Dr. Steve Chaney

Are Omega-3 Supplements Safe?

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The Flaws And Blind Spots In This Study

Author: Dr. Stephen Chaney

Pendulum
Pendulum

Has the omega-3 pendulum swung again? The recent headlines are downright scary. For example:

  • “Fish Oil May Increase the Risk of Stroke and Heart Conditions.”
  • “Fish Oil Supplements May Cause Harm, Study Finds. Is It Time to Ditch Them?”
  • “Fish Oil Supplements May Lead to Heart Problems”.
  • “Regular Use of Fish Oil Supplements Might Increase, Rather Than Lessen, The Risk of First Time Heart Disease and Stroke Among Those in Good Cardiovascular Health.”

Yikes! That sounds bad. Should we be thinking about giving up our omega-3 supplements?

But wait. Just a few weeks earlier we were reading headlines about the benefits and lack of side effects from omega-3 supplements. That’s confusing. Which headlines are correct?

To answer these questions:

  • I will point out the flaws and blind spots in the study.
  • I will strip away the hyperbole and put the headlines into perspective.

How Was The Study Done?

clinical studyThe investigators made use of data from the UK Biobank Study. The UK Biobank Study is a large, long-term study in the United Kingdom which was designed to investigate the contributions of genetic predisposition and environmental exposure [including diet and supplementation] to the development of disease.

The UK Biobank Study enrolled 502,461 participants, aged 40-69 years, between January 1st, 2006 and December 31st, 2010. Participants were followed from entry into the program until March 31st 2021, an average of 11.9 years.

The current study excluded any participants who had a diagnosis of atrial fibrillation, heart failure, heart attack, stroke, or cancer at entry into the study, leaving 415,737 participants.

The participants were:

  • 55% women.
  • Average age of 56 years, with 83.4% of them below 65 years old at entry into the study.
  • 94.5% white.

The study was designed in a unique manner, in that it was designed to test the effect of omega-3 supplements on 6 specific transitions:

  • Primary prevention. This measured the transition of healthy (no diagnosed heart disease) people to either atrial fibrillation, major cardiovascular events, or death.
  • Secondary prevention. This measured the transition from atrial fibrillation to either major cardiovascular events or death.
  • Tertiary prevention. This measured the transition from major cardiovascular events to death.
  • Major cardiovascular events were further broken down to heart attacks, stroke and heart failure.

Participants were asked whether they used fish oil supplements when they entered the study and were categorized as either regular users or non-users. [Note: The users were not asked the dose or brand of fish oil supplements they used.]

Deaths were obtained from the national death registry and disease diagnosis from the National Health Service.

Are Omega-3 Supplements Safe?

omega-3 fish oil supplementHere is what the study found.

Primary Prevention – For healthy individuals (defined as having no diagnosed heart disease) using omega-3 supplements for an average of 11.9 years:

  • Increased the risk of atrial fibrillation by 13%.
  • Did not affect the risk of major cardiovascular events and death were unaffected by omega-3 supplementation.
  • When major cardiovascular events were broken down to their component parts, omega-3 supplementation:
    • Decreased the risk of heart failure by 8%.
    • Increased the risk of stroke by 5% (this was just barely statistically significance).
    • Did not affect the risk of heart attack.

Secondary Prevention – For individuals with atrial fibrillation omega-3 supplementation:

  • Decreased the risk of major cardiovascular events by 9%.
  • Decreased the risk of death by 8%.
  • When major cardiovascular events were broken down into their component parts, omega-3 supplementation:
  • Decreased the risk of heart attacks by 15%.
  • Had no effect on the risk of stroke or heart failure.

Tertiary Prevention – For people who suffered major cardiovascular events during the study omega-3 thumbs upsupplementation:

  • Decreased the risk of death by 8%.

Since this is a very complex set of data, I have coded positive results in green and negative results in red.

And as if these complexities were not enough, when the investigators broke these effects down by population groups:

  • Omega-3 supplementation decreased the transition from healthy to death for men (7% decrease) and participants older than 65 (9% decrease).

I will discuss the significance of these observations below.

The authors concluded, “Regular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for [reducing] progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death.”

In short, they were suggesting that omega-3 supplements should be avoided by the general population because they have no positive benefits and might increase the risk of atrial fibrillation and stroke. But omega-3 supplements may be useful for those who already have heart disease.

Some of the articles you may have read about the study repeated this message. Others just emphasized the negative aspects of the study.

But is this message accurate? Let me start by discussing the flaws, blind spots, and hidden data in this study. Then I will summarize the 3 key findings of the study and tell you what they mean for you.

The Flaws, Blind Spots, And Hidden Data In This Study

flawsFlaws: As I said above, there were two major flaws in the study.

Flaw #1: The study did not identify the dose of supplement used. This is important because the increased risk of atrial fibrillation and stroke is primarily seen in clinical trials using high dose omega-3 supplements.

Flaw #2: This was an association study which cannot prove cause and effect. However, the authors of this study reported it as showing that omega-3 supplement use caused atrial fibrillation and stroke – and all the news reports on the study have repeated that claim.

Flaw #3: Other experts have pointed out that the authors inflated the risks associated with omega-3 supplementation by reporting relative risk rather than absolute risk. Let me try to simplify the distinction.

The risk of atrial fibrillation was 4.24% in the non-supplement users and 4.80% in the omega-3 supplement users. That is an absolute increase in risk of 0.56% (4.80% – 4.24%). This is the increase in risk you actually experience. In contrast, 4.80% is 13% greater than 4.24%, which is how relative risk is calculated.

In response to the questions you are probably thinking:

  • Yes, this is a perfect example of the Mark Twain quote, “There are lies. There are damn lies. And then there are statistics.”
  • Yes, all the percentages reported in this study are based on relative risk and are, therefore, inflated. However, I do not have access to their data, so I cannot tell you the absolute risk associated with their other observations.

Blind Spots: In their paper the investigators recommended against the use of omega-3 supplements to prevent heart disease because their data showed:

  • No benefit of omega-3 supplementation for preventing major cardiovascular events and deaths in a healthy population.
  • But did suggest an increased risk of atrial fibrillation and stroke in that same population.

However, their blind spot was in underestimating the difficulty of showing the benefit of any intervention in a healthy population. The example I always use is statin drugs. Statin Drugs:

  • Dramatically reduce the risk of a second heart attack and/or death in people who have already had a heart attack.
  • Reduce the risk of heart attacks in people who are at high risk of heart attacks.
  • Cannot be shown to reduce the risk of heart attacks in a healthy population.

This study suggests that omega-3 supplements are no different. In this study, omega-3 supplements:

  • Reduced the risk of death in people who had already experienced a major cardiovascular event like a heart attack or stroke.
  • Reduced the risk of major cardiovascular events and death in people with atrial fibrillation, which puts them at high risk for a heart attack or stroke.
  • Could not be shown to reduce the risk of major cardiovascular events or deaths in a healthy population.

Hidden Data: There are some important data that were buried in the text and supplemental figures but were Skepticignored in the concluding remarks of this study and all the articles written about it. For example:

  • The original study and all articles written about the study reported that omega-3 supplementation increased the risk of stroke in otherwise healthy individuals but ignored the observation that omega-3 supplementation decreased the risk of heart failure in that same group.

The second example of hidden data likely represents another blind spot of the authors. They concluded that omega-3 supplementation had no benefit for healthy individuals without asking whether omega-3 supplements might benefit higher-risk subpopulations within this group. To help you understand this statement let me start by giving you some perspective.

As I said above, statin drugs cannot be shown to reduce the risk of heart attacks in a healthy population. But when you include people at high risk of heart disease with healthy people in the dataset, you start to see a reduced risk of heart attacks.

Similarly, with supplements you often see no benefits with the general population, which is what is usually reported in the media. But when you look at higher risk groups within that population, the benefits of supplementation emerge.

This study is no different:

  • For healthy individuals, omega-3 supplementation had no effect on deaths during the 12-year follow-up period.
  • However, omega-3 supplementation reduced the risk of death by 9% for both men and people ≥ 65. These represent two groups with elevated risk of heart disease within the otherwise healthy population.
  • Once again, these data were completely ignored.

What Does This Study Mean For You?

This study made 3 major points:

Point #1: Let me start with the one you’ve heard the most about. The risk of atrial fibrillation and stroke associated with omega-3 supplementation is real. We should not ignore it.

But what this study and most of the reports on the study didn’t tell you is that the risk is dose dependent. The risk is primarily seen with high doses of omega-3s. While no one has done a comprehensive dose response analysis, I can tell you that these side effects are:

  • Seldom reported in clinical studies at doses of 1 gm/day or less.
  • Sometimes reported in clinical studies at doses of ≥2 gm/day.
  • Frequently reported in clinical studies at doses of ≥4 gm/day.

However, atrial fibrillation and stroke occur in a very small percentage of omega-3 users, even at 4 gm/day. At this point we have no idea why some people are susceptible to these side effects and others are not. More research in this area is clearly needed.

Until we know more about who is at risk, my recommendation for people who are trying to reduce the risk of heart disease is to rely on something called the Omega-3 Index to determine your individual omega-3 needs rather than using high-dose omega-3 supplements.

  • The Omega-3 Index measures the amount of omega-3 fatty acids in your tissues. It is determined by the amount of omega-3s you consume and how you metabolize them, so it is individualized to you.
  • An Omega-3 Index of 4% is associated with a high risk of heart disease, while an Omega-3 Index of 8% is associated with a low risk of heart disease. There is no evidence that more than 8% provides additional benefit.
  • Most importantly, it only takes 1-1.6 gm/day of omega-3s to raise your Omega-3 Index from 4% to 8%. At these doses your risk of atrial fibrillation and stroke is extremely small.

