How Much Protein Do You Need?

December 27, 2016 by Dr. Steve Chaney

Are You Getting Too Much Protein?

Author: Dr. Stephen Chaney

How much protein do you need? In a recent article entitled “Can You Get Too Much Protein?” the New York Times asserted that most Americans were getting too much protein in their diet. They went on to imply that protein supplements were useless at best and might be downright harmful at worst.

If you happened to read this article, you are probably wondering whether it is true or just another example of media bias. If you have read other articles about supplementation in the New York Times, you may have already suspected that they are biased against the use of supplements.

However, the problem goes way beyond media bias. In today’s online world everyone is a writer and everyone is an editor. More importantly, news is instant. Newspapers and journalists no longer have the time and resources to fully research a topic before they publish it. When a story comes along that fits their bias, the temptation is strong to publish it immediately.

In this issue of “Health Tips From the Professor” I will try to give you a more balanced perspective. If you would like other examples of a more balanced perspective, you might want to read articles from Harvard Medical School’s Health Publications newsletter or WebMD .

What Did The New York Times Get Right?

The New York Times didn’t completely miss the mark. Here are a few things that they got right:

Most Americans are getting more than the RDA for protein in their daily diets. They imply that is too much. However, the prevailing view among nutrition experts today is that the RDA is too low for some groups, and many Americans are getting too little protein, not too much.

They do acknowledge that there are groups who aren’t getting enough protein, for example – teenage girls, pregnant and lactating women, people over 60, and professional athletes. I would add, based on recent studies, that any adult who is engaged in a weight loss program and/or regular, vigorous workouts will also benefit from extra protein, especially after their workout. If you combine all those categories, we are talking about the majority of Americans not getting enough protein. The only exception is the otherwise healthy adults who are “couch potatoes”.

They are correct in saying that the average “couch potato” adult in the US doesn’t need more protein. However, even the “couch potatoes” among us would benefit from a healthy protein supplement in place of some of the high fat, high cholesterol animal protein they are eating. They don’t need more protein. They just need better protein.

Finally, they are correct in saying many protein supplements are either unsafe or suffer from poor quality control, topics I have covered in previous issues of “Health Tips From the Professor”. My advice is simple. Avoid those protein supplements making extravagant claims about “exploding” your muscles and giving you boundless energy. Also, choose protein supplements made by reputable companies that employ rigorous quality controls.

What Did The New York Times Get Wrong?

The main theme of their article was that most Americans were getting too much protein. They acknowledged that some nutritionists advocated consuming more protein but implied that most experts did not agree. That paradigm is 20 years old. The evidence has shifted. Most experts today feel that many Americans aren’t getting enough protein.

They warned high protein intake could be harmful. It could lead to increased risk of cancer, heart disease, diabetes and kidney disease. Let’s put those claims into perspective.
- Increased risk of cancer is linked to high intake of animal protein, especially red meat and processed meats.
- Increased risk of heart disease and diabetes is linked to high intake of fat and cholesterol rich animal proteins.
- In short, for these diseases it’s the kind of protein, not the amount, that is the problem.
- As for kidney disease, it is clear that protein intake should be restricted when you have kidney disease. It is not clear that high protein intake can cause kidney disease in healthy adults.
Finally, they assumed that most people just added protein supplements to the protein they were already eating. If that were true, it might be a problem. However, most people use protein supplements in place of some of the high fat animal protein in their diet. They aren’t necessarily eating more protein. They are eating healthier protein.

What Do Recent Studies Show?

If we look at recent publications on the subject, it is clear the New York Times article did not accurately report what current studies show about protein needs of Americans. Here are just a few examples:

High protein diets improve physical function and weight loss in older adults. In this study participants on the high protein diet:

Lost 15% more weight than those on the low protein diet. More importantly, the high protein group had:
- 60% better retention of lean body mass (muscle).
- 25% better loss of fat mass.
They also performed substantially better on physical function tests than the low protein group. There was no exercise component to this study. The improvement in physical function was solely related to the better retention of muscle mass and the greater loss of fat mass in the high protein group.

High protein diets improve fat mass loss and muscle mass gain in young adults on a weight loss diet(American Journal of Clinical Nutrition, 103: 738-746, 2016). In this study the high protein group:

Had 33% greater loss of fat mass than the low protein group.

Increased muscle mass by an average of 2.6 pounds compared to no change in the low protein group.

High protein diets improve satiety (The Journal of Nutrition, 146: 637-645, 2016). In this study the high protein group:

Reported greater satiety and less hunger between breakfast and lunch.

Consumed 12% fewer calories at lunch.

These are just a few recent studies. There are dozens of other studies that come to the same conclusions about how much protein you need. This is the new paradigm.

Why do some studies still come up with negative results?

The problem may be in the experimental design of those studies. Here are two recent papers that give some hints as to why some studies might fail to see the benefit of protein supplementation.

