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

Why Do Most Diets Fail?

January 6, 2020December 31, 2019 by Dr. Steve Chaney

How To Lose Weight And Keep It Off

Tomorrow is the official start of another dieting season. Millions of Americans will be making a New Year’s Resolution to lose weight. The top three reasons for these weight loss resolutions are:

1) Reduce disease risk (73%). After all, we are being told those excess pounds increase our risk of diabetes, heart disease, cancer, and just about every other disease known to man.

2) Improve self-esteem (61%). Some of this may be due to the social stigma associated with obesity, but many people simply want to improve the image they see in the mirror every morning when they get out of the shower.

3) Boost energy (49%).

Those are all good reasons for losing weight. But before you make your New Year’s resolution to embark on another weight loss journey, you should ask yourself “Do weight loss diets work?” If you look at the statistics, they aren’t very encouraging:

1) 45 million Americans go on a weight loss diet every year.

· 50% go on fad diets.

· They spend $33 billion on weight loss products.

· 90% regain almost all the weight. That’s called the yo-yo effect.

· On average, Americans gain 11 pounds on every diet yo-yo.

o They might as well have thrown that $33 billion to the wind.

2) 228,000 Americans get gastric bypass surgery.

· 80% regain almost all the weight.

o Their digestion and their health will never be the same.

As if those statistics weren’t bad enough, the obesity epidemic gets worse year after year (see the graphic on the right). Americans keep getting fatter. What we are doing clearly isn’t working.

You are probably saying to yourself: “I know that, but this year I’m going to try a new diet.” As the saying goes “Hope springs eternal in the human breast”, but is it realistic to think this time will be different?

Let me share a quote from a book and TV series called “The Weight Of the Nation” by John Hoffman & Dr. Judith Salerno”:

“First we blamed fat – low fat diets didn’t work! Then we blamed carbs, eggs, red meat, dairy, white flour, sugar, juices, sodas, high-fructose corn syrup, & partially hydrogenated fats. One by one, we replaced the evil food du jour…and watched our collective waistlines grow.”

In other words, they are saying it’s not just low-fat diets that don’t work. None of the popular diets work long term. I come across lots of people who tell me the Atkins weight-loss diet works best for them. That would be convincing if they were slender, but they aren’t! They gained it all back and then some. Now that the keto diet has been around for a few years, I am starting to see the same pattern there as well.

Clearly, the problem isn’t losing the weight. Any diet can help you lose weight. The problem is keeping the weight off. Let’s look at why this is.

Why Do Most Diets Fail?

To understand the answer to this question, let’s start with another quote from “The Weight Of the Nation”: “Our bodies were designed to store fat in times of plenty and retain fat in times of famine”

Essentially, the authors were saying when our ancestors were hunters and gatherers, there were times when food was abundant, and times when food was scarce. In order to survive, our bodies had to store energy in its most efficient form when food was abundant and hold on to those energy stores as long as possible when food was scarce.

Fat provides more than twice as many calories per gram as either carbohydrate or protein. Additionally, our ability to store carbohydrate is limited. And we don’t really have protein stores. All the proteins in our body have essential functions. However, our ability to store fat is unlimited. Now you understand why fat is the preferred energy store in times of plenty and our bodies try to hold on to it as long as possible in times of famine.

With that perspective in mind, there are three reasons why most diets fail:

1) Most dieters are looking for rapid weight loss (at least 2-5 pounds/week). That is a problem because “Our bodies were designed to…retain fat in times of famine”. When we lose weight quickly, our bodies interpret that as famine. Our bodies respond by decreasing our metabolic rate so we can hold on to those fat stores.

The solution to this problem is to set more reasonable weight loss goals. If we keep the rate of weight loss in the 1-2 pound/week range (0.5-1 pounds/week is even better), we can largely avoid this famine response. You should ask yourself, “What’s the rush?” After all, the average American only gains 1-2 pounds/year. Why do we need to get rid of that excess weight in just a few weeks?

2) Most dieters are looking for significant weight loss (more than 20 pounds). That is a problem because our bodies are designed to retain fat stores, not protein stores. When our bodies sense a famine they burn our protein stores (lean muscle mass) to spare as much of our fat stores as possible. The longer the diet (famine) lasts, the more muscle mass we lose.

That’s a problem because muscle burns calories much faster than fat. The more muscle we lose, the more our metabolic rate decreases. It gets harder and harder to lose weight, and eventually we reach a plateau. Most people get discouraged at that point and go off their diet.

That’s where the other part of the quote from “The Weight Of The Nation” kicks in: “Our bodies are designed to store fat in times of plenty”. Once again, it is fat we store, not protein. Most people never regain the protein stores they lost, so their metabolic rate remains low. They regain most of the weight they lost, and then some. This is the origin of the yo-yo effect.

There are two solutions to this problem:

· Increase your resistance exercise and your intake of protein with high levels of the essential amino acid leucine. I have covered this in a previous issue of “Health Tips From The Professor”.

· Set more reasonable weight loss goals. It is possible to lose more than 20 pounds without losing muscle mass. We just need to think in terms of reaching those weight loss goals in years rather than in months. Once again, remember it took us years to gain the weight. Why not think in terms of years to lose the weight?

3) Most dieters think in terms of diets rather than lifestyle change. Diets have an expiration date. Then most people just drift back to “the way they really live”. Lifestyle change, on the other hand, is permanent. Once we change to a healthier lifestyle, we no longer need to focus on weight loss. The weight comes off automatically.

To better understand the power of lifestyle change let’s look at something called “The National Weight Control Registry”.