For example, a recent meta-analysis of 29 studies with a total of 183,292 participants reported that people with an 8% Omega-3 Index had:

  • Decreased risk of ischemic stroke (stroke due to blood clots) with no detectable increased risk of hemorrhagic stroke (stroke due to bleeding), and…
  • No detectable increased risk of atrial fibrillation.

I recommend getting your Omega-3 Index determined, and if it is low, increasing your omega-3 intake to get it into the 8% range. Some people go from 4% to 8% more rapidly than others, so you may need to repeat the test several times to optimize your Omega-3 Index.

If your health professional doesn’t have access to the Omega-3 Index test, you can order it from https://omegaquant.com (I have no financial stake in this company, but I know it as a reputable source of the Omega-3 Index test).

Does The Professor Plan To Reduce His Intake Of Omega-3 Fatty Acids? Three weeks ago, I shared thatprofessor owl my wife and I have been taking around 3 gm/day of omega-3 supplements for the past 40 years. Now that the association of atrial fibrillation and stroke with high dose omega-3 intake has been firmly established, some of you may be wondering whether we plan to decrease our intake of omega-3 supplements.

The answer is, “No”. Remember that the increased risk of atrial fibrillation and stroke is only seen for a small subset of people taking high-dose omega-3 supplements. If we were part of that subset, we would likely have experienced one of those side effects by now.

However, if you are considering omega-3 supplementation for the first time, you don’t know whether you are part of that subset or not. So, my advice remains the same. Rely on optimizing your Omega-3 Index rather than high-dose omega-3 supplementation.

Point #2: Healthy individuals (those with no symptoms of heart disease) do not benefit from omega-3 supplementation. As I pointed out above, this ignores data from their study, namely.

  • Omega-3 supplementation reduced the risk of heart failure in healthy subjects.
  • Omega-3 supplementation reduced the risk of death in higher risk groups within the healthy population (namely men and people 65 and older).

Confusion Clinical StudiesAs I discussed above, this is a pattern seen with statin drugs and most nutritional supplements. Simply put, you can’t show any benefit of statin drugs or most nutritional supplements in a “healthy” population, but you can show benefit when you focus on higher risk individuals within the “healthy” population.

The problem, of course, is that most of us don’t really know whether we are “healthy” or not. For millions of Americans the first indication that they are at risk from heart disease is sudden death from a heart attack or stroke.

With that in mind, I will leave the decision about whether you want to supplement with omega-3s up to you. But if you decide to supplement, I recommend you optimize your Omega-3 Index rather than using a high dose omega-3 supplement.

Point #3: People with heart disease benefit from omega-3 supplementation. This recommendation is becoming non-controversial, so I won’t comment further other than to say high dose omega-3 supplements are probably not needed unless prescribed by your health professional.

The Bottom Line

You have been asking me about recent headlines saying that omega-3 supplements may increase rather than decrease the risk of heart disease. So, I analyzed the study behind the headlines. The study makes 3 claims:

  • Omega-3 supplements increase the risk of atrial fibrillation and stroke when taken by healthy people.
  • Omega-3 supplements are of no benefit for healthy individuals.
  • Omega-3 supplements are beneficial for people who have heart disease.

In the article above I review the flaws, blind spots, and hidden data in the article and discuss what it means for you.

For more details about this 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do Optimists Live Longer?

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What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

You have probably heard the statement that optimists live longer before. In fact, you have probably heard so many times you assume it must be true. But is it a myth or is it the truth?

This question is important because it can affect how people feel about themselves. If you are a natural optimist, statements like this support your feeling of self-worth. But if you are naturally pessimistic, statements like this provide one more reason to feel bad about yourself.

For example, a recent article on the topic in WebMD starts with the statement, “Want to live longer? You might want to try improving your outlook on life.” I am mostly optimistic, so I find this statement to be positive and encouraging.

But I am not sure I would feel about this statement if I were pessimistic or depressed and had tried for years to be more optimistic.

Because of this it is important to ask, “How good is the evidence supporting this claim?”

There are several published studies supporting this claim (For example). However,

  • Most of these studies have been performed with white, high-income participants. It is not clear whether these same results would apply to other racial and ethnic groups.
  • There is also the “chicken versus egg” conundrum. The studies claiming that optimists live longer are all association studies. Simply put, that means optimism is associated with longevity, but does not prove cause and effect. That is important because:
    • Some studies show that both a healthy diet and exercise improve mood.
    • Other studies show that optimists tend to take better care of themselves, and that includes both diet and exercise.
    • So, it’s hard to know which comes first – a healthy lifestyle, which creates optimism, or optimism, which creates a healthy lifestyle.
  • Because of this “chicken versus egg” conundrum, it is not clear whether it is a healthy lifestyle or optimism that is the primary cause of greater longevity.

The study (HK Koga et al, Journal of the American Geriatrics Society, 70: 2793-2804, 2022)) I will review today was designed to answer both questions. Specifically, this study was designed to ask:

  • Is higher optimism associated with a longer lifespan and exceptional longevity across diverse racial and ethnic groups?
  • To what extent do lifestyle factors influence this association?

How Was The Study Done?

clinical studyThe data for this study was obtained from the Women’s Health Initiative which enrolled 161,808 postmenopausal women of diverse racial and ethnic groups from 40 medical centers within the United States between 1993 and 1998. The women were aged 50-79 (average = 63.5) at enrollment and were followed for an average of 26 years.

Optimism was assessed at enrollment into the program using the 6-item Life Orientation Test Revised. For each item on the questionnaire, participants were asked to report the degree they agreed with each statement on a scale of 1 = “strongly agree” to 5 = “strongly disagree”. Their responses were summed to create scores ranging from 6 to 30, with 30 being the highest optimism rating.

Lifestyle was assessed on a questionnaire measuring diet quality, physical activity, BMI (a measure of obesity), smoking status, and alcohol consumption. If participants met predefined “healthy standards in each of these categories, they were given a score of 1. Otherwise, their score was 0. Scores from each category were summed to create a composite lifestyle score ranging from 0 (least healthy) to 5 (most healthy).

Longevity was based on survival compared to national averages using the National Death Index (Yes, “Big Brother” is watching you even when you die) to identify and confirm deaths. Deaths of participants were monitored through March 1, 2019. Exceptional longevity was defined as survival to age 90 or older. Overall, 64,301 women (40.3%) died over the 26 years of follow-up.

Finally, women who died within the first 2 years of follow-up were excluded from the data analysis “to mitigate concerns that health status might affect the reporting or experience of optimism levels.” In plain English, people who are within 2 years of dying are often very sick and feel lousy. Even the most optimistic individuals find it hard to maintain an optimistic outlook in those circumstances. This left 159,255 women in the database.

Do Optimists Live Longer?

When comparing women in the highest to women in the lowest quartile of optimism:

  • Longevity was increased by 5.4%, which corresponds to an additional 4.4 years. When this was broken down by race and ethnicity, longevity was increased by:
    • 1% for Non-Hispanic White women.
    • 6% for Black women.
    • 4% for Hispanic women.
    • 5% for Asian women. However, this may have been an underestimate because of the small sample size of this population in the Women’s Health Initiative database.
  • Exceptional longevity (survival ≥ 90 years) was increased 10%.

When the authors used a complex statistical method to assess the contribution of lifestyle to the increase in longevity, they found:

  • Lifestyle contributed to 24% of the increased longevity. When this was broken down by race and ethnicity, lifestyle contributed:
    • 25% for Non-Hispanic White women.
    • 10% for Black women.
    • 24% for Hispanic women.
    • 43% for Asian women.

The authors concluded, “We found that higher levels of optimism were associated with longer lifespan and greater likelihood of achieving exceptional longevity across racial and ethnic groups, suggesting the health benefits of optimism may hold across these groups.”

“The contribution of lifestyle to these associations was evident but modest.”

“As prior work has demonstrated that optimism is modifiable, it may be a novel target for interventions that aim to extend lifespan across diverse racial and ethnic groups.”

What Are The Strengths And Weaknesses Of This Study?

strengths and weaknessesThis is not the first study to suggest that optimists live longer. But it is the best study to date because:

  • It was larger (159,255 participants) than most previous studies.
  • It followed the participants far longer (26 years) than previous studies.
  • It included a more racially and ethnically diverse group of participants than previous studies.
  • It addressed the “elephant in the room” for studies of this type, namely that optimists tend to actively seek a healthier lifestyle, so the “benefits” of optimism could be due to a healthy lifestyle rather than a state of mind. The study employed statistics to estimate that a healthy lifestyle contributed around 25% to the longevity experienced by optimists.

However, the study did have some weaknesses. In my opinion, the most important weaknesses were:

  • Optimism and lifestyle were only assessed at the beginning of the study. No effort was made to determine whether either of these important variables changed during the 26-year study.
  • The relative influence of lifestyle and optimism on longevity was based on a complex statistical analysis. As Mark Twain said, “There are lies, damn lies, and statistics.” Simply put, statistics can sometimes give misleading answers. I would like to see this very important part of the study confirmed using a different method of analysis.

What Does This Study Mean For You?

Questioning WomanAs I shared above, I have some misgivings about this and other studies claiming that optimists live longer. But let’s assume this claim is true. What does that mean for you?

A 5.4% increase in lifespan might not sound like much, but it added 4.4 years to the lives of the women in the study. What would you do with an extra 4.4 years?

And, as the authors of the study pointed out, that’s equivalent to the gain in lifespan for adults engaged in a regular exercise program. Are those benefits addible? We don’t know, but it is possible that an optimist who exercised regularly and had a healthy diet might experience more than a 4-year gain in lifespan.

