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

Does Preconception Diet for Males Influence A Healthy Pregnancy?

November 5, 2019 by Dr. Steve Chaney

Is What’s Good For The Goose, Good For The Gander?

Author: Dr. Stephen Chaney

Women are bombarded with advice to eat a healthy diet, limit alcohol, and supplement with folic acid if they are even considering becoming pregnant. In fact, since some pregnancies are unplanned, many experts feel this advice should be extended to all women of childbearing age.

This advice is based on tons of clinical studies, including some showing that folic acid supplementation is most effective when taken prior to conception. If folic acid supplementation is begun after the woman discovers she is pregnant, it is much less effective at supporting a healthy pregnancy and improving health outcomes for the newborn baby.

What about men, you might ask? Is their diet and folic acid status prior to conception important? Does preconception diet for males influence a healthy pregnancy? It turns out that there are almost no clinical studies on this important topic. The few clinical studies that have been done have mostly shown that a healthy diet and adequate folic acid improve male fertility.

Rodent studies have shown that male preconception folate status affects both the pregnancy and the health of the offspring, but rodents aren’t humans. This study (N Martin-Calvo et al, Journal of Reproductive BioMedicine Online, doi.org/10.1016/j.rbmo.2019.07.005 ) is the first human clinical study to evaluate the effect of paternal preconception folate status on the length of gestation, which is considered one of the hallmarks of a healthy pregnancy.

How Was The Study Done?

This study was part of the Environmental and Reproductive Health (EARTH) Study that is focused on identifying environmental and dietary factors associated with human fertility. The participants were couples who were seeking treatment for infertility at the Massachusetts General Hospital Fertility Center and opted to enroll in an in vitro fertility program between 2007 and 2017.

Upon enrollment, the participants were given complete physical exams and asked to fill out a food frequency questionnaire. The questionnaire asked how often they had consumed 131 foods and beverages during the previous year. Supplement users were asked to identify the brand of multivitamin or supplement they used, along with the dose and frequency of use.

The only two outcomes the study measured were length of gestation and birth weight.

The study coordinators ended up with 108 couples who completed the preconception dietary surveys and had successful pregnancies. These couples had 113 pregnancies resulting in 142 births (85 single babies, 54 twins, and three triplets)

Does Preconception Diet for Males Influence A Healthy Pregnancy?

Let’s start by putting this study into perspective. It was performed in the United States. That means most processed foods made with grains are fortified with folic acid. In addition, 56% percent of the fathers and 98% of the mothers were already taking a folic acid supplement.

For the fathers, folic acid intake ranged from 228 – 925 ug/day (mean = 494 ug/day. That’s almost 100 ug/day above the RDA recommendation for men).
For the mothers, folic acid intake ranged from 827 – 1329 ug/day (mean = 898 ug/day. That’s almost 300 ug/day above the RDA recommendation for pregnant women).

That meant most of the fathers and virtually all the mothers were getting at least adequate levels of folic acid in their diet at the time of conception.

This is important because it means this study was not looking at the effect of correcting a folic acid deficiency on pregnancy outcomes. It was looking at the effect of going beyond the RDA recommendation for folic acid on pregnancy outcomes.

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

For fathers, every 200 ug/day increase in folic acid intake at conception was associated with a 2.6-day longer gestational age at delivery of the baby.
The dose response was linear. That means the difference in gestational age between the lowest intake (228 ug/day) and the highest intake (925 ug/day) of folic acid in this study was approximately 9 days. Given the risks associated with preterm births, that is a significant difference.
It did not matter whether the folic acid came from food or from supplements. The results were the same.
The association between the father’s folic acid intake prior to conception and gestational age at delivery was strongest for pregnancies involving twins or triplets, for couples who were having trouble conceiving because of male infertility, and for younger and leaner fathers.
The mechanism of this effect is uncertain, but folic acid is known to modify DNA, resulting in what is referred to as “epigenetic” changes in gene expression. A recent mouse study showed differential expression of more than 300 genes in the placenta of offspring fathered by folate-deficient males.
For mothers, folic acid intake at conception had no effect on the length of gestation. That is to be expected because the lowest folic acid intake in the mothers was significantly above the RDA.
Birth weight was not affected by folic acid intake of either the father or mother.

Does the Folic Acid Status of Males Influence a Healthy Pregnancy ?

In evaluating the significance of this finding, we need to keep in mind that:

This is the very first clinical study to look at this very important topic.
This is a very small, preliminary study.
This study only looked at two measures of reproductive health.
The effect on gestational age is small.

Obviously, more and larger clinical studies are needed to confirm and expand on this finding.

However, the true importance of this study is that it ushers in a very different perspective on prenatal counseling.

Animal studies suggest that folate deficiency of the father can have bad effects on both a healthy pregnancy and the health of the offspring.
Because of folic acid fortification of refined grains, most prospective fathers in this country have an adequate intake of folic acid. It will, therefore, be very difficult to confirm the associations observed in animal studies with human clinical trials.
The fact that most men in this country have an adequate intake of folic acid is a good thing…but…
Low carb diets that eliminate both grains and legumes (beans) are popular. Unless men following these diets are consuming lots of leafy greens, they may end up being deficient in folic acid. That could affect the health of their offspring.
This study just looked at folic acid intake. It may be just the tip of the iceberg. There are other nutrients (omega-3s) and lifestyle factors (obesity and exercise) that cause epigenetic changes to the DNA and affect pregnancy outcomes.

In the words of the authors: “The implications of these findings are of great importance because, if confirmed, they suggest that preconception exposures of the father, including his diet and lifestyle choices, may have an impact on the health of his offspring, and therefore that preconception care should shift from a woman-centric to a couple-based approach.”

I would put it more simply: “What’s good for the goose, may be good for the gander.”

The Bottom Line

A recent study looked at the effect of folic acid status of fathers prior to conception on a healthy pregnancy, namely the gestational age at delivery of their offspring. The study found:

For fathers, every 200 ug/day increase in folic acid intake at conception was associated with a 2.6-day longer gestational age at delivery of the baby.
The dose response was linear. That means the difference in gestational age between the lowest intake (228 ug/day) and the highest intake (925 ug/day) of folic acid in this study was approximately 9 days. Given the risks associated with preterm births, that is a significant difference.
It did not matter whether the folic acid came from food or from supplements. The results were the same.
The mechanism of this effect is uncertain, but folic acid is known to modify DNA, resulting in what is referred to as “epigenetic” changes in gene expression. A recent mouse study showed differential expression of more than 300 genes in the placenta of offspring fathered by folate-deficient males.
This study just looked at folic acid intake. It may be just the tip of the iceberg. There are other nutrients (omega-3s) and lifestyle factors (obesity and exercise) that cause epigenetic changes to the DNA and affect pregnancy outcomes.

I would put it more simply: “What’s good for the goose, may be good for the gander.”

For more details on the study and what it means for you, read the article above.

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

Do Sodas Increase Your Risk Of Dying?

October 29, 2019 by Dr. Steve Chaney

Are Diet Sodas Just As Bad As Regular Sodas?

Author: Dr. Stephen Chaney

Americans love our sodas.

48% of Americans drink 2 or more sodas every day. Even worse:
61% of children and 56% of young adults consume 2 or more sodas every day.
The average consumption for soda drinkers is 21 ounces a day.

However, the word is out that regular (sugar sweetened) sodas increase our risk of obesity, diabetes, and heart disease, so many people are switching to diet (artificially sweetened) sodas. In a recent survey looking at diet versus regular soda consumption:

43% of adults chose diet sodas rather than regular sodas.

When this was broken down by gender:

46% of women and 39% of men preferred diet sodas.

When this was broken down by demographics:

Older adults, people who aren’t white, and people making less than $30,000/year were the groups most likely to choose diet sodas.

However, recent studies have called into question our assumptions about the benefits of diet sodas. These studies suggest that people consuming diet sodas are just as likely to become obese and to develop diabetes and heart disease as those consuming regular sodas. Some studies have even suggested that diet sodas, but not regular sodas, increase our risk of stroke. I have discussed the evidence for these concerns about diet sodas in a recent issue of Health Tips From the Professor.

However, the latest study (A Mullee et al, JAMA Internal Medicine. Doi: 10.1001/jamainternalmed.2019.2478 ) ups the ante. It suggests that sodas increase our risk of dying and that diet sodas may be worse for us than regular sodas.

How Was The Study Done?

This study utilized data from the European Prospective Investigation into Cancer and Nutrition (EPIC). In particular, this study enrolled 451,743 adults (average age = 51) from 10 countries in Europe and followed them for between 16 and 19 years. In short, this was a very large study, and it followed study participants for a long time.

Participants were excluded from the study if they had been diagnosed with cancer, heart disease, stoke, or diabetes prior to the beginning of the study.

At the beginning of the study the participants filled out a diet survey which asked, among other things, how many 8-oz glasses of regular sodas and/or diet sodas they consumed per month, week, or day.

Mortality data were obtained from each country’s health records. During the study, 41,963 deaths were recorded.

Do Sodas Increase Your Risk Of Dying?

The results of the study were striking. When they looked at the number of deaths that occurred during the study, and compared people who consumed ≥ 2 glasses/day to those who consumed ˂ 1 glass/month, death from any cause was increased by:

17% for all sodas.
8% for regular sodas.
26% for diet sodas.

