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

Do You Need Supplements?

December 12, 2017 by Dr. Steve Chaney

Supplements As Part of a Holistic Lifestyle

Author: Dr. Stephen Chaney

Do you need supplements?

The headlines about supplementation are so confusing. Are they useful, or are they a waste of money? Will they cure you, or will they kill you? I feel your pain.

I will answer these questions in depth in my upcoming book, but let me give you a quick overview today. I call it: “Do You Need Supplements?” I created the graphic on the left to illustrate why I feel responsible supplementation is important for most Americans. Let me give you specific examples for each of these categories.

Examples of Poor Diet

Do you need supplements if you have a poor diet? You have heard the saying that supplementation fills in the nutritional gaps in our diets. So what are the nutritional gaps? According to the USDA’s 2015-2020 Dietary Guidelines for Americans, many Americans are consuming too much fast and convenience foods. Consequently, we are getting inadequate amounts of calcium, magnesium, and vitamins A, D, E and C. Iron is also considered a nutrient of concern for young children and pregnant women. According to a recent study, regular use of a multivitamin is sufficient to eliminate all these deficiencies except for calcium, magnesium and vitamin D (J.B. Blumberg et al, Nutrients, 9(8): doi: 10.3390/nu9080849, 2017 ). A well-designed calcium, magnesium and vitamin D supplement may be needed to eliminate those deficiencies.

In addition, intake of omega-3 fatty acids from foods appears to be inadequate in this country. Recent studies have found that American’s blood levels of omega-3s are among the lowest in the world and only half of the recommended level for reducing the risk of heart disease (K.D. Stark et al, Progress In Lipid Research, 63: 132-152, 2016 ;S.V. Thuppal et al, Nutrients, 9, 930: doi: 10.3390/nu9090930, 2017 ). Therefore, omega-3 supplementation is often a good idea.

In previous editions of “Health Tips From the Professor” I have talked about our “mighty microbiome”, the bacteria and other microorganisms in our intestine. These intestinal bacteria can affect our tendency to gain weight, our immune system, inflammatory diseases, chronic diseases such as diabetes, cancer, and heart diseases, our mood—the list goes on and on. This is an emerging science. We are learning more every day, but for now it appears our best chances for creating a health-enhancing microbiome are to consume a primarily plant-based diet and take a probiotic supplement.

Finally, diets that eliminate whole food groups create nutritional deficiencies. For example, vegan diets increase the risk of deficiencies in vitamin B12, vitamin D, calcium, iron, zinc and long chain omega-3 fatty acids. A recent study reported that the Paleo diet increased the risk of calcium, magnesium, iodine, thiamin, riboflavin, folate and vitamin D deficiency (A. Genomi et al, Nutrients, 8, 314; doi: 10.3390/nu8050314, 2016. The Keto diet is even more restrictive and is likely to create additional deficiencies.

Examples of Increased Need

Do you need supplements if you have an increased need? We have known for years that pregnancy and lactation increase nutritional requirements. In addition, seniors have increased needs for protein, calcium, vitamin D and vitamin B12. In previous issues of “Health Tips From the Professor” I have also shared recent studies showing that protein requirements are increased with exercise.

Common medications also increase our need for specific nutrients. For example, seizure medications can increase your need for vitamin D and calcium. Drugs to treat diabetes and acid reflux can increase your need for vitamin B12. Other drugs increase your need for vitamin B6, folic acid, and vitamin K. Excess alcohol consumption increases your need for thiamin, folic acid, and vitamin B6. These are just a few examples.

Vitamin D is a special case. Many people with apparently adequate intake of vitamin D have low blood levels of 25-hydroxy vitamin D. It is a good idea to have your blood 25-hydroxy vitamin D levels measured on an annual basis and supplement with vitamin D if they are low.

More worrisome is the fact that we live in an increasing polluted world and some of these pollutants may increase our needs for certain nutrients. For example, in a recent edition of “Health Tips From the Professor” I shared a study reporting that exposure to pesticides during pregnancy increases the risk of giving birth to children who will develop autism, and that supplementation with folic acid during pregnancy reduces the effect of pesticides on autism risk. I do wish to acknowledge that this is a developing area of research. This and similar studies require confirmation. It is, however, a reminder that there may be factors beyond our control that have the potential to increase our nutritional needs.

Examples of Genetics Influencing Nutritional Needs

Do you need supplements if your genetics call for specific nutritional needs? The effect of genetic variation on nutritional needs is known as nutrigenomics. One of the best-known examples of nutrigenomics is genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene. MTHFR gene mutations increase the risk of certain birth defects, such as neural tube defects. MTHFR mutations also slightly increase the requirement for folic acid. A combination of food fortification and supplementation with folic acid have substantially decreased the prevalence of neural tube defects in the US population. This is one of the great success stories of nutrigenomics. Parenthetically, there is no evidence that methylfolate decreases the risk of neural tube defects.

Let me give you a couple of additional examples:

One of them has to do with vitamin E and heart disease (A.P. Levy et al, Diabetes Care, 27: 2767, 2004 ). Like a lot of other studies, there was no significant effect of vitamin E on cardiovascular risk in the general population. But there is a genetic variation in the haptoglobin gene that influences cardiovascular risk. The haptoglobin 2-2 genotype increases oxidative damage to the arterial wall, which significantly increases the risk of cardiovascular disease. When the authors of this study looked at the effect of vitamin E in people with this genotype, they found that it significantly decreased heart attacks and cardiovascular deaths.

This has been confirmed by a second study specifically designed to look at vitamin E supplementation in that population group (F. Micheletta et al, Arteriosclerosis, Thrombosis and Vascular Biology, 24: 136, 2008 ). This is an example of a high-risk group benefiting from supplementation, but in this case the high risk is based on genetic variation.

Let’s look at soy and heart disease as a final example. There was a study called the ISOHEART study (W.L. Hall et al, American Journal of Clinical Nutrition, 82: 1260-1268, 2005 ; W.L. Hall et al, American Journal of Clinical Nutrition, 83: 592-600, 2006 ) that looked at a genetic variation in the estrogen receptor which increases inflammation and decreases levels of HDL. As you might expect, this genotype significantly increases cardiovascular risk.

Soy isoflavones significantly decrease inflammation and increase HDL levels in this population group. But they have no effect on inflammation or HDL levels in people with other genotypes affecting the estrogen reception. So, it turns out that soy has beneficial effects, but only in the population that’s at greatest risk of cardiovascular disease, and that increased risk is based on genetic variation.

These examples are just the “tip of the iceberg.” Nutrigenomics is an emerging science. New examples of genetic variations that affect the need for specific nutrients are being reported on a regular basis. We are not ready to start genotyping people yet. We don’t yet know enough to design a simple genetic test to predict our unique nutritional needs. That science is 10-20 years in the future, but this is something that’s coming down the road.

What the current studies tell us is that some people are high-risk because of their genetic makeup, and these are people for whom supplementation is going to make a significant difference. However, because genetic testing is not yet routine, most people are completely unaware that they might be at increased risk of disease or have increased nutritional requirements because of their genetic makeup.

Examples of Disease Influencing Nutritional Needs

Finally, let’s consider the effect of disease on our nutritional needs. Do you need supplements because of disease? If you look at the popular literature, much has been written about the effect of stress on our nutritional needs. In most cases, the authors are referring to psychological stress. In fact, psychological stress has relatively minor effects on our nutritional needs.

Metabolic stress, on the other hand, has major effects on our nutritional needs. Metabolic stress occurs when our body is struggling to overcome disease, recover from surgery, or recover from trauma. When your body is under metabolic stress, it is important to make sure your nutritional status is optimal.

The effects of surgery and trauma on nutritional needs are well documented. In my upcoming book, I will discuss the effects of disease on nutritional needs in some detail. Let me give you a brief overview here. It is very difficult to show beneficial effects of supplementation in a healthy population (primary prevention). However, when you look at populations that already have a disease, or are at high risk for disease, (secondary prevention), the benefits of supplementation are often evident.

For example, studies suggest that vitamin E, B vitamins, and omega-3s each may reduce heart disease risk, but only in high-risk populations. Similarly, B vitamins (folic acid, B6 and B12) appear to reduce breast cancer risk in high risk populations.

Do You Need Supplements?

With this information in mind, let’s return to the question: Do you need supplements? Here is my perspective.

The need for supplementation is greatest when these circles overlap, as they do for most Americans.
The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

So, let’s step back and view the whole picture. The overlapping circles are drawn that way to make a point. A poor diet doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, disease, or metabolic stress, supplementation is likely to be beneficial. The more overlapping circles you have, the greater the likely benefit you will derive from supplementation.

That is why I feel supplementation should be included along with diet, exercise, and weight control as part of a holistic approach to better health.