The authors said, “Although optimism is partly heritable (23-32%), experimental research has demonstrated that optimism is modifiable…”

Let me share a few things that have helped me maintain a more optimistic outlook:

  • Affirmations and visualizations of a positive future.
  • I start my daily prayers by listing the things I am grateful for. For others, a gratitude journal works equally well.
  • Accept positive input. You can accept compliments with humility by simply thanking the person for the compliment. But in your mind, use the compliment to overcome your inner doubts of self-worth.
  • Question negative input. Ask if each critic is the kind of person you want to become. If so, ask if what they said is really true.
  • Create a support network. These are family and friends who will support you when you need it and will give you a gentle kick in the …. when you need that.
  • Trust in a higher power. I know from experience that it is only God who can give me the “peace that passes all understanding” in my most difficult circumstances. And while I am Christian, I think this is a cornerstone of most religions.

Finally, I know that many people are predisposed to depression and pessimism, so I don’t want to be like the author of the WebMD article and tell you, “Want to live longer? You might want to try improving your outlook on life.”

We know that a healthy lifestyle is associated with longevity. And you don’t have to be an optimist to choose a healthy diet, exercise regularly, avoid smoking and excess alcohol intake, and get regular health check-ups.

We also know these things are associated with a longer healthspan which, simply put, is the number of years you live in good health.

So, whether you are a pessimist or an optimist you can live healthier longer.

The Bottom Line

You have probably heard that optimists live longer, but is it true? In the article above I describe the latest study on this topic. It is better than most previous studies on this topic because:

  • It was larger (159,255 participants) than most previous studies.
  • It followed the participants far longer (26 years) than previous studies.
  • It included a more racially and ethnically diverse group of participants than previous studies.
  • It addressed the “elephant in the room” for studies of this type, namely that optimists tend to actively seek a healthier lifestyle, so the “benefits” of optimism could be due to a healthy lifestyle rather than a state of mind. The study employed statistics to estimate that a healthy lifestyle contributed around 25% to the longevity experienced by optimists.

When the study compared women in the highest to women in the lowest quartile of optimism:

  • Longevity was increased by 5.4%, which corresponds to an additional 4.4 years.
  • Exceptional longevity (survival ≥ 90 years) was increased by 10%.
  • Lifestyle contributed to 24% of the increased longevity.

The authors concluded, “We found that higher levels of optimism were associated with longer lifespan and greater likelihood of achieving exceptional longevity across racial and ethnic groups, suggesting the health benefits of optimism may hold across these groups.”

“As prior work has demonstrated that optimism is modifiable, it may be a novel target for interventions that aim to extend lifespan across diverse racial and ethnic groups.”

For more details on this 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.

______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Relief From Headaches And Shoulder Pain

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Treating Your Levator Scapulae Muscle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

This newsletter is moving into the 21st century!  Everyone has been pushing me to get into videos, but I’m often a dinosaur and I could relate to just text and photos, so I pushed back.  And finally, I saw the benefit to everyone of using videos.

Last month I included just the self-treatment video, and this month I’m moving even further ahead.  I’ve filmed at least 40 videos explaining all kinds of info about muscles and pain.  Each month the newsletter will have one of those explanatory videos, and 1-2 self-treatment videos that relate to the topic being discussed.

I’d really appreciate your feedback on this new way of presenting my info about why muscles cause pain and what you can do about it.  I also appreciate your patience while I learn this new method as I’m sure I’ll be making some technical mistakes.  😊

A BIG shout-out to three people who are making this possible: 

    Pat White, Carla Sellers,

       and Sherri Proctor

 

I’m also a dinosaur when it comes to creating the videos that are necessary to make all of this happen in the first place.  So, I called an expert!  I spent many hours with my good friend, Sherri, creating videos of just about everything.  Sherri is a fantastic photographer and videographer.  Aside from doing all the videos I’ll be sharing with you, Sherri is responsible for almost all the videos I use when I teach massage therapists, and now the self-treatment videos that are being shared with everyone. (If you need a GREAT photographer or videographer, call Sherri at 941-345-5135)

Pat is my webmaster.  I can’t begin to list all the work he is doing with the newsletter to make these videos presentable so you can have the best experience watching them.  He is also in charge of all my websites, teaching programs for massage therapists, and so much more.  Pat also has great patience (or he hides frustration well!) as I move kicking & screaming into this new electronic world!

Thanks to Pat there will be many articles added to the website, each explaining another piece of the puzzle that makes up our body and how it works.  The articles have all been tucked away in my computer as I didn’t know what to do with them.  It’s fun working on the project of sharing them with everyone.

Plus, Pat is working on a major project that I’ll share with you when it’s ready to come out.  I’m so excited!

Carla runs all the social media sites: Facebook, LinkedIn, YouTube, and Instagram.  It all started with her just putting SEO and descriptions, and new thumbnail pictures, on each of the videos. She told me that as she watched the videos, she knew she had to do something to help me.  That grew from a smallish project to a HUGE project!  I’m incredibly grateful for all she has done, and is still doing, to bring my work to the world!

On To The June Newsletter

The body is a symphony of muscles, each playing its own part in our ability to move, and each a key player with a group of other muscles in just about everything we do.

I can’t possibly give you every treatment that needs to be done to get relief, but I will always give you information on the key muscles that need to be treated.

Relief From Headaches And Shoulder Pain 

This month I want to share a video that explains a muscle that causes shoulder pain and headaches.  The name of the muscle is Levator Scapulae.

The levator scapulae muscle originates on the first four cervical vertebrae and inserts into the medial border of your shoulder blade (scapula).

When the muscle contracts normally it lifts your shoulder blade, hence the nickname, “the shrug muscle.”

Click Here to watch the video explaining this muscle and why it causes headaches and shoulder pain

JulstroMethod Self-Treatment For The Levator Scapular Muscle

You’ll need a ball to do this self-treatment.  If you’ve been in to see me, you have the Perfect Ball, which really is perfect to do this treatment correctly.

Click Here to watch how to quickly and easily release the tension in your shoulder muscle.

Snowbirds And Clients Around The World –

Zoom Consultations Are Available

I’ve successfully worked with people around the world for many years.

I also love working with Snowbirds who are in Sarasota all winter, and then head north when it gets hot here.  It’s so nice to see you, and to help you stop aches and pains.

The way we work together is simple:

  1. You go to https://julstromethod.com/product/one-on-one-zoom-consultation/ and order a private consultation.
  1. You send me an email explaining what is wrong, where you feel the pain, what you’ve done to treat it so far, etc., etc. Don’t tell me about medications because that is far out of my scope of practice so I can’t give any advice about them.
  1. We meet on Zoom and work together to find and eliminate the source of your pain.
  1. You receive the Zoom recording so you can watch it again later to refresh your memory about the treatments.

All this for only $147.

Have a beautiful summer!

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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 donnellyJulie Donnelly has been a licensed massage therapist since 1989, specializing in the treatment of chronic pain and sports injuries. The author of several books including Treat Yourself to Pain-Free Living, The Pain-Free Athlete, and The 15 Minute Back Pain Solution.

Julie has also developed a proven self-treatment program for the symptoms of carpal tunnel syndrome.

She has a therapy practice in Sarasota, Florida, and she travels around the USA to teach massage and physical therapists how to do the Julstro Method, and she also teaches self-treatment clinics to anyone interested in taking charge of their own health and flexibility.

She may be reached at her office: 919-886-1861, or through her website: www.FlexibleAthlete.com

About The Editor

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Does EPA Reduce Migraine Frequency?

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What Causes Migraines And The Role Of Omega-3s In Prevention

Author: Dr. Stephen Chaney

MigraineMigraines can be debilitating. And they affect millions of Americans. According to a recent survey 17.1% of women and 5.6% of men in the United States suffer migraine symptoms.

Symptoms range from frequent headaches to visual disturbances, nausea and vomiting, extreme light and sound sensitivity, brain fog, and debilitating pain. Sometimes all a migraine sufferer can do is retreat to a dark, quiet room and wait out the symptoms. This makes it virtually impossible to work, socialize, and interact with family.

For example, work absenteeism due to migraines is thought to cost US businesses up to $13 billion dollars annually. And, of course, there is no way to estimate the psychological cost of lost interactions with family and friends. And people who experience frequent migraines are more likely to suffer from depression, anxiety, and sleep disorders.

Medications can provide some relief from migraine symptoms, but they all have side effects. Various natural approaches for migraine relief have been proposed, but none of them are proven.

What Causes Migraines And The Role Of Omega-3s In Prevention

MigrainesOur understanding of migraines is complicated by the fact there appear to be multiple causes of migraines. It’s almost as if what we call “migraines” are really a variety of diseases with different causes but similar symptoms.

Migraines can be triggered by:

  • Hormonal fluctuations.
  • Weather changes.
  • Foods
    • The top 3 food triggers of migraines are caffeine, red wine, and chocolate.
    • Other common food triggers are artificial sweeteners, foods containing MSG, cured meats, aged cheeses, pickled and fermented foods, frozen foods, and salty foods.
  • Stress
  • Lack of sleep.
  • Certain drugs.
  • Missed meals.

Migraine triggers vary from person to person. And multiple neurophysiological pathways have been proposed to explain how each of these triggers progresses to a full-blown migraine.

To simplify a very complex subject, there are three main factors that influence each of these proposed pathways:

  • Susceptibility to migraines clearly runs in families.
  • 75% of migraine sufferers are women.
  • Inflammation.

Because inflammation plays a strong role in progression and severity of migraines, there has been a strong interest in the use of long-chain omega-3s like EPA and DHA as nutraceuticals to reduce the frequency and severity of migraines.

However, previous studies have had mixed results. Some have suggested that omega-3s reduce the risk of migraines while others have come up empty.

The authors of the current study (H-F Wang, et al, Brain, Behavior, and Immunity 118, 459-467, 2024) postulated that some previous studies failed to find a benefit of omega-3 supplementation because they were too short in duration, used a mixture of omega-3s, or were poorly designed.