How To Lose Weight And Keep It Off

Rather than focus on the abysmal statistics for long-term weight loss, doctors Rena Hill and James O Wing decided to focus on the characteristic of people who manage to keep their weight off. They founded something called “The National Weight Control Registry” and invited people who were successful at keeping the weight off to participate in their program.

Currently, the National Weight Control Registry is tracking over 10,000 individuals who have lost 30 pounds or more and have kept it off for long periods of time. They use detailed questionnaires and annual follow-up surveys to study the behavioral and psychological characteristics and the strategies of weight loss maintainers.

When you look at how they lost weight, they are a very diverse group:

· They lost weight on every possible diet – from vegan to keto to just plain crazy.

· 50% lost weight on commercial diet programs. 50% lost weight on their own.

· Some lost weight quickly. Some lost weight slowly.

When you look at weight maintenance, you realize that the dismal weight maintenance statistics don’t have to apply to you. The good news is:

· On average, people in The National Weight Control Registry have lost 66 pounds and have kept it off for 5 years or more.

· 12-14% of them have maintained a weight loss of 100 pounds or more for 5 or more years.

· Even better, once they maintained their weight loss for 2-5 years, it became easy.

They no longer had to battle hunger and a sluggish metabolism. They no longer had to think about the lifestyle changes they were trying to maintain. Their new lifestyle became what they did automatically, without even thinking about it. Their weight loss had become permanent.

By now, you are probably wondering how they do it. Here are the top 7 characteristics of those who are successful at keeping the weight off:

1) They consumed reduced calorie, low-fat, healthy diets.

2) They had internalized their eating patterns. It had become how they ate every day without even thinking about it.

3) They monitored their weight regularly. This allowed them to make adjustments whenever they saw their weight start to creep up.

4) They ate breakfast on a regular basis.

5) They got lots of exercise (on average, about 1 hour/day).

6) They watched less than 10 hours of TV/week. If you were wondering where you would find the time to exercise an hour/day, this is probably your answer.

7) They were consistent. They had no planned “cheat days”. This doesn’t mean they were purists. They still allowed themselves to eat some of their favorite unhealthy foods on an occasional basis. They just didn’t set aside regular times when they planned to “pig out”.

There was one other interesting observation from this study:

· Those who used meal replacement shakes as part of their weight loss, focused more on diet and included meal replacement shakes as part of their maintenance program.

· Those who lost weight on their own, also followed healthy eating habits, but put a bit more emphasis on exercise to keep themselves on track.

· Both approaches were effective.

The take-home message of the National Weight Control Registry is clear. There is no magic diet that guarantees you will keep the weight off. The “secret” to keeping the weight off is a healthy eating pattern and a healthy lifestyle.

In short, if your resolution is to lose weight next year, don’t focus on the diet you will follow to lose the weight. Instead, focus on the healthy lifestyle you will follow to keep the weight off.

Of course, you will be most successful if the diet you are following to lose weight incorporates the healthy lifestyle you plan to follow to maintain your weight loss.

What Role Do Habits Play In Weight Loss?

Finally, I would like to share a recent study (G Cleo et al, International Journal of Obesity, 43: 374-383, 2019) that puts the whole issue of weight loss and weight maintenance in a different perspective. This study looked at the role that habits play in weight loss.

In short, the study enrolled 130 participants who wanted to lose weight. All the participants were told this was a weight loss study, but none of the participants were given detailed diet and exercise recommendations to follow. The study had a 12-week intervention phase followed by a 12-month follow-up phase. The participants were divided into three groups.

1) Group 1 received no advice during the intervention phase. This was the control group.

2) Group 2 focused on breaking old habits. During the intervention phase they were sent daily tests suggesting new habit patterns. These were suggestions like “Drive a different route to work today”. None of the texts had anything to do with diet or lifestyle.

3) Group 3 focused on creating new healthy habits. They were given a list of 10 healthy habits. During the intervention phase they were asked to log how many of these habits they implemented each day. The 10 healthy habits were:

#1: Keep to a daily meal routine.

#2: Choose reduced fat versions of foods.

#3: Walk off the weight (aim for 10,000 steps/day).

#4: Pack a healthy snack (Choose healthy options such as fruits, nuts, or low-fat yogurt).

#5: Read labels.

#6: Be cautious with your portions.

#7: Break up your sitting time (Stand for 10 minutes every hour).

#8: Think about your drinks (Choose water instead of sodas and fruit juices).

#9: Focus on your food (Slow down. Don’t eat while watching TV).

#10: Don’t forget your 5 servings of fruits and vegetables a day.

The results were:

· People in both habit change groups lost significantly more weight than people in the control group.

· People in the habit change groups continued to lose weight for 12 months after the intervention ended.

· Weight loss was essentially identical in the two habit change groups.

The last observation is particularly interesting. Remember that one of the habit change groups was simply focused on breaking old habits, yet people in this group did just as well as people who were taught healthy lifestyle habits. This implies that people already know about healthy lifestyle habits. They just don’t know how to break their old habits. Once they become comfortable breaking old habits, they find it easy to adopt healthier lifestyle habits.

In short, change your habits, change your lifestyle. Change your lifestyle, control your weight.

What Does This Mean For You?

I covered a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1) You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2) Ditch diets. Focus on lifestyle change.

3) Slow and steady wins the day.

4) Change your habits, change your weight.

5) Long-term weight loss is possible.

6) Low-fat, healthy eating patterns are best.

7) Once you have internalized healthy habits, they become automatic.

8) If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9) Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10) Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

The Bottom Line

I cover a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1) You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2) Ditch diets. Focus on lifestyle change.

3) Slow and steady wins the day.

4) Change your habits, change your weight.