Both total soda consumption and diet soda consumption increased the risk of death due to circulatory diseases (atherosclerosis, heart attack, congestive heart failure, and stroke). When they compared people who consumed ≥ 1 glass/day to those consuming ˂ 1 glass per month, the increase was:

27% for total soda consumption
52% for diet soda consumption.

Both total soda consumption and regular soda consumption increased the risk of death due to digestive diseases (diverticulitis, liver disease, and colon cancer). When they compared people who consumed ≥ 1 glass per day to those consuming ˂ 1 glass per month, the increase was:

50% for total soda consumption.
59% for regular soda consumption.

Total soda consumption (≥ 1 glass per day compared to ˂ 1 glass per month) also increased the risk of:

Colon cancer by 25%.
Parkinson disease by 59%.

The results were essentially the same for men and women.

The authors concluded: “This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.”

What Are The Strengths and Weaknesses Of This Study?

The strengths of this study are its size (451,743 participants, 41,693 deaths) and duration (16-19 years). The size allows for conclusions that are highly statistically significant. The duration allows enough time for diseases to develop and deaths to occur.

The weakness of this study is that it is an association study. Association studies do not prove cause and effect. There is always a chance that the association is caused by some other variable that was not measured.

For example, in this study when high consumers of sodas (≥ 2 glasses/day) were compared to low consumers of sodas (˂ 1 glass/month), they were more likely to be:

Younger.
Current smokers.
Physically active.
Overweight.

You may have noticed that two of these variables (age and physical activity) decrease the risk of death while the other two (smoking and weight) increase the risk of death. However, the authors did not just assume they cancelled each other out. They statistically corrected for these variables and many others in coming to their conclusions.

Of these variables, weight is the most concerning. We know from previous studies that soda consumption is likely to lead to obesity, and obesity increases the risk of death. However, the authors of this study not only statistically corrected for obesity. They also looked at the effect of high soda consumption on death in a subgroup of participants who were at a healthy weight (BMI ˂ 25). The increased risk of death was:

18% for all sodas.
11% for regular sodas.
27% for diet sodas.

In other words, the effect of sodas on the risk of death was virtually identical for those who were at ideal weight and those who were overweight. This finding significantly strengthens the conclusion of the study.

Finally, the conclusions of this study are strengthened by two recent, very large studies in the US that have come to similar conclusions.

All of these are association studies. However, nobody is going to do a 15-20 year randomized, placebo-controlled study in which regular and diet soda consumption are compared to water. These association studies are the best evidence we are likely to get.

Are Diet Sodas Just As Bad As Regular Sodas?

The handwriting about regular sodas has been on the wall for some time. The soda industry is still claiming that “soft drinks are safe to consume as part of a balanced diet,” but virtually all medical and public health organizations recommend that we decrease soda consumption.

But what do we replace those sodas with? Many public health organizations believe that the American public is so wedded to our sodas that diet sodas are the only viable alternative. But the evidence that diet sodas are not a good alternative to regular sodas continues to mount.

As I said in the introduction, recent studies suggest that people consuming diet sodas are just as likely to become obese and to develop diabetes and heart disease as those consuming regular sodas. Some studies have even suggested that diet sodas, but not regular sodas, increase our risk of stroke. I have discussed the evidence for these concerns about diet sodas in a recent issue of Health Tips From the Professor.

Even worse, this study and two other recent studies suggest that diet sodas are just as likely to increase the risk of premature death as regular sodas. The evidence is starting to become overwhelming that diet sodas are just as bad for us as regular sodas, and we should start turning to healthier alternatives.

Pure water is, of course, the best alternative. However, if plain water is too boring, try herbal teas. If you crave the fizz of sodas, try unsweetened sparkling water, perhaps infused with a little of your favorite fresh fruit. If you crave the caffeine of sodas, coffee or tea might suit you best, preferably without the sugar and cream. There are just two caveats:

Tea and coffee should not be your only source of liquid.
It goes without saying that you want to avoid the 500 calorie Starbucks extravaganzas.

The Bottom Line

A recent study followed 451,743 adults for 16-19 years and asked what effect soda consumption had on their risk of dying. The results of the study were striking. When they looked at the number of deaths that occurred during the study, and compared people who consumed ≥ 2 glasses/day to those who consumed ˂ 1 glass/month, death from any cause was increased by:

17% for all sodas.
8% for regular sodas.
26% for diet sodas.

27% for total soda consumption
52% for diet soda consumption.

The authors of the study concluded: “This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.”

The evidence is starting to become overwhelming that diet sodas are just as bad for us as regular sodas, and we should start turning to healthier alternatives.

Tea and coffee should not be your only source of liquid.
It goes without saying that you want to avoid the 500 calorie Starbucks extravaganzas.

For more details on the study and what it means for you, read the article above.

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

Does Vitamin D Supplementation Reduce Cancer Deaths?

October 22, 2019 by Dr. Steve Chaney

Why Are Vitamin D Studies So Confusing?

Author: Dr. Stephen Chaney

Does vitamin D supplementation reduce cancer deaths?

When I was in graduate school (which was just a few decades ago), vitamin D was thought to be important for healthy bones and teeth, and that was about it. Its role in calcium metabolism was well established, but we knew little else about its role(s) in the body. In fact, we were taught we knew all we needed to know about vitamin D.

Shortly after I graduated, it was discovered that almost every cell in our body had vitamin D receptors, and vitamin D research exploded. A few years ago, vitamin D appeared to be almost magic. Studies suggested that it:

Strengthened the immune system.
Prevented autoimmune diseases like type 1 diabetes and multiple sclerosis.
Reduced the risk of cancer and heart disease.
Helped regulate insulin levels and aided in type 2 diabetes management.
Supported the health of our lungs, brain, and nervous system.

Those were the headlines that you saw in the news and still see in Dr. Strangelove’s health blogs.

However, when these early studies were followed by a series of double-blind, placebo controlled clinical trials, the only benefit that was consistently validated was the strengthening of our immune system.

That has led to a series of headlines and posts in medical blogs saying things like: “Vitamin D supplements are worthless” and “You should stop taking your vitamin D supplements.”

“What is a person to believe? Why is it so confusing?”

In this week’s issue of “Health Tips From the Professor” I discuss a recent study confirming that vitamin D reduces cancer deaths. But before I do that, I will cover what I call “Vitamin D Metabolism 101” to put this week’s topic into context. Later in the article, I will discuss why vitamin D studies are so confusing.

Vitamin D Metabolism 101

There are two things you need to know about vitamin D metabolism to understand today’s article:

Vitamin D occurs in two forms, D3 and D2. Vitamin D3 is the form of vitamin D that our body makes when sunlight hits our skin. Vitamin D2 is a structurally similar analog derived from yeast. For years we thought that vitamin D3 and D2 were equivalent. Vitamin D2 was less expensive, so it was one most often used in supplements.
Vitamin D is inactive. It needs to be activated by the body. It is first converted to 25-hydroxyvitamin D, which is the most abundant form of vitamin D in the bloodstream. It is then taken up by our cells and converted to 1,25-dihydroxyvitamin D, which is the active form. There are two things you need to know about this.
- Since 25-hydroxyvitamin D is found in the blood, it is used as a marker to determine the vitamin D status in the body.
- Recent studies suggest that vitamin D3 is more readily activated than vitamin D2, so it has become the preferred choice for supplementation. The result of this recent conversion from D2 to D3 means that older studies on vitamin D supplementation were primarily done with D2 while newer studies were primarily done with D3.

How Was The Study Done?

This study (Y Zhang et al, BMJ, 366:I4673, 2019 ) was a meta-analysis of 52 clinical trials with 75,454 participants looking at the relationship between vitamin D supplementation cancer deaths, heart disease deaths, and deaths due to any cause.

All the clinical trials were intervention studies in which vitamin D supplementation was compared to either a placebo or no treatment. All participants were adults over the age of 18 and without any pre-existing health conditions. The meta-analysis excluded studies if:

Any participants had pre-existing health conditions.
Any participants were pregnant or lactating women.
Calcium was included along with vitamin D unless both the treatment and placebo groups were given the same amount of calcium.

Does Vitamin D Supplementation Reduce Cancer Deaths?

The results of the study were:

Vitamin D supplementation reduced cancer deaths by 16%. This difference was statistically significant. And:
- This effect was only seen with vitamin D3 supplementation, not with vitamin D2 supplementation.
- The reduction in cancer deaths by vitamin D was only seen in clinical trials that lasted more than 3 years but was not seen in shorter clinical trials.
Vitamin D supplementation did not reduce heart disease deaths. However:
- Weaknesses in the clinical trials included in this meta-analysis made it virtually impossible to determine whether vitamin D supplementation influenced heart disease deaths or not.
Vitamin D supplementation did not significantly reduce death from all causes. However:
- Death from all causes was significantly less in studies using vitamin D3 than in studies in studies using vitamin D2.
- Death from all causes was significantly lower in clinical trials with a longer duration.

Why Are Vitamin D Studies So Confusing?

[Note: This section is a bit technical, so if you aren’t really interested in why vitamin D studies are confusing, you can just skip this section.]

To understand why vitamin D studies are so confusing, it is important to look at vitamin D research from a historical perspective.