They noted that high dose EPA alone had proven to be effective in reducing the risk of heart disease and depression. So, they performed a 12-week randomized, double-blind, placebo-controlled clinical trial with migraine sufferers using 1.8 grams of EPA per day.

How Was This Study Done?

clinical studyThis was a double-blind, placebo-controlled clinical trial, the gold standard for clinical studies. The investigators recruited 70 patients (15 men and 55 women) with episodic migraines (defined as migraines with or without aura occurring fewer than 15 days per month) from the neurology clinic of Kuang Tien General Hospital in Taiwan. The average age of the patients was 39 years old.

The subjects were randomly assigned to use either 1.8 gm/day of EPA or a soybean oil placebo for 12 weeks. Both were formulated with an orange flavoring to hide the taste difference. Neither the patients nor the physicians conducting the study knew who got the EPA and who got the placebo.

The patients filled out an extensive questionnaire about their migraines and related issues at entry into the study and at the end of 12 weeks. They were also asked to maintain headache diaries for at least 4 weeks prior to the study and for every 4 weeks of the 12-week study. They received training from the study coordinator on how to fill out the diaries and were encouraged to contact the coordinator if they had any questions about how to accurately fill out the diary.

The primary outcome of the study was the decrease in migraine frequency from baseline to 12 weeks. The study also assessed changes in:

  • Headache severity.
  • The need to use headache medicines.
  • Migraine-specific disability (The extent to which migraines resulted in disability).
  • Migraine-specific quality of life index (The extent to which migraines affected the quality of life).
  • Anxiety and depression (These are often side effects of chronic migraines).

While some of those outcomes appear to be overlapping, they are all well-established assessments used in migraine research. The questionnaire the doctors used was designed to provide a numerical rating for each of these outcomes.

Does EPA Reduce Migraine Frequency?

omega-3 fish oil supplementAs expected, there were no significant changes in the placebo group. But in the group taking 1.8 gm/day of EPA:

  • Migraine frequency decreased by 60%.
  • Frequency that headache medication was needed decreased by 45%.
  • Headache severity decreased by 14%.
  • Sleep quality increased by 17%, but that increase was not statistically significant.
  • Migraine-related disability decreased by 73%.
  • Migraine-related quality of life improved by 31%.
  • Anxiety and depression decreased by 53%.

These differences were statistically significant for the women in the study, but not for men – probably because of the small number of men in the study.

The study also assessed side effects from EPA supplementation in this group. Side effects were minimal and were not different from the placebo group.

The authors concluded, “High-dose EPA significantly reduced migraine frequency and severity. Improved psychological symptoms and quality of life in migraine patients, and showed no adverse events [effects], suggesting its potential for prophylactic use for migraine patients.”

They went on to say, “The results of this study may not only serve as a valuable reference for future large-scale randomized clinical trials to investigate the optimal dosing and components of omega-3 fatty acids for migraine prevention but also underscore the need for replication of these findings in adequately powered and controlled studies.”

In other words, this study needs to be confirmed by additional studies. And future studies need to determine the optimal dose of EPA and the optimal ratio of EPA to DHA.

What This Study Means For Us And For You

Question MarkThe topic of omega-3s and migraines is of special significance for us. About 40 years ago my wife and I started taking a high purity omega-3 supplement containing both EPA and DHA to control inflammation. We didn’t have noticeable inflammation at the time, but we both had parents who suffered from rheumatoid arthritis and wished to avoid their suffering later in life.

In just a few weeks the migraines my wife had been experiencing for years disappeared. That piqued my interest, so I searched the literature and found several studies showing that omega-3 fatty acids reduce migraine symptoms. I have followed the twists and turns of omega-3 – migraine research ever since, which is how I came across this study.

As for our original purpose in taking an omega-3 supplement, all I can say is that we are now in our 80s, and neither of us suffer from the rheumatoid arthritis that plagued our parents.

And for my wife the disappearance of her migraines was an unexpected side benefit.

This study is a strong validation of the effect of omega-3s on reducing migraine symptoms. However, it is not the end of the story. As the authors said:

  • It needs to be confirmed by larger, well controlled studies.
  • The optimal dose of omega-3s needs to be determined.
  • The optimal ratio of EPA to DHA and possibly other long chain omega-3s needs to be determined.

This study used 1.8 grams/day of pure EPA. My wife takes 3 grams of EPA and 2 grams of DHA each day. But we don’t know whether she would experience the same benefit from a lower dose or whether that is the optimal ratio of EPA to DHA. We do know that EPA and DHA have different health benefits, so we plan to continue taking a supplement that contains both.

And finally, as I said above, it is almost as if what we call migraines are really a cluster of diseases with similar symptoms. There are multiple migraine triggers and multiple proposed explanations of how these triggers lead to full-blown migraines.

So, we shouldn’t think of omega-3s as a magic bullet. Rather, we should think of them as one of many approaches that may provide you with some migraine relief.

The Bottom Line

A recent double-blind, placebo controlled clinical study with migraine sufferers reported that when they were given 1.8 gm/day of EPA for 12 weeks:

  • Migraine frequency decreased by 60%.
  • Frequency that headache medication was needed decreased by 45%.
  • Headache severity decreased by 14%.
  • Migraine-related disability decreased by 73%.
  • Migraine-related quality of life improved by 31%.
  • Anxiety and depression decreased by 53%.

The authors concluded, “High-dose EPA significantly reduced migraine frequency and severity. Improved psychological symptoms and quality of life in migraine patients, and showed no adverse events [effects], suggesting its potential for prophylactic use for migraine patients.”

They went on to say, “The results of this study may not only serve as a valuable reference for future large-scale randomized clinical trials to investigate the optimal dosing and components of omega-3 fatty acids for migraine prevention but also underscore the need for replication of these findings in adequately powered and controlled studies.”

In other words, this study needs to be confirmed by additional studies. And future studies need to determine the optimal dose of EPA and the optimal ratio of EPA to DHA.

For more details about this 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance 

____________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

How Much Leucine Do Seniors Need?

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Where Can Seniors Find The Protein And Leucine They Need?

Author: Dr. Stephen Chaney 

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

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

Some of you may be saying “So what? I wasn’t planning on being a champion weightlifter in my golden years.” The “So what” is that loss of muscle mass leads to reduced mobility, a tendency to fall (which often leads to debilitating bone fractures) and a lower metabolic rate – which leads to obesity and all the illnesses that go along with obesity.

Fortunately, sarcopenia is not an inevitable consequence of aging. There are things that we can do to prevent it. The most important thing that we can do to prevent muscle loss as we age is to exercise – and I’m talking about resistance (weight) training, not just aerobic exercise.

But we also need to optimize our protein intake and our leucine intake. Protein is important because our muscle fibers are made of protein.

Leucine is an essential amino acid. It is important because it stimulates the muscle’s ability to make new protein. Leucine and insulin act synergistically to stimulate muscle protein synthesis after exercise.

In a previous issue of “Health Tips From the Professor” I shared studies showing that the amount of protein and leucine we need to prevent muscle loss increases as we get older. The study (ME Lixandrao et al, Nutrients, Volume 13, Issue 10, 10.3390/nu13103536) I am reviewing today is an update on the leucine needs for seniors.

How Was This Study Done?

clinical studyThe investigators recruited 67 healthy, elderly, overweight adults (34 men and 33 women; average age = 69.7; average BMI = 26.4) in Basel, Switzerland for the study. The participants selected for the study were not engaged in any kind of regular resistance or aerobic training in the previous 6 months.

Participants were asked to fill in three 24-hour dietary recalls (2 on non-consecutive weekdays and one on a weekend day). A trained nutritionist gave instructions on how to perform the dietary recalls. After the dietary recalls were completed, the nutritionists used pictures of foods included in each participant’s diet recall to confirm the accuracy of their portion size estimates. This diet information was used to calculate habitual daily protein and leucine intake.

The investigators used magnetic resonance imaging (MRI) to measure quadriceps cross-sectional area – a measure of muscle mass. They also used performance on a leg extension machine to measure unilateral maximum dynamic muscle strength – a measure of muscle strength.

The study correlated leucine intake with both muscle mass and muscle strength. The data were corrected for sex, age, and total protein intake normalized to body weight.

How Much Leucine Do Seniors Need? 

leucineThere was a biphasic correlation between leucine intake and both muscle mass and muscle strength in this population.

  • There was a positive association between leucine intake and muscle mass up to 7.6 gm/day. After that a plateau was reached. Additional leucine had no effect on muscle mass.
  • There was a positive association between leucine intake and muscle strength up to 8.0 gm/day. After that a plateau was reached. Additional leucine had no effect on muscle strength.
  • These associations held true even after correcting for total protein intake. This is an important control because none of these participants were taking a leucine supplement, so those consuming more leucine were also consuming more protein.

The authors concluded, “We demonstrated that total daily leucine intake is associated with muscle mass and strength in healthy older individuals, and this association remains after correcting for multiple factors, including overall protein intake. Furthermore, our…analysis revealed…a potential threshold for habitual leucine intake, which may guide future research on the effect of chronic leucine intake in age-related muscle loss [sarcopenia].

Randomized control trials should test the utility of additional leucine to counteract frailty in the elderly.”

What Does This Study Mean For You?

ConfusionLet me start by saying that leucine is not a “magic bullet” that will prevent sarcopenia (age-related loss of muscle mass) by itself. Three things are essential for preventing sarcopenia:

  • Resistance (weight bearing) exercise. You should aim for at least 3 days/week of moderate intensity weight bearing exercise a week.