So, do you need supplements?

The Bottom Line

In this article I provide a perspective on who needs supplementation and why. There are four reasons to supplement.

Fill nutritional gaps in our diet
Meet increased nutritional needs due to pregnancy, lactation, age, exercise, many common medications, and environmental pollutants.
Compensate for genetic variations that affect nutritional needs.
Overcome needs imposed by metabolic stress due to trauma, surgery, or disease.

With this information in mind, let’s return to the question: “Do you need supplements? Here is my perspective.

A poor diet alone doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, or metabolic stress, supplementation is likely to be beneficial. The more overlap you have, the greater the likely benefit you will derive from supplementation.
The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

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 B Vitamins Cause Lung Cancer In Men

December 5, 2017 by Dr. Steve Chaney

Do B Vitamins Cause Lung Cancer In Men?

Author: Dr. Stephen Chaney

Last week one of my readers contacted me and asked me to comment on an article in The Atlantic titled: “Vitamin B6 and B12 Supplements Appear to Cause Cancer in Men”. I did what any good scientist would do. I read the original study (T.M. Brasky et al, Journal of Clinical Oncology, 35: 3440-3448, 2017 ) and analyzed the data, so I could provide you with the truth behind the headlines. Continue reading to find the answer to “Do B vitamins cause lung cancer in men?”

I will give you my analysis in a minute. First, let me use the internet chatter about this study as a perfect example of how nutrition myths are born.

How Did Journalists Interpret The Clinical Study?

Journalists are not trained scientists. They seldom read the whole article. They rely on the abstract of the article and interpret it through their “filter” of reality. The author of The Atlantic article did a reasonably good job of reporting the information in the abstract. However, news articles need to be spectacular to attract readers, so the information was presented selectively.

The author was clearly trying to grab your attention by hyping the risk. For example, in page one of his article, he makes the claim that “taking vitamin B6 and B12 supplements in high doses (like those sold in many stores) appears to triple or almost quadruple some people’s risk of lung cancer.” That is enough to get your attention!

If you read to page 4 of his article, you discover that the 3-4-fold increase in risk only applies to smokers. If you read to page 5, you discover that this only applies to people taking 20 times the RDA of B6 or B12 from individual supplements.

However, in today’s world many readers have the attention span of gnats. They will read the headline and perhaps the first couple of paragraphs. Most readers of The Atlantic article will conclude that supplementation with B6 and B12 causes a 3-4-fold increase in lung cancer in men. A nutrition myth will be born!

The headlines were similar from other news sources: CNN led with “High Doses of Vitamin B Supplements Tied to Lung Cancer, Study Says”. Huffington Post said: “Men: Taking Vitamin B6 and B12 Could Increase Your Risk of Lung Cancer.” USA Today said: “Risk of Lung Cancer Increases with Vitamin B, Study Says.”

In all fairness, the articles themselves offered a more balanced interpretation of the study, but many people do not read beyond the headlines. The headlines alerted people to the potential of B6 and B12 supplementation to increase the risk of lung cancer, but readers may miss the fact that this risk is only seen in men, only associated with mega-doses of individual vitamins, and only seen in smokers.

How Will Bloggers Interpret The Clinical Study?

It is only a matter of time before the same headlines start appearing in your favorite nutrition blogs. Many bloggers like to create sensational headlines and hype the results of clinical studies. They don’t let the facts get in the way of a good story. Of course, once the claim that vitamins B6 and B12 increase the risk of lung cancer gets repeated often enough on the internet, people will start to believe it must be true. The food myth will become firmly established.

How Will The Medical Community Interpret The Clinical Study?

The medical community usually filters studies like this through a belief system that supplements do more harm than good. They tend to ignore dozens of studies showing the benefits of supplementation and focus on the one of two suggesting they might cause harm. I predict that doctors may start advising their male patients to avoid supplements with vitamins B6 and B12. I also suspect many doctors may start measuring your blood levels of B6 and B12 and warning you to cut back if they are above average.

How Does A Scientist Interpret The Clinical Study?

Do B vitamins cause lung cancer in men? For a scientifically accurate evaluation of a study like this, one needs to read the study carefully, analyze the data, and evaluate the statistics. Let me walk you through stepwise what I found when I did that.

The increased lung cancer risk was only seen in men, not in women. That would be the expected result for prostate cancer, but it is a bit unexpected for lung cancer. There is no apparent mechanism for explaining this effect.
There was no effect of folic acid on lung cancer risk.
Vitamins B6 and B12 were associated with a 30-40% increased risk of lung cancer in men. However, that statistic is misleading because:
- The increased risk of lung cancer was only seen when B6 or B12 were taken as individual supplements. There was no increased risk when B6 and B12 were in a multivitamin where all the B vitamins are in balance.
- The increased risk of lung cancer was only seen when B6 or B12 were taken as mega-doses greater than 20 times the RDA. There was no increased risk of lung cancer for doses of B6 or B12 that were less than 20 times the RDA.
Mega-doses (>20 times the RDA) of vitamins B6 or B12 were associated with a 2-fold increased risk of lung cancer in men. However, that statistic is misleading because:
- The increased risk of lung cancer in men taking mega-doses of B6 or B12 was only seen in smokers. In the words of the authors: “There were too few [lung cancer] patients among never smokers to evaluate associations [between B vitamins and lung cancer].”

Do B Vitamins Cause Lung Cancer In Men?

Much of what you read on the internet about this study is misleading. For example:

The claim that vitamins B6 and B12 increase lung cancer in men by 30% was entirely driven by men who were taking >20 times the RDA of B6 or B12 as individual supplements. The risk was zero for anyone taking lower doses B6 and B12.
The claim that mega-doses of B6 or B12 increase lung cancer risk in men by 2-fold was entirely driven by male smokers. The risk was zero for non-smokers, even non-smokers taking mega-doses of B6 or B12.
The only unambiguous conclusion from this study is that male smokers who take >20 times the RDA of either B6 or B12 as individual supplements have a 3-4-fold increased risk of lung cancer.

So, do B vitamins cause lung cancer in men?

What Does This Mean For You?

The take home lessons from this study are clear.

It is almost never a good idea to take mega-doses of individual vitamin and mineral supplements. The only exception is when they are prescribed for a specific medical condition by your health professional and that health professional is monitoring you for potential toxicity.
If you smoke, mega-doses of vitamins won’t protect you, and they may harm you. The best advice is to stop smoking.

Those are the scientifically based recommendations from the study. However, you are more likely to hear recommendations that you shouldn’t take B vitamins if you are a man. After all, nutrition myths don’t need to be based on science.

The Bottom Line

The internet is ablaze with claims that a recent study shows the vitamins B6 and B12 increase the risk of lung cancer in men. These claims are misleading because:

The claim that vitamins B6 and B12 increase lung cancer in men by 30% was entirely driven by men who were taking >20 times the RDA of B6 or B12 as individual supplements. The risk was zero for anyone taking lower doses B6 and B12.
The claim that mega-doses of B6 or B12 increase lung cancer risk in men by 2-fold was entirely driven by male smokers. The risk was zero for non-smokers, even non-smokers taking mega-doses of B6 or B12.
The only unambiguous conclusion from this study is that male smokers who take >20 times the RDA of either B6 or B12 as individual supplements have a 3-4-fold increased risk of lung cancer.

The take home lessons from this study are clear.

It is almost never a good idea to take mega-doses of individual vitamin and mineral supplements. The only exception is when they are prescribed for a specific medical condition by your health professional and that health professional is monitoring you for potential toxicity.
If you smoke, mega-doses of vitamins won’t protect you, and they may harm you. The best advice is to stop smoking.

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.

How to Boost Your Immune System

November 28, 2017 by Dr. Steve Chaney

Get Ready, The Flu Is Coming

Author: Dr. Stephen Chaney

Many of you have been asking me: “They are saying the flu is going to be bad this winter, but all I hear about in the news is shots and drugs. Is there a holistic approach for strengthening my immune system?” My answer is yes! If you want to know how to boost your immune system, here are my suggestions:

How to Boost Your Immune System

Start by eating a balanced diet composed of whole, unprocessed foods without a lot of fat and simple sugars. A great place to start designing a balanced diet that is perfect for your age, gender and activity level is https://choosemyplate.gov.
Get plenty of sleep. The experts recommend 8 hours of sleep a night, but most Americans get far less than that.
Exercise on a regular basis. Both too little and too much exercise can weaken the immune system (You might have guessed that the problem for most of us is the “too little,” not the “too much”). The experts recommend at least 30 minutes at least 5 days a week. Twice that amount is probably optimal unless you want to run marathons or become a “muscle man.”
Maintain ideal body weight. Those excess pounds really zap our immune system.
Minimize your reliance on medications. Many common medications weaken the immune system (Just listen to the disclaimers in the TV commercials for examples). But you must work with your physician on this. Once your physician knows that you are willing to take personal responsibility for your diet and lifestyle, they will generally be willing to minimize the number of medications that they prescribe.
Focus on the positive. Studies show that optimists are healthier and live longer than pessimists. And the good news is that anyone can cultivate an attitude of optimism. For most of us, it is a lifestyle choice – not something that we were born with.
Add a supplement program to assure that your immune system is functioning optimally. In the ideal world supplements wouldn’t be necessary, but there are very few “saints” who do a great job in all 6 of the areas that I mentioned.

