Dr. Steve Chaney

How Much Carbohydrates Should We Eat?

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The “Goldilocks Effect”

Author: Dr. Stephen Chaney

 

How much carbohydrates should we eat?

how much carbohydrates should we eatThe low-carb wars rage on. Low-carb enthusiasts claim that low-carb diets are healthy. Many health experts warn about the dangers of low-carb diets. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan).

However, two recent studies have come to the opposite conclusion. Those studies reported that high carbohydrate intake increased mortality, and low carbohydrate intake was associated with the lowest mortality.

One of those studies, called the Prospective Urban Rural Epidemiology (PURE) study was published just last year. It included data from 135,335 participants from 18 countries across 5 continents. That’s a very large study, and normally we expect very large studies to be accurate. The results from the PURE study had low-carb enthusiasts doing a victory lap and claiming it was time to rewrite nutritional guidelines to favor low-carb diets.

Whenever controversies like this arise, reputable scientists are motivated to take another look at the question. They understand that all studies have their weaknesses and biases. So, they look at previous studies very carefully and try to design a study that eliminates the weaknesses and biases of those studies. Their goal is to design a stronger study that reconciles the differences between the previous studies.

how much carbohydrates should we eat studySuch a study has just been published (SB Seidelmann et al, The Lancet, doi.org/10.1016/S2468-2667(18)30135-X ). This study resolves the conflicting data and finally answers the question: “How much carbohydrates should we be eating if we desire a long and healthy life?” The answer is “Enough.”

I call this “The Goldilocks Effect” You may remember “Goldilocks And The Three Bears.” One bed was too hard. One bed was too soft. But, one bed was “just right.” One bowl of porridge was too hot. One was two cold. But, one was “just right.”  According to this study, the same is true for carbohydrate intake. High carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But, moderate carbohydrate intake is “just right.”

How Was The Study Done?

This study was performed in two parts. This first part drew on data from the Atherosclerosis Risk in Communities (ARIC) study. That study enrolled 15,428 men and women, aged 45-64, from four US communities between 1987 and 1989. This group was followed for an average of 25 years, during which time 6283 people died. Carbohydrate intake was calculated based on food frequency questionnaires administered when participants enrolled in the study and again 6 years later. The study evaluated the association between carbohydrate intake and mortality.

The second part was a meta-analysis that combined the data from the ARIC study with all major clinical studies since 2007 that measured carbohydrate intake and mortality and lasted 5 years or more. The total number of participants included in this meta-analysis was 432,179, and it included data from both studies that claimed low-carbohydrate intake was associated with decreased mortality.

 

How Much Carbohydrates Should We Eat?

 

how much carbohydrates should we eat ripThe results from the ARIC study were:

  • The relationship between mortality and carbohydrate intake was a U-shaped curve.
  • The lowest risk of death was observed with a moderate carbohydrate intake (50-55%). This is the intake recommended by current nutrition guidelines.
  • The highest risk of death was observed with a low carbohydrate intake (<40%).
  • The risk of death also increased with very high carbohydrate intake (>70%).
  • When the investigators used the mortality data to estimate life expectancy, they predicted a 50-year old participant would have a projected life expectancy of:
  • 1 years if they had a moderate intake of carbohydrates.
  • Their life expectancy was 4 years less if they had a low carbohydrate intake.
  • Their life expectancy was 1.1 year less if they had a very high carbohydrate intake.
  • The risk associated with low carbohydrate intake was affected by what the carbohydrate was replaced with.
  • When carbohydrate was replaced with animal protein and animal fat there was an increased risk of mortality on a low-carb diet. The animal-based low-carb diet contained more beef, pork, lamb, chicken and fish. It was also higher in saturated fat.
  • how much carbohydrates should we eat plantbasedWhen carbohydrate was replaced with plant protein and plant fats, there was a decreased risk of mortality on a low-carb diet. The plant-based low-carb diet contained more nuts, peanut butter, dark or whole grain breads, chocolate, and white bread. It was also higher in polyunsaturated fats.
  • The effect of carbohydrate intake on mortality was virtually the same for all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.
  • There was no significant affect of carbohydrate intake on long-term weight gain (another myth busted).

The results from the meta-analysis were very similar. When the data from all studies were combined:

  • Both low carbohydrate diets and very high carbohydrate diets were associated with increased mortality.
  • Meat-based low-carb diets increased mortality, and plant-based low-carb diets decreased mortality.
  • Once again, the results were the same for total mortality, cardiovascular mortality, and non-cardiovascular mortality.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy on both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

Why Were Some Previous Studies Misleading?

This study also resolved the discrepancies between previous studies. The authors pointed out that the average carbohydrate intake is very different in Europe and the US than in Asian countries and low-income countries. In the US and Europe, mean carbohydrate intake is about 50% of calories and it ranges from 25% to 70% of calories. With that range of carbohydrate intake, it is possible to observe the increase in mortality associated with both low and high carbohydrate intakes.

White rice is a staple in Asian countries, and protein is a garnish rather than a main course. Consequently, overall carbohydrate intake is greater in Asian countries and very few Asians eat a low carbohydrate diet. High protein foods tend to be more expensive than high carbohydrate foods. Thus, very few people in developing countries can afford to follow a low carbohydrate diet, and overall carbohydrate intake also tends to be higher.

how much carbohydrates should we eat aricTherefore, in Asian and developing countries the average carbohydrate intake is greater (~61%) than in the US and Europe, and the range of carbohydrate intake is from 45% to 80% of calories. With that range of intake, it is only possible to see the increase in mortality associated with high carbohydrate intake.

Both the studies that low-carb enthusiast quote to support their claim that low-carb diets are healthy relied heavily on data from Asian and developing countries. In fact, when the authors of the current study overlaid the data from the PURE study with their ARIC data, there was an almost perfect fit. The only difference was that their ARIC data covered both low and high carbohydrate intake while the PURE study touted by low-carb enthusiasts only covered moderate to high carbohydrate intake. [I have given you my rendition of the graph on the left. If you would like to see the data yourself, look at the paper .]

Basically, low-carb advocates are telling you that diets with carbohydrate intakes of 30% or less are healthy based on studies that did not include carbohydrate intakes below 40%. That is misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

What Does This Mean For You?

There are several important take-home lessons from this study:

  • All major studies agree that very high carbohydrate intake is unhealthy. In part, that reflects the fact that diets with high carbohydrate intake are likely to be high in sodas and sugary junk foods. It may also reflect the fact that diets which are high in carbohydrate are inevitably low in protein or healthy fats or both.
  • how much carbohydrates should we eat low-carbAll studies that cover the full range of carbohydrate intake agree that low carbohydrate intake is also unhealthy. It shortens life expectancy of a 50-year old by about 4 years.
  • The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.
  • Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with previous studies. For more details on those studies, see my article “Are Any Low-Carb Diets Healthy?” in “Health Tips From The Professor” or my book, “Slaying The Food Myths.”

The health risks of meat-based low-carb diets may be due to the saturated fat content or the heavy reliance on red meat. However, the risks are just as likely to be due to the foods these diets leave out – typically fruits, whole grains, legumes, and some vegetables. Proponents of low-carb diets assume that you can make up for the missing nutrients by just taking a multivitamin. However, each food group also provides a unique combination of phytonutrients and fibers. The fibers, in turn, influence your microbiome. Simply put, whenever you leave out whole food groups, you put your health at risk.

Limitations Of This Study

how much carbohydrates should we eat limitationsMy main concern with this study and all previous studies is that they lump all carbohydrates together, as if they were equally healthy or unhealthy. We should really be focusing on healthy carbohydrates versus unhealthy carbohydrates, healthy proteins versus unhealthy proteins, and healthy fats versus unhealthy fats. We should be focusing on foods.

For example, the plant-based low carbohydrate diets in this study probably had a higher percentage of healthy carbohydrates because those diets feature whole, plant-based foods. The very high carbohydrate diets in this study probably had a higher percentage of unhealthy carbohydrates. However, we have no idea whether the diets with moderate carbohydrate intake featured healthy carbohydrates or unhealthy carbohydrates. That is critical because moderate carbohydrate intake was the baseline to which all other diets were compared.

An important unanswered question is: “What is the relationship between carbohydrate intake and lifespan when most of the carbohydrates come from whole, plant-based foods?” Is low carbohydrate intake healthier or less healthy than moderate carbohydrate intake? Is high carbohydrate intake still less healthy? We have no idea. No studies have analyzed the data in that way.