If you have physical limitations, consult with your health professional before beginning an exercise program. And if you have not done weight bearing exercise before, it is best to start with instruction from a personal trainer to be sure you are using appropriate weights and appropriate form.

[Note: The participants in this study had not done weight bearing exercise for 6 months prior to the study and did not exercise during the study.]

  • Adequate protein. I have discussed this in a previous issue of “Health Tips From the Professor”. If you are in your 30’s, 15-20 grams of protein per meal will do. But if you are in your 60’s and above, it’s better to aim for 25-30 grams of protein per meal.

[Note: On average the men in this study were consuming 87 grams of protein per day. That’s 29 grams per meal. The women in this study averaged 67 grams of protein per day or 22 grams per meal. So, most of the participants in this study were consuming adequate protein.]

  • Adequate leucine. This study showed that the benefits of leucine plateaued at around 7.6-8.0 grams per day or 2.5 to 2.7 grams per meal for non-exercising adults in their 60’s and 70’s.

This is in close agreement with studies showing that 25-30 grams of protein and 2.7 grams of leucine were optimal for seniors in this age range following weight bearing exercise.

[Note: This study only determined the optimal intake of leucine. Remember for maximal effectiveness at reducing age-related muscle mass (sarcopenia) you need optimal protein, optimal leucine, and an optimal resistance (weight bearing) exercise program.]

Where Can Seniors Find The Protein And Leucine They Need?

For most Americans this is not too difficult as the table above shows. If you look at single foods, chicken and soybeans are the best sources of both protein and leucine. Other meats and other beans & legumes are also good choices.

I included things like eggs, dairy foods, broccoli, and spinach as a reminder that you don’t need to get all your protein and leucine from a single food source. Other whole foods included in your meal can contribute to your protein and leucine totals.

This table also shows that you don’t need to be a carnivore to get the protein and leucine you need. However, if you avoid most meats or are a pure vegan, you will need to plan your diet a bit more carefully.

Finally, if you are looking to optimize your workouts with an after-workout plant-based protein shake, soy protein would be your best choice. If you chose plant protein, you should look for high-quality protein shakes with added leucine to make sure you meet both your protein and leucine goals.

The Bottom Line

Most Americans lose lean muscle mass as we age, a physiological process called sarcopenia. This loss of muscle mass leads to reduced mobility, a tendency to fall (which often leads to debilitating bone fractures) and a lower metabolic rate – which leads to obesity and all the illnesses that go along with obesity.

Fortunately, sarcopenia is not an inevitable consequence of aging. There are 3 things we can do to prevent it.

  • Exercise – and I’m talking about resistance (weight) training, not just aerobic exercise. This is the most important thing that we can do to prevent muscle loss as we age.
  • Optimize our protein intake.
  • Optimize our leucine intake.

Previous studies have determined the optimal protein intake for preventing sarcopenia. The study I describe above determined the optimal leucine intake.

For more details about 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.

______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 ______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Is The Mediterranean Diet Healthy For Women?

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What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

There is a well-known health disparity in clinical studies related to health. For years most of the studies have been done by men for men. Women have been assumed to experience the same benefits and risks from diet choices as men. But that hasn’t always proven to be true.

The Mediterranean diet is no exception. For example, it has garnered a reputation of reducing heart disease risk for both men and women.

However, most studies on the Mediterranean diet have included primarily male participants or did not report sex specific differences in outcomes.

And the few studies that reported sex specific outcomes have been inconsistent.

  • Some studies have found that men and women benefitted equally from the Mediterranean diet.
  • Other studies have reported that men benefitted more than women.

However, these were all small studies. No meta-analyses have been reported that focused on the heart benefits of the Mediterranean diet for women.

The study (A Pant et al., Heart; 109: 1208-1215, 2023) I will describe today was designed to fill that gap.

How Was The Study Done?

clinical studyThe investigators started by screening the literature to find studies that:

  • Measured adherence to the Mediterranean diet using the original MDS (Mediterranean Diet Score) or more recent modifications of the MDS.
  • Included women ≥18 years without previous diagnosis of clinical or subclinical heart disease.
  • Performed the study with only women participants or organized their data so that the data pertaining to women could be extracted from the study.

The investigators then performed a meta-analysis on data from 722,495 women in 16 studies published between 2006 and 2021 that met these criteria. These studies followed the women for an average of 12.5 years. The studies were primarily conducted in the United States and Europe.

The individual studies divided participants into either quintiles or quartiles and compared participants with the highest adherence to the Mediterranean diet to those with the lowest adherence.

  • The primary outcomes measured were total mortality and the incidence of CVD, cardiovascular disease (defined as including CHD (coronary heart disease), myocardial infarction (heart attack), stroke, heart failure, and cardiovascular death).
  • The secondary outcomes measured were stroke and CHD, coronary heart disease (heart disease caused by atherosclerotic plaque build up in the coronary arteries).

Is The Mediterranean Diet Healthy For Women?

Mediterranean Diet FoodsWhen comparing the highest to the lowest adherence to the Mediterranean diet:

  • The incidence of CVD (cardiovascular disease) was reduced by 24%.
  • Total mortality during the ~12.5-year follow-up was reduced by 23%.
  • The incidence of CHD (coronary heart disease) was reduced by 25%.
  • The risk of stroke was reduced by 13%, but that risk reduction was not statistically significant.
    • The risk reduction for both CVD and total mortality was similar to that previously reported for men.
    • Risk reduction for CVD was slightly higher for women of European descent (24%) than for women of non-European descent (21%). The later category included women of Asian, Native-Hawaiian, and African – American descent.

The authors concluded, “This study supports a beneficial effect of the Mediterranean diet on the primary prevention of CVD and death in women and is an important step in enabling sex-specific guidelines.”

I would add that the data from women of non-European decent suggests that genetic background and/or ethnicity may influence the effectiveness of the Mediterranean diet at reducing heart disease risk, but this effect appears to be small.

What Does This Mean For You?

The results of this study are not unexpected. But that doesn’t mean that studies with women are not valuable. There have been several examples in recent years where health or medical advice based on studies with men needed to be modified for females once the studies were repeated with women.

Before covering what this study means for you, I should point out that while women often fear breast cancer most, heart disease is their number one killer, as the graph on the left shows. In fact, a woman’s risk of dying from coronary heart disease is 6 times greater than her risk of dying from breast cancer.

This study shows that following a Mediterranean–style diet lowers their risk of developing and dying from heart disease. But the Mediterranean diet is not alone in providing these health benefits. It is simply a whole food, primarily plant-based diet that reflects the food preferences of the Mediterranean region.

The DASH diet, which reflects the food preferences of Americans, and the Nordic diet, which reflects the food preferences of the Scandinavian countries, are equally heart healthy. In fact, any whole food, primarily plant-based diet will reduce the risk of heart disease. You should choose the one that best fits your food preferences and lifestyle.

Of course, diet is just part of a holistic approach for reducing heart disease risk. Other important risk reduction strategies include:

  • Don’t smoke.
  • Exercise and maintain a healthy weight.
  • Manage stress.
  • Avoid or limit alcohol.
  • Know your numbers (cholesterol, triglycerides, and blood pressure, for example).
  • Manage other health conditions that increase the risk of heart disease (high blood pressure, diabetes, and high cholesterol, for example).

The Bottom Line

Most studies on the heart health benefits of the Mediterranean diet have been done with men or have not analyzed the data from men and women separately. A recent meta-analysis combining data from 16 studies with 722,495 women showed that the Mediterranean diet was just as heart healthy for women as it was for men.

The authors concluded, “This study supports a beneficial effect of the Mediterranean diet on the primary prevention of CVD and death in women and is an important step in enabling sex-specific guidelines.”

For more details on this study and information on other diets that are heart healthy, 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.

_____________________________________________________________________________My My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _____________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Is It TMJ Or Simply Your Digastric Muscle?

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Treating Your Digastric Muscle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

How wonderful, it’s May!  I especially love May when I’m up north and the flowers are all blooming, the air feels fresh, and people come out to enjoy the lovely weather.

Here in Florida, it’s just starting to get hot.  Most of our “snowbird” friends have left, although the traffic still seems heavy.  I think a lot of people have moved here, or they are just staying longer than normal.  So far, the humidity isn’t too bad.  I’m pretending that it will stay that way.  LOL

I’m Changing My Newsletter

I’ve been writing this newsletter for around 10 years. It’s time for a change.

Filming WorkoutOn Friday, April 30th, my dear friend Sherri, a fantastic photographer and videographer, came over to the office, and along with four models (Frankie, Barbara, Rachel, and Thomas) we filmed 50 short self-treatment videos for my YouTube channel.  Pat, my webmaster, will format them and put them up on YouTube, and then one by one I will add the videos to my future newsletters.

My plan is to still write the explanation of the muscle and why it causes pain, so you’ll have all the background info you want. Then there will be a link to the video so you can do the self-treatment along with the model.

You’ll also be able to subscribe to my YouTube channel and see other self-treatments, so you won’t have to wait for a newsletter on the topic if you have an ache or pain that you want to resolve.

This month is the first newsletter to be done this way.  I hope you like it.

A Muscle That Mimics TMJ Pain

We’ve discussed TMJ in previous newsletters, and now that I’m switching the pictures for videos, we’ll be talking about it again in the near future.  The muscle we’re looking at this month causes pain in the same area of your jaw, but it doesn’t really affect the jaw at all.

The name of the muscle is Digastric Muscle.

The posterior digastric muscle is right under your ear, as shown in this graphic to the left.

It originates from the mastoid bone which is the bone behind your ear.  And it inserts into the bottom of your chin.

When the digastric muscle contracts you open your mouth to chew, speak, sing, or yawn. Obviously, this is an important muscle.

Treating Your Digastric Muscle

The self-treatment is simple.  Click Here to watch how to easily eliminate this ache.