Vitamin D research, like most nutrition research, starts with association studies. Association studies have suggested that vitamin D deficiency significantly increases the risk of heart disease and cancer and slightly increased the risk of death from any cause. However, association studies have their strengths and weaknesses. For example:

Strengths:

Association studies can follow large groups of people for a long time.
Association studies are particularly good at identifying the long-term effects of nutritional patterns (such as vitamin D deficiency) on health outcomes.

Weaknesses:

Association studies cannot prove cause and effect, so they are usually followed by intervention studies, such as the ones included in this meta-analysis.

However, intervention studies and this meta-analysis also have their own strengths and weaknesses.

Strengths: The strengths of this meta-analysis are the sample size (52 clinical trials, 75,454 participants) and the rigorous criteria for inclusion of studies in the meta-analysis.

Weaknesses: There are three kinds of weaknesses associated with this study.

Weaknesses of Meta-Analysis Studies: A meta-analysis increases statistical power by combining multiple studies. However, these studies do have weaknesses. For example:

- The strength of the meta-analysis is only as good as the strength of the individual studies that go into it. This is the “garbage in – garbage out” phenomenon.

- The individual studies use different amounts of vitamin D for different lengths of time. So, this meta-analysis is unable to tell you how much supplemental vitamin D would be required to lower your cancer risk.

Weaknesses of Intervention Studies: Double-blind, placebo-controlled intervention studies are considered the “gold standard” for evidence-based medicine. However, they also have their own weaknesses.

- They are usually small. This limits their statistical power to see small effects.
- They are usually short.
  - This is a problem for studies looking at disease outcomes because most major diseases like heart disease or cancer develop over decades. Intervention studies like the ones included in this meta-analysis are simply too short to determine whether vitamin D supplementation could prevent those diseases.
  - It is also a problem for heart disease deaths because they often occur a decade or more after diagnosis. Thus, it is not surprising that the intervention studies included in this meta-analysis have failed to confirm an association between vitamin D and heart disease deaths.
  - However, most cancer deaths occur within the first 2-5 years after diagnosis. So, it is not surprising that intervention studies lasting 3 years or more have been able to confirm an association between vitamin D and cancer deaths.
Weaknesses of Studies With Popular Supplements: Once the benefits of certain nutrients show up in the headlines, people start taking those supplements. This has become a big problem for studies with vitamin D and omega-3 fatty acids. For example:
- > 75% of Americans take a multivitamin with vitamin D, and an additional 18% of adults over 50 also take a vitamin D supplement.
- In this meta-analysis more than half of the participants had a baseline 25-hydroxyvitamin D level of > 50 nmol/L, which the NIH considers to be adequate, prior to supplementation.

That means most of these studies were not asking whether correcting a vitamin D deficiency reduced the risk of death. They were asking whether giving a vitamin D supplement to someone whose vitamin D status was already adequate had any additional benefit. In this context:
- Previous association studies have suggested that a 25-hydroxyvitamin D level of 50 nmol/L is enough to reduce heart disease deaths. Since most of the participants in the clinical trials included in this study started with this level prior to supplementation, it is not surprising that this study found no benefit of vitamin D supplementation on heart disease deaths.
- However, previous association studies have suggested that a 25-hydroxyvitamin D level of 75 nmol/L or greater is required to reduce cancer deaths. Thus, it is not surprising that this and other studies have been able to show that vitamin D supplementation reduces cancer deaths.

In short, these weaknesses in intervention studies have made it virtually impossible to determine whether vitamin D supplementation influences heart disease deaths. Unfortunately, a meta-analysis like this one is only as good as the intervention studies that go into it. This is the “garbage in – garbage out” phenomenon.

However, those weaknesses did not apply to cancer deaths. This and other studies make a strong case that vitamin D supplementation does reduce cancer deaths.

What Does This Study Mean For You?

Association studies have suggested that vitamin D deficiency significantly increases the risk of heart disease and cancer and slightly increased the risk of death from any cause.

This study confirms vitamin D supplementation significantly decreases cancer deaths as predicted from association studies. This observation is strengthened by two other major clinical studies in recent months that have come to the same conclusion. I reported on one of them in a recent issue of “Health Tips From The Professor.”
This study does not indicate an optimal dosage, but the recent VITAL study) reported that 2,000 IU of vitamin D/day was effective at reducing the risk of cancer deaths.
The authors of this study concluded that vitamin D supplementation has no effect on heart disease deaths. However:
It would be more accurate to say that weaknesses in the design of the intervention trials included in their study made it virtually impossible to determine whether vitamin D supplementation influenced heart disease deaths.
To adequately assess whether vitamin D reduced heart disease deaths one would need to start with a population that was deficient in vitamin D and supplement with vitamin D for 5 years or more. That kind of study has not been performed.
The data on whether vitamin D reduces the risk of dying from any cause is less clear.
This study reported that vitamin D supplementation decreased the risk of death from any cause by a non-significant 2%.
Two other recent meta-analyses reported that vitamin D supplementation did have a significant effect on the risk of dying from any cause. However, the risk reduction was 3% in one study and 4% in the other study.
Clearly, vitamin D supplementation is not going to help you live to 100.

The Bottom Line

Previous association studies have suggested that vitamin D deficiency significantly increases the risk of heart disease and cancer and slightly increased the risk of death from any cause.

A recent meta-analysis of 52 clinical trials with 75,454 participants tested those predictions by looking at the effect of vitamin D supplementation on cancer deaths, heart disease deaths, and deaths due to any cause. All the clinical trials were intervention studies in which vitamin D supplementation was compared to either a placebo or no treatment. All participants were adults over the age of 18 and without any pre-existing health conditions.

The results of this meta-analysis were:

Vitamin D supplementation reduced cancer deaths by 16%. This difference was statistically significant. And:
This effect was only seen with vitamin D3 supplementation, not with vitamin D2 supplementation.
The effect of vitamin D supplementation on cancer deaths is strengthened by two other major clinical studies in recent months that have come to the same conclusion.
This study did not indicate an optimal dosage, but the recent VITAL study reported that 2,000 IU of vitamin D/day was effective at reducing the risk of cancer deaths.
Vitamin D supplementation did not reduce heart disease deaths. However:
Weaknesses in the clinical trials included in this meta-analysis made it virtually impossible to determine whether vitamin D supplementation influenced heart disease deaths or not.
Vitamin D supplementation did not significantly reduce death from all causes. However:
Death from all causes was significantly less in studies using vitamin D3 than in studies using vitamin D2.
Death from all causes was significantly lower in clinical trials with a longer duration.

For more details on the study and what it means for you, read the article above. Also, if you would like to understand why there is so much confusion about vitamin D’s health benefits, it is also discussed in 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.

Hip Pain Causes

October 15, 2019 by Dr. Steve Chaney

Does Dehydration Make The Pain Worse?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Let’s talk about something really serious – hydration! Since our body is mostly water, averaging 50-65% of our body weight, hydration is vital for life. The balance between water and electrolytes plays a key in how our systems function, including every cell, organs (heart, liver, etc.), nerves, and muscles. Even our bones are made up of about 30% water, and our brain is approximately 60% water.

Dehydration has disastrous results! You may experience headaches that become migraines, or even a feeling of brain fog. Your brain tells the other organs when and how to function, so dehydration in the brain will affect your entire body. Insufficient water may cause your eyes to get heavy, and you may become constipated. The effects on your heart, lungs, liver, and other vital organs is even worse.

Yet something as simple as sipping water throughout the day can prevent all of this from happening. It is suggested that men drink 8 glasses of water a day, and women drink 7.5 glasses a day. Of course, searching the internet will bring up experts who vary widely on the amount of water that is required for good health.

Since I am a muscular therapist, my major concern is how dehydration affects the muscles and our pain levels. Studies have shown that when there is insufficient water in the body, pain is felt more acutely, including muscle pain, arthritic pain, and joint pains.

What is the Best Water To Drink?

Designer water has become popular in the USA, but are they necessary? I saw a recent post saying: “If you are paying $3 a bottle for Smart Water, it isn’t working.”

As for specialized water products, Steve Chaney, PhD, the author of Slaying the Food Myths and Slaying the Supplement Myths, has stated that products such as ionized water and alkaline water “win the Flying Pig award” from a complicated chemical point of view. It’s way beyond the scope of this newsletter to explain his rationalization, but if you’re interested you can find his books on Amazon and read the full explanation (and a whole lot more!).

The bottom line, according to Dr. Chaney, is to just drink pure water, preferably water that doesn’t have chemicals added for various reasons.

William W. Li, MD, the author of Eat to Beat Disease, also recommends avoiding water that is stored in plastic bottles, even bottles without BPA plastic. Plastic particles called microplastics will shed into the water. One study (https://orbmedia.org/sites/default/files/FinalBottledWaterReport.pdf) found as many as 2,400 pieces of microplastic in eight fluid ounces of bottled water.

To protect yourself from this problem, I suggest you get a stainless-steel water bottle, and if you like to use a straw you can get stainless steel straws on Amazon. That solves the problem and also helps the ocean since so many bottles end up floating in rivers, streams, and the ocean.

Hip Pain Causes

I’ve spoken about hip pain and the muscles that cause it several times in the past. Basically, the muscles that insert into your hip bone (pelvis) and into your thigh bone (Rectus Femoris, Gluteus Maximus/Medius/Minimus, and Tensor Fascia Lata) get tight and pull up on your leg. This upsets the alignment of your hip, and you have pain.