Protein quality matters (Nutrition & Metabolism, doi: 10.1186/s12986-016-0124-8). This review concluded that protein quality, particularly the leucine content of the protein, was important in determining the effectiveness of that protein supplement in enhancing muscle mass increases following resistance training,

Spread protein throughout the day(American Journal of Physiology, endocrinology & Metabolism, 308: E734-E743, 2015 ). This study concluded that high protein intake is most effective at promoting muscle gain and weight loss when protein intake is spread evenly throughout the day.

In short, these studies suggest that good quality protein and good experimental design are essential if you wish to evaluate the role of additional protein on things like muscle mass and weight loss.

How Much Protein Do You Need?

What Do RDAs and Dietary Guidelines Say? Let’s start by looking at the RDA and how it has changed over the years. You probably have heard that the RDA is 46 grams of protein a day for women and 56 grams a day for men. However, that is misleading. The RDA for protein is based on body weight. The conversion is 0.36 grams of protein for every pound of body weight.

A simple calculation will tell you that 46 grams per day for women assumes they weigh 127 pounds, and 56 grams for men assumes they weigh 155 pounds. We haven’t seen those weights since the 50’s. Today the average weight for a 50-year-old woman is 170 pounds. The average weight for a 50-year-old man is 201 pounds. That translates into an RDA of 61 grams for the average woman and 72 grams for the average man.

You may have also heard that 10% of our calories from protein would meet our RDA requirements, and most Americans are currently getting around 16% of their calories from protein. The New York Times article implied that 16% of calories from protein was too much. Anything above that would be excessive, perhaps even dangerous.

What do the guidelines say? The current Dietary Guidelines for Americans recognizes individual variations in protein needs and recommends we get between 10% and 35% of our daily calories from protein. For a 2,000 calorie diet that represents between 50 and 175 grams of protein/day.

What Are The Experts Saying? Experts are not just recommending more protein for some groups. They are making specific recommendations for how much protein people in those groups should be getting. How much protein do you need?

If you are an inactive, otherwise healthy, middle-aged adult, 10% of your calories from protein or 0.36 grams of protein a day per pound of body weight is sufficient. However, you would probably benefit from healthier protein choices.

If you are a teenage girl, your protein requirements are only slightly higher than a woman in your 20s. However, teenage diets are often not what they should be. You may not be getting the protein you need. Aim for around 0.38 grams of protein per pound of body weight per day.

If you are pregnant or lactating, your protein requirements are between 0.47 and 0.56 grams per pound of body weight per day. That represents a 30-55% increase in protein requirements. Your developing baby needs the extra protein. Be sure you are getting enough.

If you are over 50, you are probably losing a little muscle mass every day (a condition referred to as sarcopenia). To offset that muscle loss, most experts on aging recommend seniors increase their protein intake to around 0.5 grams of protein per pound of body weight per day. Ideally, that protein should be spread evenly throughout the day with about 25-30 grams of protein per meal. Leucine needs are increased as well, so leucine-rich protein sources are best. I’ve covered this topic in detail in a previous issue Protein Needs of Older Adults of “Health Tips From the Professor.”

If you are an elite athlete, the International Society For Sports Nutrition recommends 0.63 to 0.9 grams of leucine-rich protein per pound per day. That is 1.7 to 2.5 times the RDA for sedentary adults.

If you are not an athlete, but work out on a regular basis, you will achieve better muscle gain from your workouts if you consume leucine-rich protein after each workout. If you are a young adult, 15-20 grams will suffice. If you are an older adult 20-25 grams is a better target. I’ve also covered this topic in a previous issue Leucine Trigger Muscle Growth of “Health Tips From the Professor.”

If you are trying to lose weight, diets providing about 0.72 grams of leucine-rich protein per pound (~ 2X the RDA or 28% of the total calories) appear to be more effective than RDA levels of protein at preserving muscle mass and reducing fat mass. Again, this topic is covered in a previous issue High Protein Diets and Weight Loss of “Health Tips From the Professor.”

Higher protein intake is most effective when coupled with resistance (weight bearing) exercise.

Higher protein intake is also most effective when spread throughout the day rather concentrated in a post-workout supplement or at a single meal.

The Bottom Line

A recent New York Times article asserted that most Americans were already getting too much protein in their diets and that dietary protein supplements were either unnecessary or dangerous.

That paradigm is at least 20 years out of date. Today, most experts agree that many Americans are getting too little protein in their diet.

Groups most likely to need additional protein are teenage girls, pregnant and lactating women, adults over 50, elite athletes, people who work out regularly, and people on weight loss diets.

The only group routinely getting more than enough protein from their diets are otherwise healthy, adult “couch potatoes,” and most of them would benefit from healthier protein choices in their diet.

Increased protein intake is best utilized when coupled with resistance (weight-bearing) exercise. It is also best utilized when spread out evenly throughout the day rather than being concentrated in a single post-workout supplement or a single meal.

The most current guidelines for protein needs of various groups are given in the article above.