You Can Also Find All The Solutions In One Easy-To-Read Book

pain free living bookTreat Yourself to Pain-Free Living The Comprehensive Guide to Relieving Chronic Pain

This book provides a complete introduction to the Julstro Method, along with easy-to-follow self-treatment techniques to help you live a pain-free life.

Key highlights include:

  • It reveals the root causes of chronic muscle and joint pain, including trigger points.
  • It teaches the Julstro Method, a proven approach for self-treating a wide range of pain conditions.
  • It is fully illustrated with step-by-step instructions to relieve pain in different areas of the body.
  • It offers a drug-free, cost-effective solution for pain stemming from sports, work, or other repetitive activities Whether you struggle with persistent aches, numbness, or mobility issues, this book empowers you to take control of your health and find lasting relief. Discover how to revitalize your body and reclaim your active, pain-free lifestyle.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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 DonnellyJulie Donnelly has been a licensed massage therapist since 1989, specializing in the treatment of chronic pain and sports injuries. The author of several books including Treat Yourself to Pain-Free Living, The Pain-Free Athlete, and The 15 Minute Back Pain Solution.

Julie has also developed a proven self-treatment program for the symptoms of carpal tunnel syndrome.

She has a therapy practice in Sarasota, Florida, and she travels around the USA to teach massage and physical therapists how to do the Julstro Method, and she also teaches self-treatment clinics to anyone interested in taking charge of their own health and flexibility.

She may be reached at her office: 919-886-1861, or through her website: www.FlexibleAthlete.com

About The Editor

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Which Nutrients Prevent Prenatal Depression?

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What Does This Study Mean For You?

Author: Dr. Stephen Chaney 

Yes, you read the headline correctly. Everyone talks about postnatal depression. But prenatal depression is also a “thing”, especially during the third trimester.

  • Worldwide, 4-20% of women experience some degree of depression during the third trimester – with pregnant women in high-income countries at the lower end (4-10%) of depression risk.
  • In contrast, the incidence of postnatal depression is 10-15%.

It is probably no coincidence that the incidence of depression is greatest during the third trimester and during the postnatal period.

  • The third trimester is the most difficult part of pregnancy for many women.
  • When a woman brings her baby home from the hospital her orderly life becomes chaotic.

But what role does nutrition play?

  • While not definitive, many studies suggest that supplementation with B vitamins, especially folic acid, B6, and B12; omega-3 fatty acids; vitamin D; and iron reduce the risk of postnatal depression.
  • However, there is much less information on which nutrients reduce the risk of prenatal depression.

Based on studies suggesting both iron and vitamin D deficiencies may negatively impact mental health, the authors of this study (JL Evanchuk et al, The Journal Of Nutrition. 154, 174-184, 2024) set out to determine whether iron and/or vitamin D deficiencies increase the risk of prenatal depression during the first trimester.

How Was This Study Done?

Clinical StudyThe authors recruited 2189 newly pregnant mothers from Calgary and Edmonton in Ontario Canada between 2009 and 2012. Participants in the study visited clinics in the area upon entry into the study; midway through the first, second, and third trimesters; and at multiple timepoints up to 3 months during the postpartum period.

In addition to the usual pregnancy wellness tests, participants filled out a 24-hour dietary recall and a Supplemental Intake Questionnaire to determine intakes of iron and vitamin D.

Note: The participants were all advised to take some form of prenatal supplement during the study. That’s because prenatal supplements are considered “the standard of care” for pregnant woman, so it would be considered unethical not to include a prenatal supplement in this study.

At the mid-point of the second trimester blood samples were drawn and analyzed for biomarkers of iron and vitamin D insufficiency. For iron the biomarkers were serum ferritin, soluble transferrin receptor, and hepcidin. For vitamin D, the biomarkers were 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and 3-epi-25-hydroxyvitamin D.

Iron deficiency was defined as serum ferritin levels <15 µg/L. Vitamin D insufficiency was defined as 25-hydroxyvitamin D levels < 75nmol/L. The other biomarkers were used to confirm these diagnoses.

Maternal depression was measured midway through the third trimester and ~3 months postpartum using 10-item questionnaire called the Edinburg Postnatal Depression Scale (EPDS). The EPDS ranks depression on a scale of 0 to 30, with a score of ≥13 considered an indication of likely depression.

The characteristics of the women enrolled in this study were:

  • Average age = 31.5
  • Average prepregnancy BMI = 23 (healthy weight).
  • Married or cohabitating with a partner = 97%.
  • Highly educated (college or postgraduate degree) = 68%.
  • Income above $70,000/year = 78%.
  • First child = 54%.
  • White = 80%.

Based on the Edinburg Depression Scale, probably depression for the 1822 women who completed the study was 5.6% during the third trimester and 4.4% 3 months postpartum.

Note: The low incidence of depression seen in this study was probably due to:

  • The women in this study were of high socioeconomic status and were receiving excellent healthcare.
  • The women in this study were taking prenatal supplements that provided both iron and vitamin D.

Which Nutrients Prevent Prenatal Depression? 

pregnant women taking vitaminsAs I mentioned when describing how the study was designed, all participants in this study were advised to take a prenatal supplement. Consequently:

  • 94% of the women in this study were taking a supplement containing iron with an average supplemental iron intake of 26 mg/day.
    • Note: The RDA for iron during pregnancy is 30 mg/day and most prenatal supplements provide 27 mg/day.
  • 68% of the women in this study were taking a supplement containing vitamin D, with an average supplemental vitamin D intake of 330 IU/day.
    • Note: The RDA for vitamin D during pregnancy is 600 IU/day, but most prenatal supplements provide far less than that.

When the investigators looked at iron and vitamin D status during the second trimester:

  • 63.3% of the women had adequate levels of both iron and vitamin D.
  • 14.8% of the women were low in vitamin D but had adequate iron levels.
  • 18.4% of the women were low in iron but had adequate levels of vitamin D.
  • 3.5% of the women were low in both iron and vitamin D.

RDAs are supposed to be enough to meet the nutrient requirements of 97-98% of healthy individuals, so it is perhaps surprising to see so many women with insufficient levels of iron (21.9%) and/or vitamin D (18.3%) in this study. This could be due to:

  • Insufficient intake.
    • This is a likely explanation for vitamin D because the supplements women were using in this study provided around half the recommended RDA for vitamin D and the women lived at a northern latitude where sun exposure makes a small contribution to vitamin D levels.
    • However, this is a less likely explanation for insufficient iron levels because the supplements provided 87% of the RDA for iron.
  • Inadequate RDAs. Studies like this one provide a rigorous test for the adequacy of existing RDAs. This study suggests the existing RDA for iron is adequate to meet the needs of ~80% of pregnant women, which is reassuring. However, it may need to be increased to reach the goal of meeting the iron requirements for 97-98% of pregnant women.

But the important question is whether the iron and vitamin D insufficiencies seen in this study mattered. The data suggested that they did.

  • For pregnant women with low iron, but adequate vitamin D levels in the second trimester, there was a small, but significant, increased risk of experiencing depression symptoms in the third trimester.
  • For pregnant women with low iron and vitamin D levels in the second trimester, the risk of experiencing depression symptoms in the third trimester increased by 2.2 points in the 30-point Edinburg Depression Scale.
    • This is equivalent to a 7.4% increased risk of depression from deficiencies of iron and vitamin D alone – and these are only 2 of at least 8 nutrients thought to be associated with maternal depression.

The authors concluded, “Maternal iron and vitamin D biomarkers, measured during midpregnancy, were independently associated with third trimester maternal depression symptoms…This investigation is one of the first to report on the combined adequacy of maternal iron and vitamin D status during pregnancy and its impact on maternal depression.

The novelty of this work reinforces the need to ask similar questions [with other nutrients and] in other pregnant populations. Future investigations should report on the status of multiple nutrients and explore their independent and combined impact on health outcomes of pregnant individuals and their children.”

What Does This Study Mean For You?

Questioning WomanDepression during pregnancy is bad for you. And because your fetus can sense your mood, it is bad for your baby. So, what should you do?

You can consult with your doctor about which antidepressants are safe to take during pregnancy. But the truth is there are no good choices. There are some antidepressants that are off limits. There are other antidepressants that appear to have little short-term risks, but we have no idea if there are long-term risks for your child.

So, what about natural approaches? Let’s start with nutrition.

The biggest takeaway from this study is that prenatal supplements may not be sufficient to prevent nutritional deficiencies that may cause prenatal depression for pregnant women.

  • This does not mean that every pregnant woman suffering prenatal depression should increase their iron and vitamin D levels.
  • However, if you are experiencing prenatal depression, you might want to ask your doctor about checking your iron and vitamin D status to determine if extra iron and/or vitamin D would be beneficial.

And to put this study into its proper perspective we need to remember that iron and vitamin D deficiencies are only two of many nutrients that may increase the risk of prenatal depression.

For example, in addition to iron and vitamin D, prenatal depression is associated with deficiencies of:

  • B vitamins, especially folate, B6 and B12. Most prenatal supplements provide the recommended RDA of folate for pregnant women, but not all contain RDA amounts of B6 and B12.
  • Calcium and magnesium. Very few prenatal supplements provide the recommended RDA for calcium and magnesium.
  • Omega-3s, especially DHA. Very few prenatal supplements provide DHA, and the few that do usually provide inadequate amounts of DHA.

So, when you are having your nutrition conversation with your doctor, you might not want to limit your conversation to iron and vitamin D.

Alternately, as I suggested last week’s issue of “Health Tips From the Professor”, you might wish to add a multivitamin supplement and an omega-3 supplement providing at least 300 mg of DHA plus EPA. This simple step would be sufficient to assure you have adequate levels of nutrients thought to be important for reducing the risk of prenatal depression.