5) Long-term weight loss is possible.

6) Low-fat, healthy eating patterns are best.

7) Once you have internalized healthy habits, they become automatic.

8) If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9) Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10) Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

For more details on how to lose weight and keep it off, read the article above. In fact, if you plan to lose weight in the coming year, you should really read this article first.

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.

Reduce Holiday Stress

December 17, 2019 by Dr. Steve Chaney

Treat Yourself To A “Mental Massage” and Enjoy The Season

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Merry Christmas

I love the Christmas season. The colors, the smells, the sounds of music. I’m a vegan so turkey isn’t happening for me, but the array of deliciously prepared vegetables, and the variety of desserts always make me excited for this month to get underway!

We give so much to others, especially during this season, that I want to remind you to take care of yourself too. Like they say on the airplane…”Put your own oxygen mask on first!” One of the best gifts you can give to those you love, is a healthy and happy you!

Eliminate the aches and pains that can make you feel grumpy, and if you have someone who could benefit from eliminating pain, please feel free to send them my way. That includes people who don’t live near me, we can meet on Zoom.us and work together to find, and stop, pain. I’ll be happy to help both of you.

I hope you have a wonderful, blessed Christmas!

P.S. Be sure to scroll down to the end, so you can claim my Christmas gift to you.

Reduce Holiday Stress

Isn’t it a shame that this beautiful time of year also brings an overload of stress to so many people? Shopping, especially if finances are short, is a stress producer; large family gatherings can cause stress; and just the hustle and bustle of the season with so many parties and extra functions added to our daily schedule can also be stressful.

Many, if not most, of these stressful situations are meant to be happy, and often they are happy, but they put additional stress on our already busy lives. What can we do?

Most likely you’ve already read articles that offer suggestions about limiting parties, inexpensive gifts that are thoughtful, and other great holiday ideas, and that’s all wonderful. What I want to offer you is a holiday gift you can use all year, a gift that will enable you to lower your stress every day.

Back in 1990 I was the massage therapist on the S.S. Queen of Bermuda, a cruise ship that went out of New Orleans and traveled as far south as the Panama Canal, and as far north as Montreal and Quebec. I LOVED it! I was super-busy doing 6-7 hours of massage four out of seven days, and 4 hours on the other days. It was while I was on the ship that I developed the foundation of the unique style of therapy that I do now…but that’s another story.

One of my jobs on the ship was to entertain the passengers for an hour at 9AM on Sunday morning. I didn’t know what to do, so I decided to lead a relaxing visualization program. I’d start by having everyone stand up and do a 5-minute self-applied Shiatsu (tapping) treatment on each other. You can do it to yourself, but it’s better if you have someone do it for you, and then you repay the favor. It’s a great way to relax, and when you come to the office, I’ll be happy to show it to you. That left me fifty-five minutes to go…I needed something relaxing that would start their cruise off on a happy note.

Treat Yourself To A “Mental Massage” and Enjoy The Season

That’s where my “Mental Massage” concept came about.

I had people relax in their chairs and I’d start talking – visualizing tension like a block of ice that was being melted with their thoughts. I’d gently lead them into relaxing their muscles from their forehead to their feet, watching the ice as it flowed out of their fingers and toes.

Then we’d go back up to their head and visualize fluffy blue mittens gently stroking their face, arms and legs, cradling and rocking their heart and stomach, and their muscles just totally relaxing while they felt heavy in their chairs.

Finally, we’d go back to their head again and visualize pure, positive energy, in the form of diamond dust, sparkling pink, blue and yellow crystals, filling their entire body and flowing out through their fingertips and toes.

Then they would sit there for 5 minutes just enjoying the feeling, knowing they could do this any time they wanted.

It was so relaxing that passengers would come to the massage room and ask me for a cassette tape of my visualization. I didn’t have one, so I made one and would run off copies for anyone who asked. The results were so good for so many people that it encouraged me to continue doing it when I was off the ship and started my therapy practice.

Here Is My Christmas Gift To You

There were a few of my clients who had serious conditions that caused them so much stress that they really needed to relax. One woman had Crohn’s disease, and a man had a heart condition. Another woman had an ulcer, and another man had PTSD. I ended up making them special tapes that focused on each of the organs that needed attention.

Eventually I made a professional copy of the visualization, changing the title to “Relaxing into a Perfect Body” because it ended up combining the healing statements that helped my clients, covering organs throughout the body. I’ve been giving it away ever since.

I want to give it to you so you can relax during this happy, but stressful, time of year. And then you’ll have it whenever you feel you want it. Just click here to listen to the recording: Relax into a Perfect Body!

Do Vegetarians Have A Higher Risk Of Stroke?

December 10, 2019 by Dr. Steve Chaney

What Are The Benefits And Risks Of A Vegetarian Diet?

Vegetarian diets are thought to be very healthy. Clinical studies show that vegetarian diets are associated with decreased risk of heart disease, diabetes, cancer, Alzheimer’s disease, and much more. What’s not to like?

That’s why the recent headlines claiming that vegetarian diets may increase the risk of stroke were so surprising. Advocates of meat-heavy diets like the Paleo and Keto diets were overjoyed. These results fit in with their view that we should be eating more meat protein and less plant protein. Nutrition experts, on the other hand, were asking: “What’s going on?” “How can this be?”

Those of you who are regular readers of “Health Tips From the Professor” know that I am an advocate of primarily plant-based diets. Thus, I felt a responsibility to analyze the study (TYN Tong et al, British Medical Journal, 366: 14897, 2019) behind the headlines impartially and give you, my readers, clear guidelines for the healthiest possible diet.

How Was The Study Done?