Recently I discovered yet another reason, one I’d never considered before, yet I’ve now seen it in several clients. It’s a bit complicated so I’ll go slow so you can visualize what I’m describing.

A client of mine had LEFT hip pain. When he would come in, I would work on his left hip and he would have temporary relief. I’m not used to people only having “temporary” relief, so I was going over and over in my mind what could be happening. Then he gave me a clue that really made sense.

He said as he walked down the beach and his left leg was up the slope, with his right leg closer to the water, his left hip was really hurting. But when he turned around and now his right leg is up the slope and his left leg was down, closer to the water, his hip pain went away.

This picture above is an exaggeration but look at how the walker’s right leg is up the slope and left leg is down the slope. You can imagine that his hips are also tilted with the left being lower, but he’s trying to be level (or his body would be tilted to the side – LOL).

Back to my client….remember that his LEFT hip is hurting as he’s walking down the beach with his right leg lower than his left leg. Then he turns around and with left leg now lower than his right leg, he is out of pain. I contemplated that situation, and suddenly it came to me! His RIGHT leg was actually the leg that is shorter!

My conclusion was, as he was walking with his left leg on the high side of the sand, it was jamming his left leg up into his hip, but when he turned around and was walking with his left leg on the low side of the sand, and his right leg on the high side, it made his hips be level, and he didn’t have pain.

So, I asked him to lie on the massage table with his feet off the end so I could see if one leg was shorter than the other, and sure enough, his right heel was about ¼” higher than his left heel.

That means the muscles that insert into his right leg were tight and pulling up on his thigh bone.

Treating The Hip Pain

I worked on all the muscles that impact his right hip for most of the session, and for a bit of the time I worked on his left hip muscles. I have posted all these treatments in prior newsletters, so I won’t repeat them here.

When I was finished, I did another picture, and I was so pleased to see the difference in his leg length. His two heels were now level.

I tested that theory out with other clients this week, and most of the time the shorter leg is the hip that is hurting, but with two other clients, it was the longer leg that was feeling the hip pain. Both times I worked on the hip muscles of the shorter leg, and it worked!

It amazes me that after 31 years of specializing in the treatment of chronic pain, I’m still figuring out new solutions!

Do you stretch? Most of the time stretching feels good, but sometimes it hurts more after stretching than it did before. The reason is the muscles are tied up in knots.

Think of what would happen if you had a 12” length of rope, tied a big knot in it so it’s now only 10” long, and then tried to stretch it back to 12”. Even if you get it back to the 12” you did it by making the knot tighter and overstretching the fibers on either side of the knot.

That’s what happens in your body when the muscles are shortened by spasms (knots) and you try to stretch the muscle without first releasing the knots in the fibers.

There is a solution!

Introducing a safe-stretching kit that has changed names to reflect what it’s doing to help you have more flexibility and mobility.

Originally called Trigger Point Yoga, and now called Focused Flexibility Training (https://www.mcssl.com/SecureCart/ViewCart.aspx?mid=35DED97F-0CB9-4B06-BAD3-16CDDEDAED40&sctoken=291595251fc14977a18eefe24a2bf69e&bhjs=1&bhqs=1), by any name this is the best product available for safe stretching.

For only $67.00 you can have all the tools you need to stretch safely and stop pain FAST!

Three DVD’s (and now it’s also an MP4) that give you step-by-step direction.
- One DVD shows me teaching an athlete how to do every self-treatment taught in Treat Yourself to Pain-Free Living.
- Two DVD’s where you work with an amazing yoga instructor named Ana. You’ll do 15 minutes of self-treating the muscles you’ll be stretching, and then 30 minutes of beautifully filmed, guided yoga stretching.
A Perfect Ball, which is truly perfect because it is solid in the center and soft on the outside, enabling you to work deeply without bruising your bones.
A bamboo stick (while supplies last) or a TotalTX pipe to work on your thigh muscles.

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 20 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.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

What’s Worse Saturated Fat or Sugar?

October 8, 2019 by Dr. Steve Chaney

What Causes Fatty Liver Disease?

Author: Dr. Stephen Chaney

The great American food fight continues. The low fat enthusiasts tell you saturated fat is going to kill you. The low carb enthusiasts tell you saturated fat is fine. It’s sugar that’s going to kill you.

You can find studies that support either viewpoint. And the story keeps changing. One day the headlines proclaim: “The latest study shows…” A few weeks later you see a headline saying: “Wait. That’s wrong. Science now shows…” It’s no wonder you are confused and perhaps a bit cynical.

So, what’s worse saturated fat or sugar?

Perhaps we should step back and ask how we got to this point.

Why Is the Saturated Fats and Sugar Dilemma So Confusing?

To understand why the literature around saturated fats and sugar is so confusing, we need to go back to the 1950s. The first studies implicating saturated fats as a risk factor for heart disease replaced saturated fats with unsaturated fats. Everything else in the diet was kept the same. When you do that, the answer is clear-cut. Saturated fats increase heart disease risk and unsaturated fats decrease heart disease risk.

When the American Heart Association first recommended a low-fat diet, they had in mind replacing saturated fats with fresh fruits, vegetables, whole grains, and beans. The remaining fat would be mostly unsaturated. Today, we would call that a Mediterranean diet, which, by the way, has been shown to reduce both diabetes and heart disease risk.

Big Food Inc. took one look at that and panicked. They make their money from processed foods, not from fresh fruits and vegetables. If the American people made the changes the American Heart Association recommended, Big Food Inc. would go bankrupt.

They sprang into action. They had their laboratories whip up processed foods that replaced fat with sugar, white flour, and a witch’s brew of chemicals. Then they told the American people: “Never fear. You don’t have to give up your favorite foods. We have created low fat versions of the foods you love.”

That became the diet that most Americans adopted. Even worse, most Americans continued eating foods high in saturated fats. We ended up with the worst of all possible worlds – a diet high in saturated fat and high in sugar. This became the Standard American Diet (SAD).

This shift has corrupted most of the recent research studies on saturated fat and sugar. Most of the studies on saturated fat or sugar have compared them with the Standard American Diet, not with a healthy diet. When you do that, your results are going to be skewed. Almost anything is better that the Standard American Diet.

Why Was This Study Done?

When we think of obesity, we think of the excess fat we can see. But what we have learned in recent years is that the fat you can’t see is far more damaging to our health. I am talking about fat stores in the liver, something called fatty liver disease.

Fatty liver disease has serious consequences. It causes insulin resistance and inflammation, and that increases the risk of diabetes and heart disease. Even worse, it can lead to cirrhosis and liver failure.

Excess sugar is converted to saturated fat in the liver. Therefore, the popular literature attributes the epidemic of fatty liver disease to increased intake of simple sugars. But is it true? Saturated fats require no conversion. They can simply be deposited in the liver as is. Shouldn’t they be at least as damaging to the liver as sugar?

It turns out that no studies have actually compared the effect of excess calories in the form of saturated fat, unsaturated fat, and simple sugars on fat accumulation in the liver. This study (PK Luukkonen et al, Diabetes Care, 41: 1732-1739, 2018) was designed to fill that gap.

How Was The Study Done?

The authors enrolled 38 middle aged (average age = 48), overweight (average BMI = 31) adults for the study. The participants were divided into three groups and were fed an extra 1,000 calories per day of saturated fat (SAT group), unsaturated fat (UNSAT group), or sugar (SUGAR group) for 3 weeks. The composition of those extra 1,000 calories was as follows:

The SAT group ate an extra 30 g coconut oil, 40 g butter, and 100 g blue cheese
- Macronutrient composition = 1% carbohydrate, 86% fat, 13% protein, 0% simple sugars.
- Fat composition = 76% saturated fats, 21% monounsaturated fats, 3% polyunsaturated fats
The UNSAT group ate an extra 36 g olive oil, 26 g pesto, 54 g pecans, and 20 g butter
- Macronutrient composition = 2% carbohydrate, 91% fat, 7% protein, 0% simple sugars.
- Fat composition = 21% saturated fats, 57% monounsaturated fats, 22% polyunsaturated fats
The SUGAR group ate an extra 9.5 ounces of orange juice, 16 ounces of sugar-sweetened beverages, and 200 g of candy.
- Macronutrient composition = 100% simple sugars.

Compliance to these dietary additions was confirmed by measuring the fat composition of serum triglycerides. As expected, the triglycerides were primarily composed of saturated fat in the SAT and SUGAR groups and unsaturated fats in the UNSAT group.

None of the participants had diabetes or other diseases, pre-existing liver disease, excessive consumption of alcohol (which can also lead to fatty liver disease). They were also not taking any drugs that could influence glucose or lipid metabolism.

Upon entry into the study, the three groups were comparable with respect to age, sex, BMI (a measure of obesity), amount and type of fat stores in the liver, and insulin sensitivity.

The baseline diet to which the extra calories were added was also comparable between the three groups and did not change during the study. That meant that the only difference between groups was the composition of the extra calories they consumed.

What Causes Fatty Liver Disease?