Getting The Nutrients Your Immune System Needs

A well-designed supplement program fills in the “gaps.” .We want to make sure that we are getting adequate nutrition to keep our immune system healthy. What other knowledge do you need to know how to boost your immune system? Here are the nutrients you need:

B vitamins and protein because our immune cells need to divide very rapidly when we have immune challenges.
Antioxidants because our immune cells create lots of free radicals.
Trace minerals, especially iron and zinc, because they are required by important enzymes of the immune system.
Vitamin D because it is vitally important for a strong immune system and most of us are not getting enough.
Probiotics (healthy bacteria) because 70% of our immune system reside in the gut, and “bad” bacteria and yeast in our intestines can weaken the immune system.
Omega-3 fatty acids to modulate the immune system once it has taken care of the invading bacteria or viruses.

We don’t need mega-doses. We just need enough.

One final thought: A holistic approach to strengthening our immune system is not an “either – or” proposition. I’ve seen estimates that the flu shot is 66% effective in preventing the flu for people with a strong immune system and only 33% effective in preventing the flu for people with a weak immune system.

The Bottom Line

This week I shared tips on how to boost your immune system, so you can withstand the worst that winter brings.

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.

Epsom Salt Bath for Sore Muscles!

November 21, 2017 by Dr. Steve Chaney

Epsom Salt – An Inexpensive “Miracle Cure”

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

An Epsom Salt bath for sore muscles is an old remedy that until recently has been overlooked by modern medicine. For hundreds of years people have used Epsom salt baths for relieving sore muscles, healing cuts, drawing out inflammation, and treating colds. To many people this has long been a miracle cure, the first “go-to” for pain relief. Research has proven why Epsom Salt works so well, and how to use it so you benefit the most.

Why An Epsom Salt Bath for Sore Muscles Works

Epsom Salt is a combination of magnesium and sulfate. When you are under stress – and who doesn’t have stress in their life – your body becomes depleted in magnesium. Magnesium is a key component in a mood-elevating chemical of the brain called serotonin. Serotonin creates relaxation and a feeling of calm, so it reduces stress, helps you sleep better, improves your ability to concentrate, and lessens the tension of irritability. It is also a component in the production of ATP (adenosine triphosphate), which produces energy for the cells.

The magnesium in Epsom Salt regulates the activity of over 325 enzymes, helps prevent hardening of the arteries, and is beneficial for muscle and nerve function. Sulfates improve the absorption of nutrients and flushes toxins out of the body. All of this is why an Epsom salt bath for sore muscles works.

Massage and Epsom Salt – a “Marriage Made in Heaven!”

Every month I explain how massaging one area of your body will help eliminate or reduce pain. My book (see below) teaches many self-treatments for a long list of aches and pains. Massage has been proven to help with:

Joint pain
Stiffness
Muscle aches
Fibromyalgia
Insomnia
Sports injuries
TMJ
Headaches
and much, much more!

Massage will also force toxins out of your muscles and improve circulation. Epsom Salt baths are beneficial after a massage because it will remove the toxins out of the body. In the past I had heard that a 15-minute bath was sufficient, but that has changed. Recently I read an article that explained it takes 40 minutes of soaking to make the transfer complete. Toxins are drawn out and magnesium enters into the body

Self-Massage is Convenient and Easy-to-Do

It’s wonderful to go to a qualified massage therapist and relax while the spasms are worked out of your muscles. However, if you have a stressful job or you love to exercise, you can’t go to a therapist as frequently as you should. That’s where self-massage becomes a life-saver.

Before relaxing in your Epsom salt bath, do the techniques demonstrated in my book, “Treat Yourself to Pain-Free Living” to release the spasms that are causing joint and muscle pain.

As you untie the “knots,” you are releasing toxins into your blood stream and lymphatic system. A relaxing, 40-minute soak in a tub of comfortably hot water and 2 cups of Epsom Salt will eliminate the toxins from your body.

Life is more stressful than ever before, and you deserve a relaxing break. Massage and Epsom Salt baths are the perfect beginning to a restful night’s sleep! Plus, the benefits of both massage and Epsom Salt will improve your health and vitality.

Wishing you well,

Julie Donnelly

About The Author

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

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

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.

Myths of Methyl B12 and Methylfolate Benefits: Part 2

November 14, 2017 by Dr. Steve Chaney

Debunking The Myths

Author: Dr. Stephen Chaney

Now that I have shared the saga of how the methylfolate and methyl B12 stories progressed from a kernel of truth to myths and eventually to outright lies, let me systematically debunk the myths of the mehtyl B12 and methylfolate benefits.

Debunking The Myths of Methylfolate Benefits

Methylfolate Benefits Myth: Methylfolate is natural. It comes from whole food. Folic acid is synthetic.

Fact: I covered this earlier. Methylfolate is chemically synthesized from folic acid. It is physically impossible to extract enough from whole foods.

Methylfolate Benefits Myth: Methylfolate is better utilized by the body than folic acid.

Fact: This claim is based on levels of methylfolate in the blood after taking supplements providing equivalent amounts of methylfolate and folic acid. However, methylfolate has no biological activity in our blood. The measurement that matters is total folate levels (methylfolate plus other folates) in our cells. If you take equivalent amounts of folic acid and methylfolate, you end up with identical folate levels in your cells (B.J. Venn et al, The Journal of Nutrition, 132: 3333-3335, 2002 ). In short, there is no difference in our ability to utilize methylfolate and folic acid.

Methylfolate Benefits Myth: If you have a mutation in the MTHFR gene, folic acid isn’t effective.

Fact: MTHFR slightly increases the need for folic acid (from 400 ug to between 600 and 800 ug), but multiple studies show that folic acid supplementation is effective in people with MTHFR mutations. For example, homocysteine levels are easily measured and are a reliable indicator of methylfolate status. One study has shown that folic acid and methylfolate were equally effective at lowering plasma homocysteine in people who were MTHFR C677T homozygotes (I.P. Fohr et al, American Journal of Clinical Nutrition, 75: 275-282, 2002 ). That study also showed that folic acid was more effective than methylfolate at lowering homocysteine in people who were C677T heterozygotes and in people with normal MTHFR activity. Another study showed folic acid was just as effective as a diet providing equivalent quantities of folate from foods at lowering homocysteine levels in people with various MTHFR mutations (P.A. Ashfield-Watt et al, American Journal of Clinical Nutrition, 76: 180-186, 2002 ).

At present, lowering of homocysteine levels is the only indicator of methylfolate status for which methylfolate and folic acid have been directly compared. However, there are other studies suggesting that folic acid is likely to be effective for people with MTHFR defects.

For example, folic acid has been shown in multiple studies to be effective in preventing neural tube defects (L.M.De-Regil et al, Cochrane Database Systematic Reviews 2010 Oct 6;(10):CD007950. PMID: 20927767 ), which are highly associated with the C677T MTHFR gene defect. Three studies have shown that supplementation with folic acid, B12, and B6 slowed cognitive decline in older people with elevated homocysteine levels (J.Durga et al, The Lancet, 369: 208-216, 2007 ; A.D.Smith et al, PLoS ONE 5(9): e12244. doi:10.1371/journal.pone.0012244, 2010 ; G.Douaud et al, Proceedings of the National Academies of Sciences, 110: 9523-9528, 2013 ). In contrast, the one study that substituted methylfolate for folic acid showed no effect (J.A. McMahon et al, New England Journal of Medicine, 354: 2764-2769, 2006 ).

Methylfolate Benefits Myth: Folic acid causes cancer.

Fact: The studies suggesting that folic acid supplementation might increase the risk of cancer were all “outliers.” By that I mean they contradicted many other studies showing no increased risk. Scientists are accustomed to this. We know that studies sometimes come up with conflicting results. In some cases, we can point to an error in experimental design or statistical analysis as the cause of the aberrant results. In other cases, we never know the reason for the differences, so we go with the weight of experimental evidence (what the majority of studies show). The weight of evidence clearly supports the safety of folic acid.

