making his saintly status somewhat questionable.

The world’s shortest St. Patrick’s Day parade is held in an Irish village. It lasts only 100 yards, between the village’s two pubs.

1962 marked the first time Chicago dyed their river green for St Patrick’s Day.

Your Questions Answered

I have so many people asking me questions about the cause of their aches and pains that I’ve decided to add a new section to this newsletter – it’s a Q&A section where you can send in a question and I’ll pick one each month to answer. I’ll explore the most logical cause of the pain and tell you where in my books you can find the self-treatment to eliminate it quickly.

Q: When I yawn or chew my jaw clicks, close to my ear. I can feel the bones rubbing together. I’ve been told it may be TMJ. What do you think?

A: I agree that it is most likely TMJ.

If you press your three middle fingers into your cheeks, right where your back teeth meet, and then clench your teeth, you’ll feel the muscle bulge. The name of the muscle is Masseter and it goes from your cheek bones (above your top back teeth) to your jaw line (below your lower back teeth.

When you chew, you are contracting that muscle, and you lengthen it as you open your mouth wide to put food into your mouth. Chewing gum or clenching your teeth contracts the muscle without the opposite movement of opening your mouth wide. As a result, it’s being repetitively strained, and the body reacts by shortening the muscle fibers. This causes your jaw to shift over to the side of the shortened muscle each time you try to open your mouth.

The clicking you are feeling is the bones rubbing across each other because the muscle is too tight to allow your jaw to open correctly. This can potentially cause real problems in your jaw, but fortunately it’s simple to reverse.

The treatment is shown on page 52-53 in Treat Yourself to Pain Free Living. Most times you can reverse the problem after just 2-3 self-treatments.

What Causes Pain Between Your Shoulder Blades?

I had to solve a mystery in my office. A client was complaining of a pain between her shoulder blades, and after looking at the usual muscles (Rhomboids) I needed to do some detective work. It’s a little confusing, but if you visualize it while you’re reading it will help a lot.

Your rhomboids attach to the medial border of your scapula (between your shoulder blades). When they contract normally, they pull your shoulder blades in toward your spine.

Your pectoralis minor muscle is in your chest, originating on your ribs and inserting into a small part of your shoulder blade (scapula), called the coracoid process. When the pecs minor contacts normally it pulls on your scapula, moving your shoulder forward and rounding out your back.

Here’s what was happening to my client.

When your pecs minor is pulling your scapula forward it’s causing your rhomboids to be pulled up toward your head. This isn’t a movement that works well for the rhomboids, so they go into a spasm, or at the very least they are over-stretched, and you feel the pull on the bone.

Relief From Pain Between Your Shoulder Blades

Simply releasing the tight pectoralis minor muscles allowed her shoulder blade to return to its proper location and the strain was taken off her rhomboids.

Looking at the pictures, begin by placing a ball on the front of your chest, just below your shoulder. Basically, it is where your fingers are when you do the Pledge of Allegiance. Lean into a wall and bend your legs so you move the ball up and down on the muscle.

You can also squeeze the muscle by putting your fingertips into your armpit and your thumb in the same place as the location of the ball as shown in the picture. Squeeze the muscle and pull down toward the floor as you are squeezing. As a bonus, you’ll be stretching the muscle as your releasing the tension in the muscle fibers.

I’m happy to say, treating my client’s pectoralis minor took the strain off her rhomboids, and her back pain disappeared!

The most important thing is she also learned how to self-treat her muscles, so the pain won’t return.

All my self-treatments are in either Treat Yourself to Pain-Free Living or The Pain-Free Athlete. If you have nagging aches and pains, you can release the tension and stop pain FAST!

Graphic Credit: Pectoralis Minor muscle graphic thanks to https://www.quora.com/What-is-the-difference-between-a-pectoralis-major-and-a-pectoralis-minor-muscle

___________________________________________________________________________

You really CAN “Treat Yourself to Pain-Free Living!” As you already know, I’ve written a book, “Treat Yourself To Pain-Free Living“, that shows you how to self-treat muscles from your head to your feet, but maybe you would like to have me help you.

Just because you aren’t in Sarasota, Florida, we can still work together very successfully via the computer. I’ve worked with people all over the world, and the results are excellent! To request a consult, click here.

___________________________________________________________________________

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.

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 31 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

Why Do Diet Sodas Make You Fat?

March 10, 2020 by Dr. Steve Chaney

Is Mixing Diet Sodas With Carbs Bad For You?

Many people, and many doctors, believe that diet sodas and artificially sweetened foods are a healthy choice. After all:

Cutting calories by drinking diet sodas and eating artificially sweetened foods should help you lose weight.

If sugar is the problem for diabetics, diet sodas and artificially sweetened foods should be a healthier choice.

On the surface, these ideas appear to be self-evident. They seem to be “no-brainers”. The truth, however, is more complicated.

When studies are tightly controlled by dietitians so that the people consuming diet sodas don’t add any extra calories to their diet, the results are exactly as expected. People consuming diet sodas lose weight compared to people drinking regular sodas.

However, as I have described in an earlier issue of “Health Tips From the Professor”, the results are different in the real world where you don’t have a dietitian looking over your shoulder. In those studies, diet sodas are just as likely to cause weight gain as regular sodas.

As Barry Popkin, a colleague at the University of North Carolina, put it” “The problem is that we [Americans] are using diet sodas to wash down our Big Macs and fries.” In short, people drinking diet sodas tend to increase their caloric intake by adding other foods to their diet. Even worse, the added foods aren’t usually fruits and vegetables. They are highly processed junk foods.

Why is that? The short answer is that nobody knows (more about that later). However, a recent study (JR Dalenberg et al, Cell Metabolism, 31: 493-502, 2020) suggests an unexpected mechanism for the weight gain associated with diet soda consumption. Let’s look at that study.

How Was The Study Done?

The study recruited 45 healthy young adults (ages 20-45) who habitually consumed less than 3 diet sodas a month. They were randomly assigned to three groups. The participants in each group came into the testing facility seven times over a span of 2 weeks. Each time they were given 12 ounces of one of three equally sweet tasting beverages in a randomized, double-blind fashion.

Group 1 received a sucralose-sweetened drink contained 0.06 grams of sucralose (equivalent to two packets of Splenda).

Group 2 received a sugar-sweetened drink contained 7 teaspoons of sucrose (table sugar).

Group 3 received a combo drink contained 0.06 grams of sucralose plus 7 teaspoons of maltodextrin. Maltodextrin is a water-soluble carbohydrate that does not have a sweet taste.

o Maltodextrin was used because Splenda and most other commercial sucralose products contain it along with sucralose. You need something to fill up those little sucralose-containing packets.

o This drink was included as a control. The expectation was that it would give the same results as the sucralose-sweetened drink.

Three measurements were performed prior to and following the 2-week testing period:

An oral glucose tolerance test in which participants drink a beverage containing a fixed amount of glucose. Then their blood sugar and blood insulin levels are measured over the next two hours.

o This is a measure of how well they were able to control their blood sugar levels.

A test in which they were given samples that had either a sweet, sour, salty, or savory taste. Then:

o They were asked to identify each taste and report how strong the taste was.

o MRI scans of their brains were performed to determine how strongly their brains responded to each of the tastes.

Is Mixing Diet Soda With Carbs Bad For You?