At the end of three weeks:

All 3 groups gained weight, but the weight gain was slightly larger (0.6 pounds) for the SAT and SUGAR groups than for the UNSAT group (0.4 pounds).
Fat stores in the liver increased by 55% in the SAT group, 33% in the SUGAR group, and 15% in the UNSAT group.
The fat stores were primarily saturated fat in the SAT and SUGAR groups and primarily unsaturated fat in the UNSAT group.
Insulin resistance was increased in the SAT group, but not in the SUGAR and UNSAT groups.

Previous studies have suggested that the effect of liver fat stores on insulin resistance might be mediated by fat metabolites called ceramides. Therefore, they also measured plasma ceramide levels.

Plasma ceramides were increased in the SAT group, but not in the SUGAR and UNSAT groups.

Previous studies have also suggested that the effect of saturated fat on insulin resistance might be mediated by a change in gut bacteria that produce endotoxins which end up in the bloodstream.

A change in gut bacteria and an increase in plasma endotoxins was observed in the SAT group, but not in the SUGAR and UNSAT groups.

What is Worse Saturated Fat Or Sugar?

The authors of this study concluded: “Saturated fat induced the greatest increase in fat stores in the liver, insulin resistance, and harmful ceramides. Decreased intakes of saturated fat could be beneficial in reducing fat stores in the liver and the associated risk of diabetes.”

Is that statement true? This study was well designed. However, this is a very small study. It needs to be replicated by larger studies. In the meantime, we can ask if the findings are consistent with previous studies.

You may have noticed, the authors included three variables in their study (saturated fats, unsaturated fats, and simple sugars), but I focused only on the comparison between saturated fats and simple sugars in this article. That is because the damage caused by saturated fats versus simple sugars is controversial in the popular literature. In contrast, most (but not all) experts agree that saturated fats are worse for you than unsaturated fats.

Let’s start with the relatively non-controversial comparison (saturated fats versus unsaturated fats) before turning to the comparison between saturated fats and simple sugars. When comparing saturated fats and unsaturated fats, the author’s conclusion that saturated fats are worse for you is probably true.

In this study saturated fats caused greater fat accumulation in the liver than unsaturated fats, and these differences were statistically significant.
The fat stores in the liver mirrored the fat composition of the diet. Saturated fat caused saturated fat stores. Unsaturated fat caused unsaturated fat stores.
Saturated fats increased insulin resistance while unsaturated fats did not.
This is consistent with several previous studies that have shown:
Saturated fats cause greater fat accumulation in the liver than polyunsaturated fats in younger, normal weight individuals.
High saturated fat intake is associated with fatty liver disease and insulin resistance.
Saturated fat increases heart disease risk, while unsaturated fat decreases heart disease risk.

However, the differences between saturated fats and sugar were less clear.

In this study saturated fats caused greater fat accumulation in the liver and more insulin resistance than simple sugars.
The conclusion that saturated fats are worse for you than simple sugars was strengthened by the following:
Saturated fat caused insulin resistance, while simple sugars did not.
Saturated fat caused a change to gut bacteria which resulted in increased endotoxin levels in the bloodstream, while simple sugars did not.
The conclusion that saturated fats are worse for you than simple sugars was weakened by the following:
The difference in fat accumulation in the liver was not statistically significant. A larger study may have provided a more definitive answer.
Previous studies have suggested that saturated fats and simple sugars may be equally bad for you. They both increase the risk of diabetes and heart disease.

Clearly, this study does not end the debate about whether saturated fats or simple sugars are worse for you. However, it does provide a new perspective.

Previous studies have not compared the effects of saturated fat and sugar on fatty liver disease when all other aspects of the diet were identical. If the observations of this study are confirmed in subsequent studies, it could influence how we evaluate the relative risks of saturated fats and sugars in the future.

What Does This Study Mean For You?

When you strip away all the noise, there are three obvious conclusions from this and most previous studies:

Excess calories in any form are bad for us. We don’t just store fat in the liver, and fat stores in other parts of our body have bad effects on our health as well.
Unsaturated fats are better for us than saturated fats. They reduce the risk of heart disease. This study suggests they also reduce the risk of fatty liver disease, insulin resistance, and possibly diabetes.
The jury is still out on the health consequences of saturated fats versus simple sugars. This study suggests that simple sugars may be less likely to cause fatty liver disease. While fatty liver disease can lead to diabetes and heart disease, so can fat stores anywhere else in the body. Other studies suggest that excess calories as saturated fats and simple sugars are equally likely to lead to obesity, diabetes and heart disease.

My recommendation is to avoid both saturated fats and simple sugars. Don’t focus on low fat diets or low carb diets. Instead focus on whole food diets with healthy fats and healthy carbs.

The Bottom Line

A recent study compared the effect of diets high in saturated fats (SAT group), unsaturated fats (UNSAT group), or simple sugars (SUGAR group) on fat accumulation in the liver. The results were:

Fat stores in the liver increased by 55% in the SAT group, 33% in the SUGAR group, and 15% in the UNSAT group.
The fat stores were primarily saturated fat in the SAT and SUGAR groups and primarily unsaturated fat in the UNSAT group.
Insulin resistance was increased in the SAT group, but not in the SUGAR and UNSAT groups.

The authors of this study concluded: “Saturated fat induced the greatest increase in fat stores in the liver and insulin resistance. Decreased intakes of saturated fat could be beneficial in reducing fat stores in the liver and the associated risk of diabetes.”

My recommendation is to avoid both saturated fats and simple sugars. Don’t focus on low fat diets or low carb diets. Instead focus on whole food diets with healthy fats and healthy carbs.

For more details on the study and what it means for you, read the article above.

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

Omega-3s During Pregnancy Are Healthy

October 2, 2019October 1, 2019 by Dr. Steve Chaney

It’s Definite: Omega-3s Reduce Preterm Births

Author: Dr. Stephen Chaney

The role of omega-3s on a healthy pregnancy has been in the news for some time. Claims have been made that omega-3s reduce preterm births, postnatal depression, and improve cognition, IQ, vision, mental focus, language and behavior in the newborn as they grow.

The problem is that almost all these claims have been called into question by other studies. If you are pregnant or thinking of becoming pregnant, you don’t know what to believe.

Should you eat more fish?
Should you take omega-3 supplements?
Or should you just ignore the claims about omega-3s and a healthy pregnancy?

Omega-3s during pregnancy is healthy or not? These are not trivial questions. Let’s consider preterm births as an example. The medical profession has made enormous advances in keeping premature babies alive. However, premature babies are still at higher risk of several health conditions including:

Visual impairment.
Developmental Delay.
Learning difficulties.

Plus, it is expensive to keep premature babies alive. One recent study estimated that increasing omega-3 intake during pregnancy could reduce health care costs by around $6 billion in the United Stated alone.

Unfortunately, it’s not just omega-3s and pregnancy. The same is true for almost all nutritional health claims. One day a study comes out claiming that nutrient “X” cures some disease or has some miraculous benefit. The bloggers and news media hype that study. Suddenly you see that health claim everywhere. It becomes so omnipresent that you are tempted to believe it must be true.

But, wait. A few months later another study comes to an opposite conclusion. Now the media is telling you that health claim is false. The months come and go, and new studies keep coming out. Some support the health claim. Others refute it.

Pretty soon the nutrition headlines just become “noise.” You don’t know what to believe. If you want the truth, “Who ya gonna call?”

Who Ya Gonna Call?

It’s not Ghostbusters. It not Dr. Strangelove’s health blog. It’s a group called the Cochrane Collaboration.

The Cochrane Collaboration consists of 30,000 volunteer scientific experts from across the globe whose sole mission is to analyze the scientific literature and publish reviews of health claims so that health professionals, patients, and policy makers can make evidence-based choices about health interventions.

The Cochrane Collaboration reviews all the relevant studies on a topic, exclude those that are biased or weak, and make their recommendations based on only the strongest studies. Their reviews are considered the gold standard of evidence-based medicine.

If you are of a certain age, you may remember that TV commercial “When EF Hutton talks, people listen.” It is the same with the Cochrane Collaboration. When they talk, health professionals listen.

This week we will examine the Cochrane Collaboration’s review titled “Omega-3 Fatty Acid Addition During Pregnancy.”

How Was The Study Done?

For this analysis the Cochrane Collaboration reviewed 70 randomized controlled trials which compared the effect of added omega-3s on pregnancy outcomes with the effect of either a placebo or no omega-3s. These trials included almost 19,927 pregnant women.

In one sense, Cochrane reviews are what is called a “meta-analysis”, in which data from numerous studies are grouped together so that a statistically significant conclusion can be reached. However, Cochrane Collaboration reviews differ from most meta-analyses found in the scientific literature in a very significant way.

Many published meta-analyses simply report “statistically significant” conclusions. However, statistics can be misleading. As Mark Twain said: “There are lies. There are damn lies. And then there are statistics.”

The problem is that the authors of most meta-analyses group studies together without giving sufficient consideration to the quality of studies included in their analysis. This creates a “Garbage In – Garbage Out” effect. If the quality of individual studies is low, the quality of the meta-analysis will also be low. Simply put, the conclusions from some published meta-analyses are not worth the paper they are written on.