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

Merry Christmas 2016

December 20, 2016 by Dr. Steve Chaney

Merry Christmas

Author: Dr. Stephen Chaney

The Christmas season is a wonderful time of year. It is a time when we get together with family and reconnect with friends. It’s a time of year when we remember the joy of giving and the joy of making the world a better place.

For those of us who are Christians, it is a time to remember that God gave us his only son. But, no matter what our religion, it is a time of year when we can focus on the common beliefs we share and the true purpose of our lives here on earth.It is a time to share the Christmas spirit of peace on earth and good will to all.

The Professor and his family wish you a blessed Christmas and happy, healthy & prosperous New Year

TMJ Pain Relief

December 13, 2016 by Dr. Steve Chaney

TMJ Treatment Can Relieve Stress & Pain

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

TMJ is the common term for a jaw condition called temporomandibular joint dysfunction. The muscle that is key to the TMJ pain relief treatment described below is the masseter muscle. The holiday season is “famous” for increasing stress as we rush around, adding more “to do’s” to our lives. Aside from the usual work and family commitments, the holiday’s mean extra shopping, parties, and therefore, stress.

TMJ Symptoms

Common symptoms of TMJ are:

Jaw Pain
Clicking when opening your mouth
Clicking while chewing
Jaw moving toward one side
Ear pain
Trouble opening mouth fully

While there are other pains that are common with TMJ, these are the most prevalent.

A Common Cause of TMJ Disorder

Do you find yourself clenching your teeth? Do you chew gum? These are two of the most common causes of TMJ.

Your masseter muscle is a small, but powerful muscle that goes from above your back teeth, to your jaw.

You can feel it if you put your flat fingers on the back of your cheek and clench your teeth.

Your masseter is used when you chew. As you hold your fingers on your masseter muscle, clench and open your jaw repeatedly. Like any other muscle in the body, it can be subject to repetitive strain injury. Normally you open your mouth wide to put in food, and then chew. This motion both contracts and lengthens the muscle.

However, if you chew gum you are contracting (shortening) the muscle, but not lengthening it. And it stays contracted if you clench your teeth when you are stressed, or at night while you sleep. Eventually the muscle will form spasms from the repetitive movement.

It is called TMJ because of the joint the masseter crosses over at the very back of your jaw. The problem is the way your movable jaw attaches to your skull. As the muscle tightens into the spasm, it prevents your jaw from opening properly. When one side is tighter than the other, your jaw will move toward the tighter side. As this happens the bones click over each other and you will feel pain.

TMJ Treatment Saved This Woman From a Lifetime of Drooling!

Several years ago a woman came to the medical office where I had my therapy practice. Both sides of her jaw were so tight that she couldn’t open her mouth at all. She had to “eat” liquefied food through a straw and her fear was if she regurgitated, she could choke. The next day her oral surgeon planned on severing both masseter muscles. This surgery meant her mouth would hang open permanently. This would result in her drooling for the rest of her life! What a nightmare!

Her masseter muscles felt like rocks had been stuffed into her cheeks. The medical doctor who owned the office understood repetitive strains and wouldn’t give her surgical clearance until she saw me. I taught her the following TMJ treatment, and in just 15 minutes she was opening and closing her mouth normally.

First, I worked on her muscles, then I taught her how to do it. The TMJ pain relief treatment starts with first pressing the muscles as described below, holding the pressure, and then releasing it. She did this several times, alternating between her right and left sides. The last part of the TMJ treatment is applying pressure to both sides at the same time. Then while still holding the pressure, I told her to just open her mouth slowly and she did. Without pain!

She started to cry because she was only one day away from a lifetime of drooling. And the best part is it only took 15 minutes to solve.

TMJ Pain Relief Treatment

To begin the TMJ pain relief treatment, place the length of your three middle fingers on both jaws. Clench your teeth so you can feel the muscle bulge under your fingers.

Press deeply on just one side, feeling for the “knot” in the muscle. Press in for the count of five, and hold it for the count of five. Then slowly release that side and repeat it on the opposite side of your jaw. Go back and forth, repeating this several times.

Feel along the muscle and find other knots and repeat the sequence. Do this to each spasm you find.

Go to the point just in front of your ear lobe and press. If it hurts, there is a spasm. Do the same treatment. This is a small area so you’ll probably only need one finger to be effective.

After you are finished treating each spasm, put your fingers on both masseter muscles at the same time. Now, slowly open your mouth to stretch the muscles.

That’s it! It’s easy to apply this TMJ pain relief treatment when you know where to go and what to do.

Treat Yourself To Pain Free Living has the TMJ treatment and also has treatments for your entire body. You don’t need to be in pain when it’s so easy to find solutions you can do yourself.

Discover the secret of why you hurt and how to stop the pain FAST!

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.

The Dangers of Iodine Deficiency During Pregnancy

December 6, 2016 by Dr. Steve Chaney

Does Your Prenatal Contain Enough Iodine?