The results were surprising. The first surprise came when the investigators unblinded the results of the oral glucose tolerance test:

Blood sugar and blood insulin responses were unaffected by the 2-week exposure to sugar-sweetened drinks.

o This was expected.

Blood sugar and blood insulin were relatively unaffected by the 2-week exposure to sucralose-sweetened drinks. If anything, the control of blood sugar levels was slightly improved at the end of two weeks.

o This was a disappointment for the investigators. One of the prevailing theories is that artificially sweetened beverages alter the blood sugar response. The investigators found no evidence for that idea.

Following the 2-week exposure to the combo drinks (sucralose plus maltodextrin), blood sugar levels were unaffected, but blood insulin levels were increased. This implies that more insulin was required to control blood sugar levels. In other words, these participants had developed insulin resistance.

o This result was unexpected. Remember the investigators had included this drink as a control.

o The investigators pointed out that the insulin resistance associated with the sucralose-maltodextrin combo could increase the risk of type 2 diabetes and obesity.

Because of this unexpected result, the investigators did a follow-up study in which participants were given a maltodextrin-only drink using the same study protocol. The oral glucose tolerance test was unchanged by the 2-week exposure to maltodextrin-only drinks.

When the investigators conducted taste tests, the ability of participants to taste all four flavors was unchanged by a 2-week exposure to any of the drinks.

However, when the investigators did MRI scans to measure the brain’s response to these flavors:

A two-week exposure to the sucralose plus maltodextrin drinks reduced the brain’s response to sweet but not to any of the other flavors.

o In other words, the subjects could still taste sweet flavors, but their brains were not responding to the sweet taste. Since sweetness activates pleasure centers in the brain this could lead to an increased appetite for sweet-tasting foods.

o This might explain the weight gain that has been observed in many previous studies of diet sodas.

Two-week exposures to the other drinks had no effect on the brain’s response to any of the flavors. Once again, this effect was only seen in the sucralose-maltodextrin combination.

The investigators concluded:

“Consumption of sucralose combined with carbohydrates impairs insulin sensitivity…and…neural responses to sugar.

Insulin sensitivity is not altered by sucralose or carbohydrate consumption alone.

The results suggest that consumption of sucralose in the presence of a carbohydrate dysregulates gut-brain regulation of glucose metabolism.”

The investigators pointed out that this could have several adverse consequences. Again, in the words of the authors:

“Similar exposure combinations (artificial sweeteners plus carbohydrates) almost certainly occur in free-living humans, especially if one considers the consumption of a diet drink along with a meal. This raises the possibility that the combination effect may be a major contributor to the rise in incidence of type 2 diabetes and obesity. If so, addition of artificial sweeteners to increase the sweetness of carbohydrate-containing food and beverages should be discouraged and consumption of diet drinks with meals should be counseled against.”

Why Do Diet Sodas Make You Fat?

As I mentioned at the start of this article, there are a lot of hypotheses as to why diet sodas make us fat. These hypotheses break down into two classifications: psychological and physiological.

The psychological hypothesis is easiest to explain. Essentially, it goes like this: We feel virtuous for choosing a zero-calorie sweetener, so we allow ourselves to eat more of our favorite foods. It is unlikely that this hypothesis holds for all diet soda drinkers. However, it is also hard to exclude it as at least part of the explanation for the food overconsumption associated with diet soda use.

There are multiple physiological hypotheses. Most of them are complicated, but here are simplified explanations of the three most popular hypotheses:

The sweet taste of artificial sweeteners tricks the brain into triggering insulin release by the pancreas. This causes blood sugar levels to plummet, which increases appetite.

The sweet taste of artificial sweeteners is not appropriately recognized by the brain. This diminishes release of hormones that suppress appetite.

Artificial sweeteners interfere with insulin signaling pathways, which leads to insulin resistance.

There is some evidence for and against each of these hypotheses.

However, this study introduces a new physiological hypothesis – namely that it is the combination of artificial sweeteners and carbohydrates that results in a dysregulation of the normal mechanisms controlling appetite and blood sugar.

What Does This Study Mean For You?

Let’s start with the obvious. This is just a hypothesis.

This was a very small study. Until it is confirmed by other, larger studies, we don’t know whether it is true.

This study only tested sucralose. We don’t know whether this applies to other artificial sweeteners.

The study only tested maltodextrin in combination with sucralose. We don’t know whether it applies to other carbohydrates.

Therefore, in discussing how this study applies to you, let’s consider two possibilities – if it is true, and if it is false.

If this hypothesis is true, it is concerning because:

We often consume diet sodas with meals. If, for example, we take the earlier example of a diet soda with a Big Mac and fries, both the hamburger bun and the fries are high carbohydrate foods.

Sucralose and other artificial sweeteners are used in low calorie versions of many carbohydrate rich processed foods.

If this hypothesis is false, it does not change the underlying association of diet soda consumption with weight gain and type 2 diabetes. It is merely an attempt to explain that association. We should still try to eliminate diet sodas and reduce our consumption of artificially sweetened, low calorie foods.

My recommendation is to substitute water and other unsweetened beverages for the diet drinks or sugar sweetened beverages you are currently consuming. If you crave the fizz of sodas, drink carbonated water. If you need more taste, try herbal teas or infuse water with slices of lemon, lime, or your favorite fruit. If you buy commercial brands of flavored water, check the labels carefully. They may contain sugars or artificial sweeteners. Those you want to avoid.

The Bottom Line

Many studies have called into question the assumption that diet sodas and diet foods help us lose weight. In fact, most of these studies show that diet soda consumption is associated with weight gain rather than weight loss.

There are many hypotheses to explain this association, but none of them have been proven at present.

This study introduces a new hypothesis – namely that the combination of artificial sweeteners and carbohydrates results in a dysregulation of the normal mechanisms controlling appetite and blood sugar. In particular, this study suggested that combining sucralose with carbohydrates caused insulin resistance and reduce the ability of the brain to respond appropriately to sweet tastes.

The authors concluded: “Similar exposure combinations (artificial sweeteners plus carbohydrates) almost certainly occur in free-living humans, especially if one considers the consumption of a diet drink along with a meal. This raises the possibility that the combination effect may be a major contributor to the rise in incidence of type 2 diabetes and obesity. If so, addition of artificial sweeteners to increase the sweetness of carbohydrate-containing food and beverages should be discouraged and consumption of diet drinks with meals should be counseled against.”

If this hypothesis is true, it is concerning because:

We often consume diet sodas with meals. If, for example, we take the example of a diet soda with a Big Mac and fries, both the hamburger bun and the fries are high carbohydrate foods.

Artificial sweeteners are used in low calorie versions of many carbohydrate rich processed foods.

If this hypothesis is false, it does not change the underlying association of diet soda consumption with weight gain and type 2 diabetes. It is merely an attempt to explain that association. We should still try to eliminate diet sodas and reduce our consumption of artificially sweetened, low calorie foods.

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 Diet Affect Sperm Quality?

March 3, 2020 by Dr. Steve Chaney

Do Real Men Eat Meat?

Meat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile. In that world view, vegetarianism is effeminate.

How much of that is true? Let’s start by looking at the bigger and stronger part:

Animal proteins are higher in the branched chain amino acids, especially leucine, which help drive the increase in muscle mass associated with exercise. However, meat protein is digested slowly.

Milk protein is also high in branched chain amino acids and is digested more quickly. That’s why many body building supplements are whey protein based.