The Cochrane Collaboration also reports statistically significant conclusions from their meta-analyses. However, they also carefully consider the quality of each individual study in their analysis. They look at possible sources of bias. They look at the design and size of the studies. Finally, they ask whether the conclusions are consistent from one study to the next. They clearly define the quality of evidence that backs up each of their conclusions as follows:

High-quality evidence. Further research is unlikely to change their conclusion. This is generally reserved for conclusions backed by multiple high-quality studies that have all come to the same conclusion. These are the recommendations that are most often adopted into medical practice.
Moderate-quality evidence. This conclusion is likely to be true, but further research could have an impact on it.
Low-quality evidence. Further research is needed and could alter the conclusion. They are not judging whether the conclusion is true or false. They are simply saying more research is needed to reach a definite conclusion.

It’s Definite: Omega-3s During Pregnancy is Healthy

Here are the conclusions that the Cochrane Collaboration said were supported by high-quality evidence:

Omega-3s reduce the risk of preterm births.
Omega-3s reduce the risk of low birth weight infants.

The authors concluded: “Omega-3 supplementation during pregnancy is an effective strategy for reducing the risk of preterm birth…More studies comparing [the effect of] omega-3s and placebo [on preterm births] are not needed at this point.”

In other words, they are saying this conclusion is definite. Omega-3 supplementation should become part of the standard of medical care for pregnant women.

However, they did say that further studies were needed “…to establish if, and how, outcomes vary by different types of omega-3s, timing [stage of pregnancy], doses [of omega-3s], or by characteristics of women.”

That’s because these variables were not analyzed in this study. The study included clinical trials:

Of women at low, moderate, and high risk of poor pregnancy outcomes.
With DHA alone, with EPA alone, and with a mixture of both.
Omega-3 doses that were low (˂ 500 mg/day), moderate (500-1,000 mg/day), and high (> 1,000 mg/day).

Do Omega-3s Make For A Healthy Pregnancy?

What about the effect of omega-3s on other pregnancy outcomes?

The conclusions the Cochrane Collaboration said were supported by moderate quality evidence included reductions in:

Perinatal death.
Admissions to the neonatal intensive care unit.

There was not enough high or moderate quality data to determine the effect of omega-3s on other pregnancy outcomes such as postnatal depression. More research is still needed in those areas. However, if they do occur, you can just consider them as side benefits.

What Does This Report Mean For You?

The proven effect of omega-3 supplementation on preterm births is significant because preterm births increase the risk of:

Visual impairment.
Developmental Delay.
Learning difficulties.

The likely effect of omega-3s on admission to neonatal intensive care units is significant because those units are very expensive.

One recent study concluded that omega-3 supplementation during pregnancy might save the US health care system $6 billion per year.

This study did not determine whether omega-3 supplementation was equally important for women at low, moderate, and high likelihood of poor pregnancy outcomes.

Therefore, omega-3 supplementation should be considered for all pregnant women.

This study did not determine whether omega-3 supplementation was equally important during the first, second, or third trimester.

Therefore, omega-3 supplementation should be considered by all women of childbearing age who might become pregnant.

This study did not determine whether DHA, EPA, or a mixture of the two was most effective.

Therefore, your omega-3 supplement should probably contain both DHA and EPA. A group of experts recently recommended that adults consume at least 650 mg/day of omega-3s with 220 mg of that coming from DHA and 220 mg/day coming from EPA.

This study did not determine the minimum effective dose of omega-3s to reduce preterm births.

Most health organizations recommend that pregnant women consume between 200-500 mg/day of omega-3s.
For example, one group of experts recently recommended pregnant women consume at least 300 mg/day of DHA and 220 mg/day of EPA.
The American College of Obstetrics and Gynecology recommends supplementation with 200 mg/day of DHA. However, that recommendation assumes that the increase will come from fish and was influenced by concerns that omega-3-rich fish are highly contaminated with heavy metals and PCBs.
Since most pregnant women in this country consume around 89 mg/day of DHA + EPA, some degree of omega-3 supplementation in the 200-500 mg/day range is warranted.

The Bottom Line

The effect of omega-3s on pregnancy outcomes have been confusing. Some studies conclude that omega-3s during pregnancy is healthy. Other studies suggest they are ineffective. What are you to believe?

Fortunately, a group called the Cochrane Collaboration recently conducted a comprehensive review of this topic. This is significant because Cochrane Reviews are internationally recognized as the highest standard in evidence-based health care. They influence the treatment protocols recommended by the medical community.

This Cochrane Review concluded that omega-3 supplementation during pregnancy:

Reduces preterm births and low birth weight infants.
Likely reduces perinatal death and admissions to the neonatal intensive care unit.

The authors of the review said: “Omega-3 supplementation during pregnancy is an effective strategy for reducing the risk of preterm birth…More studies comparing [the effect of] omega-3s and placebo [on preterm births] are not needed at this point.”

In other words, they are saying this conclusion is definite. Omega-3 supplementation should become part of the standard of medical care for pregnant women.

This study did not determine the minimum effective dose of omega-3s to reduce preterm births.

Most health organizations recommend that pregnant women consume between 200-500 mg/day of omega-3s.
Since most pregnant women in this country consume around 89 mg/day of DHA + EPA, some degree of omega-3 supplementation is warranted.

For more details on the study and what it means for you, read the article above.

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

Will A Healthy Lifestyle Help Prevent Alzheimer’s Disease?

September 24, 2019 by Dr. Steve Chaney

Can Lifestyle Overcome Genetics?

Author: Dr. Stephen Chaney

Will a healthy diet help prevent Alzheimer’s disease?

Alzheimer’s disease and other forms of dementia are among the most feared diseases of aging. What use is it to have a healthy body, a loving family, and a successful career if you can’t remember any of it? You should be able to enjoy your Golden years, not see them slip through your fingers.

If you have a family history of dementia or have sent your DNA off for testing and learned you are genetically predisposed to dementia, you are probably worried. You are not alone.

According to the World Health Organization:

50 million people worldwide have dementia.
Alzheimer’s Disease accounts for 60-70% of all dementia cases.

According to the Alzheimer’s Association:

8 million Americans are currently living with Alzheimer’s Disease.
1 in 3 seniors will die from Alzheimer’s or another form of dementia.
The number of Americans with Alzheimer’s Disease is expected to increase to 14 million by 2050.

Perhaps the scariest thing about Alzheimer’s is that the medical community has no answers. There are no drugs to prevent or cure Alzheimer’s and brain transplants are out of the question. Some medical professionals will tell you nothing can be done, but is that true?

Studies have suggested that a healthy lifestyle can help reduce your risk of developing Alzheimer’s and other forms of dementia. But what about genetics? Will a healthy lifestyle only reduce your risk of dementia if your genetic risk is low or will it be equally effective when your genetic risk is high? Can lifestyle overcome genetics?

This study (I Lourida et al, JAMA, 322: 430-437, 2019 ) was designed to answer that important question.

How Was The Study Done?

This study used data collected from the UK Biobank study, which was designed to assess the effect of genetics and lifestyle on health outcomes. The UK Biobank study enrolled more than 500,000 participants between 2006 and 2010.

At the time of enrollment, UK Biobank participants were given a physical exam. Blood samples were taken and preserved for subsequent genetic analysis. They also completed an online questionnaire and were interviewed about lifestyle, medical history, and nutritional habits.

This study used a subset of the UK Biobank data, consisting of 196,383 people who were 60 years or older and free of cognitive impairment or dementia at the time of enrollment. They were followed for an average of 8 years.

The authors created the following scoring system to assess the effect of genetics and lifestyle on Alzheimer’s disease and dementia:

The Genetic Risk Score represents the combined effect of all genetic variants known to increase the risk of Alzheimer’s disease and dementia. [Note: There is no single gene that determines whether you will develop Alzheimer’s and other forms of dementia. There are multiple gene variations that affect your risk.]

The Healthy Lifestyle Score was based on 4 well-established dementia risk factors (smoking status, physical activity, diet, and alcohol consumption). The risk factors were defined as follows:

Smoking status was categorized as current or no current smoking.
Regular physical activity was defined as meeting the American Heart Association of:
≥ 150 minutes of moderate exercise per week – OR –
≥ 75 minutes of vigorous activity per week.

A healthy diet was defined as meeting at least 4 of these 7 criteria.

≥ 3 servings/day of fruit.
≥ 3 servings/day of vegetables.
≥ 2 servings/week of fish.
≥ 3 servings/day of whole grains.
≤ 1 serving/week of processed meats.
≤ 1.5 servings/week of red meat.
≤ 1.5 servings/day of refined grains.

Moderate alcohol consumption was defined as:

Up to one drink a day for women.
Up to two drinks a day for men.

Finally, the diagnosis of Alzheimer’s Disease or dementia was obtained from the centralized databank of the UK National Health Service.

Will A Healthy Lifestyle Help Prevent Alzheimer’s Disease?

Here are the results from the study:

People at high genetic risk were almost twice as likely to develop dementia as those at low genetic risk.

In other words, genetics matter. If you have “bad” genes, your risk of developing dementia is increased significantly.

A healthy lifestyle decreased the risk of developing dementia by about 40% for both people at high genetic risk and for people at low genetic risk.

In other words, lifestyle also matters. You can significantly decrease your risk of developing dementia, no matter what your genetic risk.

People at high genetic risk and an unhealthy lifestyle were almost three times more likely to develop dementia than people at low genetic risk and a healthy lifestyle.

In other words, the combination of a high genetic risk and an unhealthy lifestyle is the worst of all possible worlds.