Let’s start with some background:

· A major study called the “European Prospective Investigation Into Cancer and Nutrition” (EPIC) has been underway since the early 90’s.

· The British component of this study is known as the EPIC-Oxford study.

· While the study has “cancer” in it’s title, it was designed to measure the impact of nutrition on many diseases. In this case, the study focused on heart disease and stroke.

· Finally, enrollment in the EPIC-Oxford study was designed to give a high proportion of vegetarians in the study population.

The EPIC-Oxford study enrolled 48,188 participants with no previous history of heart disease, stroke, or angina between 1993 and 2001. A detailed diet analysis was performed upon enrollment and again in 2010. Based on these data, the participants were divided into three groups:

1) Meat eaters (24,428 participants).

2) Fish eaters (7,506 participants). This group consumed fish but no other meats. People with this eating style are often called pescatarians.

3) Vegetarians (16, 254 participants). This group consumed dairy and eggs, but no meat. People with this eating style are often called lacto-ovo vegetarians.

4) The diet analysis also identified participants who were vegans (no animal foods). However, this group was too small to obtain statistically significant comparisons, so they were included with the lacto-ovo vegetarians in the vegetarian group.

Data on heart disease and stroke were obtained from the UK’s health service records through March 31st, 2016. The average time of follow-up for participants in the study was 18.1 years.

Without going into greater detail, this was a very large, well-designed study.

How Did The Diets Of The Three Groups Compare?

The first step in analyzing this study is to ask how the diets of the three groups compared.

Compared to meat eaters, the fish eaters consumed:

· No meat other than fish.

· Slightly less milk and significantly more cheese.

· Slightly more fruits & vegetables.

· Significantly more legumes & soy foods, nuts & nut butter.

· Slightly more carbohydrate and slightly less protein.

· Slightly less saturated fat and slightly more polyunsaturated fat.

· Around 260 fewer calories per day.

Compared to fish eaters, the vegetarians consumed:

· No meat.

· Slightly less milk & cheese.

· About the same amount of fruits & vegetables.

· Significantly more legumes & soy foods, nuts & nut butter.

· Slightly more carbohydrate and slightly less protein.

· About the same saturated and polyunsaturated fat.

· Around 125 fewer calories per day.

On average, the vegetarians consumed about 1 cup of milk and one ounce of cheese per day. The fish eaters consumed 1.4 ounces of fish per day.

In terms of comparisons:

· The biggest differences were between the fish eaters and the meat eaters. It would be fair to say that the fish eaters consumed a primarily plant-based diet with added fish and dairy.

· The biggest differences between the vegetarians and fish eaters was that the fish eaters got a significant percentage of their protein from fish, while the vegetarians got a significant amount of their protein from plant sources. Otherwise, their diets were fairly comparable.

Finally, the 10-year follow-up diet analysis showed that most participants stuck with their initial diet.

Do Vegetarians Have A Higher Risk Of Stroke?

Now, for the study results:

· Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

· Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

· The risk of stroke was essentially identical for fish eaters and meat eaters.

In many other aspects, vegetarians were healthier than meat-eaters. For example, they:

· Weighed less.

· Had lower blood pressure.

· Had lower total and LDL cholesterol.

· Were less likely to have developed diabetes during the study.

· Were less likely to have required long-term treatment for other illnesses.

What Are The Strengths And Weaknesses Of The Study?

The strength of this study is obvious. It was a very large, well-designed study. The study also lasted a long time. Participants in the study were followed for almost 20 years.

There are two clear weaknesses, however:

1) Numerous previous studies have confirmed that vegetarian diets decrease heart disease risk by about 20%. However, none of those previous studies have reported an increase in stroke risk. This study is an outlier.

2) There is no clear mechanism that explains why a vegetarian diet might increase stroke risk. Based on previous observations that statin drugs increase the risk of hemorrhagic stroke, the authors suggested the increased stroke risk might be due to lowered LDL cholesterol levels.

This mechanism is speculative at present. Furthermore, if true, it would suggest that any intervention (drug or nutritional) that lowers LDL cholesterol would increase stroke risk.

In the words of the authors:

· “The present study has shown that British adults who were fish eaters or vegetarians had lower risks of heart disease than meat eaters, but that vegetarians had higher risks of stroke.

· Future work should include further measurements…to identify which factors may cause the observed associations. [In plain English: We need to understand how vegetarian diets might increase stroke risk before we put too much weight on the results of this study.]

· Additional studies in other large-scale cohorts with a high proportion of non-meat eaters are needed to confirm the generalizability of these results and assess their relevance for clinical practice and general health.” [In plain English: More studies are needed to confirm this observation before we start changing our recommendations about what constitutes a healthy diet.]

What Are The Benefits And Risks Of A Vegetarian Diet?

Let’s assume for a minute that the results of this study are accurate and take a closer look at the benefits and risks of a vegetarian diet. Here is my assessment:

1) This report is troubling, but it may not be correct. The association of vegetarian diets with a slight increase in stroke risk has only been seen in a single study. This study needs to be confirmed before we become too concerned about vegetarianism increasing stroke risk.

2) On the balance, vegetarian diets should still be considered very healthy. They lower the risk of heart disease, high blood pressure, diabetes, some cancers, inflammatory diseases and possibly even Alzheimer’s disease.

3) However, I have often said that we have 5 food groups for a reason, and it is not a good idea to eliminate whole food groups. In the past, I have used that statement to critique diets that leave out important plant food groups like fruit, whole grains, and legumes.

If the data on stroke risk in this study are true, it suggests it might also not be a good idea to leave out meat. However, you don’t need a lot of meat. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of stroke.

