Dr. Steve Chaney

Do Omega-3 Supplements Reduce ADHD Symptoms?

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Will The Omega-3 Controversy Continue?

adhd symptoms childrenThe 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?

Clinical StudyThis 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?

adhd symptoms omega-3sThe 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?

ArgumentThis 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?

confusionWhile 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.

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.”

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

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The Holidays Don’t Have To Be Unhealthy

Thanksgiving TurkeyWhile “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

Healthy Thanksgiving DinnerHere 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

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A Bone Health Lifestyle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Woman Enjoying Autumn LeavesFall 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

Exercise And NutritionWeight-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

A Bone Healthy Lifestyle
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?

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Is The Paleo Diet Bad For Your Gut?

the paleo dietThere 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?

can you believe clinical studies doctorThis 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?

Paleo FoodsOnly 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?

Bas BacteriaBecause 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?

heart diseaseWhen 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?

low carb dietThe 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?

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

Author: Dr. Stephen Chaney

 

preconception diet for malesWomen 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?

preconcepiton diet for males studyThis 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?

 

healthy pregnancyLet’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 ?

 

male folic acid status before pregnancyIn 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.

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.”

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?

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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.

do sodas increase your risk of dyingHowever, 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?

soda studyThis 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?

 

vampire holding sodaThe 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?

strengths and weaknessesThe 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?

 

sugar free soda canThe 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.

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.

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.

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.

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?

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Why Are Vitamin D Studies So Confusing?

Author: Dr. Stephen Chaney

 

Does vitamin D supplementation reduce cancer deaths?

vitamin d supplementationWhen 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 supplementation 101Vitamin 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?

scientific studyThis 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 reduce cancer deathsVitamin 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?

strengths weaknesses[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.
    • thumbs down symbolThey 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?

what does vitamin d supplementation mean for youAssociation studies have suggested that vitamin D deficiency significantly increases the risk of heart disease and cancer and slightly increased the risk of death from any cause.

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

 

The Bottom Line

 

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

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

The results of this meta-analysis were:

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

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

 

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

Hip Pain Causes

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Does Dehydration Make The Pain Worse?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

 

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

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

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

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

 

What is the Best Water To Drink?

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

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

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

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

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

 

Hip Pain Causes

 

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

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

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

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

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

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

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

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

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

 

Treating The Hip Pain

 

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

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

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

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

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

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

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

There is a solution!

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

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

 

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

  • Three DVD’s (and now it’s also an MP4) that give you step-by-step direction.
    • One DVD shows me teaching an athlete how to do every self-treatment taught in Treat Yourself to Pain-Free Living.
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julie donnelly

 

 

 

 

Wishing you well,

Julie Donnelly

 

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

 

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

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

What’s Worse Saturated Fat or Sugar?

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What Causes Fatty Liver Disease?

Author: Dr. Stephen Chaney

 

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

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

So, what’s worse saturated fat or sugar?

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

 

Why Is the Saturated Fats and Sugar Dilemma So Confusing?

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

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

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

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

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

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

Why Was This Study Done?

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

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

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

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

How Was The Study Done?

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

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

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

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

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

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

 

What Causes Fatty Liver Disease?

fatty liver disease dietsAt the end of three weeks:

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

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

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

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

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

 

What is Worse Saturated Fat Or Sugar?

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

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

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

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

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

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

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

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

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

What Does This Study Mean For You?

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

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

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

 

The Bottom Line

 

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

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

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

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

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

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

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

 

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

Omega-3s During Pregnancy Are Healthy

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

Author: Dr. Stephen Chaney

 

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

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

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

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

  • Visual impairment.
  • Developmental Delay.
  • Learning difficulties.

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

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

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

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

 

Who Ya Gonna Call?

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

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

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

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

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

 

How Was The Study Done?

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

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

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

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

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

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

 

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

 

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

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

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

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

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

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

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

 

Do Omega-3s Make For A Healthy Pregnancy?

 

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

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

  • Perinatal death.
  • Admissions to the neonatal intensive care unit.

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

 

What Does This Report Mean For You?

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

  • Visual impairment.
  • Developmental Delay.
  • Learning difficulties.

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

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

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

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

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

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

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

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

 

The Bottom Line

 

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

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

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

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

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

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

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

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

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

 

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

Health Tips From The Professor