Author: Dr. Stephen Chaney

A recent study (S.M. O’Kane et al, British Journal of Nutrition, doi.org/10.1017/S0007114516003925) concluded that 2/3 of Irish women had no idea that iodine was important during pregnancy. In fact, 57% of the women had no idea what iodine was, and 41% were unable to name any health problem related to iodine deficiency. The authors of the study considered this ignorance about iodine to be alarming. I’ll discuss why below.

First, let’s consider the situation in the United States. I suspect ignorance about the importance of iodine is just as widespread in the United States as it is in Ireland. Think about the nutrients we have been told are essential for healthy pregnancy outcomes.

We have heard about the importance of iron and calcium for decades.

The importance of folic acid and other B vitamins has been widely publicized over the last 20 years.

In recent years, we have learned about the importance of omega-3s, especially DHA.

But who has been telling us about the importance of iodine? Almost nobody.

What Are The Recommendations For Iodine Intake?

The RDAs for iodine are:

150 ug/day for adults
220 ug/day for pregnant women
290 ug/day for breastfeeding women

How Common Is Iodine Deficiency During Pregnancy?

Here are some quick facts about iodine deficiency in the US from a recent American Academy of Pediatrics position paper and the National Institutes of Health Consumer information site:

Approximately 1/3 of pregnant and lactating women in the United States are at least marginally iodine deficient.
To meet their RDA requirements for iodine during pregnancy and lactation the American Thyroid Association, The National Academy of Sciences, and The American Academy of Pediatrics all recommend pregnant and lactating women take supplements containing 150 ug of iodine.
Although most pregnant and lactating women take supplements:
- Only 50% of prenatal supplements in the United States contain iodine.
- Even worse, only 15% of the supplements pregnant and lactating women take contain iodine (some pregnant and lactating women take multivitamins rather than prenatal supplements).
Labeling can be deceptive. Most multivitamins and prenatal supplements specify the amount of potassium iodide in the supplement, not iodine. It requires at least 197 ug of potassium iodide to provide 150 ug of iodine.

In short, many pregnant and lactating women in this country are not getting enough iodine from their diet and the supplements they are taking may not provide the iodine they need.

Why Are So Many Americans Deficient In Iodine?

The best and most reliable natural sources of iodine are seaweeds and ocean fish. Meats, dairy, and grains can be moderate sources of iodine, but their iodine content is highly variable. It depends on the iodine content of the soil in which they were produced and how they were processed.

Because the soil in the interior of this country is very low in iodine, crops and animals raised in much of our country are also low in iodine. That lead to widespread iodine deficiency in this country prior to the introduction of iodized salt in the 1920s. Iodized salt largely eliminated iodine deficiency in the 1920s. However, since the 1970s, iodine deficiency has been gradually returning to this country for many reasons.

In the 1920s most of our food was prepared at home, so most of the salt in our diet was iodized. However, today:

Processed foods are replacing home-cooked meals, and the salt used in processed foods is not iodized.

Much of the salt we use today is “gourmet” salt that is not iodized. Even sea salt often contains far less iodine than iodized salt.

Seaweed has never been considered a delicacy in this country, and increasingly, Americans are avoiding ocean fish because of concerns about our polluted oceans.

Iodine in commercial breads has traditionally come from the use of iodate as a dough conditioner. Today iodate has largely been replaced with bromide in commercial bread making. Not only does this trend decrease the amount of iodine available in our diet, but bromide also interferes with iodine utilization in our bodies.

Iodine in milk has traditionally come from the use of iodine-containing disinfectants to clean milk cans and teats. However, they have largely been replaced with other disinfectants.

Together these trends have combined to create the “perfect storm”. Iodine deficiency has, once again, become a major health concern in the US and other developed countries.

The Dangers Of Iodine Deficiency During Pregnancy

Iodine is an essential component of the thyroid hormone. Accordingly, inadequate iodine intake leads to hypothyroidism. Thus, you might expect iodine deficiency to be associated with symptoms like fatigue, sensitivity to cold, dry skin, and unexpected weight gain.

However, you may not have known that thyroid hormone is also essential for bone and neural development during fetal development and infancy. Because of that, thyroid hormone production increases dramatically during pregnancy and lactation (Hence, the increase in iodine requirement for pregnant and lactating women).

I can’t emphasize strongly enough the consequences of iodine deficiency during pregnancy and lactation. Here is what the experts say:

The American Academy of Pediatrics says: “…mild iodine deficiency can affect cognitive development of the child”

The National Institutes of Health says: “[Mild] iodine deficiency can cause lower than average IQ in infants and children…”

The World Health Organization says: “Iodine deficiency is the single greatest cause of preventable intellectual disability in children worldwide.”

The Bottom Line

Iodine is important for bone and neural development during both fetal development and infancy. Because of this, iodine requirements are significantly higher during pregnancy and breastfeeding.

The iodine content of the American diet has decreased significantly since the 1970s. Today approximately 1/3 of pregnant and lactating women in the United States are at least marginally iodine deficient.