However, that is not enough. If there is the slightest possibility that something causes cancer, we investigate it further. Consequently, the scientific community followed up with larger studies. Those studies showed either reduced cancer risk or no difference in cancer risk with folic acid supplementation. None of the studies found any evidence that folic acid increased cancer risk. I have covered this in detail for folic acid and colon cancer risk in a previous issue of “Health Tips From The Professor.”

There have also been a couple of small studies suggesting that folic acid might increase the risk of prostate and breast cancer. Although these were small, individual studies, they have been widely hyped by the methylfolate advocates. Once again, the definitive study has been done (S.E. Vollset et al, The Lancet, 381: 1029-1036, 2013 ).

It was a meta-analysis of every placebo controlled study prior to 2010 that analyzed the effect of folic acid supplementation on cancer risk, a total of 13 studies involving over 50,000 subjects. The results were clear cut. Folic acid supplementation caused no increase in overall cancer risk, and no increase in the risk of colon cancer, prostate cancer, breast cancer, or any other individual cancer. Moreover, the average dose of folic acid in those studies was 2 mg/day, which is 5 times the RDA.

Of course, the bloggers and the companies selling methylfolate supplements ignore the definitive studies showing folic acid does not increase cancer risk. The myths and the lies continue.

Methylfolate Benefits Myth: Folic acid supplementation during pregnancy increases autism risk.

Fact: This myth is based on a recent study presented at an international meeting. There are two important things you should know about this myth.

#1: This study has not yet gone through the peer review process necessary for publication. We do not know if it is a valid study.

#2: The authors of this study are desperately trying to correct the misleading information that is being circulated on the internet about their study. They say their study does not apply to women taking a prenatal supplement containing folic acid during pregnancy. In fact, several studies show that supplementation with 400 ug of folic acid during pregnancy decreases autism risk.

The authors emphasize that the increase in autism risk in their study was only seen in women with 4 times the recommended levels of folate in their blood at delivery. In other words, it only applies to women taking mega-doses of folic acid during pregnancy. Taking mega-doses of any vitamin during pregnancy is a bad idea.

Unfortunately, the best efforts of the authors have not deterred irresponsible bloggers and journalists from spreading the myth that folic acid supplementation during pregnancy may cause autism. That is incredibly bad advice because it may discourage some expectant mothers from taking prenatal vitamins with folic acid. Multiple studies have shown folic acid supplementation during pregnancy reduces the risk of birth defects.

Methylfolate Benefits Myth: Folic acid can mask a B12 deficiency.

Fact: True, but irrelevant if you use a supplement with folic acid and B12 in balance.

For more details and references, watch my “Truth About Methyl Folate” video in the Video Resources section of Health Tips From The Professor.

Debunking The Myths of The Methyl B12 Benefits

Along with the methylfolate myths have come the methyl B12 myths. Some supplement manufacturers are now claiming that methyl B12 (methylcobalamin) is more natural and more effective than the cyanocobalamin that has been used in supplements for the past 70 years. The arguments are essentially the same as for methylfolate, so let me briefly debunk the methyl B12 claims as well.

Methyl B12 Benefits Myth: Methyl B12 (methylcobalamin) is more natural than cyanocobalamin. We get the methyl B12 in our supplements from foods.

Fact: As with methylfolate, it would be impossible to extract enough methylcobalamin from foods. In fact, most of the methylcobalamin in supplements is chemically synthesized from either cyanocobalamin or hydroxycobalamin. It can never be more natural than it’s starting ingredients. A small amount of methylcobalamin is made from genetically modified bacteria.

Methyl B12 Benefits Myth: Cyanocobalamin is toxic.

Fact: You get much more cyanide from common foods such as almonds, lima beans, any fruit with a pit such as peaches, and even some fruits with seeds, such as apples. For example, a single almond contains 200 times more cyanide than a supplement providing the RDA of cyanocobalamin.

Methyl B12 Benefits Myth: Because methylcobalamin is one of the active forms of B12 inside cells (adenosylcobalamin is the other), it is better utilized by cells than cyanocobalamin.

Fact: Cyanocobalamin and methylcobalamin are equally well absorbed by the intestine and equally well transported to our cells. At the cell membrane, the cyano and methyl groups are stripped off and cobalamin (B12) binds to a transport protein called transcobalamin II. Once inside the cell either a methyl group or adenosyl group is added back to cobalamin. In short, methylcobalamin offers no advantage over cyanocobalamin because its methyl group is removed before it enters our cells. Once the methyl and cyano groups have been removed, the cell has no way of knowing whether B12 started out in the methyl or cyano form.

Methyl B12 Benefits Myth: Methylcobalamin is better utilized than cyanocobalamin for people with methylation defects.

Fact: A methylation defect would affect methylation of cobalamin once it is released from transcobalamin II inside the cell. Because the methyl and cyano groups are removed before cobalamin binds to transcobalamin II, methylcobalamin offers no advantage over cyanocobalamin.

What Does This Mean For You?

MTHFR mutations only result in partial loss of activity. Most individuals with MTHFR defects remain symptom free with the RDA, or slightly above the RDA, of folic acid. However, there may be some individuals with a MTHFR defect and additional gene defects in metabolic pathways involving methylation who might benefit from methylfolate. This is due to a phenomenon that geneticists call penetrance and would likely represent a small subset of the population with MTHFR defects. The claims that everyone would benefit from methylfolate instead of folic acid are false. They are contradicted by human metabolism and published clinical studies.

The claims that everyone would benefit from methylcobalamin (methyl B12) instead of cyanocobalamin is even more outrageous. Anyone who takes the time to research how B12 enters our cells would realize that the claim is biochemically impossible.

In short, folic acid has been used for over 80 years and cyanocobalamin for 70 years. There are hundreds of clinical studies showing they are safe and effective, even in most individuals with a MTHFR deficiency. I can’t tell you whether the companies selling methylfolate and methyl B12 are ignorant of basic metabolism and the published studies refuting their claims or whether they are purposely trying to deceive the public—but neither is a good thing.

The Bottom Line

Last week I shared the story about how the myths about methylfolate and methyl B12 arose and how they eventually became lies. This week I debunked the myths of methyl B12 and methylfolate benefits.

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.

Methylfolate and Methyl B12 – Myths or Lies? Part 1

November 7, 2017 by Dr. Steve Chaney

How Did The Myths Arise?

Author: Dr. Stephen Chaney

How did methylfolate become the center of a myth?

How are the lies of the food supplement industry created? Some of them start innocently enough. They are often based on a kernel of truth which is misinterpreted by some well-meaning medical doctors. It’s not their fault. We teach future doctors what I call “metabolism light” in medical school. There simply isn’t room in the medical curriculum to teach all the details and nuances of human metabolism. We also try to teach them the basics of how to interpret the scientific literature. However, it takes years of experience to get really good at picking out the strengths and weaknesses of clinical studies.

The doctors form their hypothesis and test it on a few patients. If it works, they publish a paper. At that point their idea is picked up by the “sensationalist” bloggers. These are the bloggers who like to focus on the sensational. They delight in writing about “new findings” that go against what the medical profession has been telling you for years. The bloggers don’t stop there. They usually expand the claims. They ‘cherry pick” the scientific literature by quoting only studies that support their viewpoint, and ignoring studies that refute it. In short, they put together a very compelling story. Soon the story is picked up by other bloggers who embellish it further. After it appears in enough sites, people start believing it. A myth is born.

Then supplement companies get in the act. They sense there is money to be made. They manufacture supplements to provide nutrients supported by the myths. They embellish the mythology even more and put together a compelling story to market their products. This is where the mythology becomes deception. Companies have the responsibility to design their products based on the best science. They have an obligation to tell the truth about their products. They know, or should know, that all their claims are not true. When they make claims they know cannot be true, they are lying to you.

The saga of the methylated B vitamins is a perfect example of how observations based on a kernel of truth became myths and eventually became downright lies. Let me share that story with you.

The Kernel Of Truth About Methylfolate

Let’s start with the “kernel of truth” that launched the whole methylfolate saga. It started with a doctor who was having a very difficult time finding a solution for a patient with some significant health issues. The doctor ordered a genetic test and discovered the patient had a deficiency in the methylene tetrahydrofolate reductase (MTHFR) gene. The doctor remembered the reaction catalyzed by MTHFR, and a light bulb went off. “Eureka”, he said. His patient must be unable to make N5-methyltetrahydrofolate (commonly referred to as methyl folate), and methylfolate is required for some very important methylation reactions in the cell.

He gave his patient methylfolate, and the patient’s symptoms got better. The doctor leapt to the conclusion that other patients with MTHFR deficiency needed methyl folate as well. Many of those patients responded to methylfolate as well. He didn’t bother to check whether they responded equally well to folic acid. He just assumed methylfolate was the magic elixir. He wrote a paper on his clinical observations, and the methylfolate story was launched. It all seemed so logical. However, the story was not nearly as straight forward as the doctor and the people publicizing his findings assumed. Let me walk you through some “Metabolism 101”. Don’t worry. There won’t be a quiz.