In addition, leucine is now being added to some of the plant protein supplements. Those supplements are often as effective as whey protein supplements at driving the increase in muscle mass associated with exercise

But what about virility? Does meat make men more virile? Fortunately, we now have an answer to these questions. A recent study (L Nassan et al., JAMA Network Open, 2020; 3(2) :e1921610) has looked at the effect of diet on sperm count and sperm quality.

How Was The Study Done?

In Denmark, all men are required to undergo a physical examination around age 18 to determine their fitness for military service. Research staff at the University Department of Growth and Reproduction at Rigshospitalet in Copenhagen approached young men undergoing their physical exams and invited them to participate in this study.

The men filled in a food frequency questionnaire, answered questions about their lifestyle and medical history and provided semen and blood samples for the study prior to undergoing their physical exam. 2935 men who were unaware of their fertility status and not using anabolic steroids were included in the data analysis.

The average age of participants in the study was 19 and 78% of them were of normal body weight.

The participants were divided into four groups based on their diet:

1. Western Diet characterized by a higher intake of pizza, French fries, processed and red meats, snacks, refined grains, sugary beverages and sweets.

2. Danish Diet characterized by a higher intake of cold processed meats, whole grains, fruits, mayonnaise, cold fish, condiments, and dairy.

3. Vegetarian Diet characterized by a higher intake of vegetables, soymilk, and eggs, without red meat or chicken.

4. Prudent (Healthy) Diet characterized by a higher intake of fish, chicken, vegetables, fruit, nuts, and water.

The effect of these diets on sperm count and sperm quality were compared.

Does Diet Affect Sperm Quality?

When the authors measured sperm counts in the study participants, the results were as follows:

Greatest adherence to a prudent diet resulted in a sperm count of 167 million.

Greatest adherence to a vegetarian diet resulted in a sperm count of 151 million.

Greatest adherence to a Danish diet resulted in a sperm count of 146 million.

Greatest adherence to a Western diet resulted in a sperm count of only 122 million -27% lower than for men eating a prudent diet.

Similar results were reported for measure of sperm quality, such as sperm motility (how fast the sperm can swim) and normal sperm morphology (sperm without visible defects).

These results are similar to several earlier studies showing that men eating a healthy diet have greater sperm count and sperm quality.

The authors concluded: “Our findings support the evidence that adhering to generally healthy diet patterns is associated with better semen quality and more favorable markers of testicular function. Because diet is modifiable, these results suggest the possibility of using dietary intervention as a potential approach to improving testicular function in men of reproductive age.”

Do Real Men Eat Meat?

Now it is time to come back to the original question, “Do real men eat meat”. Or more specifically, does red meat consumption increase virility? Of course, the whole question of whether a single food affects virility, or any other aspect of manliness, is bogus.

Individual foods don’t affect our health. Diets do. So, let’s review how diets affect men’s sperm count and sperm quality.

The highest sperm count and sperm quality was associated with the prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet high in vegetables, fruits, nuts, and water (in place of sugary beverages).

The second highest sperm count and sperm quality was associated with the vegetarian diet. This diet relied on beans and eggs as the primary protein sources. It specifically excluded red meat and chicken but did not exclude fish. It was also high in fruits and nuts. Soy milk, tea, and coffee were the main beverages.

The third highest sperm count and sperm quality was associated with the Danish diet. This diet relied on cold processed meats (some of which were red meats), cold fish, and dairy for protein. However, it also was rich in whole grains and fruits. Water and sugary beverages were consumed in equal proportions.

The lowest sperm count and sperm quality was associated with the Western diet. This diet relied on red and processed meats as the primary protein source. However, it was also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

So, if we are using sperm count and sperm quality as a measure of virility, it is clear that real men don’t eat red meat. Or put another way, a diet rich in red meat is more likely to reduce sperm count and sperm quality than it is to increase it.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and quality.

In short, diet does affect sperm quality. For example, based on this study:

An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.

If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.

If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

The Bottom Line

Meat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile.

How much of that is true. We already know that meat has no magical power to make men bigger and stronger. But what about virility? Does meat make men more virile? Fortunately, we now have an answer to that question. A recent study has looked at the effect of diet on sperm count and sperm quality.

The highest sperm count and quality was associated with a prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet rich in vegetables, fruits, nuts, and water (in place of sugary beverages). In other words, it was a healthy diet.

The lowest sperm count and quality was associated with the Western diet. This is a diet that relies on red and processed meats as the primary protein source. However, it is also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and sperm quality.

In short, it appears that diet does affect sperm quality:

An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.

If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.

If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

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 A Probiotic Supplement Make You Healthier?

February 25, 2020 by Dr. Steve Chaney

What Is The Truth About Our Microbiome?

Our gut bacteria, often referred to as our microbiome, are a “hot” topic in today’s world. They have been in the news a lot in recent years. If you believe the headlines, the right gut bacteria can make you smarter, healthier, and cure what ails you. They appear to have almost mystical powers. Could a probiotic supplement make you healthier?

How much of this is true and how much is pure speculation? It’s hard to say. Our microbiome is incredibly complex. To make matters more confusing, the terminology used to classify our gut bacteria into groups is not consistent. It varies from study to study.

Perhaps it is time to take an unbiased look at the data and separate fact from speculation.

Could A Probiotic Supplement Make You Healthier?

To answer the question of whether a probiotic supplement could make you healthier, we need to differentiate between what we know is true and what we think might be true. Let’s start with what we know for certain:

Our gut bacteria are affected by diet. People consuming a primarily plant-based diet have different populations of gut bacteria than people consuming a primarily meat-based diet.

- The populations of gut bacteria found in people consuming a plant-based diet are associated with better health outcomes, but associations have their limitations as discussed below.

Our gut bacteria are affected by exercise.

- It’s not clear whether it is the exercise or the fitness (increased muscle mass, decreased fat mass, improved metabolism) associated with exercise that is responsible for this effect.

Most of the other claims for the effects of gut bacteria on our health are based on associations. However, associations do not prove cause and effect. For example:

Certain populations of gut bacteria are associated with obesity.

- Do our gut bacteria make us obese, or does obesity affect our gut bacteria? There is evidence to support both viewpoints.

Certain populations of gut bacteria are associated with better mental health.

- Do gut bacteria influence mental health, or does the stress associated with poor mental health influence our gut bacteria? Again, there is evidence to support both viewpoints.

Certain populations of gut bacteria are associated with better health outcomes (reduction in diseases like heart disease, diabetes, and high blood pressure).

- Here the question is a little different. In general, the populations of gut bacteria associated with disease reduction are produced by a healthy diet, exercise, and weight control. In this case, the question becomes: Is it the gut bacteria that caused disease reduction, or is it diet, exercise, and weight control that caused disease reduction?

To better understand these points, let’s look at four recently published studies. After reviewing those studies, I will come back to the question of whether a probiotic supplement might decrease our disease risk.

Is Our Microbiome Better Than Our Genes For Predicting Disease?

This study (T. Tierney et al, bioRxiv, 2020) reviewed 47 studies that analyzed people’s microbiome (their gut bacteria) and their genes and asked which was better at predicting their risk of various diseases. The study focused on 13 diseases that are considered “complex” because they are caused by both genetic and environmental factors such as diet and exercise. Examples include diabetes, high blood pressure, digestive disorders, asthma, Parkinson’s disease, and schizophrenia.

The study found that our microbiome was a better predictor of these diseases than our genes. This finding is not surprising. Our microbiome is heavily influenced by diet and other environmental factors. Our DNA sequence is not.