The National Institutes of Health, the American Academy of Pediatrics, and the World Health Organization all warn that even mild iodine deficiency during pregnancy and lactation can result in cognitive impairment in children.

Because of this, the American Thyroid Association and the American Academy of Pediatrics recommend that pregnant and lactating women take a supplement providing 150 ug of iodine. That corresponds to at least 197 ug of potassium iodide (the unit shown on most supplement labels).

Only 50% of prenatal supplements and 15% of multivitamin supplements contain iodine. Many that do contain iodine do not provide the recommended 197 ug of potassium iodide.

In short, many pregnant and lactating women in this country are not getting enough iodine from their diet; the consequences of even mild iodine deficiency are significant; and the supplements they are taking may not provide the iodine they need.

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.

Can You Eat Spinach For Muscle Growth

November 29, 2016 by Dr. Steve Chaney

Was Popeye Right?

Author: Dr. Stephen Chaney

You may have seen the recent headlines proclaiming that eating spinach will make you stronger. The more “mature” adults among my readers may remember the Popeye cartoons of our youth. Every time Popeye was on the brink of disaster he would down a can of spinach and become superhuman. Was Popeye right? Can spinach actually improve strength and endurance? Can you eat spinach for muscle growth? To answer those questions, I analyzed the study behind the headlines.

The short answer is that there may be some truth to the headlines, but you would never be able to prove it from the study they quoted.

Even worse, this study and the headlines it generated are typical of the sports nutrition marketplace. There are far too many headlines and sports nutrition products based on weak and inconclusive studies.

Spinach for Muscle Growth?

Let’s start at the beginning. In the first place the study behind the headlines (De Smet et al., Frontiers In Physiology, 7: 233-244, 2016) did not actually use spinach. In fact, participants were advised to avoid nitrate-rich foods like spinach and beets during the study.

The study enrolled moderately-trained male students from the University of Leuven in Belgium. All the participants completed 5 weeks of sprint interval training (SIT) consisting of 30 second sprints followed by 4.5-minute recovery intervals on an exercise cycle. This was repeated 4-6 times per session 3 times per week.

One group took a sodium nitrate supplement containing 400 mg of nitrate 30 minutes before each workout. The other group received a placebo. There were only 9 students in each group. [I have simplified the study design for the purposes of this discussion. There were other aspects of the study, but they are not relevant to our discussion.]

The investigators measured maximum oxygen consumption (a measure of exercise efficiency and endurance), maximum power output during a 30-second sprint, and composition of quadriceps muscle fibers both before the 5-week training started and again when it was completed.

The results were disappointing:

Nitrate supplementation caused a modest increase in fast twitch (type IIa) muscle fibers compared to placebo. That is a physiological response that may (or may not, depending on who you believe) allow high intensity exercise to be sustained for longer without fatigue.
Nitrate supplementation failed to show any significant benefit for any other measure of exercise capacity. In particular, no effect of nitrate supplementation was observed on:
- Maximum oxygen consumption
- Maximum power output
- Peak heart rate
- Time to exhaustion.
- Various metabolic markers of exercise efficiency

In spite of these largely negative results, the authors concluded: “The current experiment demonstrated that oral nitrate supplementation during short-term sprint-interval training increased the proportion of type IIa muscle fibers, which may contribute to enhanced performance in short maximal exercise events…”

“May” is the operative word here. Their data did not provide any evidence that nitrate supplementation actually improved performance.

Online headlines (the kind of nutrition information most people read) took it a step further. For example, one headline claimed “Spinach Can Boost Your Physical Fitness and Muscle Strength.” That headline came out of thin air.

Sports Nutrition Myths

Unfortunately, this study is typical of many of the sports nutrition studies I have reviewed over the years. Most of them are very small studies. In many of them only one or two measure exercise performance change, while other measures show no effect of supplementation.

That doesn’t stop bloggers from hyping the studies and creating sports nutrition myths. It also doesn’t stop companies from offering sports products with those ingredients and making outrageous claims about how their product will make you bigger, faster, and stronger. For example, a claim that you can eat spinach for muscle growth.

It is only when dozens of studies have been published, and a meta-analysis combines the data from all the studies that we are in a position to see whether any particular nutrient has a statistically significant effect on performance.

Must You Eat Spinach for Muscle Growth or Could Nitrates Provide Exercise Benefits?

Despite the weakness of this particular study, there is reason to believe that nitrates might improve exercise performance.

There is a plausible mechanism. In the body nitrates are converted to nitric oxide, which improves arterial health, lowers blood pressure, and enhances blood flow. Increased blood flow to the muscles could enhance exercise efficiency.

Other studies have come to a similar conclusion. There are several other exercise studies Health Benefits of Beetroot Juice involving supplements containing either nitrates or beetroot juice (which is rich in nitrates) that have suggested that supplementation improves exercise efficiency. Each of the studies are small and inconclusive by themselves, but in the aggregate they suggest that nitrate may have some benefits.