Why The Original Assumptions About Methylfolate Were Misleading

MTHFR mutants only have a partial loss of activity.

Individuals with 2 copies of a mutation from A to C at position 1298 of the MTHFR gene(A1298C homozygotes) comprise about 5% of the US population. They have 60% enzyme activity and appear to be normal in clinical studies.
Individuals with 2 copies of a mutation from C to T at position 677 of the MTHFR gene (C677T homozygotes) have 30% enzyme activity. They comprise about 10% of the US population. C677T homozygotes often have elevated homocysteine levels. The homozygous C677T mutation is associated with depression, anxiety, and mood swings in some people, but not in others (I will come back to the significance of that qualifying statement later).
C677T heterozygotes (one mutant gene) have 65% activity and are normal.

We Don’t Need 100% MTHFR Activity

Our human body is wonderfully designed. For many of our most essential metabolic reactions we have built in redundancy. We don’t require 100% activity of key enzymes. This helps protect us from bad effects of mutations as they arise.

The best analogy I can think of is the US space program. Most space vehicles had built in redundancy so that if one system failed, the mission could go on. For example, you may remember the Hubble space telescope. It was launched with four gyroscopes to keep the telescope pointed in the right direction. After a few years, one gyroscope gave out. That was not a problem because there were three left. A few years latter the second gyroscope gave out. Again, there was no problem because there were still two gyroscopes left. It was only after the third gyroscope gave out that Hubble became a bit “wonky”, and a space shuttle was sent up to replace the gyroscopes. It is the same with MTHFR. Only when you get down to around 30% activity, does it become a bit wonky”. (That’s about as non-technical as I get.)

Not Everyone With MTHFR Deficiency Experiences Symptoms

This is due to a phenomenon my geneticist friends refer to as penetrance. Simply put, that means that not everyone with the same mutation experiences the same severity of symptoms. That is because the severity of a mutation is influenced by diet, lifestyle, and genetic background. Let me start with genetic background. In terms of MTHFR mutants you can think of genetic background as being mutations in a related methylation pathway. People who have a mutation in both MTHFR and a gene in a related pathway will experience more severe symptoms and are more likely to require methyl folate. Once you understand penetrance, you realize that individuals requiring methyl folate may represent only a small subset of people with MTHFR mutations.

Penetrance is a concept that most proponents of the methylfolate hypothesis completely ignore. The most severe MTHFR mutation (C677T homozygote) increases the probability that individuals will exhibit symptoms, but some individuals with that mutation are completely normal. Now that you understand the concepts of redundancy and penetrance, you can understand why that is.

When Did The Kernel of Truth About Methylfolate Become A Myth?

Up to this point the hype around methylfolate could be chalked up to an honest misunderstanding. The doctors who published the original papers may not have known that MTHFR mutations only resulted in a partial reduction in enzyme activity. They probably didn’t know the concepts of redundancy (our cells don’t need 100% enzyme activity) or penetrance (the same mutation may cause severe symptoms in some patients and have no effect in others). It seemed logical to assume that everyone with a MTHFR mutation might do better with methyl folate supplementation. That was incorrect, but it was an honest mistake.

However, the message was picked up by the bloggers who specialize in sensational stories, especially stories that contradict what experts have been telling you for years. They picked up the methyl folate story and distorted it beyond recognition. They knew that “natural” is a buzz word, so they told you that methylfolate was natural and folic acid is synthetic (I exposed that lie earlier). They told you that methylfolate was better utilized than folic acid. They told you that methylfolate was more effective than folic acid. They told you folic acid was toxic. It was going to increase your risk of heart disease and cancer. Suddenly, it was no longer about people with MTHFR deficiency. You were being told that everyone should avoid folic acid and use methylfolate instead.

On the surface, these pronouncements should not have passed the “If it sounds too good to be true…” test, or in this case, the “If it sounds too bad to be true…” test. You were being asked the believe that folic acid, which has been in use for over 80 years and is backed by hundreds of studies showing it is safe and effective, was neither safe nor effective. You were asked to believe that the government was poisoning you by fortifying foods with folic acid.

However, to make their blogs sound more convincing, they listed clinical studies supporting their stories. The problem is they “cherry picked” the studies that supported their story and ignored the rest. Their bias was particularly outrageous when it came to the “story” that folic acid increases cancer risks. They ignored 10 or 20 studies showing no cancer risk and reported one suggesting it might increase risk. I call that deceptive.

Unfortunately, the myths created by the bloggers have been repeated often enough that many people now believe they are true. I will debunk their myths next week, but first let me touch on how their deceptions became downright lies.

When Did The Myths About Methylfolate and Methyl B12 Become Lies?

If you are writing a blog, you are covered by “freedom of speech.” You can say whatever you want. It doesn’t have to be true. However, if you are a supplement manufacturer, you are held to a higher standard. Ignorance is no longer an excuse. You can no longer cherry pick the “facts” you like and ignore the rest. You are ethically obligated to research all the available literature and be guided by the best scientific evidence.

Reputable companies have been guided by the scientific evidence and have not jumped on the methylfolate bandwagon. They know folic acid is both safe and effective in a wide variety of clinical situations. They also know that, while methylfolate may be just as effective as folic acid, its potential is largely unproven at this point. It has not been tested in many clinical situations.

Less reputable companies, however, sensed money to be made by capitalizing on the buzz around methylfolate. They repeated the myths of the bloggers to claim that their products were superior to others on the market. They call it marketing. I call it lying. They have an obligation to fact check their claims, and only make claims that are true.

It gets worse. Since lots of people already believed they needed methylfolate, why not extend the claim to one of the methylated B vitamins, methyl B12? That would boost sales even more. The claims for methyl B12 were even more outrageous than for methylfolate. There wasn’t even a “kernel of truth” like MTHFR deficiency to serve as a foundation. The claim was the methyl B12 was needed because of some sort of ambiguous “methylation deficiency”. The lies had become whoppers.

Next week I will debunk the methylfolate and methyl B12 myths. Stay tuned.

The Bottom Line

This week I have shared the story about how the myths about methylfolate and methyl B12 arose and how they eventually became lies. Next week I will debunk the myths.

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 Low Carb Diets Healthy?

October 31, 2017 by Dr. Steve Chaney

Can You Eat Low Carb & Live A Long And Healthy Life?

Author: Dr. Stephen Chaney

Are low carb diets healthy?

Atkins, Paleo, Keto…It seems like everyone is following a low carb diet nowadays. They are popular, but they are also controversial. At this point you are probably wondering are low carb diets healthy and is there any evidence to support it one way or the other? I searched the literature to find the answer to that question. The answer is:

Yes, there is evidence that some low carb diets are healthy…

…but, not for the reasons low carb enthusiasts give…

…and, not for the diets they promote.

Let me elaborate.

Why Are The Arguments Of Low Carb Enthusiasts Misleading?

Most proponents of low carb diets claim they are healthy based on improvements in blood parameters, usually things like lower triglycerides, higher HDL, lower blood glucose and insulin levels, and lower blood pressure. They sometimes claim lower LDL levels and lower levels of inflammation, although clinical studies are inconsistent for the effects of low carb diets on LDL and inflammation. They then go on to extrapolate from these data to claim their diet will reduce the risk of heart disease, diabetes, and other diseases.

These extrapolations are misleading for three reasons:

#1: Most of these comparisons are with the standard American diet. As I have said previously, almost anything is better than the standard American diet.

#2: Most of these studies are short term. The comparisons are generally made during the weight loss phase of these diets or at a time when the dieters have achieved significant weight loss. That is significant because weight loss improves all those parameters. If the comparisons were made during the maintenance phase or after most of the weight had been regained (as it usually is), the results might have been completely different.

#3: These blood parameters are imperfect indicators of disease risk. I find it particularly amusing that low carb proponents downplay the risk of saturated fats by saying that LDL and HDL cholesterol are imperfect indicators of disease risk and then use the same indicators to predict their diet will lower the risk of heart disease.

The only accurate way to determine the effect of a diet on disease risk is to conduct long term studies that measure the health outcomes of the diet. Those studies have been done, but they don’t support popular diets like Atkins, Paleo, or Keto.

Are Low Carb Diets Healthy and If So, Which Ones?

There are, in fact, several long-term studies showing that low carb diets are healthy, but only if you ditch the animal protein and animal fats, and replace them with vegetable protein and vegetable oils.

For example, a 20-year study of 82,802 women in the Nurses’ Health Study found that women who ate a low-carbohydrate diet that was high in vegetable protein and oils had 30% lower risk of developing heart disease compared to women who ate high-carbohydrate, low-fat diets (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006). In contrast, the women who consumed a low-carbohydrate diet that was high in animal protein and fat fared no better than women consuming a high-carbohydrate, low-fat diet.