4) In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths”, primarily plant-based diets ranging from vegan through pescatarian and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

5) Finally, if you have a family history, or are at high risk, of stroke, I recommend prudence until we know more. You may wish to adopt a version of primarily plant-based diets that incorporates some meat (That would be in the pescatarian to DASH range of primarily plant-based diets). Your heart will thank you, and you won’t increase your risk of stroke.

The Bottom Line

A recent study enrolled 48,188 British adults; divided them into meat eaters, fish eaters, and vegetarians; followed them for 18.1 years; and looked at their risk for heart disease and stroke. The results were:

· Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

· Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

· The risk of stroke was essentially identical for fish eaters and meat eaters.

Here is my perspective:

4) In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths” (https://slayingthefoodmyths.com), primarily plant-based diets ranging from vegan through pescatarian (the fish eaters in this study) and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

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 Omega-3 Supplements Reduce ADHD Symptoms?

December 3, 2019 by Dr. Steve Chaney

Will The Omega-3 Controversy Continue?

The prevalence of ADHD has increased dramatically in the last couple of decades. One study reported that the percentage of children diagnosed with ADHD has increased by 42% between 2003 and 2011. Another study reported an increase of 67% between 1997 and 2015. Currently, 10-12% of American schoolchildren are diagnosed with ADHD. That amounts to around 6 million children with ADHD, at a cost to taxpayers of over $45 billion.

An estimated 65% of children with ADHD are taking medications to control their symptoms. Unfortunately, those medications don’t work for 20-40% of patients with ADHD. Even worse, ADHD medications come with serious side effects like loss of appetite and delayed growth, sleep disorders, nausea & stomach pains, headaches, moodiness and irritability.

Even more worrisome is that many children say they “just don’t feel right” while they are on the drugs. Finally, there is the unintended message we are sending our children that drugs are the solution to their problems.

It is no wonder that millions of parents are looking for more natural solutions for their child’s ADHD. One of the most popular natural approaches is supplementation with omega-3s. But do omega-3 supplements work, or is this just another myth created by supplement companies to lighten your wallet?

The scientific evidence is conflicting. Some clinical studies support the efficacy of omega-3 supplements for reducing ADHD symptoms. Other studies claim they have no benefit.

In today’s issue of “Health Tips From The Professor”, I review a recent meta-analysis (JP-C Chang et al, Neuropsychopharmacology, 43: 534-545, 2018) that attempts to provide a definitive answer to this question.

How Was The Study Done?

This study was designed to answer three questions:

1) Does omega-3 supplementation reduce ADHD symptoms?

2) Does omega-3 supplementation improve cognitive skills in children with ADHD?

3) Is there an association between omega-3 status and ADHD?

Previous meta-analyses on these topics had design flaws such as:

· Including both children and adult subjects.

· Including subjects with diagnosis other than ADHD.

· Including trials that supplemented with vitamins and other nutrients in addition to omega-3s.

The authors of this study tried to avoid these limitations by using the following criteria for the studies that were included in their meta-analysis.

1) The studies were randomized, double-blind, placebo-controlled trials of omega-3 supplementation with DHA and EPA alone or in combination.

2) The participants were school-aged children (4-12 years) and adolescents (13-17 years) who had a diagnosis of ADHD.

3) The study measured the effect of omega-3 supplementation on clinical symptoms of ADHD or measures of cognitive performance (omission errors, commission errors, forward memory, backward memory, and information processing).

4) The studies were large enough to measure statistically significant differences.

5) The studies were published in peer-reviewed journals.

With these criteria there were:

· Seven studies with 534 children looking at the effect of omega-3 supplementation on ADHD symptoms.

· Three studies with 214 children looking at the effect of omega-3 supplementation on cognitive performance.

· Twenty studies with 1276 children looking at the association between omega-3 status and ADHD.

Do Omega-3 Supplements Reduce ADHD Symptoms?

The results of this meta-analysis were as follows:

1) Omega-3 supplementation significantly reduced ADHD symptoms reported by parents.

2) Omega-3 supplementation significantly improved cognitive measures associated with attention span (omission and commission errors). [Note: Omission errors consist of leaving important information out of an answer. Commission errors consist of including incorrect information in an answer.]

· Omega-3 supplementation did not improve cognitive measures associated with memory and information processing. This has also been reported in most previous studies.

· The best way to think of this is that children with ADHD are fully capable of learning their schoolwork. However, they may have trouble demonstrating what they have learned on exams because of omission and commission errors.

· In this context, omega-3 supplementation may help them perform better on exams and reduce test-taking anxiety.

3) For hyperactivity, only studies with EPA dosages of 500 mg per day or greater showed a significant reduction in symptoms.

4) Children diagnosed with ADHD have lower levels of DHA, EPA, and total omega-3s.

The authors concluded: “In summary, there is evidence that omega-3 supplementation … improves clinical symptoms and cognitive performances in children and adolescents with ADHD, and that these youth have a deficiency in omega-3 levels. Our findings provide further support to the rationale for using omega-3s as a treatment option for ADHD.”

They also said: “Our paper shows that EPA supplementation dosage >500 mg should be considered when treating youth with ADHD, especially those with predominantly hyperactivity/impulsivity presentation.”

Will The Omega-3 Controversy Continue?

This is an excellent study, but it is unlikely to be the final word on this subject. That is because there is a fundamental flaw in all previous studies on this important subject, including the ones included in this meta-analysis.

In the words of the authors: “In terms of ‘personalized medicine’, it is tempting to speculate that a subpopulation of youth with ADHD and low levels of omega-3s may respond better to omega-3 supplementation, but there are no studies to date attempting this approach.”