Arginine, which also enhances nitric oxide production, is well established in the sports nutrition world. There are dozens of published exercise studies involving arginine and meta-analyses of these studies suggest that arginine provides modest benefits. However, there is an important caveat, which I shall explain below.

In short, the idea that nitrate supplementation might improve exercise performance is plausible. However, plausible is a long way from proven.

The Ultimate Irony

When you analyze the meta-analyses of arginine supplementation and exercise performance studies, the ultimate irony is that arginine supplementation is most effective for untrained individuals who are just beginning an exercise program. It provides little benefit for trained athletes (R. Bescos et al, Sports Medicine, 42: 99‐117,2012).

There is a logical explanation for this observation. Intense exercise also enhances nitric oxide production and blood flow to the muscle. Most highly trained athletes have already maxed their nitric oxide levels and have excellent blood flow to their muscles. Arginine (or nitrate) supplementation provides little additional benefit for them.

Why do I call this the ultimate irony? Think about it for a minute.

The people most likely to use sports supplements with arginine or nitrate are gym rats and highly trained athletes – the people who get the least benefit from those supplements.

The people least likely to use special sports supplements with arginine or nitrate are the weekend warriors and the busy professionals who are just trying to stay fit – the people who are most likely to benefit from those supplements.

The Bottom Line

Recent headlines have suggested that you can eat spinach for muscle growth and exercise performance.

When you look at the study behind the headlines, the study was done with nitrate, not with spinach. Spinach is a nitrate-rich food (as are beet roots), but the headlines were clearly misleading.

The study was also inconclusive. It was a small study, and most parameters of exercise performance were not affected by nitrate supplementation.

Unfortunately, this kind of small, inconclusive study is all too common in the sports nutrition literature. That doesn’t stop bloggers from hyping the studies and creating sports nutrition myths. It also doesn’t stop companies from offering sports nutrition products with those ingredients and making outrageous claims about how their product will make you bigger, faster, and stronger.

However, other studies suggest the idea that nitrate in food or supplements could improve exercise performance is plausible.

In our bodies, nitrate is converted to nitric oxide, which enhances blood flow to the muscles.

Other studies with nitrate and with beetroot juice (an excellent source of nitrate) have shown some exercise benefits.

Arginine, which is also converted to nitric oxide, is a fairly well established sports supplement.

Of course, plausible is a long way from proven.

The ultimate irony is that the people most likely to use sports supplements with arginine or nitrates are gym rats and highly trained athletes. They already have excellent blood flow to their muscles. They are the people who get the least benefit from those supplements.

In contrast, the people least likely to use special sports supplements with arginine or nitrates are the weekend warriors and the busy professionals who are just trying to stay fit. Those are the people who are most likely to benefit from those supplements.

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 There Anti-Aging Vitamins?

November 22, 2016 by Dr. Steve Chaney

Could You Live To Be 120 And Beyond?

Author: Dr. Stephen Chaney

Recent headlines suggest that we can slow biological aging just by increasing our consumption of certain vitamins. That sounds wonderful. After all, everyone is still hoping for that mythical “Fountain of Youth” and anti-aging vitamins could be just the ticket.

But, what did the paper behind the headlines actually show? The paper (J-Y Lee et al, Journal of Human Nutrition and Dietetics, DOI: 10.1111/jhn.12403, 2016) reported that people who consumed the most vitamin C and folic acid had the longest telomeres.

You might be wondering how journalists extrapolated from that study to headlines proclaiming that those vitamins could slow biological aging. To understand the answer to that question you need to know two things:

What is biological aging?

What are telomeres and why are they important?

What Is Biological Aging?

In simplest terms, biological aging refers to the aging process on a cellular level. This concept is based on the “Hayflick Limit” first proposed by Leonard Hayflick in 1962. He showed that normal human cells have a maximum lifespan of 40-60 cell divisions. As they approach that upper limit, DNA damage accumulates and cell division slows and eventually stops.

The “Hayflick Limit” is important because our tissues depend on constant cell division to remain young and vital. Our organs are made up of various tissues and depend on those tissues performing at an optimal level. Thus, as more and more cells lose the ability to divide, our tissues and our organs begin to age. This is thought to be associated with disease and eventually death.

Thus, even though biological aging refers to aging at a cellular level, its significance is thought to extend far beyond the cellular level. It is thought to influence aging, disease, and death at a whole-body level. It reminds me of the famous quote “For want of a nail…the kingdom was lost.” If you’ve forgotten that quote, look it up. It is a perfect analogy for how something that seems so inconsequential can have such a profound effect on our health and mortality.

What Are Telomeres And Why Are They Important?

Telomeres are sequences of repetitive DNA at the ends of our chromosomes that protect their integrity. Telomeres become progressively shorter as we age. As a very simple analogy we can think of telomeres as being similar to the tips of our shoelaces. If you have ever lost the tip of your shoelace, you know that the shoelace is worthless once the tip is gone.