This study supports previous studies in suggesting that our microbiome is a better predictor of most diseases than our DNA sequence. The exception would be diseases that are clearly caused by gene mutations, such as sickle cell disease.

Does this mean our microbiome is directly influencing these diseases, or is it merely serving as a marker for diet and other environmental factors that are influencing these diseases? Nobody knows.

Does The Mediterranean Diet Support Gut Bacteria Linked To Healthy Aging?

This study ( TS Ghosh et al, Gut, 17 February 2020) divided people aged 65-79 into two groups. One group consumed a Mediterranean diet rich in fruits, vegetables, nuts, legumes, olive oil, and fish and low in red meat and saturated fat. The other group consumed a typical western diet. After a year on the diets the gut bacteria in the microbiomes of the two groups was analyzed.

The study found that the group consuming the Mediterranean diet had an increase in gut bacteria associated with healthy aging, reduced inflammation, and reduced frailty.

The title of the paper describing this study was “Mediterranean diet intervention alters the gut microbiome in older people, reducing frailty and improving health status”. But is that true?

There is already good evidence that the Mediterranean diet improves health status. Is it the gut bacteria supported by the Mediterranean diet that were responsible for healthy aging, or were other aspects of the Mediterranean diet responsible for healthy aging? Nobody knows.

Are Low Fat Diets Healthy Because Of Their Effect On Our Microbiome?

This study (Y Wang et al, Gut Microbes, 21 January 2020) put participants on a low fat diet (20% fat and 66% carbohydrates), a moderate fat diet (30% fat and 56% carbohydrate) or a high fat diet (40% fat, 46% carbohydrates). To assure the accuracy of the diets, participants were provided with all foods and beverages they consumed. After 6 months on the three diets, the gut bacteria of each group were analyzed.

Note: Because all food and beverages were provided, none of the diets included sodas, added sugar, refined flour, saturated fats, or highly processed food. In short, the diets were very different than the typical low fat or low carb diets consumed by the average American.

This study found that participants consuming the high fat, low carb diet had gut bacteria associated with increased risk of heart disease and diabetes. In contrast, the low fat, high carbohydrate diet group had gut bacteria associated with decreased risk of heart disease and diabetes.

To understand this study, you need to reevaluate what you may have learned from Dr. Strangelove’s health blog. It is true that low fat diets in which fat has been replaced with sugar, refined flour, and highly processed low-fat foods are unhealthy. But that’s not what happened in this study.

Remember that all the food and drink the participants consumed was selected by dietitians.

When you replace the fat with whole foods – fresh fruits and vegetables, whole grains, nuts, and legumes, as was done in this study, you end up with a very healthy diet.

The authors talked about the importance of the “diet-gut axis” for reducing the risk of heart disease and diabetes. However, is it the gut bacteria that influenced the risk of heart disease and diabetes, or is it the diets themselves that influenced disease risk? Nobody knows.

Can Gut Bacteria Reduce Heart Disease Risk?

This study (Y Heianza et al, Journal of The American College Of Cardiology, 75: 763-772, 2019) focused on the interactions between diet, gut bacteria, and a metabolite called TMAO (trimethylamine N-oxide).

Here is what we know for certain:

L-carnitine (found in high levels in red meat) can be converted to TMA (trimethylamine) by gut bacteria and then to TMAO in the liver.

The gut bacteria of meat eaters are very efficient at converting L-carnitine to TMA. Thus, meat eaters tend to have high levels of TMAO in their blood.

The gut bacteria of vegans and vegetarians are very inefficient at converting L-carnitine to TMA. Thus, people consuming a primarily plant-based diet tend to have low TMAO levels in their blood.

Here is what we are uncertain about:

High TMAO levels are associated with increased heart disease risk. However, there is no direct evidence that TMAO causes heart disease.

What made this study unique is that it measured TMAO levels in the study participants at their entrance into the study and again 10 years later. The study found:

Participants with the greatest increase in TMAO levels over the 10 years had a 67% increased risk of heart disease compared to participants whose TMAO levels remained constant.

Participants consuming a healthy, primarily plant-based diet had little or no increase in TMAO levels over 10 years. It was the participants consuming an unhealthy diet who had significant increases in their TMAO levels.

This study strengthens the association between TMAO levels and heart disease risk. Because gut bacteria are required to produce TMAO, it also strengthens the association between gut bacteria and heart disease risk. However, is it the high TMAO levels that increased heart disease risk or is it the unhealthy diet that increased heart disease risk? Nobody knows.

What Is The Truth About Our Microbiome?

By now you have probably noticed a common theme that runs through all four studies. This is also true of most published studies on our microbiome.

We have good evidence that whole food, primarily plant-based diets lead to improved long-term health outcomes.

We also have good evidence that whole food, primarily plant-based diets influence the populations of gut bacteria found in our microbiome.

We know the populations of gut bacteria supported by primarily plant-based diets are associated with improved health outcomes.

We don’t really know whether it is the gut bacteria or the diets that are responsible for the improved health outcomes.

Don’t misunderstand me. I am not a microbiome skeptic. I think we have enough evidence to say that our gut bacteria are likely to have an important effect on our health. However, to claim that gut bacteria play a primary role in influencing our health would be pure speculation at this point.

A Cautionary Tale

Why do I make this point? It’s because I suspect that some in the supplement industry will be tempted to make probiotic supplements and claim they contain bacteria “known” to reduce the risk of heart disease, diabetes, or cancer. You wouldn’t need to change your diet. All you would need to do to improve your health would be to take their probiotic supplement.

Lest you be taken in by such future claims, let me share a cautionary tale.

High HDL cholesterol levels are associated with a reduced risk of heart disease. Exercise and weight loss increase HDL levels. However, those require work. They aren’t easy. So, pharmaceutical companies were constantly looking for ways to raise HDL levels without the hard work.

A few years ago, a pharmaceutical company discovered a drug that increased HDL levels. They thought they had discovered a wonder drug that would bring in billions of dollars. People wouldn’t need to exercise. They wouldn’t need to lose weight. All they would need to do would be to take their drug. HDL levels would go up and heart disease risk would go down.

However, when they tested their drug in a major clinical trial, it didn’t move the needle. HDL levels went up, but heart disease risk stayed the same. It turns out it was the exercise and weight loss that decreased heart disease risk, not the increase in HDL levels.

My message is simple. Even if our gut bacteria are found to play a major role in mediating the effect of diet on health outcomes, don’t assume we can take a probiotic and forget about the role of diet and exercise. Good health starts with a whole food, primarily plant-based diet and a healthy lifestyle.

The Bottom Line

Our gut bacteria, often referred to as our microbiome, are “hot”. If you believe the headlines, the right gut bacteria can make you smarter, healthier, and cure what ails you. How much of this is true and how much is pure speculation? In this article I reviewed four recent studies on diet, gut bacteria, and health outcomes. I took an unbiased look at the data and separated fact from speculation.

There was a common theme that ran through all four studies. This is also true of most published studies on our microbiome.

We have good evidence that whole food, primarily plant-based diets lead to improved long-term health outcomes.

We also have good evidence that whole food, primarily plant-based diets influence the populations of bacteria found in our gut, also known as our microbiome.

We know the populations of gut bacteria supported by primarily plant-based diets are associated with improved health outcomes.

We don’t really know whether it is the gut bacteria or the diets that are responsible for the improved health outcomes.