Until studies of omega-3 supplementation and ADHD symptoms include measures of omega-3 status before and after supplementation, those studies are likely to continue giving conflicting results. That is because:

· If most of the children in the study have low omega-3 status, we are likely to see a positive effect of omega-3 supplementation on ADHD symptoms.

· If most of the children in the study have high omega-3 status, we are likely to see a negative effect of omega-3 supplementation on ADHD symptoms.

What Does This Study Mean For You?

While this study is unlikely to end the omega-3 controversy, it is a very well-designed study that combines the results of multiple double-blind, placebo-controlled clinical trials. In short, it is a very strong study.

Omega-3s have no side effects and multiple health benefits. If your child suffers from ADHD, omega-3 supplementation is worth a try.

However, we need to keep omega-3 supplementation in perspective:

· Not every child with ADHD will respond to omega-3 supplementation.

· Omega-3s alone are likely to reduce, but not eliminate, the symptoms.

· There are other natural approaches that should be considered.

You will find details on omega-3s and other natural approaches for reducing ADHD symptoms in an earlier issue of “Health Tips From The Professor”.

The Bottom Line

A recent meta-analysis looked at the effect of omega-3 supplementatation on ADHD symptoms. Here is a brief summary of the data:

1) Omega-3 supplementation significantly reduced ADHD symptoms reported by parents.

· Omega-3 supplementation did not improve cognitive measures associated with memory and information processing. This has also been reported in most previous studies.

· In this context, omega-3 supplementation may help them perform better on exams and reduce test-taking anxiety.

3) For hyperactivity, only studies with EPA dosages of 500 mg per day or greater showed a significant reduction in symptoms.

4) Children diagnosed with ADHD have lower levels of DHA, EPA, and total omega-3s.

For more details on the study and a perspective on omega-3 supplementation compared to other natural approaches for reducing ADHD symptoms, 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.

Healthy Thanksgiving

November 26, 2019 by Dr. Steve Chaney

The Holidays Don’t Have To Be Unhealthy

While “Healthy Thanksgiving” doesn’t quite have the appeal of the more familiar “Happy Thanksgiving” greeting, I used it here to make the point that Thanksgiving dinner (and many other holiday meals) doesn’t have to be an unhealthy affair.

After all, there is a lot to like about the ingredients in Thanksgiving dinner. Turkey can be a healthy, low- fat meat, if prepared correctly. Sweet potatoes, yams, winter squash and pumpkin are all loaded with vitamin A and other important nutrients. And cranberries are a nutrition powerhouse.

Healthy Thanksgiving

Here are some tips to make your Thanksgiving meal one that contributes to your health:

1) Skip the basting. Choose a plain bird and cook in a bag to seal in the moisture. Remove the skin before serving.

2) Refrigerate the turkey juices and skim off the hardened fat before making gravy and use a gravy cup that pours from the bottom to minimize fat.

3) Use ingredients like whole wheat bread, vegetables, fruits (cranberries, raisins, dates or apples), nuts and your favorite spices for the stuffing and bake it in the oven rather than in the turkey.

4) Serve your sweet potatoes or yams baked rather than candied and let your guests add butter and nutmeg to taste.

5) Use skim milk or buttermilk rather than whole milk and skip the butter for your mashed potatoes.

6) Give your meal gourmet appeal by cooking your green vegetables with garlic, nuts and herbs rather than creamy or fat-laden sauces.

7) Don’t serve the meal on your largest plates. By using smaller plates, you ensure smaller portion size and even that second helping isn’t quite so damaging.

8) Consider something like a cranberry, walnut, Greek yogurt parfait for dessert. However, if everyone is expecting grandma’s chocolate pound cake recipe, use small dessert dishes. Of course, you can also experiment with using less fat or sugar when you make the cake.

9) Use a low calorie, plant-based protein shake for one or more meals the day before and/or after Thanksgiving so that your total fat, cholesterol, and caloric intake over the three-day period is not excessive.

By now you have the idea. There are lots of little things that you can do to make your Thanksgiving dinner one that your waist and your heart will thank you for. Bon Appetit and have a Happy, Healthy Thanksgiving!

The Bottom Line

If you make healthy food choices and choose your portion sizes wisely, you can make this a Healthy Thanksgiving as well as a Happy Thanksgiving.

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.

Preventing And Reversing Osteoporosis

November 19, 2019 by Dr. Steve Chaney

A Bone Health Lifestyle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Fall is glorious in my book. I was up in New York a few weeks ago, and the trees were just changing – I was about a week too early for the best colors, but it was still beautiful. Then I flew out to Lake Tahoe, and it was really beautiful there. The air was crisp and clean, and I loved all the fall decorations.

In Florida we are entering our most wonderful time of year. It’s starting to get cooler, the humidity is going down, and hurricane season is over. Hooray! It’s great to be outdoors again!

Please remember all the people who are still going through very difficult times in the Bahamas. Many people have lost their homes, their workplaces and the income that supports them, and some have lost loved ones. A devastating loss.

We here in the USA were blessed that Dorian didn’t come any further west and do the same thing to Florida, Georgia, and the Carolinas. I wanted to share what I have with the people who now have nothing. That made me search for places I trust that will send all the money I donate. In case you want to help, and you don’t have a favorite charity, I want to share those places with you:

https://disaster.salvationarmyusa.org

http://secure.americares.org/help/now‎

https://www.mercycorps.org/articles/hurricane-dorian-bahamas#mercy-corps-helping

Preventing And Reversing Osteoporosis

Weight-bearing exercise builds strong bones. That statement is so common that just about everyone knows they need to exercise for strong muscles and bones, and for all the good it does for just about every system in the body. And, we are what we eat, so nutrition is vital.