A follow-up study with the same group of women compared the effect of the same diets over a period of 20 years on the risk of developing type 2 diabetes (T.L. Halton et al, American Journal of Clinical Nutrition, 87: 339-346, 2008 ). The results were very similar. Women consuming a low-carbohydrate diet high in vegetable protein and oils had an 18% decreased risk of developing diabetes. Once again, the women consuming a low-carbohydrate diet high in animal protein and fats had just as high a risk of developing diabetes as women consuming the high-carbohydrate, low-fat diet.

This may have been because women consuming a low-carbohydrate, high animal protein and fat diet gained just as much weight over 20 years as women consuming a high-carbohydrate, low-fat diet. In contrast, women who consumed the low-carbohydrate diet high in vegetable protein and oils gained much less weight. At the end of the 20-year study, they weighed significantly less than the women in the other two groups (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006 ). This is not surprising, since we already know that vegetarians weigh less than their meat-eating friends.

However, it does run counter to what the low carb diet promoters have been telling you. They claim their diets help you lose weight. You do lose weight more rapidly on a typical low carb diet, but at the end of a year or two you end up weighing just as much as if you followed a low-fat diet (F.M. Sacks et al, New England Journal of Medicine, 360: 859-873, 2009) . By the end of 20 years you will have gained significant weight compared to someone following a more plant-based diet (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006 ). It appears that the only low carb diet likely to give you permanent weight loss is a low carb vegetarian diet.

This is reinforced by another study showing that consumption of junk foods (potato chips and fries), sodas, processed meats, red meats, butter, sweets & desserts, and refined grains was associated with weight gain over a 4-year period (D. Mozaffarian et al, New England Journal of Medicine, 364: 2392-2404, 2011 ). In contrast, consumption of vegetables, fruits, nuts, whole grains, and yoghurt was associated with weight loss.

It’s not just women. A 20-year study of 40,475 men found that men consuming a low-carbohydrate diet high in animal protein and fat had a 37% increased risk of developing type 2 diabetes (L. de Koning et al, American Journal of Clinical Nutrition, 93: 844-850, 2011 ). In contrast, men consuming a low-carbohydrate diet high in vegetable protein and oils had a 34% decreased risk of developing type 2 diabetes.

Other Healthy Low Carb Diets

I have previously shared evidence that a Mediterranean diet reduces the risk of developing type 2 diabetes. Several recent studies have shown that a low-carbohydrate version of the Mediterranean diet is preferable for managing people who already have diabetes.

For example, one recent study put people who had just developed type 2 diabetes on either the low-carbohydrate Mediterranean diet or the low-fat, calorie-restrict diet usually recommended for overweight patients with diabetes (K. Esposito et al, Annals of Internal Medicine, 151: 306-314, 2009). At the end of 4 years, only 44% of the patients on the low-carbohydrate Mediterranean diet required drug treatment compared to 70% in the low-fat group.

Another entry into the low carb diet category is the eco-Atkins diet. It is a low-carbohydrate vegan diet (I find it amusing to label a diet “Atkins” when it has no meat and no saturated fat). For example, one recent study suggests it is more effective than a low-fat diet at reducing blood lipid levels and reducing blood pressure (D.J.A. Jenkins et al, Archives of Internal Medicine, 169: 1046-1054, 2009 ).

If you want to follow a low carb diet, the low carb Mediterranean and eco-Atkins diets are both healthy diets. You could create your own plant-based low carb diet, but you can find meal plans and recipes for both these diets online.

What Does This Mean For You?

Vegan, vegetarian, and primarily plant-based diets like the Mediterranean diet are all healthy diets. Long-term studies show they decrease your risk of developing heart disease, diabetes, cancer, and other diseases. Long-term studies also show that plant-based low carb diets help keep the pounds off and reduce your risk of heart disease and diabetes.

In contrast, meat-based low carb diets offer no advantage over low fat diets at keeping the pounds off or reducing the risk of heart disease or diabetes. There are no long-term studies on meat-based low carb diets and cancer risk, but we already know that red meat is a probable carcinogen. We also know that plant-based diets decrease your risk of several cancers. In short, there is no long-term evidence that the low-carb, meat-based diets decrease your risk of any disease and some evidence they may increase your risk of disease.

So, are low carb diets healthy? Yes, if you stop eating animal protein and animal fats and make vegetable protein and oils a part of your diet.

The Bottom Line

Ignore the claims by proponents of the popular low carb diets that their diets are healthy. Those claims are based on:
- Comparisons with the standard American diet. Anything is better.
- Short term studies when the participants were losing weight. Any diet looks good during the weight loss phase.
- Blood parameters (HDL, triglycerides, blood sugar, etc.). These are imperfect measures of long-term health outcomes.

Long-term (20-year) studies of the effects of low carb diets on health outcomes have been performed. Those studies show:
- People following a meat-based low carb diet (one that focuses on animal proteins and animal fats):
  - Gained just as much weight over a 20-year period as people following a low-fat diet.
  - Had the same or greater risk of developing heart disease and diabetes as people following a low-fat diet.
- People following a plant-based low carb diet (one that focuses on vegetable protein and vegetable oils):
  - Weighed significantly less than the other two groups at the end of 20 years.
  - Had a significantly lower risk of developing heart disease and diabetes than the other two groups.

In summary, vegan, vegetarian, and primarily plant-based diets like the Mediterranean diet are all healthy diets. Long-term studies show they decrease your risk of developing heart disease, diabetes, cancer, and other diseases. Long-term studies also show that plant-based low carb diets help keep the pounds off and reduce your risk of heart disease and diabetes.

For more details and the low carb diets I recommend, 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.

Should You Avoid Sugar Completely?

October 24, 2017 by Dr. Steve Chaney

Is It The Sugar, Or Is It The Food?

Author: Dr. Stephen Chaney

Should we avoid sugar completely? Almost every expert agrees that Americans should cut down on the amount of sugar we are consuming. However, for some people this has become a “sugar phobia”. They have sworn that “sugar shall never touch their lips”. Not only do they avoid sugar sweetened sodas and junk food, but they also have become avid label readers. They scour the label of every food they see and reject foods they find any form of sugar listed as an ingredient. Is this degree of sugar avoidance justified?

Should We Avoid Sugar to Keep it From Killing Us?

Let me add some perspective:

If you just take studies about the dangers of sugar at face value, sugar does, indeed, look dangerous. Excess sugar consumption is associated with increased risk of obesity, diabetes, and heart disease. However, when you look a little closer, you find that most of these studies have been done by looking at the correlation of each of these conditions with sugar sweetened beverage consumption (sodas and fruit juices).

A few studies have looked at the correlation of obesity and disease with total “added sugar” consumption. However, 71.6% of added sugar in the American diet comes from sugar sweetened beverages and junk food. None of the studies have looked at the sugar from healthy foods like fruits, vegetables, and whole grains. That’s because there is ample evidence that these foods decrease the risk of obesity, diabetes, and heart disease.

For example, if apples had a nutrition label, it would list 16 grams of sugar in a medium 80 calorie apple, which corresponds to about 80% of the calories in that apple. The sugar in an apple is about the same proportion of fructose and glucose found in high fructose corn syrup. Apples are not unique. The nutrition label would read about the same on most other fruits. Does that mean you should avoid sugar from all fruits? I think not.

Avoid Sugar or Avoid Certain Foods

The obvious question is: “Why are the same sugars, in about the same amounts, unhealthy in sodas and healthy in fruits?” Let’s go back to those studies I just mentioned—the ones that are often used to vilify sugars. They are all association studies, the association of sugar intake with obesity and various diseases.

The weakness of association studies is the association could be with something else that is tightly correlated with the variable (sugar intake) that you are measuring. Could it be the food that is the problem, not the sugar?

If we look at healthy foods (fruits, vegetables, whole grains) they are chock full of vitamins, minerals, phytonutrients, fiber, and (sometimes) protein. Fiber and protein slow the absorption of sugar into the bloodstream. As a result, blood sugar levels rise slowly and are sustained at relatively low levels for a substantial period of time.

In sodas there is nothing to slow the absorption of blood sugar. You get rapid rise in blood sugar followed by an equally rapid fall. The same is true of junk foods consisting primarily of sugar, refined flour and/or fat. Avoid sugar from those types of foods.

Another consideration is something called caloric density. Here is a simple analogy. I used to explain the concept of caloric density to medical students in my teaching days. There are about the same number of calories in a 2-ounce candy bar and a pound of apples (around 278 in the 2-ounce candy bar and 237 in a pound of apples). You can eat a 2-ounce candy bar and still be hungry. If you eat a pound of apples you are done for a while. In this example, the 2-ounce candy bar had a high caloric density (a lot of calories in a small package). Perhaps a more familiar terminology would be the candy bar was just empty calories.