Similarly, we know from multiple studies that meat-based, low-carb diets increase mortality and plant-based, low-carb diets decrease mortality when compared to moderate carbohydrate intake with no differentiation of protein source. But, what if the moderate carbohydrate group had also been subdivided into meat eaters and plant eaters? Would meat-based, low-carb diets still be less healthy than meat-based, moderate-carbohydrate diets? Would plant-based,  low-carb diets still be healthier than plant-based, moderate-carb diets? We have no idea.

 

The Bottom Line

The low-carb wars are raging. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan). However, two recent studies have come to the opposite conclusion. Those studies have low-carb enthusiasts doing a victory lap and claiming it is time to rewrite nutritional guidelines to favor low-carb diets.

However, a study just published a couple of weeks ago resolves the conflicting data and finally answers the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough.”

I call this “The Goldilocks Effect.”  According to this study, high carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But, moderate carbohydrate intake is “just right.”

Specifically, this study reported:

  • Moderate carbohydrate intake (50-55%) is healthiest. This is also the carbohydrate intake recommended by current nutritional guidelines.
  • All major studies agree that very high carbohydrate intake (60-70%) is unhealthy. It shortens life expectancy of a 50-year old by about a year.
  • All studies that cover the full range of carbohydrate intake agree that low carbohydrate intake (<40%) is also unhealthy. It shortens life expectancy of a 50-year old by about 4 years.
  • The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.
  • Meat-based, low-carb diets decrease life expectancy while plant-based, low carb diets increase life expectancy. This is consistent with the results of previous studies.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

For more details, read the article above.

 

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

Are ADHD Symptoms Reduced by Omega-3s?

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Can Natural Approaches Cure ADHD?

Author: Dr. Stephen Chaney

 

adhd symptoms childrenYou keep seeing headlines saying that omega-3 fatty acids can help children with ADHD. But your pediatrician doesn’t recommend them. Why not? Is the story about omega-3s helping with ADHD symptoms just another myth created by supplement companies wanting to lighten your wallet? Or, is your doctor not keeping up with the latest scientific advances? As usual, the truth lies somewhere in between.

This week I will discuss the latest study (J.P-C. Chang et al, Neuropyschopharmacology, 43: 534-545, 2018) on omega-3s and ADHD symptoms. It provides an excellent update on the role of omega-3s in reducing ADHD symptoms.

 

How Was The Study Done?

adhd symptoms studyThe study was a meta-analysis. Meta-analyses combine the data from multiple studies. Their strength comes from the fact that they include data from subjects of different backgrounds and ethnicity. However, a meta-analysis can never be stronger than the studies it includes in its analysis. Simply put, if it combines data from poorly designed studies, it is no better than the weakest study.

The problem is that there have been a lot of poorly designed studies in this area of research. Some studies have included both children and adults. Others included subjects with psychiatric diagnoses other than ADHD. Still others combined omega-3 supplementation with other vitamins and nutrients. Finally, some used inadequate measures of ADHD symptoms and cognitive function. Because the design of previous studies has been so varied, the results have been conflicting. Some studies have found that omega-3 supplementation reduced ADHD symptoms. Others found no benefit.

Because of the confusion arising from poorly designed studies, the authors of this study applied very rigorous criteria in selecting the studies to be included in their meta-analysis. Their criteria were:

  • The studies were randomized, double-blind, placebo-controlled trials of mega-3 supplementation with DHA or EPA alone or in combination.
  • Participants were school-aged children (4-12 years) and adolescents (13-17 years) who had a diagnosis of ADHD.
  • The study measured clinical symptoms of ADHD as reported by parents. Some also included reports by teachers. When cognitive data were included, the studies relied on well-established cognitive tests.
  • The data allowed a calculation of effect size (this is a statistical requirement that simply says the quality of the data were good enough to reliably calculate the difference between the supplemented and control groups).
  • The publications were in peer reviewed journals.

They ended up with seven studies with a total of 534 subjects (318 received omega-3s and 216 received a placebo).

They also performed a separate metanalysis of studies that have measured omega-3 levels in school-aged children and adolescents who had been diagnosed with ADHD. The criteria for inclusion in this metanalysis were similarly rigorous. They ended up including nine studies totaling 558 subjects, 297 with ADHD and 261 controls in this meta-analysis.

 

Do Omega-3s Reduce ADHD Symptoms?

adhd symptoms omega-3sThe results from the first meta-analysis were:

  • Omega-3 supplementation significantly improved parental reports of total ADHD symptoms scores as well as scores of inattention and hyperactivity.
  • When the children were given cognitive performance tests, the omega-3 supplemented group performed better than the placebo group when tested for omission errors (for example, a number or word left out in a memory test) and commission errors (an incorrect number or word in a memory test).
  • A dose of EPA + DHA of 500 mg/day or greater appeared to be optimal.

The results from the second meta-analysis were:

  • Children and adolescents with ADHD had significantly lower levels of DHA, EPA, and total omega-3s in their red blood cells (a good measure of omega-3 status) than controls.

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

The authors went on to say: “In the context of ‘personalized medicine,’ it is tempting to speculate that a subpopulation of youth with ADHD and low levels of omega-3s may respond better to omega-3 supplementation, but there are no studies to date attempting this stratification approach [looking at the effect of omega-3 supplementation in the subpopulation with both ADHD and omega-3 deficiency]…Therefore, stratification of ADHD children by omega-3 levels…could be one approach to optimize the therapeutic effects of omega-3 supplementation.”

Basically, they are suggesting that the benefits of omega-3 supplementation are likely to be greatest for those children with ADHD who are also omega-3 deficient. They are also saying that future studies should measure omega-3 status before and after supplementation so that the true benefit of omega-3 supplementation can be determined. I agree

 

What Does This Mean For You?

adhd symptoms youthThis study was very well done. By including only the best designed studies in their meta-analysis, the authors have provided good evidence that omega-3s can be of benefit in reducing ADHD symptoms. The authors also pointed out that low-dose omega-3 supplementation is virtually free of side effects. Thus, this is an option that should be tried first, before considering medications to control ADHD symptoms.

On the other hand, I wouldn’t expect miracles. This was not a huge effect. Not all the ADHD symptoms improved with omega-3 supplementation. Teacher’s reports did not show the same benefits as parent’s reports.

There are two ways to interpret the limitations of omega-3 benefits seen in this meta-analysis.

  • Clinical studies report the average results for all the children in the study. Your child may not be average. If your child doesn’t like fish, especially the oil, cold-water fish that are rich in omega-3s, they may experience a greater benefit from omega-3 supplementation.
  • The benefit of omega-3s seen in this meta-analysis is just one facet of a holistic, natural approach for controlling ADHD without drugs. One of the best reviews on natural approaches for controlling ADHD was written by two pediatricians with years of experience dealing with ADHD. I wrote about their review in a previous issue, adhd diet vs medication, of “Health Tips From the Professor”. You should check it out. There was a lot of wisdom in their advice.

 

The Bottom Line

 

  • A recent meta-analysis has reported that omega-3 supplementation improves clinical symptoms and cognitive performances in children and adolescents with ADHD.
  • The optimal dose appeared to be 500 mg/day or above.
  • The authors also reported that children with ADHD were more likely to be omega-3 deficient than children without ADHD and suggested that omega-3 supplementation is most likely to be effective for those children who are omega-3 deficient.
  • The authors also pointed out that low-dose omega-3 supplementation had negligible side-effects, so it should be tried before the child is put on medication.
  • Omega-3s are just one facet of a holistic, natural approach for reducing ADHD symptoms.

For more details, read the article above.

 

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

Red Meat and Heart Health

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Can Red Meat Be Part Of A Heart Healthy Diet?

Author: Dr. Stephen Chaney

 

What about red meat and heart health?

red meat and heart health studyIt is so confusing. One recent headline proclaimed “Plant-based foods decrease the risk of heart disease and cancer.”  Another headline read: “Including beef with the Mediterranean diet improves heart health.”  You are probably wondering which of these studies is correct. More importantly, you are probably wondering whether you should include more meat or less meat in your diet.

If you read the articles, you will find that the dueling headlines are deceptive. Both studies reached essentially the same conclusion. The first study (K.S. Petersen et al, Current Developments in Nutrition, 2017; 1:e001289 ) concluded that plant-based diets significantly decreased the risk of heart disease and diabetes. It also concluded that you can include small amounts of animal protein in a plant-based diet without losing its health benefits. The second study (L.E. O’Connor et al, American Journal of Clinical Nutrition, 108: 1-8, 2018 ) concluded that the Mediterranean diet, which is a primarily plant-based diet, significantly decreased the risk of heart disease and diabetes. It also concluded that you could include small amounts of lean, unprocessed red meat in the Mediterranean diet without losing its health benefits.