My message is simple. Even if our gut bacteria are found to play a major role in mediating the effect of diet on our health outcomes, don’t assume we can take a probiotic and forget about the role of diet and exercise. Good health starts with a whole food, primarily plant-based diet and a healthy lifestyle.

For more details, read the article above. You may be particularly interested in the cautionary tale I shared about HDL and heart disease risk.

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

Relief From Plantar Fasciitis Pain

February 18, 2020 by Dr. Steve Chaney

Get Rid Of Foot Pain And Enjoy Running Again

Sometimes I like to start my blog with ideas I think you may find helpful. This year, I’m not only writing goals, I’m doing something that was suggested by Pegine Echevarria. I’m looking back on last year and writing down as many of my successes as I can remember. Goals are the roadmap for the future, but remembering past successes lifts our confidence that we’ll be able to achieve the goals we have set.

In fact, this year I’m going to look at each day and write down a success that I’ve had that day. How wonderful it will be on New Year’s Eve to look back and read 365 successes for 2020!

I hope you are enjoying a wonderful start to 2020. Here’s to a year of adventure, joy, health, prosperity, and fulfillment of all your dreams!

Foot Pain And Plantar Fasciitis

With the new year here, lots of people have decided to get into a routine of walking, or running, to improve their health. I’ve also spoken to so many people about pain in the arch of the foot, a condition called plantar fasciitis. Most people have been told to focus their attention on the foot.

However, the muscles of your lower leg are responsible for the movements of your foot, so ignoring them and focusing on your foot is useless.

That’s like pulling your hair and then putting your focus on the pain in your head…while you’re still pulling your hair. It doesn’t work! You’re looking in the wrong place!

The vast majority of pain in your arch isn’t coming from your foot, it’s coming from your lower leg.

Stick with me, this is going to be so logical that you’ll wonder why you haven’t already heard about treatment and stretches for the real source of plantar fasciitis.

Relief From Plantar Fasciitis Pain

Let’s take a look at the muscles that move your foot. There are many tiny, intrinsic muscles but we’re not talking about them today…we’re talking about the major movers of your foot.

In case you would like to find the muscles in an anatomy book or on the internet, they are:

· Gastrocnemius: A calf muscle that merges into the Achilles tendon.

· Soleus: Under the gastrocnemius, the soleus also merges into the Achilles tendon. These two muscles pull your heel up so you can stand on your toes. When they are tight, they are pulling up on your Achilles tendon and pulling the bone up, even when you want to keep your foot flat on the ground. This causes your arch muscle to be pulled backward, causing arch pain.

· Tibialis Anterior: Primary muscle causing plantar fasciitis because it inserts into your arch. The tibialis anterior muscle is along the outside of your shin bone and inserts into the long bone on the inside of your arch. When it contracts the foot rolls toward the outside of the foot. This muscle also causes shin splints. When it is tight it is pulling hard on the bone and you feel pain in your arch.

· Peroneals: A group of two muscles inserting into the outside of your foot and arch. The peroneals originate along the length of your lower leg bone (Fibula) and insert into the bones on the outside and the inside of your arch. When they are tight, they pull the bones toward the outside of your foot, and you have arch pain.

These four muscles are pulling your arch in three different directions at the same time. This creates arch pain, but the source is in your lower leg!

Before jumping into the stretches for plantar fasciitis, I recommend first doing the self-treatments to release the tension in these muscles.

3 Self-Treatments For Plantar Fasciitis Pain

To treat your tibialis anterior, place a ball just below your knee and on the outside of your shin. Then move your leg so the ball rolls down toward your ankle.

If your arch feels like it’s going to cramp, simply roll your toes as shown in this picture.

To treat your peroneals, place a ball as shown in the picture on the right. Put your hand on your leg so you can press the muscle down into the ball. Then move your leg so the ball rolls down toward your ankle

There are several ways to treat your calf but they all use the same principle. Put the center of your calf directly on your opposite kneecap. Press your leg down so your kneecap goes deeply into your calf muscle.

Don’t slide, just rock your leg up and down, along the length of the muscle.

You can also do this treatment while sitting in a chair.

3 Stretches For Plantar Fasciitis Pain

Note: It is most beneficial to release the spasms (muscle knots) in the muscles as shown above before doing the stretches for plantar fasciitis relief. This is the case for any muscle as it “unties the knot” that has shortened the muscle allowing you to stretch without injuring the muscle fibers.

The picture on the left shows a common, runners stretch for the gastrocnemius muscle.

In order to get a proper stretch, it is important to keep your heel on the ground as you tilt your body forward.

Notice that you don’t need to be leaning forward and holding on to anything. Stand up straight.

To stretch the deeper muscle, the soleus, slowly bring your bottom back while bending the knee of the leg you are stretching.

Keep your heel firmly on the floor.

This stretch is deeper and often overlooked by runners, yet it is a key muscle for calf pain, Achilles tendonitis, heel pain, and plantar fasciitis.

You can stretch both the tibialis anterior muscle and the peroneal muscles by just a slight rotation of your ankle.

Curl your toes so the top of your toes are on the ground.

If your foot is squared so the top of your toes are flat on the ground, this stretches the tibialis anterior.

If you move slightly (as shown), this stretches the peroneal muscles.

You will feel the lengthening along your entire lower leg as you are doing an excellent series of stretches for plantar fasciitis and shin splints.

As a bonus, this is also the treatment for a sprained ankle!

BTW, all the pictures in this newsletter were taken from The Pain-Free Athlete. You can easily learn how to self-treat all of the major muscles in your body by using The Pain-Free Athlete or Treat Yourself to Pain-Free Living. These books show you how to self-treat muscles from your head to your feet, but maybe you would like to have me help you.

Is The Impossible Burger Healthy For You?

February 11, 2020 by Dr. Steve Chaney

Is The Impossible Burger Healthy For the Planet?

Americans love their meat. In 2018 we averaged over 200 pounds of meat per person. If we just focus on beef, we eat about 54 pounds per year. That’s equivalent to four quarter pounders a week!

But we are also getting the message that too much meat, especially red meat, may be bad for us. Nearly 40% of us are trying to eat a more plant-based diet.

The problem is that we love the convenience of fast food restaurants, and we love our burgers. Plus, in the past the meatless burgers on the market were, in a word, disappointing. Their taste and texture left something to be desired. You really needed to be committed to a plant-based diet to eat them in place of a regular burger.

That all changed a few years ago with the introduction of the and new generation of meatless burgers – the Impossible Burger and the Beyond Burger. They had the taste and texture of a real burger, but they were completely plant-based. What wasn’t to like?

Both companies claimed that their meatless burgers were healthier for the planet than regular burgers. For example, Impossible Food’s mission statement is: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems. So, we’re doing something about it: We’re making meat using plants, so that we never have to use animals again”.

Neither company claims their burgers are healthier for you. However, because their burgers are plant-based, the almost universal assumption has been that they are healthier than regular burgers.

Since their introduction they have taken the world by storm. You can find them in almost every supermarket and in many of your favorite fast food restaurants. Now that they are omnipresent, it is perhaps time to step back and take a closer look at this new generation of meatless burgers. In this article, I will ask two questions:

Are they healthier for you than regular burgers?

Are they healthier for the planet than regular burgers?

For the sake of simplicity, I will focus on the Impossible Burger with occasional comparisons with the Beyond Burger. It is beyond the scope of this article to compare these burgers with the many other meatless burgers that are now starting to flood the marketplace.