People at low genetic risk and an unhealthy lifestyle were just as likely to develop dementia as people at high genetic risk and a healthy lifestyle.

In other words, bad genetics does not doom you to Alzheimer’s and dementia. A healthy lifestyle can cut your risk almost in half. Conversely, good genetics is not a “Get Out of Jail Free” card. You can squander the advantage of good genetics with an unhealthy lifestyle.

Simply put, both genetics and lifestyle influence the risk of developing Alzheimer’s Disease and dementia. However, the take-home lesson from this study is that:

A healthy lifestyle can partially offset the effect of bad genetics.
A healthy lifestyle can enhance the effect of good genetics.
An unhealthy lifestyle can negate the benefit of good genetics.

Can Lifestyle Overcome Genetics?

This study clearly suggests that a healthy lifestyle can significantly reduce the effect of “bad” genetics on your risk of developing Alzheimer’s and other forms of dementia as you age. Considering that the medical profession has no other answer for preventing or treating Alzheimer’s Disease, this is really good news.

In the words of Dr. John Haaga of the U.S. National Institute on Aging: “No one can guarantee you’ll escape this awful disease, but you can tip the odds in your favor with clean living.”

The main strength of this study is its very large size. It is also supported by many smaller studies that have come to similar conclusions.

Moreover, a recent intervention study has been performed in Scandinavia in which one group was enrolled in a healthy lifestyle program while the other group continued with their previous health habits. That study also concluded that healthy habits could help prevent mental decline. The Alzheimer’s Association also has a similar intervention study in the United States. We should have more definitive information on this important subject very soon.

Finally, Alzheimer’s Disease may not be unique. Another recent study found that a healthy lifestyle can partially overcome a high genetic risk for developing heart disease.

The Bottom Line

A recent study looked at the effect of genetics and lifestyle on developing Alzheimer’s Disease and other forms of dementia. Here are the results from the study:

People at high genetic risk were almost twice as likely to develop dementia as those at low genetic risk.

In other words, genetics matter. If you have “bad” genes, your risk of developing dementia is increased significantly.

A healthy lifestyle decreased the risk of developing dementia by about 40% for both people at high genetic risk and for people at low genetic risk.

In other words, lifestyle also matters. You can significant decrease your risk of developing dementia, no matter what your genetic risk.

People at high genetic risk and an unhealthy lifestyle were almost three times more likely to develop dementia than people at low genetic risk and a healthy lifestyle.

In other words, the combination of a high genetic risk and an unhealthy lifestyle is the worst of all possible worlds.

People at low genetic risk and an unhealthy lifestyle were just as likely to develop dementia as people at high genetic risk and a healthy lifestyle.

In the words of Dr. John Haaga of the U.S. National Institute on Aging: “No one can guarantee you’ll escape this awful disease, but you can tip the odds in your favor with clean living.”

For more details on the study and how a healthy lifestyle was defined in this study, read the article above.

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

Can Plant-based Diets Be Unhealthy?

September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

Plant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

How Was The Study Done?

This study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

Do Plant-Based Diets Reduce Heart Disease Deaths?

The participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

Can Plant-Based Diets Be Unhealthy?

Now, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, read the article above.

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

Can Eating Fish Make Kids Smarter?

September 3, 2019 by Dr. Steve Chaney

Will Omega-3s Turn Your Kid Into A Genius?

Author: Dr. Stephen Chaney

You have probably heard the old saying that fish is brain food. Is it true? Could eating fish make your kid(s) smarter?

It is certainly a plausible hypothesis. Many fish are good sources of long chain omega-3s (omega-3 fatty acids). Long chain omega-3s, particularly DHA, are an important part of the myelin sheath that coats our neurons.

We can think of the myelin sheath as analogous to the plastic coating on electrical wiring. The coating on electrical wires assures that the electrical signal gets from the beginning of the wire to the end without shorting out somewhere in the middle. The myelin sheath plays a similar role for our neurons.

A number of clinical studies suggest that adequate intake of fish and/or fish oil during pregnancy and the early stages of childhood is important for brain development. Other studies suggest that omega-3 supplementation may improve mental focus and reading skills in school-age children.

The current clinical study (J Liu et al, Scientific Reports, 7: 17961, 2017) looked at the effect of fish consumption in Chinese children aged 9-11 on their IQ score measured at age 12.

How Was The Study Done?

This study included 541 Chinese school children who were part of an ongoing prospective longitudinal study. [That is scientific jargon meaning that one variable (diet) was measured at the beginning of the study and correlated with a second variable (IQ) measured several years later.]

The children were asked to fill out a food frequency questionnaire at ages 9-11. Fish intake frequency was measured by asking the children: “How often do you consume fish in a typical month?” The children were required to choose from:

seldom (less than 2 times per month),
sometimes (2-3 times per month), and
often (at least once a week).

It was assumed that the children might not have known what kind of fish their mothers prepared, so they were not asked to identify the kind of fish they ate.

At the time the children were enrolled in the program the investigators collected data on 13 other variables which might influence IQ. These variables included:

Gender
Parent’s education.
Parent’s occupation.
Parent’s marital status.
Whether the child was breastfed or not.
Duration of breastfeeding.
Home location.
Siblings.
Breakfast consumption (previous research has suggested breakfast intake may influence cognition).

At age 12 the IQ of the children was assessed using the Chinese version of a standard IQ test. The IQ tests were administered independently by two trained investigators to minimize investigator bias.

Verbal IQ was assessed based on:
- Information Recall.
- Comprehension
- Arithmetic
- Vocabulary
- Recognition of Similarities.

Performance IQ was assessed based on:
- Picture Arrangement.
- Picture Completion.
- Object Assembly.
- Block Design.
- Coding
- Mazes
The Total IQ score was based on a combination of the Verbal and Performance scores.

The study measured the impact of fish consumption at ages 9-11 on IQ at age 12 and included statistical correction for other variables that might have influenced IQ.

Can Eating Fish Make Your Kids Smarter?

When the children who frequently consumed fish (≥once a week) were compared to children who seldom consumed fish (˂2 times a month), their IQ scores were:

75 points higher in verbal IQ.
79 points higher in performance IQ.
80 points higher in total IQ.

When the children who sometimes consumed fish (2-3 times a month) were compared to children who seldom consumed fish, their IQ scores were:

92 points higher in verbal IQ.
52 points higher in performance IQ.
31 points higher in total IQ.

These data are consistent with previous studies showing that both dietary fish and omega-3 intake are associated with improved cognitive and academic performance in school age children.

[Note: This study also suggested that fish consumption may improve sleep quality, and the improved sleep quality may influence IQ. This is a complex subject. As such, it is best discussed in a future issue of “Health Tips From the Professor”.]

What Are the Strengths And Weaknesses Of This Study?

Strengths: The strengths of the study were:

It was a relatively large study.
Fish consumption was measured 1-3 years earlier than IQ.
The association between fish consumption and IQ remained significant after adjusting for 13 other variables known to influence IQ.
There was a clear dose-response relationship between the three levels of fish consumption.
It is consistent with a number of other studies showing that fish/omega-3 intake improves cognitive performance in children.

Thus, the authors concluded: “We believe the findings cannot be easily attributed to chance and that, instead, they reflect a reliable relationship between early, frequent fish consumption and later, improved cognitive performance.”

Weaknesses: The weaknesses of the study were:

It did not ask what kinds of fish the children were eating. Some fish are much better sources of omega-3s than others, so it is not entirely accurate to attribute the higher IQ to omega-3 intake.
It did not assess the effect of “diet context” on the results. The Chinese diet is a primarily plant-based, low-fat diet. It is unclear whether eating fish once a week would have the same effect on IQ in the context of a typical American diet.
It is an “association study.” It simply measured the association between fish consumption and IQ. It does not prove cause and effect.

Finally, this is the first study to measure the correlation between fish consumption and IQ in this age group. Clearly, more experiments are needed to confirm these findings.

Will Omega-3s Turn Your Kid Into A Genius?

Who wouldn’t want their children or grandchildren to have higher IQs?

However, I wouldn’t read too much into a study like this.

Let me share some perspective by way of a personal story. When I was in grade school, every child was given an IQ test and an aptitude test (I scored very low on anything mechanical in the aptitude test, which my wife can attest to.)

We children, as might be expected, shared our IQ scores. However, the scores didn’t prove to be as meaningful as we initially expected.

There were some kids in my class who had much higher IQ scores. In fact, they ranked in the genius category. However, many of them did mediocre in school and had undistinguished careers. In contrast, some of the kids who scored lower on their IQ tests had spectacular careers in their chosen fields.

The moral of this story is, of course, that there is a lot more than IQ that goes into success in school and success in life. With IQ, like many other things, it is important to have enough, but more is not necessarily better.

However, this study is consistent with many other studies suggesting that omega-3s, especially DHA, are important for brain development, mental focus, and cognitive skills in children. Consequently, if you have a child or grandchild, you want to make sure that they are getting enough omega-3s in their diet.

How much is enough, you might ask? Recommendations range from 70 mg/day EPA+DHA for children ages 1-3 to 100-150 mg/day EPA+DHA for older children, with about 2/3 of that coming from DHA.

While that may not sound like much, a recent study of 10, 942 American children ages 1-11 found that only around 25% of them were getting the recommended amount of EPA+DHA from their diet. In fact, most American children only get around 20-40 mg of EPA+DHA from their diet.