And, of course, there are other lifestyle factors, as well. For example:

  • Diets high in highly processed foods are known to increase the risk of depression. And whole food, primarily plant-based diets decrease the risk of depression.
  • Overweight and obesity increase the risk of depression.
  • Regular exercise decreases the risk of depression.

The Bottom Line

A recent study looked at whether taking a prenatal supplement was sufficient to eliminate deficiencies of iron and vitamin D during pregnancy and whether deficiencies of these two nutrients during the second trimester of pregnancy increased the risk of depression during the third trimester.

When the investigators looked at iron and vitamin D status during the second trimester:

  • 14.8% of the women were low in vitamin D but had adequate iron levels.
  • 18.4% of the women were low in iron but had adequate levels of vitamin D.
  • 3.5% of the women were low in both iron and vitamin D.

But the important question is whether the iron and vitamin D insufficiencies seen in this study mattered. The data suggested that they did.

  • For pregnant women with low iron, but adequate vitamin D levels in the second trimester, there was a small, but significant, increased risk of experiencing depression symptoms in the third trimester.
  • For pregnant women with low iron and vitamin D levels in the second trimester, the risk of experiencing depression symptoms in the third trimester increased by 2.2 points in the 30-point Edinburg Depression Scale.
  • This is equivalent to a 7.4% increased risk of depression from deficiencies of iron and vitamin D alone.

When you consider that iron and vitamin D are just two of 8 or more nutrients thought to be important for preventing depression during pregnancy, the question becomes what you can do to decrease your risk of developing depression during pregnancy and after the birth of your child.

For more details about 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.

 ____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

___________________________________________________________________________

About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

What Nutrients Are Missing In Prenatal Supplements?

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Do These Deficiencies Matter?

Author: Dr. Stephen Chaney

healthy pregnancyIf you are a pregnant mom, nothing is more important than the health of your baby. And if you are pregnant or thinking of becoming pregnant, your doctor has probably recommended a prenatal supplement. But does the prenatal supplement he or she recommended provide you with all the nutrients you need?

In a previous issue of “Health Tips From the Professor” I shared two studies that suggested the answer is, “No”. Those studies concluded that most prenatal supplements had little or no vitamin K, choline, DHA, and iodine – all of which are essential for the health of your newborn baby. And while most prenatal supplements contained calcium, the amount they provided was far below recommended levels.

The authors of the first study also made the point that most women going on a prenatal supplement will probably discontinue taking their multivitamin supplement, so a good prenatal supplement should provide all the essential nutrients.

But they don’t. Folic acid, iron, calcium, and vitamin D have long been recognized as essential for a healthy pregnancy. So, virtually every prenatal supplement contained these four nutrients, although calcium is often present in suboptimal amounts. Beyond those four nutrients, the design of prenatal supplements is haphazard. Some contain vitamin K, choline, iodine, or DHA (often in suboptimal amounts). But almost none contain all four nutrients.

And when you consider the other essential nutrients you find in most multivitamins, prenatal supplements often come up empty. Is that a problem? That’s what this study (KM Godfrey et al, PLOS Medicine, 1-27, December 5, 2023) was designed to find out.

How Was This Study Done?

clinical studyThis was a double-blind, placebo-controlled clinical trial, the gold standard for clinical studies. The investigators recruited 1,729 women who were planning to get pregnant from England, Singapore, and New Zealand between 2015 and 2017.

The women were randomly split into two groups:

  • The control group received a supplement containing nutrients that were most frequently included in prenatal supplements in those countries (folic acid, iron, calcium, iodine, and beta-carotene).
  • The intervention group received a supplement containing those nutrients plus riboflavin, vitamin B6, vitamin B12, vitamin D, zinc, inositol, and probiotics).
  • Riboflavin, vitamin B6, vitamin B12, vitamin D, and zinc were included because they are included in most multivitamins but are often missing in prenatal supplements.
  • Inositol was included because some studies have suggested that inositol may reduce the risk of maternal hyperglycemia and gestational diabetes.

Blood samples to assess nutritional status were obtained from all women in the study before the trial started (baseline) and after 1 month of supplementation with either the control or intervention formulation.

Of the women entering the study, 512 went on to have a singleton (one child) pregnancy. For these women supplementation was continued until childbirth. Additional blood samples were obtained in early and late pregnancy and at 6 months postdelivery. [Note: no supplementation was provided to either group postdelivery. And this is also a period of time when most women would be breastfeeding.]

The blood samples were tested for:

  • Blood levels of folic acid, riboflavin, vitamin B6, vitamin B12, and vitamin D.
  • Functional biomarkers of deficiencies of each of these vitamins.

What Nutrients Are Missing In Prenatal Supplements?

Question MarkThere was no difference in maternal hyperglycemia or gestational diabetes between the control group and the intervention group supplemented with inositol, so I will focus on the other nutrients present in the intervention group.

At baseline when subjects were first entered into the study.

  • 29.2% of the subjects had low or marginal status for folic acid.
  • 82.0% of the subjects had low or marginal status for riboflavin.
  • 1.3% of the subjects had low or marginal status for vitamin B6.
  • 9.1% of the subjects had low or marginal status for vitamin B12.
  • 48.7% of the subjects had low or marginal status for vitamin D.
  • 91.0% of the subjects had low or marginal status for one or more of these vitamins.

In the control group receiving folic acid but no riboflavin, vitaminB6, vitamin B12, and vitamin D:

  • Folic acid deficiency fell to 4.1% after 1 month of supplementation (the supplement used by the control group contained folic acid), 1% in early pregnancy, 6.1% in late pregnancy, and rose to 31.8% 6 months after supplementation was discontinued. The intervention group got the same amount of folic acid, and their results were similar.
  • Riboflavin deficiency ranged from 82-92% during pregnancy and returned to 82% 6 months postdelivery.
  • Vitamin B6 deficiency increased to 54% in late pregnancy and returned to 1.2% 6 months postdelivery.
  • Vitamin B12 deficiency increased to 55% in late pregnancy and returned to 12.4% 6 months postdelivery.
  • Vitamin D deficiency ranged from 35-43% during pregnancy and returned to 31% 6 months postdelivery.
  • Functional markers of vitamin B6 deficiency were evident by late pregnancy.

In short, data from the control group fell into 3 categories:

  • The data with folic acid confirm previous studies showing that folic acid in the amount present in most prenatal supplements is effective at preventing folic acid deficiency before and during pregnancy. It also strengthens the argument for continuing folic acid supplementation during breastfeeding.
  • Deficiencies of riboflavin and vitamin D are prevalent in women of childbearing age, but pregnancy does not appear to significantly impact the percentage of women who are deficient in these nutrients.
  • Deficiencies of vitamins B6 and B12 are rare in women of childbearing age, but pregnancy significantly depletes both nutrients.
    • This was particularly evident for vitamin B6. Blood levels of vitamin B6 markers decreased to a level that could impact the functioning of vitamin B6-depended metabolic pathways.

pregnant women taking vitaminsFor the intervention group receiving additional riboflavin, vitamin B6, vitamin B12, and vitamin D:

  • Deficiencies of these vitamins were eliminated by one month of supplementation.
  • Vitamin levels remained adequate during pregnancy.
  • Except for vitamin B12, deficiencies of these vitamins reappeared when supplementation was discontinued for 6 months. The maintenance of adequate B12 levels 6 months after supplementation stopped was expected because the body holds on to its B12 stores very tightly.

In short deficiencies of these nutrients before and during pregnancy could be eliminated by supplementation with levels of these nutrients found in many multivitamins.

The authors concluded, “Over 90% of the trial participants had low concentrations of one or more of folate, riboflavin, vitamin B12, or vitamin D during preconception, and many developed markers of vitamin B6 deficiency in late pregnancy. Preconception/pregnancy supplementation in amounts available in over-the-counter supplements substantially reduces the prevalence of vitamin deficiency and depletion markers before and during pregnancy, with higher maternal plasma vitamin B12 maintained during the recommended lactation period.”

Do These Deficiencies Matter?

New ParentsIt is well established that deficiencies of folic acid and vitamin D cause health risks for the mother and developmental risks for the fetus, so I won’t discuss these nutrients here.

However, the effect of riboflavin, vitamin B6, and vitamin B12 deficiencies on pregnancy is less well known, which is probably why these nutrients are often not added to prenatal supplements.

The authors of the study said small studies have suggested that:

  • Low or deficient riboflavin status may be associated with a higher risk of anemia during pregnancy.
  • Low vitamin B6 status may be associated with an increased risk of preterm birth and development of metabolic health risks in the child.
  • Low vitamin B12 status may be associated with increased risk of gestational diabetes and pre-eclampsia in the mother, and increased risk of neural tube defects, preterm birth, low birth weight, and neurocognitive delays in the baby – with the strongest evidence being an effect on neurocognitive development.

While none of these risks have been definitively proven, the authors point out that deficiencies of these nutrients can easily be eliminated with inexpensive, over-the-counter multivitamin supplements.

What Does This Study Mean For You?

Questioning WomanPerhaps I should start this section by asking why these deficiencies are so common in women of child-bearing age.

The authors speculate that part of the reason is that many women are giving up meat (B12 and iron) and dairy (calcium and riboflavin) for health or environmental reasons.

However, they also point out that a more likely cause is that more than 60% of calories consumed in countries like England, New Zealand, and the United States comes from ultra-processed foods – otherwise known as “empty calories”.

Whatever the cause, the authors conclude, “…the findings suggest a need to reappraise dietary recommendations for preconception and pregnancy to consider further the role of multiple micronutrient supplements for women living in higher-income countries.” I agree.