You might be wondering how it is possible to go from a study showing that small amounts of lean, unprocessed red meat did not reduce the heart-health benefits of the Mediterranean diet to a headline claiming: “Including Beef With A Mediterranean Diet Improves Heart Health.”  Did I mention that the study was funded by money from the beef industry and the headlines came from an online issue of Beef Magazine? That might explain it.

Let’s look at:

  • How the studies were designed.
  • The study results in detail.
  • What these studies mean for you.

 

How Were The Studies Done?

red meat heart health and heart diseaseStudy #1: The first study (K.S. Petersen et al, Current Developments in Nutrition, 2017; 1:e001289 ) was a systematic review of over 50 recent studies looking at the relative contribution of plant-based foods and animal products to healthy dietary patterns.

Study #2: The second study (L.E. O’Connor et al, American Journal of Clinical Nutrition, 108: 1-8, 2018 ) was, in the words of the authors, an investigator-blinded, randomized, crossover, controlled feeding trial. That is probably Greek to most of you, so let me explain.

  • A “controlled feeding study” is one in which subjects are given diets designed by dietitians to contain precise amounts of macronutrients and micronutrients. In this case, both diets were Mediterranean diets. One of the diets was the standard Mediterranean diet with 1 ounce/day of lean, processed red meat. This diet was referred to as Med-Control. The other diet was a version of the Mediterranean diet containing 2.47 ounces/day of red meat. It was referred to as Med-Red. (More about the design of these diets below). The diets were prepared for the subjects by the Indiana Clinical Research Center Bionutrition Facility at Purdue University. The subjects completed weekly menu check-off lists and met with staff weekly to monitor compliance.
  • A “crossover study” is one in which subjects are given one experimental diet, followed by a “washout period” when they consume their normal diet, followed by the second experimental diet. In this case both experimental diets were followed for 5 weeks and the washout period was 4 weeks. In this type of study each subject serves as their own control.
  • The term “randomized” simply means that some subjects consumed the Med-Control diet first and others consumed the Med-Red diet first.
  • The term “investigator-blinded” simply means the investigators did not know the order of the experimental diets each subject received. It is, of course, impossible to conduct a double-blind study when you are conducting a dietary intervention study, such as this one. The subjects know which diet they are consuming.

Other important features of the study were:

  • The study included 41 middle-aged (46±2 years), obese (BMI=30.5±0.6) adults from West Lafayette, Indiana.
  • Fasting blood samples were taken at entry into the study and during the last week of both experimental diets and the washout period. The investigators measured total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, ApoB, C-reactive protein, insulin, and blood glucose levels.
  • Blood pressure was also measured at the same times.

In interpreting the results of this study, it is important to know other features of the experimental diets. They are:

  • red meat heart health foodsOverall macronutrient composition was identical for the two diets. It was 40% carbohydrate, 22% protein, and 40% fat. In other words, it was nether low-carb nor low-fat. Instead it consisted of healthy carbs and healthy fats.
  • The differences between the two diets was almost entirely based on the relative amount of red meat and poultry in the diets. The Med-Control had more poultry and less red meat. The Med-Red had more red meat and less poultry.
  • The red meat was lean beef or pork tenderloin. The poultry was chicken or turkey breast (white meat with the skin removed prior to cooking). All meats were low in fat and cholesterol (˂10% total fat, ˂5% saturated fat, ˂95 mg cholesterol). In short, none of the subjects were eating juicy steaks and burgers or fried chicken.
  • Fish intake was the same on both diets (22% of protein intake) so that omega-3 intake was similar.
  • Nuts, seeds, and legumes (primarily soy) were the same on both diets (40% of protein intake). When you include grains and other plant protein sources, plant-based protein probably constituted almost 50% of total protein intake.
  • Both diets included the same amount of olive oil. The overall fat profile of the diet (7% saturated, 20% monounsaturated, and 13% polyunsaturated) was very healthy.
  • Both diets were rich in fruits and vegetables (4 servings/day of fruit and 7-8 servings/day of vegetables). This is much more than you would find in the typical American diet.
  • Both diets were composed primarily of whole grains. There was almost no sugar or refined grain in either diet. Again, this is very different from what most Americans eat.

 

Red Meat and Heart Health?

 

red meat and heart health dietsStudy #1: While the authors of this paper reviewed a variety of studies, I will focus on studies looking at the inclusion of red meat into otherwise healthy diets. For example, the authors reported on a recently published study looking at inclusion of 3 different levels (1 ounce/day, 4 ounces/day, and 5 ounces/day) of lean, red meat into the DASH diet, a diet specifically designed to reduce the risk of high blood pressure. That study showed:

  • Inclusion of up to 5 ounces/day of lean red meat did not reduce the effectiveness of the DASH diet at reducing heart disease risk factors. In fact, total and LDL cholesterol levels were slightly better than when red meat was limited to 1 ounce/day.
  • However, the authors noted that:
    • The DASH diet is already fairly high in animal protein. The increase in red meat consumption was achieved by replacing other animal protein sources in the diet.
    • These were very lean cuts of red meat. All 3 versions of the DASH diet were designed to limit saturated fat intake to ˂6% of total calories.
    • Plant protein was about 50% of total protein intake in all 3 diets.
    • All 3 diets eliminated “empty calorie” foods and provided lots of fruits and vegetables (8-10 servings/day).
    • All 3 diets included 4-5 cups of low fat dairy products.
  • The authors also noted that dietary intake was closely controlled in this study and that similar results might be difficult to achieve in a free-living setting. For example, they pointed out that previous studies have shown:
    • Higher meat consumption in the American population is associated with lower consumption of fruits, vegetables, legumes, nuts, seeds and soy products.

The authors concluded: “It is likely that consumption of animal products (excluding processed meats) at recommended amounts in the context of a dietary pattern that meets recommendations for fruits, vegetables, whole grains, nuts, seeds, and legumes, and does not exceed recommendations for added sugar, sodium, and saturated fat, may not adversely affect, and may benefit cardiometabolic risk [risk of heart disease and diabetes].”

The authors went on to say: “However, population adherence to these recommendations is markedly suboptimal. Therefore, improving intake patterns to align with dietary guidelines should be the focus of our efforts rather than engaging in debate about whether diets for cardiovascular disease prevention should be exclusively plant-based or include animal foods in recommended amounts.”

In case you think that was clear as mud, let me offer my translation: “Lean, unprocessed meat consumption does not increase the risk of heart disease or diabetes when consumed as part of an extremely healthy diet. However, the American diet is lousy. We should focus on eating a healthy diet rather than arguing about whether it should be completely plant-based or can include some meat.”

Study #2: This study found that:

  • red meat heart health vegetables fruitsTotal and LDL cholesterol decreased more with Med-Red Meat than with Med-Control. However, the authors noted that the Mediterranean diet has little effect on total and LDL cholesterol levels, so its effect on reducing heart disease risk must be due to other factors.
  • The other parameters (HDL cholesterol, ApoB, triglycerides, C-reactive protein, insulin and blood glucose levels) were essentially the same on the Med-Red and Med-Control diets. However, the Med-Control diet also had little effect on these parameters compared to the normal diet of the subjects in the study. That probably reflected the short duration (5 weeks) of the diet intervention phase. Much longer dietary interventions would be required to adequately assess the effectiveness of either the Mediterranean diet or the Mediterranean diet with red meat at reducing disease risk.
  • Once again, the Med-Red diet was a carefully controlled diet that featured:
    • Small amounts (2.5 ounces/day) of very lean (<10% fat, <5% saturated fat) red meat in place of very lean poultry with about 50% of the protein in the diet coming from plant sources.
    • Lots of fruits, vegetables, whole grains, nuts, seeds, legumes, omega-3-rich seafood, and olive oil.
    • Almost no sugar and refined carbs.
    • A very healthy fat profile (7% saturated, 20% monounsaturated, and 13% polyunsaturated fat).
  • In short, this diet was radically different from the typical American diet.

The authors concluded: “Adults who are overweight or obese can consume 2.5 ounces/day as lean and unprocessed beef and pork when adopting a Mediterranean Pattern to improve cardiometabolic disease [heart disease and diabetes] risk factors.”

The authors went on to say: “Our results support previous observational and experimental evidence which shows that unprocessed and/or lean red meat consumption does not increase the risk of developing cardiovascular [heart] disease…”

As discussed below, the second conclusion is not supported by the data. We need to remember that this study was funded by money from the beef industry.