Fish are the preferred source of EPA+DHA because they also provide a healthy protein source, something else your child may not be getting enough of. The best fish sources of omega-3s are mackerel, salmon, sea bass, and sardines.

Of course, if your child is one of the many children who are not fond of omega-3-rich fish, you may want to consider an omega-3 supplement, especially one rich in DHA.

The Bottom Line

A recent study analyzed the correlation between fish consumption and IQ in school aged children. The study found:

When the children who frequently consumed fish (≥once a week) were compared to children who seldom consumed fish (˂2 times a month), their IQ scores were:

75 points higher in verbal IQ.
79 points higher in performance IQ.
80 points higher in total IQ.

When the children who sometimes consumed fish (2-3 times a month) were compared to children who seldom consumed fish, their IQ scores were:

92 points higher in verbal IQ.
52 points higher in performance IQ.
31 points higher in total IQ.

These data are consistent with previous studies showing that both dietary fish and omega-3 intake are associated with improved cognitive and academic performance in school age children.

For more details on the study and perspective on what the study means for you, read the article above.

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

Do Older Adults Eat Enough Protein?

August 27, 2019 by Dr. Steve Chaney

The Impact Of Inadequate Protein Intake On Healthy Aging

Author: Dr. Stephen Chaney

Do older adults eat enough protein?

Most Americans lose lean muscle mass as they age, a physiological process called sarcopenia. There are three factors that influence the rate at which we lose muscle mass as we age:

Our physiology changes. Our bodies break down our protein stores more rapidly and we have a harder time utilizing the protein in our diet to replenish those protein stores.
We become less active. In some cases this reflects physical disabilities, but all too often it is because we are not giving weight-bearing exercises the proper priority in our busy lives.
Our diets become inadequate. The major driver of this phenomenon is loss of appetite which results in decreased caloric intake. However, physical disability, isolation, and insufficient income also contribute.

Sarcopenia in turn results in:

Loss of muscle strength. Even the simple act of picking up a grandchild or a bag of groceries can become problematic.
Increased risk of falls and fractures.
Lower quality of life.

Obviously, sarcopenia is a major health issue for those of us in our golden years. If you are younger, it is a concern for your parents or grandparents. Sarcopenia is a health issue that affects everyone.

But what can be done to prevent sarcopenia? We can’t change our physiology, but we can change our activity level and our diet. Weight-bearing exercise tugs on our muscle fibers. That stimulates those fibers to incorporate protein into new muscle cells. It is no wonder that weight-bearing exercise is recommended for preventing sarcopenia.

What about diet? Are older adults getting enough protein in their diet? The conventional wisdom is that protein intake is not a problem. We’ve been told that Americans get enough protein in our diet. In fact, we’ve been told that most of us get more protein than we need.

Is that true for older Americans? In fact, very few studies have specifically looked at protein intake in older Americans. This study (JL Krok-Schoen et al, The Journal of Nutrition, Health & Aging, 23: 338-347, 2019 ) was designed to fill that void.

How Was The Study Done?

This study used data on 11,680 Americans who participated in NHANES surveys between 2005 and 2014. (NHANES or National Health and Nutrition Examination Surveys is a program run by the CDC that is designed to assess the health and nutritional status of adults and children living in the United States).

Participants in the study were grouped into three groups: 51-60 years (4,016 participants), 61-70 years (3,854 participants), and 71 years and older (3,810 participants).

Protein intake and diet quality were based on the average of two 24-hour dietary recall interviews. Trained dietary interviewers collected detailed information on all foods and beverages consumed during the past 24 hours.

Participants also filled out a questionnaire designed to assess health outcomes that might be affected by loss of muscle mass.

Note: The NHANES database is used for many studies on the association between diet and health outcomes. However, it is important to remember that a 24-hour diet recall is a single snapshot in time. This is a weakness of this and all similar studies. For example, in this study a participant’s average protein intake may be more or may be less than the amount reflected in the 24-hour diet recall.

Are Older Adults Eat Enough Protein?

To determine whether American older adults eat enough protein in their diet, the investigators compared protein intake in each age group with the DRI (Dietary Reference Intake) for protein of 0.8 grams of protein per kilogram of body weight (0.36 grams per pound). This is the standard set by the Food & Nutrition Board of the National Academy of Sciences for all adults over the age of 19.

The results were:

Up to 46% of older adults were not getting the recommended 0.8 g/kg/day of protein. When broken down by age groups, the percentages were:
- 38% of the 51-60 age group.
- 42% of the 61-70 age group.
- 46% of those over 70.
Women were more likely to be consuming inadequate protein than men.
Blacks were more likely to be consuming inadequate protein than other demographic groups.

When the investigators looked at the correlation between diet quality and protein intake, those consuming inadequate protein:

Had significantly lower calorie intake.
Skipped meals more frequently.
Had lower HEI (Healthy Eating Index) scores. Specifically:
They scored low on intake of greens, beans, dairy, total protein foods, seafood protein foods, and plant protein foods.
They scored high on intake of refined grains and added sugars.
Had inadequate intakes of fiber, zinc, selenium, vitamin C, vitamin E, and vitamin D.

The Impact Of Inadequate Protein Intake On Healthy Aging

When the investigators compared older adults with inadequate protein intake to adults in the same age groups with adequate protein intake, those with inadequate protein intake:

Had a higher prevalence of physical, mental, and social limitations.
Were more likely to be limited when stooping, crouching, or kneeling, standing or sitting for long periods, walking up 10 steps, preparing meals, and walking for a quarter mile.
They had trouble lifting more than 10 or 15 pounds.

Limitations on everyday activities like these have a significant impact on the quality of life experienced by these individuals.

What Does This Study Mean For You?

If you are over 50 or have a family member over 50, this study should serve as a wake-up call. You or your loved ones may not be getting enough protein.

In the words of the authors: “A considerable portion of older adults (31%-50%) did not meet their protein recommendation (0.8 g/kg/d)…This contradicts the common perception that Americans are usually meeting or exceeding the 0.8 g/kg/d protein recommendation.”

The situation may be even worse than this study indicates. This study used the DRI standard for adequate protein intake of 0.8 g/kg/d. Many recent studies suggest that significantly higher protein intakes (1-1.2 g/kg/d) are needed for older adults to prevent loss of muscle mass (sarcopenia). If so, the likelihood that you or your loved ones are not getting enough protein is even higher.

In the words of the authors: “There is a general consensus recommending dietary protein intakes of 1-1.2 g/kg/d…for older adults…If over one third of older adults are not meeting the recommendation of 0.8 g/kg/d, these data suggest that far fewer older adults would be meeting the proposed higher levels (1-1.2 g/kg/d) needed to meet the demands to promote healthy aging.”

The consequences of inadequate protein intake in the older adults may have a significant effect on their quality of life.

In the words of the authors: “This analysis found a positive association between achieving the recommended protein intake and self-reported physical functioning. The functional limitations associated with not meeting the protein requirement were all related to activities of daily living…”

Because of decreased appetite in many older adults, it is difficult to meet protein intakes of 1-1.2 g/kg/d with food alone. Protein supplementation can play a valuable role.

In the words of the authors: “When food alone is insufficient to meet a patient’s needs, oral nutritional supplementation may provide a means to meet protein intake recommendations.

“To some extent, sarcopenia can be managed with protein supplementation, considering all the factors that are working to reduce food intake in aging.” [The authors used the phrase “To some extent” because weight-bearing exercise is also required to manage sarcopenia].

While this study focused on protein intake, weight-bearing exercise is also essential to prevent sarcopenia. Exercise and adequate protein intake work together to build and maintain lean muscle mass.
Finally, we should not ignore the fact that those adults who were not getting enough protein were also getting insufficient levels of many micronutrients that affect the aging process. A good diet and supplementation are also important for healthy aging.

Specifically, the authors noted:

“Dietary fiber is associated with many benefits, especially in reducing the risk of heart disease.”
“Vitamin D inadequacy is associated with reduced mobility and an increase in risk for falls and fracture.”
“Zinc deficiencies…may cause dysfunctions in immunity and reduced healing time.”

The Bottom Line

A recent study analyzed protein intake in older American adults. The conclusions of the study were:

If you are over 50 or have a family member over 50, this study should serve as a wake-up call. You or your loved ones may not be getting enough protein.
The situation may be even worse than this study indicates. This study used the DRI standard for adequate protein intake of 0.8 g/kg/d. Many recent studies suggest that significantly higher protein intakes are needed for older adults to prevent loss of muscle mass (sarcopenia). If so, the likelihood that you or your loved ones are not getting enough protein is even higher.
The consequences of inadequate protein intake in the older adults may have a significant effect on their quality of life.
Because of decreased appetite in many older adults, it is difficult to meet protein intakes of 1-1.2 g/kg/d with food alone. Protein supplementation can play a valuable role.
While this study focused on protein intake, weight-bearing exercise is also essential to prevent sarcopenia. Exercise and adequate protein intake work together to build and maintain lean muscle mass.
Finally, we should not ignore the fact that those adults who were not getting enough protein were also getting insufficient levels of many micronutrients that affect the aging process. A good diet and supplementation are also important for healthy aging.

For more details on the study, read the article above.

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