That analogy holds perfectly with respect to our telomeres. As the telomers become progressively shorter, DNA division slows and eventually stops. DNA division is essential for cell division. Telomere shortening is postulated to be responsible for the Hayflick Limit. Thus, it is no surprise that telomere shortening is associated with aging, age-related diseases such as hypertension, diabetes, heart disease and dementia, and death.

Telomere shortening is a bad news, good news phenomenon. On the “bad” side, telomere shortening is inevitable. I hate to be the bearer of bad news, but we will all die at some point.

On the “good” side, there is tremendous heterogeneity in telomere length between individuals at any given age. Some of these differences in telomere length may be genetic, but many appear to be lifestyle related (MA Shammas, Current Opinion in Clinical Nutrition & Metabolic Care, 14: 28-34, 2011). For example, short telomers appear to be associated with things like smoking, environmental pollution, stress, meat consumption, and fat consumption. Long telomeres are associated with the lack of those things and with positive lifestyle characteristics such as exercise and consumption of fresh fruits and vegetables.

Are Some Vitamins Anti-Aging Vitamins?

More recent studies have begun to look at the influence of individual nutrients on telomere length. The study featured this week (J-Y Lee et al, Journal of Human Nutrition and Dietetics, DOI: 10.1111/jhn.12403, 2016) is just the latest example.

This study used food frequency questionnaires to assess nutrient intake of 1958 middle-aged and older Koreans between June 2001 and January 2003. They measured intake of vitamins A, B1, B2, B3, B6, B9 (folate), C and E plus calcium, phosphorous, potassium iron and zinc.

Ten years later they measured telomere length in the same population and reported that:

Telomere length was positively associated with intake of vitamin C, folate, and potassium.

No association with telomere length was seen for the other nutrients.

So, are these anti-aging vitamins? Let’s look at the strengths and weaknesses of this study.

This study has some notable strengths:

It is a fairly large study, so the results are statistically significant.

There is a good biochemical rationale for vitamin C and folate being protective for telomeres.

Antioxidants such as vitamin C, vitamin E, carotenoids, and polyphenols protect the DNA from oxidative damage.

Folic acid, vitamin B6, and vitamin B12 are involved in pathways that stabilize and repair DNA.

It is consistent with previous studies (See below)

However, this study also has some glaring weaknesses:

It only measures associations, not cause and effect.

The diet analysis was not repeated at the end of the study. The authors assumed that dietary habits did not change, but we don’t know that.

The use of dietary supplements was not assessed, so we don’t know how that might have influenced the outcome.

What Does This Study Mean For You?

If we look at the totality of published studies(MA Shammas, Current Opinion in Clinical Nutrition & Metabolic Care, 14: 28-34, 2011) :

There is good evidence that optimal intake of the antioxidants C and E is positively associated with telomere length.

There is good evidence that optimal intake of folic acid and vitamin B12 is positively associated with telomere length.

There is preliminary evidence that optimal intake of carotenoids, polyphenols, and omega-3 fatty acids is positively associated with telomere length.

However, there is a lot we don’t know about telomeres. We know that short telomeres are associated with aging, age-related diseases and death. What we do not know is whether telomere shortening is the cause of the aging process or merely a marker of aging. Let me rephrase those two possibilities in a more understandable manner.

If telomere shortening is the cause of the aging process, anything we can do to decrease the rate of telomere shortening would slow the aging process and delay the onset of age-related diseases. If the vitamins mentioned above then caused this decrease, they could indeed be considered anti-aging vitamins.

If telomere length is simply a marker of aging, we can consider it like the “canary in the coal mine”. That analogy might be particularly apt. The value of the canary is that it can detect toxic gases when they are still undetectable to humans. It turns out that it is virtually impossible to detect the effect of nutrient intake on longevity (We simply live too long), and it has proven very difficult to determine the effect of nutrient intake on age-related diseases. Having a simple marker of the aging process may well give us valuable insight into how we can best delay the aging process.

Either way longer telomeres are probably a good thing. Based on a limit of 40-60 cell divisions for normal human cells, Leonard Hayflick estimated a maximum human lifespan of 120 years. If we could truly decrease the rate of telomere shortening, would that potentially increase maximum human lifespan or would it mean that more of us reach 120 in good health? Most of us would probably be happy with either outcome.

The Bottom Line

Telomeres are the tips at the end of our chromosomes that protect the chromosomes from unraveling.

Our telomeres get progressively shorter as we get older. Short telomeres are associated with aging, age-related diseases, and death.

Recent studies have shown that our lifestyle can influence the rate of telomere shortening. For example:

Short telomers are associated with things like smoking, environmental pollution, stress, meat consumption, and fat consumption.

Long telomeres are associated with the lack of those things and with positive lifestyle characteristics such as exercise and consumption of fresh fruits and vegetables.

Recent studies have also shown that optimal intake of certain nutrients can influence the rate of telomere shortening. For example:

There is good evidence that optimal intake of the vitamins C, E, folic acid, and B12 is positively associated with telomere length.