What Does This Mean For You?

red meat heart health lean meatsThe beef industry and low carb enthusiasts are telling you that red meat consumption as part of a healthy diet is good for your heart. These claims are very misleading. That’s because most Americans assume that their diet is already healthy. In addition, some Americans are being misled into believing that low carb diets are healthy (As I document in my book, “Slaying The Food Myths” those claims are currently unproven). Finally, many Americans interpret these claims as telling them that the juicy steaks, burgers, and sausages they love are heart healthy. The reality is far different.

  • The studies the claims are based on looked at red meat consumption in the context of the heart healthy DASH and Mediterranean diets, not in the context of the typical American diet or low carb diets.
  • The only risk factors affected in most of the studies are total and LDL cholesterol, which have low reliability of predicting heart disease risk by themselves. Furthermore, they appear to have almost no effect on the heart healthy benefits of the Mediterranean diet. In addition, the studies have been too short (typically 5 weeks) to reliably assess the effect of red meat on other heart disease risk factors.
  • The effect of red meat on heart disease risk factors has been assessed in carefully controlled diets that feature:
    • Small amounts of very lean (<10% fat, <6% saturated fat), unprocessed red meat in place of very lean poultry with about 50% of the protein in the diet coming from plant sources.
    • Lots of fruits, vegetables, whole grains, nuts, seeds, legumes, omega-3-rich seafood, and vegetable oils.
    • Almost no sugar and refined carbs.
    • A very healthy fat profile (7% saturated, 20% monounsaturated, and 13% polyunsaturated fat).

The authors of one recent review accurately concluded: “It is likely that consumption of animal products (excluding processed meats) at recommended amounts in the context of a dietary pattern that meets recommendations for fruits, vegetables, whole grains, nuts, seeds, and legumes, and does not exceed recommendations for added sugar, sodium, and saturated fat, may not adversely affect, and may benefit cardiometabolic risk [risk of heart disease and diabetes]”.

How you extrapolate from that kind of conclusion to an unqualified claim that “Observational and experimental evidence shows that unprocessed and/or lean red meat consumption does not increase the risk of developing cardiovascular [heart] disease” is beyond me.

My summary would be: “Small amounts of lean, unprocessed meat do not appear to increase the risk of heart disease or diabetes when consumed as part of an extremely healthy plant-based diet. However, the American diet is lousy. Low carb diets leave out too many healthy foods. We should focus on eating a healthy diet [as defined above] rather than arguing about whether it should be low carb, low fat, completely plant-based or can include small amounts of lean, unprocessed meat.”

 

The Bottom Line

 

The beef industry and low carb enthusiasts are telling you that red meat consumption as part of a healthy diet is good for your heart. These claims are very misleading. That’s because most Americans assume that their diet is already healthy. In addition, some Americans are being misled into believing that low carb diets are healthy (As I document in my book, “Slaying The Food Myths” those claims are currently unproven). Finally, many Americans interpret these claims as telling them that the juicy steaks, burgers, and sausages they love are heart healthy. The reality is far different.

  • The studies the claims are based on looked at red meat consumption in the context of the heart healthy DASH and Mediterranean diets, not in the context of the typical American diet or low carb diets.
  • The only risk factors affected in most of the studies are total and LDL cholesterol, which have low reliability of predicting heart disease risk by themselves. In addition, they appear to have almost no effect on the heart healthy benefits of the Mediterranean diet. The studies have been too short (typically 5 weeks) to reliably assess the effect of red meat on other heart disease risk factors.
  • The effect of red meat on heart disease risk has been assessed in carefully controlled diets that feature:
    • Small amounts of very lean (<10% fat, <6% saturated fat), unprocessed red meat in place of very lean poultry with about 50% of the protein in the diet coming from plant sources.
    • Lots of fruits, vegetables, whole grains, nuts, seeds, legumes, omega-3-rich seafood, and vegetable oils.
    • Almost no sugar and refined carbs.
    • A very healthy fat profile (7% saturated, 20% monounsaturated, and 13% polyunsaturated fat).

The authors of one recent review accurately concluded: “It is likely that consumption of animal products (excluding processed meats) at recommended amounts in the context of a dietary pattern that meets recommendations for fruits, vegetables, whole grains, nuts, seeds, and legumes, and does not exceed recommendations for added sugar, sodium, and saturated fat, may not adversely affect, and may benefit cardiometabolic risk [risk of heart disease and diabetes].”

How you extrapolate from that kind of conclusion to an unqualified claim that “Observational and experimental evidence shows that unprocessed and/or lean red meat consumption does not increase the risk of developing cardiovascular [heart] disease” is beyond me.

My summary would be: “Small amounts of lean, unprocessed meat do not appear to increase the risk of heart disease or diabetes when consumed as part of an extremely healthy plant-based diet. However, the American diet is lousy. Low carb diets leave out too many healthy foods. We should focus on eating a healthy diet [as defined above] rather than arguing about whether it should be low carb, low fat, completely plant-based or can include small amounts of lean, unprocessed meat.”

For more details, read the article above.

 

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

Do Stretches For Sciatica Nerve Pain Work?

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Sciatica Treatment

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

 

Stretches for sciatica nerve pain work,
but only when muscle spasms are released first!

stretches for sciatica nerve pain tree exampleMost people have been told to stretch tight muscles, but they haven’t been told that muscle spasms (trigger points) shorten the fibers and tie the muscles into tiny micro knots.

Here is an analogy that helps explain how muscle spasms cause pain.

Consider what happens if you have two trees, a big strong one and one that easily moves.  Tie a rope straight across from tree to tree.  If you pull on the rope it’s easy to see that the flexible tree bends.

stretches for sciatica nerve pain tree leanHowever, if you tie several knots in the rope the flexible tree leans over toward the strong tree.  Now if you try to stretch the rope to make the flexible tree stand up straight the knots put a strain on the points where the rope is tied.

Trying to stretch the rope causes the knots to tighten and overstretches the rope on either side of the knot.

This is what happens with your muscles.

In the case of sciatica, the muscle that crosses over your sciatic nerve is the piriformis.  When the piriformis is shortened by a muscle spasm, it places a downward pressure on the sciatic nerve, impinging the nerve.  This gets complicated because other muscles cause your pelvis to rotate and press the bone up into your sciatic nerve.

If you try to stretch the piriformis muscle, it causes the tight muscle to press down onto the sciatic nerve and can potentially tear the muscle.

 

 Release the Muscle Knots Before Beginning Stretches for Sciatica Nerve Pain

stretches for sciatica nerve pain reliefBefore stretching, it’s easy and essential to release the muscle that causes sciatica pain.

Lie on the floor, place the Trigger Point Therapy Ball or a new tennis ball onto the piriformis muscles (pictured left).

Ease onto the ball until it doesn’t hurt.  Then move the ball just a bit to search for other tender points.  Hold 30-60 seconds on each tender point to release the muscle knots.

 

Stretches for Sciatica Nerve Pain Can Now Commence Safely !

stretches for sciatica nerve painThis seated spinal twist is a great stretch for sciatica.

Make sure you are seated tall and exhale as you twist.  Hold for a minute and switch sides.

 

 

 

Wishing you well,

Julie Donnelly

 

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

About The Author

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

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

Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

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What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

For more details, read the article above.

 

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

Does Vitamin D Reduce Cholesterol In Children?

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Is Vitamin D Associated With Heart Disease Risk?

Author: Dr. Stephen Chaney

 

vitamin-d-reduce-cholesterol-childrenNot too many years ago, we thought of vitamin D as affecting bone density and little else. Then we discovered that almost every cell in our body has vitamin D receptors. This has lead to research suggesting that vitamin D affects our health in many ways that were unimaginable only a couple of decades ago.

For example, low vitamin D levels are associated with increased risk of heart disease. The linkage between vitamin D and heart disease has not been proven. Nor do we know the mechanism. However, this has lead to ongoing research asking if there is any relationship between vitamin D and cholesterol metabolism.

The answer appears to be yes. Several studies have suggested a correlation between low vitamin D levels and elevated total cholesterol, LDL cholesterol, and triglycerides – all risk factors for heart disease.

The next question is how early in life is this correlation found. Again, some studies have suggested that the same correlation between low vitamin D and high levels of unhealthy lipids are found in teens. But, what about pre-teens, children who haven’t gone through puberty yet? That’s what this study was designed to determine.

 

How Was The Study Done?

vitamin-d-reduce-cholesterol-children studyThe current study  was based on data collected from 419 children, ages 6-8, in the Physical Activity and Nutrition in Children (PANIC) Study in Eastern Finland. This was a lifestyle study that collected information on body weight, diet, and activity levels.