In a previous “Health Tips From the Professor” article, I reported a recent study showing that most prenatal supplements have either no or inadequate amounts of vitamin K, choline, DHA, iodine, and calcium, nutrients that are absolutely essential for a healthy pregnancy. And I gave recommendations for choosing the best prenatal supplement for you and your child.

That study also noted that many women discontinue their multivitamin supplement when they start taking a prenatal supplement. The current study indicates that practice may be unwise. It shows that:

  • Many women of childbearing age are deficient in one or more of these essential nutrients, and…
  • Essential nutrients not found in most prenatal supplements may also be important for a healthy pregnancy.

So, if you are pregnant or thinking of becoming pregnant, follow this article’s recommendation to start with a well-designed prenatal supplement that provides adequate amounts of folate, iron, calcium, vitamin D, vitamin K, choline, DHA, and iodine and add a multivitamin supplement that provides the other essential nutrients. Alternatively, a simpler approach would be to choose a well-designed prenatal supplement that includes all the essential nutrients. That would be my recommendation.

I would also note this study showed that deficiencies of most of these nutrients reappeared as soon as supplementation was discontinued. Although the authors of this study did not mention it, this reinforces the importance of continuing supplementation during breastfeeding.

The Bottom Line

I have previously reported on a study that concluded many prenatal supplements lack one or more nutrients shown to be important for a healthy pregnancy. But let’s say you have found a prenatal supplement that provides all those nutrients. Is that enough?

Studies show that most women stop taking their multivitamin supplement when they start on a prenatal supplement. But is that a good idea? Are there essential nutrients found in multivitamins, but not in many prenatal supplements that are also important for a healthy pregnancy?

A recent study asked that question in women who were trying to become pregnant. The study found that:

  • Many women of childbearing age are deficient in one or more essential nutrients found in multivitamin supplements but often missing in prenatal supplements, and…
  • Essential nutrients not found in most prenatal supplements may also be important for a healthy pregnancy.

For more details about this 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 ______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Can Personalized Diets Help Control Blood Sugar?

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What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

Personalized diets are highly advertised. We are told to forget the old “one size fits all” diets of the past. We are told we are all different, so diets should be individualized to us.

We are promised that by collecting DNA samples from our tissue or bacteria in our gut, blood samples, and personal medical history, a personalized diet can be created that “fits us like a glove”.

But are those promises true, or are they hype? Diets to control blood sugar spikes should be a perfect topic for testing those claims. Millions of Americans have trouble controlling their blood sugar levels. Specifically:

  • 1 million adults (14.7% of US adults) have diabetes, mostly type 2 diabetes.
  • 6 million adults (38.0% of US adults) have prediabetes.
    • That amounts to 52% of the US population who have trouble controlling blood sugar levels.
  • Previous studies have shown that prediabetes and type 2 diabetes are largely reversible with diet and lifestyle change.
  • Recent studies have shown tremendous inter-person variability in the blood sugar response to any given food.
  • Previous studies have shown that our gut bacteria influence our blood sugar response to foods.

In theory, blood sugar control should be the perfect candidate for personalized diets. With that in mind, the authors of this study have created an algorithm called PNP (Personal Nutrition Program) that combines continuous blood glucose monitoring, HbA1c measurement (a measure of blood sugar control), personal characteristics (physical activities, sleep times, stress, and hunger), and a DNA analysis of stool samples to identify the species of gut bacteria. They also created a PNP app to allow participants to monitor and modify the foods they ate on a continuous basis.

In this study (AY Kharmats et al, The American Journal of Clinical Nutrition, 118: 443-451, 2023) the authors compared the effectiveness of their Personalized Nutrition Program algorithm with a standard, one-size-fits-all, low fat diet for improving blood sugar control in patients with prediabetes and type 2 diabetes.

Note: They used a low fat diet because, despite what you may have heard, low fat diets are better than low carb diets for diabetics. Of course, the low fat diet they used was created by dietitians. The carbohydrates came from whole foods rather than added sugars.

How Was The Study Done? 

Clinical StudyThe investigators recruited 156 participants from the NYU Langone Health Center between January 2018 and March 2021. The participants selected were overweight with prediabetes or moderately controlled type 2 diabetes. For participants with type 2 diabetes, it was managed with lifestyle alone or lifestyle plus metformin. Other characteristic of the study participants were:

  • Gender: 33.5% male, 66.5% female.
  • Race & Ethnicity: 55.7% white, 24.1% black, 16.5% Hispanic.
  • Education: 69.5% with a college degree.
  • Baseline BMI: 33 (Obese).
  • Baseline HbA1c: 5.8% (prediabetic range) with 12% of participants ≥6.5% (diabetic range).

The participants were randomly divided into two groups that were matched with respect to weight and blood sugar control. One group was put on a diet based on the investigator’s PNP algorithm. The other group was put on a standardized low fat (< 25% of calories from fat) diet that is often used with diabetic patients.

Upon admission to the study, blood samples were drawn for HbA1c, a detailed questionnaire was filled out, and stool samples were obtained for DNA analysis to identify the species of bacteria in their gut.

Each participant was given a continuous glucose monitoring device to wear during the study. This allowed the investigators to monitor the participants blood sugar control throughout the study.

All this information was used to provide individual diet recommendations for the personalized diet group using the PNP algorithm developed by the investigators.

The study lasted 6 months and measured improvements in blood sugar control as assessed by a decrease in blood sugar spikes and a reduction in HbA1c.

Both Groups were put on a registered dietitian-led behavioral intervention program targeting 7% weight loss and a calorie deficit goal of 500 calories per day. The 1-hour sessions were conducted by Webex weekly for 4 weeks and then every other week for the remaining 5 months. The sessions included:

  • Education (e.g., obesity risks, benefits of weight loss, strategies for restricting calories, protocols for aerobic exercise and strength training, and dealing with weight loss plateaus)
  • Behavioral change (e.g., importance of behavioral change, goal setting, self-reward, and problem-solving around common barriers to weight loss success)

The participants were advised to gradually build up to 150 min/week of moderate intensity exercise.

Each participant was given access to the PNP mobile app designed by the investigators. The app provided real-time feedback regarding their dietary intake relative to the target specific to their group (low fat diet or personalized diet). Participants were asked to use the app to:

  • Enter their dietary intake and self-monitor their meals (If the meal did not match the target specific to their group, the participants were trained how to substitute other foods, so their meal better matched their target.)
  • For the Standardized Low Fat Group, the PNP app provided real-time feedback regarding calorie intake and macronutrient distribution for meals and snacks logged in by the participants.
  • For the Personalized Group the PNP app scored meals as excellent, very good, good, bad, or very bad based on the PNP algorithm developed by the investigators.

Can Personalized Diets Help Control Blood Sugar? 

The results were clear-cut:

  • Weight loss was identical on both diets. This is no surprise. The study design included an exceptionally well-designed weight loss protocol for both groups.
  • The decrease in HbA1c was identical on both diets.
  • The improvement in blood sugar control was identical on both diets.

The investigators concluded, “[The] personalized diet did not result in an increased reduction in GV [blood sugar control] or HbA1c in patients with prediabetes or moderately controlled type 2 diabetes compared to a standardized diet.”

Since the investigators had designed the algorithm used to create personalized diets for this study, this was probably not the result they wanted.

So, they added, “Additional subgroup analyses may help to identify patients who are more likely to benefit from this personalized intervention.”

What Does This Study Mean For You? 

QuestionsThis first takeaway from this study was obvious:

  • The personally designed diet did not perform any better than a standard, one size fits all, diet at improving blood sugar control.

Of course, this was not any standard diet. It was a diet that has been used successfully with diabetics for years. However, a lot of research had gone into developing the personalized diet. One might have expected it to perform better.

This is not the first study in which a personalized diet has performed no better than a standard diet. It doesn’t mean that the concept behind personalized diets is faulty. It just means we don’t yet know enough to design a personalized diet that really works.

The second takeaway from this study might be less obvious:

  • Weight loss is the most important factor for improving blood sugar control. Any diet that reduces weight will improve blood sugar control. This is also true for many other health issues such as high cholesterol, high blood pressure, high triglycerides, and osteoarthritis.
  • However, this should not come as a surprise either.
    • Vegan and keto diets are polar opposites. Yet both give similar short-term weight loss and provide similar short-term health benefits.
    • Studies have shown that intermittent fasting gives no better weight loss and health benefits than any diet that cuts calories to a similar extent.
    • In other words, the diet you choose or the way you choose to restrict calories doesn’t matter. It is weight loss that provides the health benefits.
  • However, diet does appear to matter in the long term. If you look at studies ranging from 10 to 30 years, primarily plant-based diets provide better health benefits than primarily meat-based diets. And diets consisting primarily of whole, unprocessed foods provide better health benefits than diets high in processed foods.

Finally, there is an important corollary to this study showing that a personalized diet performed no better than a standardized diet at controlling blood sugar.

  • Some companies are trying to sell you expensive personalized diets with extravagant claims about the health benefits of their diet. Be wary of those diets. The science supporting their diets is premature. Their claims may be misleading.
  • And if the companies claim their diet is supported by published clinical studies, you should evaluate those studies carefully. The study I reviewed in this article was an exceptionally well-designed study. Any study that does not control for weight loss is likely to provide misleading results.

The Bottom Line 

A recent study compared the effectiveness of a personalized diet and a standardized diet in improving blood sugar control for patients with prediabetes or type 2 diabetes. The results were clear-cut:

  • Weight loss was identical on both diets. This is no surprise. The study design included an exceptionally well-designed weight loss protocol for both groups.
  • The decrease in HbA1c was identical on both diets.
  • The improvement in blood sugar control was identical on both diets.

This doesn’t mean that the concept behind personalized diets is faulty. It just means we don’t yet know enough to design a personalized diet that really works.

For more information on this 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.

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

 

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Health Tips From The Professor