Are Sodas and Junk Foods Killing Us?

Putting all that together, you can start to understand why the foods the sugars are in are more important than the sugars themselves. When you consume sugars in the form of sugar sweetened beverages or sugary junk foods, your appetite increases. We don’t know for sure whether it is the intense sweetness of those foods, the rapid increase and fall in blood sugar, or the high caloric density (lots of calories ina small package) that makes us hungrier. It doesn’t matter. We crave more food, and it isn’t usually fruits, vegetables, and complex carbohydrates we crave. It’s more junk. That sets in motion a predictable sequence of events.

We overeat. Those excess calories are stored as fat and we become obese. [Note: The low carb enthusiasts will tell you our fat stores come from carbohydrates alone. That is incorrect. All excess calories, whether from protein, fat, or carbohydrate, are stored as fat.]
It’s not just the fat you can see (belly fat) that is the problem. Some of that fat builds up in our liver and muscles. This sets up an unfortunate sequence of metabolic events.
The fat stores release inflammatory cytokines into our bloodstream. That causes inflammation. Inflammation increases the risk of many diseases including heart disease and cancer.
The fat stores also cause our cells to become resistant to insulin. That reduces the ability of our cells to take up glucose, which leads to hyperglycemia and type 2 diabetes. [Note: The low carb enthusiasts will tell you carbohydrates cause type 2 diabetes. That is also incorrect. It is our fat stores that cause insulin resistance and type 2 diabetes. Our fat stores come from all excess calories, not just excess calories from carbohydrates.]
Insulin resistance also causes the liver to overproduce cholesterol and triglycerides and pump them into the bloodstream. That increases the risk of heart disease.
Sugar sweetened beverages and sugary junk foods also displace healthier foods from our diet. That leads to potential nutrient shortfalls that can increase our risk of many diseases.

However, none of this has to happen. The one thing that every successful diet has in common is the elimination of sodas, junk foods, fast foods and convenience foods. You should avoid sugar from those foods as much as possible. Once you eliminate those from your diet,you significantly enhance your chances of being at a healthy weight and being healthy long term.

What About Protein Supplements And Similar Foods?

Of course, the dilemma is what you, as an intrepid label reader, should do about protein supplements, meal replacement bars, or snack bars. They are supposed to be healthy, but the label lists one or more sugars. Even worse, the sugar content is higher than your favorite health guru recommends. So, should you avoid sugar from supplements and the like?

In this case, a more useful concept is glycemic index, which is a measure of the effect of the food on your blood sugar levels. Healthy foods like apples may have a high sugar content, but they havea low glycemic index.

The same is true for the protein supplements and bars you are considering. Rather than looking at the sugar content, you should be looking for the term “low glycemic” on the label. That means there is enough fiber and protein in the food to slow the absorption of sugar into the bloodstream and stabilize your blood sugar levels.

What Does This Mean For You?

Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should work on ways to avoid sugar or reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners. I have warned about the dangers of artificial sweeteners previously.

We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. For example, some Starbucks drinks are mostly sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

So we don’t have to avoid sugar completely, but we should reduce sugar from sugar sweetened beverages and junk food.

The Bottom Line

We need to keep warnings about the dangers of sugar in perspective:

The studies showing that sugar consumption leads to obesity, diabetes, and heart disease have all been done with sodas and junk foods.
Many fruits have just as much sugar as a soda. They also contain about the same proportion of fructose and glucose as high fructose corn syrup. Yet we know fruits are good for us.
Diets rich in fruits, vegetables and whole grains decrease our risk of obesity, diabetes, and heart disease.
That is because the sugar in whole foods is generally present along with fiber and protein, which slows the absorption of sugar and prevents the blood sugar spikes we get with sodas and junk foods.
In the case of prepared foods like protein supplements, you should look for “low glycemic” on the label rather than sugar content. Low glycemic means that there is enough fiber and protein in the product to slow the absorption of sugar and prevent blood sugar spikes.
Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should all work on ways to avoid sugar from junk foods or to reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners.
We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

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.

Emergency Treatment For Calf Cramps

October 17, 2017 by Dr. Steve Chaney

To Stretch or Not To Stretch

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

A calf cramp is caused by several different conditions, such as dehydration and mineral deficiency. These each need to be addressed to prevent future calf cramps, but when your calf spasms wake you with a jolt at night or send you crashing to the ground in agony, you need a solution NOW!

And, stretching is definitely NOT the first thing to do.

Emergency Treatment for Calf Cramps

A muscle always contracts 100% before releasing. Once started, a calf cramp will not partially contract and then reverse because you stretch, as it may cause the muscle fibers to tear, which will cause pain to be felt for days afterward.

As a result, it is most beneficial to help your muscle complete the painful contraction before you try to stretch it. It sounds counter-intuitive, but it cuts the time of the calf cramp down, and enables you to start flushing out the toxins that formed during the sudden spasm.

Your muscle will be all knotted up, screaming in pain, so it’s good to practice this self-treatment when you are not having a calf cramp.

Grab your calf muscles as shown in this picture. Hold it tightly, and then as hard as you can, push your two hands together.

The intention is to help the muscle complete the contraction as quickly as possible. During an actual calf cramp it won’t be as “neat” as the picture shows, but anything you can do to shorten the muscle fibers will hasten the completion of the spasm.

Follow These Steps To Release Your Calf Cramps

Hold your hands and continue pushing the muscle together until you can begin to breathe normally again. Continue holding it another 30 seconds, bringing in as much oxygen as possible with slow, deep, breathing.
Release your hands and keep breathing deeply.
Repeat #1. This time it won’t hurt, but you are helping any last muscle fibers to complete the contraction before you move to release the spasm.
Begin to squeeze your entire calf as if you were squeezing water out of a thick towel. Move from the top of your calf and go down toward your ankle. This will feel good, so do it for as long as you can.
It is now safe to stretch your calf muscle because the cramp has completed and you have flushed out the toxins. Stretch slowly, and don’t go past the point of “feels so good”. You don’t want to overstretch.

This calf cramps emergency treatment has been proven successful by endurance athletes who have written to me saying how they could continue their race (or training) without any further pain.

This is a very important tip to share with all athletes. Please tell your friends on Facebook and Twitter, it helps athletes prevent injury and pain.

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

Do Vegetarians Live Longer?

October 10, 2017 by Dr. Steve Chaney

What Are The Health Benefits Of A Vegetarian Diet?

Author: Dr. Stephen Chaney

“Vegetarians don’t live longer, it just seems that way.” Many of you have probably heard that joke, but is it true? Are vegetarians healthier? Do vegetarians live longer? Is meat going to kill you? Let’s take a deep dive into the pros and cons of vegetarianism.

What Is Vegetarianism?

Vegetarianism encompasses a wide range of diets. At one extreme is the vegan diet. Vegans eat only plant derived foods. They don’t eat fish, meat, milk, eggs, or honey. It also goes without saying they eat only whole foods (whole grains, plant proteins, and fruits & vegetables) and avoid things like sodas, sugary foods, junk foods, and convenience foods. The most extreme form of veganism, popularized by such recent movies as “Eating You Alive” and “What the Health,” also eliminates all oils. This keeps fat at <10% of total calories.

To avoid confusion, I will refer to this as a “very low fat vegan diet.” I will use the term “vegan diet” to refer to the more common veganism that includes vegetable oils in the diet. The vegan diet is still 100% plant based. It is also still relatively low in fat, generally in the 20-30% range. Since the fat comes from plants, it is predominantly the healthy monounsaturated and polyunsaturated fats.

Lacto-ovo vegetarians add low fat dairy foods and eggs to a plant based diet. The Ornish diet is a modified lacto-ovo vegetarian diet that also eliminates all oils and keeps fat at <10% of calories. Pesco-vegetarians add fish to a plant based diet, and semi-vegetarians add limited amounts of meat to a plant based diet.

Can Vegetarian Diets Reverse Atherosclerosis?

Let me start with studies on the very low fat vegan and Ornish diets. In addition to the diet, both programs emphasize regular exercise and stress reduction practices. Adherents to both plans generally achieve a serum total cholesterol of 150 or less. The Ornish diet and lifestyle program was designed to reduce the risk of cardiovascular disease, and it has been very well studied from that perspective. In studies of patients with severe atherosclerosis (clogged arteries) for periods of up to 5 years, the Ornish program results in a significant reduction in the degree of atherosclerosis (unclogs the arteries), inflammation, cardiac events (heart attack, stroke, etc.), and cardiac deaths (H.S. Dod et al, American Journal of Cardiology, 105: 362-367, 2010 ). Studies with the very low fat vegan diet are more limited, but suggest that it also reverses atherosclerosis and reduces cardiac deaths (C.B. Esselstyn et al, Journal of Family Practice, 63: 356-364, 2014 ).