Do you like to exercise? Some people are almost addicted to exercise, but I’m not one of them. I go to the gym and I have a fitness trainer to help me stay on track, but it fits right in with my eagerness of going to the dentist. I must say, I’d like that to change, and maybe if I can find a workout partner, it will.

Meanwhile I need to do something because I’ve been told I have osteoporosis. Yikes! One thing for sure, I’m not taking any type of medication. I truly believe there is another solution.

While I’m not an exercise nut, I do love nutrition and I know that the body is so adaptable that if it’s given the proper nutrition, it can do miracles. I believe nutrition and exercise can reverse this osteoporosis diagnosis.

A Bone Healthy Lifestyle

The first thing I did was contact my friend, Steve Chaney, PhD, author of the weekly blog “Health Tips From The Professor. He pointed me to an article he had written on a “Bone Healthy Lifestyle”. Here is a brief summary:

Exercise, calcium, and vitamin D are all essential for bone formation. If any of them are missing, you can’t form healthy bone. The reason so many clinical studies on calcium supplementation and bone density have come up empty is that exercise, or vitamin D, or both were not included in the study.

Get plenty of weight bearing exercise. This is an essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the adequate range – optimal is even better. Adequate blood levels of 25-hydroxy vitamin D are also essential for you to be able to utilize calcium efficiently.
Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.
Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.
Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. Dr. Chaney wasn’t advocating a “one-size fits all” 1,000 to 1,200 mg/day for everyone. Supplementation is always most effective when you actually need it. For example:

o If you are not including dairy products in your diet (either because they are acid-forming or for other health reasons), it will be difficult for you to get adequate amounts of calcium in your diet. You can get calcium from other food sources such as green leafy vegetables. However, unless you plan your diet very carefully you will probably not get enough.

o If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Ask your pharmacist about the effect of any medications you are taking on your calcium requirements.

If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. Dr. Chaney recommends that it also contain zinc, copper, and manganese.

Between increasing my exercise and ramping up all the nutrients that build bone, I just know that by this time next year I’m going to be surprising the doctor with my great health

Is The Paleo Diet Bad For Your Heart?

November 12, 2019 by Dr. Steve Chaney

Is The Paleo Diet Bad For Your Gut?

There is a lot to like about the Paleo diet:

· It is a whole food diet. Any diet that eliminates sodas, junk foods, and highly processed foods is an improvement over the American diet.

· It includes lots of vegetables and some fruits.

· It helps you lose weight, and any diet that results in weight loss improves your blood work – things like cholesterol, triglycerides, blood sugar control and more.

However, there are concerns the Paleo diet may not be healthy long term.

· In part, that is because the diet is high in meat, red meat, and saturated fat.

· Equally important, however, is what the diet eliminates – namely whole grains, legumes (beans), and dairy.

Those of you who have read my book, “Slaying The Food Myths”, know that I say: “We have 5 food groups for a reason”. This is particularly true for the plant food groups. That’s because each plant food group provides a unique blend of:

· Vitamins and minerals. Those can be replaced with good multivitamin/multimineral supplement.

· Phytonutrients. You can only get the full complement of health-promoting phytonutrients from a variety of foods from all 5 food groups.

· Fiber. There are many kinds of fiber and they each play different roles in our intestine. You can only get all the health-promoting varieties of fiber by consuming fruits, vegetables, whole grains and legumes.

· Gut bacteria. What we call fiber, our gut bacteria call food. Each of the plant food groups supports different populations of friendly gut bacteria.

Based on this reasoning, one might suspect that the Paleo diet might alter our gut bacteria in ways that could be bad for our health. Until recently, this sort of reasoning was just a theoretical concern. That’s because:

1) We knew far too little about the health effects of different populations of bacteria. This is rapidly changing. Several recent studies have systematically investigated the connection between gut bacteria and health outcomes.

2) We knew our diet influenced the bacteria populations found in our gut, but we had no understanding of how these changes might influence our health. This too is changing. The study (A Genoni et al, European Journal of Nutrition, https://doi.org/10.1007/s00394-019-02036-y) I discuss this week is an excellent example of recent studies linking diet, gut bacteria, and risk factors for disease.

How Was The Study Done?

This study recruited 91 participants from Australia and New Zealand. It was a very well designed study in that:

· The Paleo diet group (44 participants) was recruited based on self-proclaimed adherence to the Paleo diet (< 1 serving/day of grains and dairy products) for one year or more. This is important because short term effects of switching to a new diet are confounded by weight loss and other factors.

o After analyzing the diets of the Paleo group, the investigators found it necessary to subdivide the group into Strict Paleo (< 1 serving/day of grains and dairy products) and Pseudo-Paleo (> 1 serving/day of grains and dairy).

· The control group (47 participants) was recruited based on self-proclaimed adherence to a “healthy diet” for 1 year or more with no change in body weight (A healthy diet was defined as a whole food diet containing a variety of foods from all 5 food groups). This is important because far too many studies compare the diet they are promoting to an unhealthy diet with a lot of sugar and highly processed junk foods. These studies provide little useful information because almost anything is better than an unhealthy diet.

· The participants completed a diet survey based on the frequency of consumption of various foods during the previous year. However, because diet surveys based on the recollection of participants can be inaccurate, the investigators used two rigorous tests to validate the accuracy of those diet surveys.

o The first was a 3-day weighed dietary record (WDR). Simply put, this means that participants weighed and recorded all foods and beverages before they were eaten for 3 days. Two of those days were weekdays, and one was a weekend day.

o Secondly, the investigators used blood, urine, and metabolic measures to independently determine protein and energy intake of each participant. Participants who were identified by these means as under reporting both protein and energy were considered unreliable dietary reporters and were excluded from the analysis.

o It is very rare to find a study that goes to this length to validate the accuracy of the dietary data used in their analysis.