Fasting blood samples were also collected and analyzed for blood lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) and for 25-hydroxyvitamin D (25(OH)D), which is considered the most accurate measure of vitamin D status. The National Institutes of Health considers:

  • <30 nmol/L of 25(OH)D an indicator of vitamin D deficiency.
  • 30 to <50 nmol/L 25(OH)D an indicator of vitamin D insufficiency.
  • ≥50 nmol/L 25(OH)D an indicator of adequate vitamin D status.

To put this study in perspective, vitamin D status is a major concern in Finland because of its proximity to the Arctic Circle. There is little sunlight in the winter, and, although the days are long in the summer, the sun is weak. The major sources of vitamin D in the Finnish diet are fish, vitamin D-fortified fluid milk products, vitamin D-fortified fat spreads, and vitamin D supplementation. Vitamin D fortification was introduced in Finland in 2003. Vitamin D supplementation has also become increasing popular. The number of people using vitamin D supplements has increased from 11% in 2000 to 41% in 2011.

A recent study  looking a vitamin D status between 2000 and 2011 found that the combination of food fortification and vitamin D supplementation has been successful at improving vitamin D status in the Finnish population, increasing average 25(OH)D levels from 48 nmol/L to 65 nmol/L.

 

Does Vitamin D Reduce Cholesterol In Children?

vitamin dIn this study the mean serum 25(OH)D in the children was 68.1 nmol/L. 20% of the children had serum 25(OH)D below 50 nmol/L, and only 4 children (1%) had serum 25(OH)D below 30 nmol/L. When 25(OH)D levels were compared with blood lipid levels:

  • Higher serum 25(OH)D levels were associated with lower plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • The association between higher 25(OH)D levels and lower blood levels of total cholesterol, LDL cholesterol, and HDL cholesterol remained after correcting for weight, physical activity, sedentary behavior, diet, daylight time, parental education, and genetic mutations known to affect vitamin D metabolism.

What Does This Mean For You?

I don’t want to overinterpret the study. Not all studies show an inverse association between 25(OH)D and cholesterol levels. Most of the previous studies have also indicated that higher 25(OH)D levels were associated increased HDL levels, while this study found higher 25(OH)D levels associated with decreased HDL levels. Much more research needs to be done.

However, this study is yet another indication that optimal vitamin D status may be important for heart health, even in young children. While the correlation between vitamin D status and heart health is not definitive at present, virtually everyone agrees that adequate vitamin D status is a good thing.

My recommendations are to:

  • Get as much vitamin D as possible from vitamin D-fortified foods, oily fish, and sensible sun exposure.
  • Get your serum 25(OH)D level determined and take vitamin D supplements if it is low.

 

The Bottom Line

 

A recent study of vitamin D status in Finnish children ages 6-8 found:

  • Higher vitamin D status was associated with lower plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • The association between better vitamin D status and lower blood levels of total cholesterol, LDL cholesterol, and HDL cholesterol remained after correcting for weight, physical activity, sedentary behavior, diet, daylight time, parental education, and genetic mutations known to affect vitamin D metabolism.

This study is another indication that optimal vitamin D status may be important for heart health, even in young children. While the correlation between vitamin D status and heart health is not definitive at present, virtually everyone agrees that adequate vitamin D status is a good thing.

My recommendations are to:

  • Get as much vitamin D as possible from vitamin D-fortified foods, oily fish, and sensible sun exposure.
  • Get your serum 25-hydroxyvitamin D level determined and take vitamin D supplements if it is low.
  • Make sure your children are getting enough vitamin D in their diet and have optimal serum 25-hydroxyvitamin D.

For more details, read the article above.

 

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

Why Is Fructose Bad For You?

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Is It The Sugar, Or Is It The Food?

Author: Dr. Stephen Chaney

 

why fructose bad for youI don’t usually report on studies done in mice, but this study sheds light on a particularly puzzling question: Why is fructose bad for you?

The studies are clear-cut. High fructose consumption is associated with inflammation, obesity, non-alcoholic liver disease, insulin resistance, type 2 diabetes, kidney disease, increased LDL cholesterol and triglycerides, and heart disease. Based on these associations, fructose appears to be deadly. Why would anyone want to consume it?

Yet fructose is found in virtually every fruit. In fact, fructose, also known as fruit sugar, was first isolated from fruits. Hence the name fructose. Humans have been eating fruits safely for thousands of years. Fruits are very good for us. That raises the question: “If fruits are good for us, how can fructose be bad for us?”.

An important clue can be found by looking at what the food industry has done to the American diet. Because fructose imparts a pleasurable, sweet taste to foods, the food industry keeps adding it to more and more foods. As a result, dietary intake of fructose has increased 100-fold over the past two centuries. It has reached the point where fructose now accounts for almost 10% of the caloric intake in the United States.

 

Is It The Sugar, Or Is It The Food?

 

Let me expand the discussion by using a couple of graphics I developed for my book, “Slaying The Food Myths.”  

There Are No Sugar Villains. There Are No Sugar Heroes:

why fructose bad for you sugar foodVirtually all sweeteners are primarily a mixture of fructose and glucose. The graphic on the left compares high fructose corn syrup (the current villain) with other “natural” sweeteners used in foods (our current heroes). High fructose corn syrup ranges from about 40% fructose to 55% fructose. The exact percentage depends on what kind of food product is being made with it. Honey and coconut sugar are about 45% fructose. Sucrose and grape juice concentrate are around 50% fructose. Apple juice concentrate is around 60% fructose, and agave sugar comes in at a whopping 80% fructose.

In other words, if fructose is the culprit that everyone makes it out to be, “healthy” sugars are no better than high fructose corn syrup. Simply substituting a “healthy” sugar for high fructose corn syrup is unlikely to provide any meaningful benefit.

 

Is It The Sugar, Or Is The Food?

why fructose bad for you fruitsThis graphic shows us what a nutrition label would look like on a medium apple. I am sure that label is a wake-up call for many of you. The amount of sugar and the percentage of fructose and glucose are about the same as in an 8-ounce soda sweetened with high fructose corn syrup. The same is true for virtually every other fruit you can think of.

Now let me share one more thing you won’t hear from what I refer to as “Dr. Strangelove’s Health Blog” (You probably know the ones I am referring to). Virtually all the studies showing the bad effects of fructose consumption have been done with sodas and sugary junk foods. They haven’t been done with apples.

In fact, virtually every study looking at fruit and vegetable consumption has shown they are incredibly good for us. They lower inflammation and reduce the risk of obesity, diabetes, heart disease, and cancer. And, the more the better. One study found that the health benefits of fruit and vegetable consumption topped out at around 10 servings a day.

With this background, you should now fully understand why the question “If fruits are good for us, how can fructose be bad for us?” is so perplexing.

My simplistic explanation has always been that whole foods like fruits have fiber, which slows the absorption of fructose from the intestine. Our bodies were designed to handle fructose in a safe manner when it enters the bloodstream slowly. Sodas and junk foods, on the other hand, have little to slow the absorption of fructose. When fructose enters the bloodstream rapidly, our “safe” metabolic pathways for handling it are overwhelmed, and it is forced into the pathways that are harmful. For example, the “excess” fructose is converted to fat by the liver, which causes inflammation, obesity, fatty liver disease, and triglyceride production.

This is, of course, simply my hypothesis for explaining the different effect of fructose in fruits and sodas. It is based on sound metabolic principles, but it is far from proven. That is why I found the current study (C. Jang et al, Cell Metabolism, 27: 351-361, 2018 ) so interesting. It provides a metabolic rationale for my hypothesis.

How Was The Study Done?

Mice were fed a 1:1 mixture of fructose and glucose at doses that approximated the ranges of typical human fructose consumption. The fructose was isotopically labeled so that fructose and its metabolites could be identified by LC-MS (liquid chromatography – mass spectrometry). After feeding the mice the labeled fructose, the investigator measured the amount of fructose and its metabolites in various organs and in the portal vein, which transports sugars from the intestine to the liver for additional metabolism before they enter the bloodstream.

 

Why Is Fructose Bad For You?

why fructose bad for you intestine liverThe first surprise was that most of the fructose was metabolized by the intestinal mucosal cells that line the small intestine rather than the liver. Previous reports had assumed that fructose was primarily metabolized by the liver because that was where most of the bad effects of fructose metabolism had been observed.