What’s In The Impossible Burger?

When we think of a burger, the first thing we think of is protein. The Impossible Burger gets its protein from soy, while the Beyond Burger gets its protein from peas.

However, soy and pea protein don’t give you the mouth feel, flavor, red color, and texture of a beef burger.

The mouth feel of a burger comes from its saturated fat. Both the Impossible Burger and Beyond Burger use coconut oil as their source of saturated fat.

- Coconut oil has gained a reputation as a “healthier” saturated fat. However, as I have discussed in my book, “Slaying The Food Myths”, we have no long term studies on the health effects of diets high in coconut oil. We don’t really know whether it is healthier than other saturated fats.

The taste and color of a beef burger come from its heme content. Heme does not occur in the parts of plants we eat. However, heme is involved in nitrogen fixation, so it is found in the roots of some legumes.

- The Impossible Burger has genetically engineered yeast to produce a type of heme called leghemoglobin that is found in soy roots. The Beyond Burger uses beet juice extract and annatto for the color and unspecified “natural flavor” for the flavor.

To get the texture of a beef burger, both the Impossible Burger and the Beyond Burger use maltodextrin, modified food starch, and a variety of other ingredients. They are both highly processed foods.

Iron is another important nutrient you expect to get from a beef burger. The Impossible Burger contains 4.5 mg of iron and the Beyond Burger contains 5.4 mg of iron.

- However, that is only part of the story. When iron is attached to a heme molecule, it is more efficiently absorbed by our bodies. Beef burgers and the Impossible Burger contain heme iron. The Beyond Burger does not.

In addition, the Impossible Burger adds in the vitamins, including B12, that we would expect to get from a beef burger. The Beyond Burger does not.

What Are The Pluses Of The Impossible Burger?

There are some definite pluses for the Impossible Burger and Beyond Burger:

Both the Impossible Burger and Beyond Burger are made from plant-based ingredients rather than from meat.

Both are cholesterol free.

Both contain modest amounts of fiber (3 grams for the Impossible Burger and 2 grams for the Beyond Burger), while a meat burger contains none.

Both are good sources of iron, and the iron in the Impossible Burger is heme-iron, which is efficiently absorbed by our bodies.

What Are The Minuses of the Impossible Burger?

There are, however, some definite minuses as well.

Both the Impossible Burger and Beyond Burger are high in saturated fat. The Impossible Burger is higher in saturated fat and the Beyond Burger contains the same amount of saturated fat as a real burger. That’s important because the latest advisory of the American Heart Association warns that saturated fat increases our risk of heart disease (I have discussed this finding in detail in a previous issue of “Health Tips From the Professor”).

- The saturated fat in both burgers comes from coconut oil. However, as I discussed above, we don’t know whether coconut oil is better or worse for us than other saturated fats. The relevant studies have not been done.

Both the Impossible and Beyond burgers are high in sodium. They have almost 5-times more sodium than a beef burger.

The heme in red meat catalyzes the formation of N-nitroso compounds in our gut which increase the risk of colon cancer. We do not know whether the form of heme added to Impossible Burgers catalyzes the same reaction, but it is likely.

Both plant-based burgers are low in protein compared to a beef burger (~20 grams versus 27 grams). On the other hand, 20 grams of protein is reasonable for a single meal.

The plant proteins used for these burgers (soy for the Impossible Burger and pea for the Beyond Burger) are highly processed. They lack the phytonutrients found in the unprocessed proteins.

- The isoflavones found in soy are thought to decrease the risk of cancer and osteoporosis.

- The phytonutrients found in peas have antioxidant and anti-inflammatory benefits. They are also thought to decrease the risk of certain cancers.

The Impossible Burger is GMO. The leghemoglobin is produced by genetically engineered yeast, and the soy is also GMO.

Neither the Impossible Burger nor Beyond Burger are certified organic. Organic certification refers to how the plant was grown. Both burgers are highly processed. Many of the ingredients in both burgers came from factories, not farms.

Is The Impossible Burger Healthy For You?

Now, it is time to return to the original question: “Is the Impossible Burger healthy for you?” Since it is plant-based, it would be easy to assume that it is healthier than a burger made from beef. However, when you look more closely, it is not clear that it is healthier.

The manufacturers of the Impossible Burger and similar burgers have gone to the laboratory and have been successful at creating meatless burgers with the taste, mouth feel, and texture of real burgers. However, these improvements have come with a price.

The Impossible Burger and similar burgers are higher in saturated fat than a beef burger. This means they may be just as likely to increase the risk of heart disease as a beef burger.

The Impossible Burger contains as much heme as a beef burger, which means it may be just as likely to increase the risk of cancer as a beef burger.

The Impossible Burger and similar burgers are highly processed. That means:

- The plant proteins no longer contain the phytonutrients thought to be responsible for some of their health benefits.

- They also don’t contain the vitamins you would expect to find associated with the plant proteins.

The Impossible Burger and similar burgers are not organic. Even worse, the Impossible Burger is GMO.

On balance, we can’t really assume the Impossible Burger is any healthier than the beef burgers it replaces. Plus, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that use only whole, unprocessed ingredients.

For example, I looked up the Organic Sunshine brand South West Black Bean burgers. It only provides half as much protein as an Impossible Burger, but all the ingredients are organic, non-GMO, and minimally processed. Note: I am not recommending a particular brand. However, with a little research I am confident you can find a healthy meatless burger with a taste you will enjoy.

Is The Impossible Burger Healthy For the Planet?

Now, let’s look at the second question: “Is the Impossible Burger healthy for the planet?” The answer to this question seems obvious. As the Impossible Burger company states in their mission statement: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems”. It seems logical that any meatless burger would be an improvement.

If we are talking about a minimally processed black bean burger, like the one I described above, the answer is a clear yes. It is healthier for the planet. However, when you look more closely at the Impossible Burger, the answer isn’t as clear.

As coconut oil has increased in popularity massive areas of untouched, forested land have been cleared for coconut plantations.

- These forested areas provide an essential ecosystem for animals and provide natural storm protection by absorbing rainwater. Therefore, coconut oil, like beef, also destroys our ecosystems.

- In addition, many of the coconut plantations use large amounts of chemical fertilizers which contribute to phosphate pollution and algae overgrowth in lakes, rivers, and coastal ocean areas. This also degrades our environment.

The Impossible Burgers and similar meatless burgers contain many highly processed ingredients. Each of these ingredients imposes its own environmental burden. For example:

- Coconut oil is often processed with hexane, which is categorized as a hazardous air pollutant by the Environmental Protection Agency.

- In addition, coconut oil is primarily grown in the Philippines, Indonesia, and India. Transporting it to this country generates significant greenhouse gas emissions.

- And, of course, coconut oil represents only one of the many highly processed ingredients in the Impossible Burger and similar meatless burgers.

In short, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

The Bottom Line

Two weeks ago, I wrote about recent headlines claiming that the best advice for the American public was to eat as much red meat as they like. I looked at the study behind the headlines and pointed out the many flaws in that study.

Last week I wrote about headlines claiming that red meat was just as heart healthy as white meat. I looked at the study behind the headlines and showed it was an excellent example of how the beef industry influences the design of clinical trials to minimize the health risks of red meat. It is also an example of how the media misleads and confuses the public about the effect of nutrition on their health.