The participants also provided blood, urine and stool samples and completed a physical activity assessment.

What Were The Differences Between The Paleo Diet And The Healthy Control Diet?

Only the Strict Paleo Diet group was faithfully following the Paleo diet. In addition, most of the results with the Pseudo Paleo Diet Group were intermediate between the other two diets. Therefore, to simplify my discussion of this study I will only compare the Strict Paleo Diet group, which I refer to as the Paleo Diet group, with the Healthy Diet control group.

The Paleo diet emphasizes fresh vegetables, especially green leafy vegetables, and discourages grains. Thus, it is no surprise that:

· The Paleo Diet group ate 74% more vegetables and 3 times more leafy green vegetables than the Healthy Diet group.

· The Paleo Diet group ate only 3% of the grains and 3% of the whole grains compared to the Healthy Diet group.

The Paleo diet encourages consumption of meat and eggs and discourages consumption of dairy and plant proteins. Thus, it is not surprising that:

· The Paleo Diet group ate 3 times more red meat and 5 times more eggs than the Healthy Diet group.

· The Paleo Diet group ate 10% of dairy foods compared to the Healthy Diet group.

· The Paleo Diet group consumed two times more saturated fat and cholesterol than the Healthy Diet group.

The most interesting comparison between the two diets was the following:

· Intake of total fiber, insoluble fiber, and soluble fiber was comparable on the two diets.

· However, intake of resistant starch was 50% lower in the Paleo Diet group. This is significant because:

o Resistant starch is a type of fiber found primarily in whole grains, legumes, potatoes, and yams (Potatoes and yams are also dietary “no nos” on most low-carb diets).

o Resistant starch is an especially good food for certain species of healthy gut bacteria.

Is The Paleo Diet Bad For Your Gut?

Because resistant starch affects gut bacteria, the study next looked at the effect of the two diets on the populations of gut bacteria. This is where the story starts to get interesting. When they looked at different groups of gut bacteria, they discovered that:

· Bifidobacteria were much more abundant in the Healthy Diet group than in the Paleo Diet group, and the amount of Bifidobacteria in the gut was directly proportional to the amount of whole grains in the diet.

o This is important because previous studies have suggested Bifidobacteria help maintain intestinal barrier integrity and protect against irritable bowel syndrome and obesity.

· Roseburia were also much more abundant in the Healthy Diet group and proportional to the amount of whole grains in the diet.

o This is important because previous studies have suggested Roseburia protect against inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.

· Hungatella were much more abundant in the Paleo Diet group and were inversely proportional to the amount of whole grains in the diet.

o This is important because Hungatella metabolize carnitine and choline, which are found in meats (especially red meats), egg yolks, and high fat dairy, into a compound called trimethylamine or TMA. TMA is then further metabolized in the liver to trimethylamine-N-oxide, or TMAO.

o TMAO is a bad player. It is positively associated with heart disease, stroke, kidney disease, diabetes, and Alzheimer’s disease. However, the evidence is strongest for heart disease. TMAO has been called an independent risk factor for cardiovascular death.

Because of this, the study looked at TMAO levels in the blood of the two diet groups. These results were concerning:

· TMAO levels were 2.5-fold higher in the Paleo Diet group than in the Healthy Diet group.

· As might be expected, TMAO levels were positively correlated with red meat intake and inversely proportional to whole grain intake.

Is The Paleo Diet Bad For Your Heart?

When you put all the evidence together you have a compelling argument that the Paleo diet is likely to increase the risk of heart disease. Let me summarize the data briefly:

1) The Paleo diet discourages the consumption of whole grains.

2) Whole grains are a major source of a dietary fiber called resistant starch.

3) Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4) Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5) TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

The authors of the study concluded: “Although the Paleo diet is promoted for improved gut health, results indicate long-term adherence is associated with different gut microbiota and increased TMAO. A variety of fiber components, including whole grain sources, may be required to maintain gut and cardiovascular health.”

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes like heart attack and stroke. Until we have these studies my advice is:

· Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

· Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

Are Low Carb Diets Healthy?

The Paleo diet is not the only diet that is high in red meat and low in whole grains. The same is true for virtually all the popular low-carb diets. There are studies showing other low-carb diets also alter gut bacteria and raise TMAO levels, so there is a similar concern that they may also increase the risk of heart disease.

This is in addition to concerns about the high saturated fat consumption which increases the risk of heart disease and red meat consumption, which may increase the risk of certain cancers.

Finally, there are no studies showing that any low-carb diet is healthy long term, even the Atkins diet, which has been around for more than 50 years. Until we have long-term studies about the health consequences of low-carb diets, my advice is similar to that for the Paleo diet.

· Don’t accept claims that low-carb diets are healthy. There are no long-term clinical studies to back up that claim.

· Be aware that low-carb diets affect your gut bacteria in ways that may be bad for your health.

The Bottom Line

A recent study looked at the effect of the Paleo diet on an important risk factor for heart disease. Here is a brief summary of the data:

1) The Paleo diet discourages the consumption of whole grains.

2) Whole grains are a major source of a dietary fiber called resistant starch.

3) Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4) Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5) TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes – like heart attack and stroke. Until we have these studies my advice is:

· Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

· Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

· Virtually all the popular low-carb diets discourage consumption of whole grains, so my advice for them is the same as for the Paleo diet.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

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 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.