These investigators observed that fructose was primarily converted to glucose and small molecular weight metabolites by the intestinal mucosal cells before being released into the portal vein, where they were transported to the liver. However, there was a strong dose response effect.

  • At low fructose doses, 90% of fructose was metabolized by intestinal mucosal cells before being released to the liver.
  • At high fructose doses, only 70% of fructose was metabolized by intestinal mucosal cells.
  • That means at high fructose doses the amount of fructose reaching the liver unchanged increases from 10% to 30%. That is a 3-fold increase!

The authors concluded:

  • “Based on these findings, we propose that the small intestine shields the liver from fructose and that excessive doses of fructose overwhelm the small intestine, spilling over to the liver where they cause toxicity.”
  • “A key difference between the health effects of fiber-rich fruits (and perhaps even fiber-rich prepared foods) and juices/sodas is their rate of intestinal fructose release.”
  • “It is likely that the appearance rate of free fructose in the small intestine plays a critical role in dictating its metabolic fate. Like the lower doses in our experiments, a slower rate of fructose appearance will result in more complete intestinal clearance, whereas higher doses and faster rates result in fructose overflow to the liver.”

This study needs to be confirmed, and the mechanism may be entirely different in humans. However, whether the mechanism is the same in mice and humans is immaterial. We already know that fructose in sodas and junk foods exerts a very different effect on our health than fructose in fruits and other fiber-containing foods.

The Bottom Line

 

Previous studies have clearly shown that fructose in sodas and junk foods is bad for us, while fructose in fruits is good for us. A recent study in mice provides a metabolic explanation for this difference. The study found:

  • At low fructose doses, 90% of fructose was metabolized by intestinal mucosal cells before being released to the liver.
  • At high fructose doses, only 70% of fructose was metabolized by intestinal mucosal cells.
  • That means at high fructose doses the amount of fructose reaching the liver unchanged increases from 10% to 30%. That is a 3-fold increase!

The authors concluded:

  • “Based on these findings, we propose that the small intestine shields the liver from fructose and that excessive doses of fructose overwhelm the small intestine, spilling over to the liver where they cause toxicity.”
  • “A key difference between the health effects of fiber-rich fruits (and perhaps even fiber-rich prepared foods) and juices/sodas is their rate of intestinal fructose release.”
  • “It is likely that the appearance rate of free fructose in the small intestine plays a critical role in dictating its metabolic fate. Like the lower doses in our experiments, a slower rate of fructose appearance will result in more complete intestinal clearance, whereas higher doses and faster rates result in fructose overflow to the liver.”

This study needs to be confirmed, and the mechanism may be entirely different in humans. However, whether the mechanism is the same in mice and humans is immaterial. We already know that fructose in sodas and junk foods exerts a very different effect on our health than fructose in fruits and other fiber-containing foods.

For more details, read the article above.

 

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

 

What Is The Pegan Diet?

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Is The Pegan Diet Healthy?

Author: Dr. Stephen Chaney

 

pegan diet newsJust when you thought you had heard about every possible diet, along comes a new one called the Pegan diet. What is the Pegan Diet and is it healthy?

The Pegan diet was introduced by Dr. Mark Hyman in his new book, “Food: What the Heck Should I Eat?”. I don’t agree with Dr. Hyman on everything (which will become apparent when I review his diet), but I hold him in high regard. He is much more credible than most of the doctors who are writing popular blogs and diet books.

Basically, the Pegan diet is a combination of the Paleo and Vegan diets (hence the name). It
was meant to combine the best features of each while eliminating their drawbacks.

 

What Are The Pros & Cons Of The Vegan And Paleo Diets?

 

pegan diet fruits and vegetablesPros And Cons Of The Vegan Diet:

Dr. Hyman listed the following pros:

  • The diet ideally incorporates mostly whole, plant-based foods.
  • It provides lots of vitamins (especially antioxidants and most of the B vitamins), fiber, and healthy fats (monounsaturated and polyunsaturated fats).
  • It avoids what he calls the “baggage that comes from feedlot meat”. He is, of course, referring to the inhumane way that most of the animals that end up on our plates are treated. It also avoids the saturated and trans fats associated with the meats most Americans prefer.

I would add that Vegan diets are very healthy. As I discuss in my book, “Slaying the Food
Myths” (https://slayingthefoodmyths.com). we know that people who consume whole food
Vegan diets over a period of many years weigh less and have lower incidence of heart
disease, diabetes, and cancer than the general population.

Dr. Hyman listed the following cons:

  • Vegan diets are likely to be deficient in vitamin B12, iron, zinc, copper, and vitamin D.
    Of these deficiencies, B12 is the most serious because B12 only comes from animal
    foods.
  • Vegan diets will not provide enough of the heart healthy omega-3s, EPA and DHA.
    Again, that’s because these omega-3 fatty acids come primarily from animal sources.
  • Vegan diets may not provide enough protein, especially for seniors because they have
    increased protein requirements. It is possible to get enough protein from Vegan foods,
    but some diligence is required.
  • The food industry provides plenty of highly processed, junk food versions of “Vegan”
    foods. So, it is possible to be Vegan and eat an unhealthy diet.

I would concur and add that calcium is another likely deficiency for Vegans

Pros & Cons Of the Paleo Diet:

pegan diet meatDr. Hyman listed the following pros:

  • The Paleo diet eliminates most sugars and grains. That eliminates sodas, junk foods, and most processed foods, which is a very good thing.
  • It is a low-glycemic diet, which is helpful for people with diabetes. He went on to say that it could reverse type 2 diabetes.

I would concur and add that it has a healthier profile of fats than most low-carb diets.

However, I would also note that a low-carb version of the Mediterranean diet is also helpful for people with diabetes, and a whole food, very low-fat version of the Vegan diet has also been shown to reverse type 2 diabetes.

Dr. Hyman listed the following cons:

  • The Paleo diet is essentially a myth. There were many types of diets in prehistoric times.
  • Many people following the Paleo diet consume too much meat and too little plant-based foods.
  • Our prehistoric ancestors may have consumed as much as 100-150 grams of fiber a day. The average American consumes 8 -15 grams a day, and people on a Paleo diet may consume even less. (Note: The estimate of 100-150 grams of fiber per day is based on the same type of faulty evidence that lead to the Paleo diet in the first place. Our prehistoric ancestor’s fiber intake probably varied tremendously depending on their local food supply. However, it is safe to assume they ate much more fiber than we do.)

I would concur and add:

  • Studies have shown that women consuming the Paleo diet have low intakes of calcium, magnesium, iodine, thiamin, riboflavin, and folate.
  • The Paleo diet relies heavily on red meat, which an agency of the World Health Organization has classified as a probable carcinogen. Reliance on grass-fed beef in the Paleo diet does not reduce this concern.
  • There is no evidence that the Paleo diet is healthy long term. In fact, there is no evidence that any meat-based, low-carb diet is healthy long term.

For more about the pros and cons of the Vegan and Paleo diets – plus which diets I consider healthy – see my book “Slaying The Food Myths.”

What Is The Pegan Diet?

In the words of Dr. Hyman: “…the best versions of both diets [Paleo and Vegan] are built on the same foundation: Eat real, whole food. Vegan and Paleo diets focus on foods that don’t raise our blood sugar, plenty of fresh vegetables and fruits, healthy protein and [healthy] fats, and no crap [junk foods].” Dr. Hyman started with that foundation for the Paleo diet.

Here are Dr. Hyman’s 12 characteristics of his Pegan diet with my comments:

 

#1. Stay away from sugar. My comment: He gets an A+ for this one because, unlike many of today’s diet gurus, he is not telling you to avoid all sugars. He is focusing on the sugars and refined carbohydrates that cause spikes in blood sugar and insulin levels. As I point out in my book, there is the same amount of sugar in an 8-oz soda and a medium apple. It’s the sodas, refined carbs, and sugary foods you want to avoid, not apples.

pegan diet plant-based#2: Eat mostly plants. My comment: Again, he gets an A+ for this one. He recommends covering half your plate with a variety of colorful fruits and vegetables.

#3. Easy on the fruits. My comment: This one is an A-. He is correct in pointing out that some fruits like grapes and melons are higher in sugar and/or lower in fiber than other fruits. He is missing the point that blood sugar response to foods is a very individual characteristic. Some people do well on most fruits. Other people need to be more careful about which fruits they eat.

#4: Stay away from pesticides, antibiotics, hormones, and GMO foods. My comment: Another A+, especially because he included artificial additives, preservatives, dyes, and sweeteners.