Before moving on to other forms of vegetarianism, let me make the point that these are the only diets that have been shown to actually reverse atherosclerosis. That is a big deal.

The Seventh-Day Adventist Studies

Perhaps the largest group of studies on the health effects of vegetarians has been conducted on the Seventh-day Adventist population located in Southern California. Seventh-day Adventists believe that “God calls us to care for our bodies, treating them with the respect a divine creation deserves.” The Adventist church advocates a vegan diet consisting of legumes, whole grains, nuts, fruits, and vegetables. However, it allows personal choice, so a significant number of Adventists choose lacto-ovo vegetarian, pesco-vegetarian, or semi-vegetarian diets.

That diversity has not only allowed studies of the Adventist population to not only compare a vegetarian diet to the standard American diet of the non-Adventist population living in the same area, but also to compare the various forms of vegetarian diets. There are dozens of published studies and several reviews on this topic. I will cite only the most recent review here (L.T. Le and J. Sabate, Nutrients, 6: 2131-2147, 2014 ), but I will provide a complete list in my upcoming book.

This and other reviews have concluded that vegetarians weigh less, have less inflammation, have lower cholesterol levels and have lower risk of diabetes, heart disease, and hypertension than non-vegetarians. When we compare the various forms of vegetarianism, vegan diets appear to offer somewhat greater protection against obesity, hypertension, diabetes, and cardiovascular mortality than lacto-ovo and semi-vegetarian diets. The health benefits of vegetarian diets also seem to be somewhat greater for men than for women. One might speculate that might be because the average American male has a worse diet than the average American female. So, when men adopt a vegetarian diet, it may represent a greater improvement.

The reviews also looked at the nutritional adequacy of vegetarian diets. Vegetarian diets in general are very rich in antioxidants, most B vitamins, and polyphenols. Nutrients of concern for vegan diets are vitamin B12, vitamin D, calcium, iron, zinc, and long chain omega-3 fatty acids. Of those, vitamin B12 and long-chain omega-3 fatty acids are the ones most likely to require supplementation. Adequate levels of the other nutrients can be achieved by a well-designed vegan diet.

I would add protein to the list. Don’t misunderstand me. It is possible to get adequate protein on a vegetarian diet that includes beans and other legumes as a protein source. However, vegan advocates have been telling people they get all the protein they need from broccoli and other vegetables. That is incredibly bad advice, especially for seniors who are likely to suffer from sarcopenia (age related loss of muscle mass). Broccoli only provides 3 grams of protein per serving. You would need 15 servings to meet the protein RDA for women and almost 19 servings for men. Unfortunately, I often run across seniors who think they are getting all the protein they need from green salads and steamed vegetables. The bad advice from vegan advocates may be condemning them to unnecessary frailty in their old age.

What about the health claims of the low carbohydrate diets? Most of those “health benefits” are inferred from changes in blood parameters that occur over the first few weeks or months someone adopts those diets. There are no long-term data showing that low carbohydrate diets reduce the prevalence of diabetes, heart disease or cancer. Moreover, the few studies that compare low carbohydrate and vegetarian diets suggest the vegetarian diet is superior. For example, a recent study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009 ) compared the Atkins diet (the granddaddy of the low carb diets) with the Ornish diet. People on the low-fat Ornish diet had significantly lower LDL-cholesterol, apoB, and C-reactive protein (a marker of inflammation) and had better arterial function than people on the high fat Atkins diet.

Do Vegetarians Live Longer?

What about the original question. Do vegetarians live longer? The answer isn’t clear. The Adventist Health Studies have reported that Adventist men live 6-7 years longer and Adventist women live ~4 years longer than their non-Adventist neighbors. However, the Adventist population may have other characteristics that contribute to their longevity. I will cover that in the section on “Blue Zones” in my upcoming book. In contrast, a very recent Australian study(S. Mihrshahi et al, Preventive Medicine, 97: 1-7, 2017 ) concluded that all-cause mortality was virtually identical for vegetarians and non-vegetarians. However, the authors of this study speculated that vegetarians in Australia have become less healthy in recent years because they are now consuming more high-sugar, processed “vegetarian” foods. Remember what I said about “Big Food Inc.” not being your friend.

What Does This Mean For You?

There are a few simple take-home messages from the research on the various forms of a vegetarian diet:

The Ornish diet and the very low fat vegan diet are the only diets shown to reverse atherosclerosis. If you have serious heart disease and would like to minimize your reliance on drugs and surgery, you should consider them. You will, of course, want to let your doctor know what you are doing.
Vegetarians are leaner and significantly healthier than non-vegetarians.
Vegans are slightly healthier than lacto-ovo and semi-vegetarians, but even vegetarians who include some dairy, eggs & meat in a primarily plant-based diet are much healthier than most Americans.
Vegetarians may not live longer, but they do live healthier longer.

There are also several subtle, but equally important, implications from these studies:

You can forget the claims you must be a vegan purist to obtain any health benefits from vegetarianism.If you watch movies like “Eating You Alive” or “What the Health”, you are led to believe you will suffer terrible health consequences if you add any dairy, eggs, or meat to a vegan diet. In fact, the evidence for reversing atherosclerosis is stronger for the Ornish diet, which is a lacto-ovo-vegetarian diet, than it is for a pure vegan diet. For several other health outcomes, the vegan diet is slightly more effective, but both lacto-ovo-vegetarian and semi-vegetarian diets are much healthier than the standard American diet.
Vegetarian diets are whole food diets.If you start adding in processed and convenience foods, even if they are labeled “vegan,” you are likely to lose all the health benefits of a vegetarian diet.
You can forget claims that you get all the protein you need from vegetables like broccoli. That is incredibly bad advice which is likely to condemn seniors to unnecessary frailty in old age.
You can forget the claims that you must avoid carbs at all costs. The proponents of the low carb diets will tell you that recommendations to limit fat are based on a lie. They tell you that fat is good for you and carbs will cause you to gain weight, increase inflammation, and increase your risk of diabetes, heart disease, and cancer. You are told to avoid grains and any other foods containing carbohydrate, including some fruits and vegetables. The “danger” of carbohydrates is only true for the refined grains, sugary sodas and junk foods in the standard American diet. Vegetarian diets emphasize whole grains, fruits and vegetables. They are high in carbohydrate and low in fat, and they reduce weight, inflammation, diabetes, heart disease, and some cancers.
You can forget most claims of weight loss. Most low carb diets tout rapid initial weight loss. Unfortunately, most of that weight comes back a year or two later. Only vegetarian diets are associated with lower weight over a period of many years.

In summary, a pure vegan diet is probably the healthiest form of vegetarianism, but it is difficult to follow. Vegetarian diets that are primarily plant based, but contain small amounts of dairy, eggs, or meat are also very healthy, and may be easier for the average American to follow.

The Bottom Line

Vegetarianism encompasses a wide range of diets. The standard vegan diet is entirely plant-based. There is a very low fat version of the vegan diet that also eliminates all oils. Lacto-ovo-vegetarian diets include some dairy and eggs. Semi-vegetarian diets include some meat. The Ornish diet is a very low fat version of the lacto-ovo-vegetarian diet.

There are a few simple take-home messages from the research on the various forms of a vegetarian diet:

The Ornish diet and the very low fat vegan diet are the only diets shown to reverse atherosclerosis.
Vegetarians are leaner and significantly healthier than non-vegetarians.
Vegans are slightly healthier than lacto-ovo– and semi-vegetarians, but even vegetarians who include some dairy, eggs & meat in a primarily plant-based diet are much healthier than most Americans.
In a head to head comparison, the Ornish diet was significantly healthier than the Atkins diet.
Vegetarians may not live longer, but they do live healthier longer.

There are also several subtle, but equally important, implications from these studies:

You can forget the claims you must be a vegan purist to obtain any health benefits from vegetarianism. Primarily plant-based diets with small amounts of dairy, eggs or meat are also very healthy.
Vegetarian diets are whole food diets. If you start adding in processed and convenience foods, even if they are labeled “vegan,” you are likely to lose all the health benefits of a vegetarian diet.
You can forget claims that you get all the protein you need from vegetables like broccoli. That is incredibly bad advice which is likely to condemn seniors to unnecessary frailty in old age.
You can forget the claims that you must avoid carbs at all costs. That is only true for the refined grains, sugary sodas and junk foods in the standard American diet. Vegetarian diets are high in carbohydrate, low in fat, and very healthy.
You can forget most claims of weight loss. Only vegetarian diets are associated with lower weight over a period of many years.

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.