What the studies I reviewed the last two weeks really showed was that very small amounts (2-3 ounces) of very lean red meat is probably OK as part of a healthy diet like the Mediterranean diet. Larger servings of fattier cuts of red meat as part of the typical American diet is problematic.

However, if you love your burgers, what are you to do? Are the meatless burgers like the Impossible Burger and Beyond Burger that are showing up in your favorite fast food restaurants the answer? Specifically, you are probably asking:

Is the Impossible Burger, and similar burgers, healthy for you?

Is the Impossible Burger, and similar burgers, healthy for the planet?

I looked at the composition, pluses, and minuses of this new generation of meatless burgers in this article. The bottom line is:

On balance, the Impossible Burger is only slightly healthier than the beef burgers it replaces. And, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that are organic, non-GMO, and use only whole, unprocessed ingredients.

Similarly, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

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 Red Meat As Healthy As White Meat?

February 4, 2020 by Dr. Steve Chaney

The Lies of the Beef Industry

Last week I wrote about a recent review claiming that the evidence for the health risks of red meat consumption was so weak that the best advice for the American public was to eat as much of it as they like. I pointed out the many flaws in that study.

One of the flaws was that the review discounted dozens of association studies showing a link between red meat consumption and disease and relied instead on randomized controlled trials. Normally, that would be a good thing, but…

The association studies looked at health outcomes and had hundreds of thousands of participants. They found clear links between red meat consumption and increased risk of heart disease and cancer.

The randomized controlled trials looked at blood parameters like LDL cholesterol and averaged less than 500 participants. These studies were too small to provide meaningful results, and, not surprisingly, the results were conflicting. Some linked red meat consumption to increased risk, while others did not.

Because they had discounted evidence from association studies, the authors of the review concluded that the overall evidence was weak.

This week I want to address why the evidence from randomized controlled trials for health risks of red meat is so weak. More importantly, I want to highlight the role of the beef industry in making sure the evidence on the health risks of red meat consumption is weak.

I will also point out the role of the media in this process because they are equally complicit in spreading misleading information about the health risks of red meat consumption.

You might be asking: “How does the beef industry influence clinical trials to produce outcomes supporting their message that red meat is perfectly healthy?” “Surely they can’t convince reputable scientists to falsify their results.”

The answer is they don’t need to convince scientists to falsify their results. They just need to influence the design of the experiments so the results will be to their liking.” I will give two examples of that in this article.

Next you might be wondering: “What is the role of the media in this? Surely they just report what the scientific publication says.” Don’t be deceived. The media isn’t interested in accuracy. They are interested in generating the largest possible audience. They know controversy attracts an audience. They are looking for “man bites dog” headlines even if it isn’t true.

If you actually read the studies, you discover that reputable scientists always discuss the weaknesses and flaws in their study. The media either doesn’t read the publication or ignores the weaknesses. Instead they focus on the most controversial headline they can craft. I will give some examples of that as well.

Is Red Meat As Healthy As White Meat?

For years we have been told that red meat increases our risk of heart disease because it is high in saturated fats. We’ve been told that white meat and plant proteins are better alternatives.

But the latest headlines claim that red meat is just as heart healthy as white meat. You are probably wondering what to believe. Let’s examine the study behind the headline and ask two important questions?

Did the beef industry influence the study?
Did the media distort the study in their reporting?

I will start by reporting the study design and the results of the studies without comment. Then I will discuss how the beef industry influenced the design of the study to produce misleading results.

The Headlines Said: “Red Meat and White Meat Are Equally Heart Healthy.” The study behind the headlines was a 4-week study (N Bergeron et al, American Journal of Clinical Nutrition, 110: 24-33, 2019) comparing equivalent amounts of red meat, white meat, and non-meat protein on LDL levels. It did report that red meat and white meat raised LDL cholesterol levels to the same extent, but here is what the headlines didn’t tell you:

The authors of this study are heavily funded by the dairy and beef industries. I will point out the implications of this funding below.

4 weeks is a very short time. This study provides no information on the long-term effects of red meat versus white meat consumption.

The study only measured LDL and related lipoproteins. It did not measure heart disease outcomes. LDL and lipoprotein levels are only one indicator of heart disease risk. Thus, they are imperfect predictors of heart disease risk. I will point out why that is important below as well.

The study was performed at two levels of saturated fat – low (7% of calories) and high (14% of calories).

At the low level of saturated fat, only the leanest cuts of red meat (top round and top sirloin) were used to keep saturated fat low in the red meat group. High fat dairy foods were added to the non-meat protein group to increase saturated fat content. Thus, all 3 groups consumed the same amount of saturated fat.

At the high level of saturated fat, butter and high-fat dairy foods were added to the white meat and non-meat protein groups to increase saturated fat content. Once again, saturated fat content was identical in all 3 groups.

Here were the results:

LDL and related lipoproteins were higher for the high saturated fat group than the low saturated fat group. Nothing new here. This is consistent with dozens of previous studies. We know that saturated fat increases LDL cholesterol levels when other aspects of the diet are kept constant.

In both the low and high saturated fat groups, red and white meat raised LDL cholesterol to the same extent. In other words, when saturated fat levels are held constant, red meat and white meat raise cholesterol levels to the same extent.

In interpreting that statement, you need to remember the study design.

- In the low saturated fat group, only two cuts of red meat were low enough in saturated fat for a direct comparison to white meat.

- In the high saturated fat group, butter and high fat dairy had to be added to white meat so it could be compared to red meat.

Obviously, this is not the real world. 95% of the red meat the average American consumes is higher in saturated fat than most white meat.

The authors concluded “The findings…based on lipid and lipoprotein effects, do not provide evidence for choosing white over red meat for reducing heart disease risk”. That conclusion is clearly inaccurate.

The study did not measure heart disease outcomes. It measured only LDL cholesterol and related lipoprotein levels. That is just one factor in determining heart disease risk. The significance of that statement will be explained below.

Red meat and white meat raised LDL cholesterol levels to the same extent only when saturated fat is held constant. We know that most red meat is higher in saturated fat than white meat and saturated fat raises LDL cholesterol levels. In fact, the study confirmed that the high-fat red meats most people consume raised LDL cholesterol more than white meats.

The accurate conclusion to this study would have been: “Most red meat raises LDL cholesterol more than white meat, which suggests red meat may increase heart disease risk compared to white meat.”

Did I mention that the authors are heavily funded by the beef industry?

What About TMAO And Heart Disease Risk?

Interestingly, the authors also looked at another risk factor for heart disease in the same study, something called TMAO. I have discussed the relationship between red meat, TMAO, and heart disease risk in a previous issue of “Health Tips From the Professor”).

Let me summarize briefly here:

Red meat has 10-50-fold higher concentrations of a compound called L-carnitine than white meat.

Meat eaters have a very different population of gut bacteria than people who eat a primarily plant-based diet. It is not clear whether that is due to the meat or the loss of plant foods that meat displaces from the diet.

The gut bacteria of meat eaters convert L-carnitine to trimethylamine (TMA), which the liver then converts to trimethylamine N-oxide (TMAO).

The gut bacteria of people consuming a primarily plant-based do not convert L-carnitine to TMA, so no TMAO is formed. For example, in one study investigators fed an 8-ounce sirloin steak to meat eaters and to vegetarians. The meat eaters ended up with high levels of TMAO in their blood. The vegetarians had little or no TMAO in their blood.