#5: Eat foods containing healthy fats. My comment: I give him a B- for this one. He is right on the mark when he talks about polyunsaturated omega-3 fats and the monounsaturated fats found in nuts, seeds, olive oil, and avocados as being healthy. He is a bit off-base when he starts talking about “healthy” saturated fats in grass-fed beef and butter. He also advocates coconut oil despite the fact there is no good long-term evidence coconut oil is healthy.

#6: Stay away from most vegetable, nut, and seed oils. My comment: He gets a C- for this one. These oils are a good source of omega-6 polyunsaturated fats, which are essential for the human body. There is nothing inherently unhealthy about them. However, I do agree with him that we consume way too much of these oils in relation to monounsaturated and omega-3 polyunsaturated oils. If he had said “reduce consumption of” rather than “stay away from” those oils, I would have upgraded him to an A-.

pegan diet dairy#7: Avoid or limit dairy. My comment: He gets a B for this one. The statement that dairy “doesn’t work for most people” is a myth. Avoiding or limiting dairy is excellent advice for anyone who is dairy-sensitive. I would also agree that we should not necessarily be aiming for 2 to 3 servings of dairy per day for everyone. However, dairy is a major source of calcium, magnesium, and vitamin D in the American diet. If dairy is to be eliminated or limited, consideration should be given to where people will get those important nutrients.

#8: Think of meat and animal products as condiments – not the main course. My comment: He gets an A+ for this one. As I say in my book, fruits and vegetables can neutralize many of the toxic effects of meats. One or two ounces of meat in a green salad or a stir fry is much healthier than a 6-ounce steak with fries.

#9: Eat sustainably raised or harvested low-mercury fish. My comment: He gets an A- for this one. I downgraded him because he ignored contamination of fish with PCBs and other industrial chemicals. Once you take that into account, most farm-raised and some sustainably harvested fish are eliminated from consideration.

#10. Avoid gluten. My comment: He gets a C- for this one. It is good advice if you are gluten sensitive. If you are not, gluten-containing foods are not generally a problem. The real focus should be on the blood sugar response to the food, not on whether the food contains wheat or another gluten-containing grain.

#11: Eat gluten-free whole grains sparingly. My comment: This one rates a D. Whole grains are a good source of some nutrients like vitamin E. They are also an excellent source of fiber. It is important to realize that there are many types of fiber and each plays a different role in intestinal health. The fibers found in whole grains are different than those found in fruits and vegetables. They are an important part of a healthy diet. Dr. Hyman states that whole grains also raise blood sugar. That is an overstatement. Their effect on blood sugar may not be zero, but it is less than that of refined grains. Moreover, when eaten as part of a healthy meal, their effect on blood sugar is minimal.

#12: Eat beans only once in a while. My comment: He gets a D- for this one. He has already limited meat to a condiment. If you are also only eating beans every once in a while, you will have trouble meeting your protein requirements, especially as you get older.

You will find more details about the science behind many of the comments I made above in my book, “Slaying The Food Myths.”

 

Is The Pegan Diet Healthy?

The simple answer is that no long-term studies have been done, so we have no evidence that the Pegan diet is either healthy or unhealthy. However, the Pegan diet incorporates many of the best features of the Vegan diet, and we know the Vegan diet is very healthy long term. We also know that a semi-vegetarian diet is almost as healthy as the Vegan diet, so incorporating small amounts of meat into the Pegan diet is unlikely to make it unhealthy. On the basis of those considerations, the Pegan diet would appear to be healthy.

However, we have 5 food groups for a reason. Any time you eliminate food groups you introduce potential nutritional deficiencies that can affect your health. That is why I have concerns about statements like “Stay away from most vegetable, nut, and seed oils”, “Avoid dairy”, “Eat…whole grains sparingly”, and “Eat beans only once in a while”. If you removed those limitations, the Pegan diet would likely be very healthy. However, as it is currently described, the Pegan diet has too many questionable restrictions to be considered as healthy.

 

The Bottom Line

 

Dr. Mark Hyman has combined the best features of the Paleo and Vegan diets to create a new diet, which he calls the Pegan diet.

I have analyzed the Pegan diet in great detail in the article above:

  • It has many characteristics of a healthy diet.
  • However, it also has several unwarranted dietary restrictions that are likely to create nutritional deficiencies which may have adverse health consequences.
  • There are no long-term studies to tell us whether the Pegan diet is healthy or unhealthy.

In summary, the diet has some good features and some bad features. Because it has both good and bad features, one cannot predict whether the diet will be healthy or unhealthy long term. Until there is long-term experimental evidence that it is healthy, I cannot recommend it.

For more details, read the article above.

 

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

Yoga Pain Relief From Tight Muscles

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Yoga Shouldn’t Cause You Pain

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

yoga pain relief

Do you love to practice yoga?  Do you feel energized after stretching your muscles?  Or do you have yoga pain that prevents you from moving easily after your session is complete.  You probably would like to know how to achieve yoga pain relief from tight muscles.

Why Tight Muscles Cause Yoga Pain

A muscle originates on a bone, merges into a tendon, crosses over a joint, and inserts into another bone. When the muscle contracts it pulls on the tendon, and the joint moves.  However, if the muscle is strained either by repetitive use, or trauma, it becomes too short.  Now you will feel pain when you try to lengthen it to its normal length.  If you try to stretch it you’ll feel even worse pain, and you won’t be able to move properly.

yoga pain relief stretchHere is an analogy to help you better understand the concept. If you tied a rope between two trees and knotted the rope, the flexible tree would bend. If you then tried to force the flexible tree to stand up straight, the knots would get tighter. Also, the fibers outside of the knots would over-stretch.

This is what happens in your body when a muscle is shortened by spasms (knots).  And in your body, the two ends are attached to a bone. As a result, when you try to stretch the knotted muscles, they put a strain on your joint.  You feel pain, and you may have even injured your muscles.

It makes sense to untie the spasms before you stretch.  This would help prevent the need for yoga pain relief.

How To Prevent Yoga Pain By Releasing Muscle Spasms First

yoga pain relief bookFor over 15 years I have been helping people around the world via email and Zoom consultations.  A person orders a consultation, sends me an email explaining the problem, and I send back some treatment ideas. Along with the consultation they get a copy of Treat Yourself To Pain-Free Living  so they can do the treatments I suggest.

An amazing yoga instructor in Texas, named Ana, was having pain in her calf muscles. She was accustomed to yoga eliminating all pains, so she was frustrated that the pain didn’t disappear.  She found me by doing an internet search and decided to have a telephone consultation.

Ana sent an email to me describing her problem.  I told her to order the Treat Yourself To Pain-Free Living book and described the self-treatment for her calf pain.  We then made an appointment to talk in two weeks.

yoga pain relief calfThe treatment for the pain in her calf muscles is shown on the left. You lie on your back and put your calf over top of your opposite bent knee.  Press down and slowly move your leg up toward your head so your knee moves down your calf.  If you find a sore point, that’s a spasm. Hold your pressure on the point for about 30 seconds, then release the pressure for about 30 seconds.  Then repeat 1-2 more times.  It will hurt, but since it’s releasing the spasm, you’ll find it will hurt less each time you do it.

It took Ana just two days to resolve her calf issue and get yoga pain relief. By then, her book had arrived. Since she still had 12 days before we talked, she decided to use the information in the book and work on her hips.  She was shocked to find her hips actually had a lot of spasms.  She treated them as the book showed, and her yoga improved.  Then she took a look at her shoulders that were also “fine.”  Again, she was shocked to find they also had multiple spasms. She treated them as shown in the book, and again her yoga improved.  She was thrilled!

Yoga Pain Relief

yoga pain relief dvdWhen we finally spoke, Ana had made the decision that this was information that needed to come out to yoga instructors everywhere.  That was the beginning of Trigger Point Yoga.  Ana and I worked together to create a product to teach how to release tight muscles before stretching.

Ultimately the product name was changed to Focused Flexibility Training so athletes would also release muscles before stretching.

It’s important to release the spasms that tie your muscles into knots before you stretch.  Focused Flexibility Training shows you where to press, and how to best treat the knot.  And the yoga stretching DVDs are truly first-class.

 

Wishing you well,

Julie Donnelly

About The Author

julie donnelly

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

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

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.

Should We Use Supplements For Cardiovascular Health?

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Are You Just Wasting Your Money On Supplements?

Author: Dr. Stephen Chaney

 

supplements for cardiovascular health wast moneyYou’ve seen the headlines. “Recent Study Finds Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.”  You are being told that supplements are of no benefit to you. They are a waste of money. You should follow a healthy diet instead. Is all of this true?

If I were like most bloggers, I would give you a simple yes or no answer that would be only partially correct. Instead, I am going to put the study behind these headlines into perspective. I am going to give you a deeper understanding of supplementation, so you can make better choices for your health.

 Should we use supplements for cardiovascular health?

In today’s article I will give you a brief overview of the subject. Here are the topics I will cover today:

  • Is this fake news?
  • Did the study ask the right questions?
  • Is this a question of “Garbage In – Garbage Out?“
  • Reducing Heart Disease Risk. What you need to know.

All these topics are covered in much more detail (with references) in my book “Slaying The Supplement Myths”, which will be published this fall.

 

How Was This Study Done?

supplements for cardiovascular healthThis study (D.J.A. Jenkins et al, Journal of the American College Of Cardiology, 71: 2540-2584, 2018 ) was a meta-analysis. Simply put, that means the authors combined the results of many previous studies into a single database to increase the statistical power of their conclusions. This study included 127 randomized control trials published between 2012 and December 2017. These were all studies that included supplementation and looked at cardiovascular end points, cancer end points or overall mortality.

Before looking at the results, it is instructive to look at the strengths and weaknesses of the study. Rather than giving you my interpretation, let me summarize what the authors said about strengths and weaknesses of their own study.

The strengths are obvious. Randomized control trials are considered the gold standard of evidence-based medicine, but they have their weaknesses. Here is what the authors said about the limitations of their study:

  • “Randomized control trials are of shorter duration, whereas longer duration studies might be required to fully capture chronic disease risk.”
  • “Dose-response data were not usually available [from the randomized control studies included in their analysis]. However, larger studies would allow the effect of dose to be assessed.”

There are some other limitations of this study, which I will point out below.

Is This Fake News?

supplements for cardiovascular health fake newsWhen I talk about “fake news” I am referring to the headlines, not to the study behind the headlines. The headlines were definitive: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” However, when you read the study the reality is quite different:

  • In contrast to the negative headlines, the study reported:
    • Folic acid supplementation decreased stroke risk by 20% and overall heart disease risk by 17%.
    • B complex supplements containing folic acid, B6, and B12 decreased stroke risk by 10%.
    • That’s a big deal, but somehow the headlines forgot to mention it.
  • The supplements that had no significant effect on heart disease risk (multivitamins, vitamin D, calcium, and vitamin C) were ones that would not be expected to lower heart disease risk. There was little evidence from previous studies of decreased risk. Furthermore, there is no plausible mechanism for supposing they might decrease heart disease risk.
  • The study did not include vitamin E or omega-3 supplements, which are the ones most likely to prove effective in decreasing heart disease risk when the studies are done properly (see below).

Did The Study Ask The Right Question?

Most of the studies included in this meta-analysis were asking whether a supplement decreased heart disease risk or mortality for everyone. Simply put, the studies started with a group of generally healthy Americans and asked whether supplementation had a significant effect on disease risk for everyone in that population.

That is the wrong question. We should not expect supplementation to benefit everyone equally. Instead, we should be asking who is most likely to benefit from supplementation and design our clinical studies to test whether those people benefit from supplementation.

supplements for cardiovascular health diagramI have created the graphic on the right as a guide to help answer the question of “Who is most likely to benefit from supplementation?”. Let me summarize each of the points using folic acid as the example.

 

Poor Diet: It only makes sense that those people who are deficient in folate from foods are the most likely to benefit from folic acid supplementation. Think about it for a minute. Would you really expect people who are already getting plenty of folate from their diet to obtain additional benefits from folic acid supplementation?

The NIH estimates that around 20% of US women of childbearing age are deficient in folic acid. For other segments of our population, dietary folate insufficiency ranges from 5-10%. Yet, most studies of folic acid supplementation lump everyone together – even though 80-95% of the US population is already getting enough folate through foods, food fortification, and supplementation. It is no wonder most studies fail to find a beneficial effect of folic acid supplementation.

The authors of the meta-analysis I discussed above said that the beneficial effects of folic acid they saw might have been influenced by a very large Chinese study, because a much higher percentage of Chinese are deficient in folic acid. They went on to say that the Chinese study needed to be repeated in this country.

In fact, the US study has already been done. A large study called “The Heart Outcomes Prevention Evaluation (HOPE)” study reported that folic acid supplementation did not reduce heart disease risk in the whole population. However, when the study focused on the subgroup of subjects who were folate-deficient at the beginning of the study, folic acid supplementation significantly decreased their risk of heart attack and cardiovascular death.  This would seem to suggest using supplements for cardiovascular health is a good idea.

Increased Need: There are many factors that increase the need for certain nutrients. However, for the sake of simplicity, let’s only focus on medications. Medications that interfere with folic acid metabolism include anticonvulsants, metformin (used to treat diabetes), methotrexate and sulfasalazine (used to treat severe inflammation), birth control pills, and some diuretics. Use of these medications is not a concern when the diet is adequate. However, when you combine medication use with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial.

Genetic Predisposition: The best known genetic defect affecting folic acid metabolism is MTHFR. MTHFR deficiency does not mean you have a specific need for methylfolate. However, it does increase your need for folic acid. Again, this is not a concern when the diet is adequate. However, when you combine MTHFR deficiency with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial. I cover this topic in great detail in my upcoming book, “Slaying The Supplement Myths”. In the meantime, you might wish to view my video, “The Truth About Methyl Folate.”

Diseases: An underlying disease or predisposition to disease often increases the need for one or more nutrients that help reduce disease risk. The best examples of this are two major studies on the effect of vitamin E on heart disease risk in women. Both studies found no effect of vitamin E on heart disease risk in the whole population. However, one study reported that vitamin E reduced heart disease risk in the subgroup of women who were post-menopausal (when the risk of heart disease skyrockets). The other study found that vitamin E reduced heart attack risk in the subgroup of women who had pre-existing heart disease at the beginning of the study.

Finally, if you look at the diagram closely, you will notice a red circle in the middle. When two or three of these factors overlap, that is the “sweet spot” where supplementation is almost certain to make a difference and it may be a good idea to use supplements for cardiovascular health.

Is This A Question Of “Garbage In, Garbage Out”?

supplements for cardiovascular health garbage in outUnfortunately, most clinical studies focus on the “Does everyone benefit from supplementation question?” rather than the “Who benefits from supplementation?” question.

In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.

Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.

 

Should We Use Supplements For Cardiovascular Health?

 

If you want to know whether supplements decrease heart disease risk for everyone, this meta-analysis is clear. Folic acid may decrease the risk of stroke and heart disease. A B complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but the analysis did not include vitamin E and/or omega-3s.

However, if you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.

I would be remiss, however, if I failed to point out that we know healthy diets can decrease heart disease risk. In the words of the authors: “The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with [heart disease] risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and meat, but high in fruits and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet. These diets, with their accompanying recommendations, continue the move towards more plant-based diets…” I cover the effect of diet on heart disease risk in detail in my book, “Slaying The Food Myths”.

 

The Bottom Line

 

You have probably seen the recent headlines proclaiming: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” The study behind the headlines was a meta-analysis of 127 randomized control trials looking at the effect of supplementation on heart disease risk and mortality.

  • The headlines qualify as “fake news” because:
    • The study found that folic acid decreased stroke and heart disease risk, and B vitamins decreased stroke risk. Somehow the headlines forgot to mention that.
    • The study found that multivitamins, vitamin D, calcium, and vitamin C had no effect on heart disease risk. These are nutrients that were unlikely to decrease heart disease risk to begin with.
    • The study did not include vitamin E and omega-3s. These are nutrients that are likely to decrease heart disease risk when the studies are done properly.
  • The authors of the study stated that a major weakness of their study was that that randomized control studies included in their analysis were short term, whereas longer duration studies might be required to fully capture chronic disease risk.
  • The study behind the headlines is of little use for you as an individual because it asked the wrong question.
  • Most clinical studies focus on the “Does everyone benefit from supplementation question?” That is the wrong question. Instead we need more clinical studies focused on the “Who benefits from supplementation?” question. I discuss that question in more detail in the article above.
  • In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.
  • Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.
  • If you want to know whether supplements decrease heart disease risk for everyone, this study is clear. Folic acid may decrease the risk of stroke and heart disease. A B-complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but they did not include vitamin E and/or omega-3s in their analysis.
  • If you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.
  • However, we do know that healthy, plant-based diets can decrease heart disease risk. I cover heart healthy diets in detail in my book, “Slaying The Food Myths.”

 

For more details, read the article above.

 

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

Health Tips From The Professor