High levels of TMAO are associated with atherosclerosis, increased risk of heart attacks, and death. Therefore, TMAO is considered an independent risk factor for heart disease.

The authors of the study comparing red meat and white meat also found that blood TMAO levels were two-fold higher in the red meat group than in the other two groups and this was independent of dietary saturated fat. However, rather than publishing this in the same paper where it might have interfered with their message that red and white meat affect heart disease risk to the same extent, the authors chose to publish these data in a separate paper (Z.Wang, European Heart Journal, 40: 7: 583-594, 2018).

Did I mention the authors are heavily funded by the beef industry?

Is Red Meat Healthy As Part Of A Mediterranean Diet?

Let me briefly touch on one other study funded by the beef industry. The headlines said: “You may not have to give up red meat. It is healthy as part of a Mediterranean diet.”

The study (LE O’Connor et al, American Journal of Clinical Nutrition, 108: 33-40, 2018) behind the headlines did report that lean beef and pork did not raise LDL cholesterol levels when they were included in a Mediterranean diet. However, it is important to look at what the headlines didn’t tell you.

The red meat group consumed only 2.4 ounces of red meat a day. We aren’t talking about 8-ounce steaks or a rack of pork ribs here.

The red meat group ate only the very leanest (tenderloin) cuts of beef or pork.

On a positive note, while it wasn’t measured in this study, it is likely that TMAO levels would be relatively low because the subjects were consuming a primarily plant-based diet. They were consuming 7 servings of vegetables, 4 servings of fruit, and 4 servings of whole grains each day.

Similarly, red meat has several components that appear to increase cancer risk. However, they can be largely neutralized by various plant foods. This is something I have discussed in more detail in my book “Slaying The Food Myths”.

In summary, it would have been more accurate to conclude that very small, very lean servings of red meat may be healthy as part of a primarily plant-based diet like the Mediterranean diet.

The Lies Of The Beef Industry

Both these studies utilized the very leanest cuts of red meat so they could conclude that red meat is healthy. This is a common design of studies funded by the beef industry. Rather than looking at the health effects of the high fat red meats most people consume, the studies focus only on the leanest cuts of meat.

The studies appear to be designed to purposely mislead the American public. Let’s look at how that happens. When studies like these are incorporated into larger meta-analyses or reviews, investigators often look at the conclusions, not at the experimental design.

Meta-analyses and reviews are only as good as the studies they include, a concept referred to as “Garbage in – Garbage Out”. That is what happened with the review and recommendations I discussed last week. The review relied heavily on short-term randomized controlled trials.

However, this is problematic. Because of the way they are designed, industry funded studies tend to find no adverse effects of consuming red meat. Independently funded studies tend to find adverse health effects from red meat. If you throw them all together without considering how the experiments were designed, the studies cancel each other out.

On that basis the authors of the review concluded that the evidence for red meat adversely affecting health outcomes was weak and recommended that everyone could continue consuming red meat. (That is a recommendation that virtually every health organization and top expert in the field have rejected for the reasons I summarized last week).

The beef industry doesn’t have to influence the design of every study, just enough studies to confuse the science and confuse the media.

The Complicity Of The Media

Unfortunately, the media is equally guilty of misleading the public. As I said above, the media is interested in attracting an audience, not in accuracy. For example:

The headlines describing the first study should have said: “Saturated fat raises LDL cholesterol levels”. But everyone knows that. Headlines like that are non-controversial. They don’t attract readers.

The headlines describing that study could have said: “Very lean cuts of red meat don’t raise LDL levels any more than white meat”. That would have been accurate, but that wouldn’t attract readers either. Most Americans prefer high fat cuts of red meat. They aren’t interested in reading articles suggesting they should change what they are eating.

Similarly, the headlines describing the second study should have said: “Very small amounts of very lean red meat may be healthy as part of a Mediterranean diet.”

In fact, the authors of both studies admitted in their discussions that they could not extrapolate their findings to the effects of higher-fat red meats. The media ignored those statements. Presumably, they decided the American public didn’t want to hear that message.

The first study also found that LDL and related lipoprotein levels were lower for the non-meat protein group than the red and white meat groups at both saturated fat levels. In fact, the main conclusion of the authors was: “The findings are in keeping with recommendations promoting diets with a high proportion of plant foods.” Somehow the media completely ignored that finding.

When the media consistently misleads the public about what constitutes a healthy diet, it leads to confusion. Confusion leads to inaction. At a time when so many Americans are suffering from preventable diseases, this is inexcusable.

Is Red Meat Healthy?

Let’s return to the question I posed last week: “Is red meat healthy?” Most of what I say below is identical to what I said last week. However, with the information I provided in the article above it may be easier to understand.

The saturated fat in red meat is associated with increased heart disease risk.

Red meat increases blood levels of TMAO, which is associated with increased heart disease risk.

The heme iron in red meat can be converted in the gut to N-nitroso compounds, which are associated with increased risk of cancer.

Benzopyrene and heterocyclic amines are formed when red meat is cooked. And they are associated with increased risk of cancer.

As I said last week, “There are too many studies that show a strong association between red meat consumption and disease risk to give red meat a clean bill of health. We can’t say red meat is healthy with any confidence.”

However, that doesn’t mean we need to eliminate red meat from our diet. As described above, the health risks of red meat are determined by the type of red meat consumed, the amount of red meat consumed, and the overall composition of our diet. For example:

Very lean cuts of red meat contain no more saturated fat than white meat.

Primarily plant-based diets alter our gut bacteria in such a way that production of TMAO and N-nitroso compounds are decreased.

Diets high in plant fiber sweep benzopyrene and heterocyclic amines out of our intestine before they can cause much damage.

So, what does that mean to you?

If you are thinking in terms of a juicy 8-ounce steak with a baked potato and sour cream, red meat may increase your risk of disease.

However, if you are thinking of 2-3 ounces of very lean steak in a vegetable stir fry or a green salad, red meat is probably OK.

If you are thinking about the very leanest cuts of red meat, they are probably just as healthy as white meat.

What About Grass Fed Beef?

Of course, one question I am frequently asked is: “What about grass fed beef? Is it healthier than conventionally raised beef?” Grass fed beef does have a slightly healthier fat profile. It is modestly lower in saturated fat and modestly higher in omega-3 fats. However, grass feeding doesn’t affect TMAO, N-Nitroso, benzopyrene, and heterocyclic amine formation.

That means the 8-ounce steak is only slightly less unhealthy and the 2-3 ounces of steak in a green salad only slightly healthier when you substitute grass-fed for conventionally raised beef. It’s probably not worth the extra cost.

Next week I will return with the answer to another question I get a lot. “If plant protein is good for me, what about all those meatless burgers that are popping up in my favorite fast food restaurants. Are they healthy?”

The Bottom Line

This week I provided two examples of how the beef industry influences the design of clinical trials to minimize the health risks of red meat and the media misleads the public about what the studies showed.

The bottom line is that red meat likely has no adverse health effects only if you are consuming very small amounts of very lean red meat in the context of a primarily plant-based diet. Unfortunately, this is not the message you are getting from the media and from Dr. Strangelove’s health blog.

As for grass-fed beef, it is only modestly healthier than conventionally raised beef for reasons I have given in the article above. It’s probably not worth the extra cost.

Next week I will return with the answer to another question I get a lot. “If plant protein is good for me, what about all those plant-based burgers that are popping up in my favorite fast food restaurants. Are they healthy?” Stay tuned.

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.