There is preliminary evidence that optimal intake of carotenoids, polyphenols, and omega-3 fatty acids is positively associated with telomere length.

There is a lot that we do not know about telomere length. In particular,

We do not know whether telomere shortening is the cause of the aging process or merely a marker of aging, like the canary in the coal mine.

In either case, anything we can do to reduce the rate of telomere shortening is probably a good thing.

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.

Pain Behind The Knee Relief

November 15, 2016 by Dr. Steve Chaney

Is Surgery The Only Option?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Recently I was speaking at a convention and a woman came to me complaining of back of knee pain that was sharp each time she stood up. She had been told she needed knee surgery, but this was a solution she didn’t want to entertain. Her job has her sitting in one position for hours, and when I felt the back of her knee I found a small point that caused her a great deal of pain. She needed pain behind the knee relief.

What Causes Pain Behind The Knee After Sitting?

Pain behind the knee can be caused by a small muscle called “Popliteus.” The popliteus muscle originates on the posterior side of the tibia (shin bone) and inserts into the posterior femur (thigh bone). When it contracts (shortens) it causes your knee joint to bend. The nickname is “the key that unlocks the knee.” If your popliteus doesn’t contract, you can’t bend your knee.

Why A Muscle Can Cause Pain Behind The Knee

The problem is caused by the muscle being held contracted for an extended period of time. Muscle memory is a phenomenon that causes a muscle to stay in the shortened length after it has been held contracted for a long time. For example, in this case when your knee has been bent while you drive your car or sit at your desk, could cause pain behind the knee.

When you go to stand up the popliteus has shortened due to muscle memory and it won’t lengthen. You now have stiffness and back of knee pain because the muscle and tendon are pulling hard on the bones. Often a person will tell me that the pain feels like it’s “deep inside my knee joint.” It is deep inside your knee joint.

So, you sit down again, and the pain at the back of your knee stops hurting. However, it’s only not hurting because you have brought the two bones closer together so the pressure has stopped. It’s only making the matter worse in the long run.

BTW, this is what is happening all over your body. As a muscle gets tight because of spasms or shortened fibers, it is pulling hard on the tendon attachment at the insertion point. If you try to stretch the muscle without first releasing the tension, you are placing a greater strain on the joint where the tendon is attached.

So, what to do?

Releasing The Tension Can Relieve Pain Behind The Knee

I’ve always explained that applying steady pressure to the spasm (also called a “trigger point”) will release the tension and allow the muscle to stretch normally. As you hold the point it will become less and less painful, and soon it won’t hurt anymore. After the pain is gone you can safely stretch the muscle without tearing the fibers. This will release the tension and begin to relieve pain behind the knee.

Now it’s important to drink a lot of water after the treatment. If your muscle feels a bit sore you can use either ice (wrapped in a cloth) or arnica gel (a wonderful homeopathic remedy). Ice &/or arnica will heal the bruising caused by the knotted muscle fibers.

Treating The Muscle That Causes Pain Behind The Knee

I’ve written several self-treatment books and filmed unique self-treatment DVD programs, through the years. I’m happy to share this simple treatment that I demonstrate in my book, Treat Yourself To Pain-Free Living.

Put your foot onto a stool or chair. Bend your knee and wrap your hands around your knee joint. Have your middle fingers press directly into the area behind your knee joint and put your thumbs on your kneecap. You are using your thumbs as leverage and pressing into the muscles with your middle fingers. Move around an inch in any direction until you find the tender point and then maintain the pressure for at least 60 seconds.

You can also sit on the floor or your bed with your foot flat and your knee bent. Press up into the back of your knee, feeling for the painful tender point. Hold the pressure for 30-60 seconds.

End the treatment by slowly straightening your leg while you are still maintaining the pressure. You can repeat this movement 2-3 times.

It only took a few minutes of sustained pressure on the trigger point and the lady I mentioned above was out of pain! I had her press on the muscle, and she didn’t feel any discomfort. I checked again, and the pain behind the knee was gone. Imagine, only a few minutes and she avoided the possibility of knee surgery. She was thrilled!

It is always beneficial to check the muscles for spasms before you have non-life threatening surgery. Many times the pain can easily be eliminated by simply releasing the spasms that are putting pressure on the insertion point at the joint.

Wishing you well,

Julie Donnelly

About The Author

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 There Any Honest Nutritional Supplement Companies?

November 8, 2016 by Dr. Steve Chaney

Do They “Cherry Pick” Scientific Studies?

Author: Dr. Stephen Chaney

When we buy a food supplement from a company we assume that it will provide a benefit. We are trusting that company to be honest in their product claims. But, are there any honest nutritional supplement companies?

What if they were lying to us?
What if they had no clinical studies done with their product?
What if they were just quoting studies done with ingredients found in their product?
What if they were “cherry picking” the studies they listed to support the claims they wanted to make?

Unfortunately, that happens far too often in the nutraceutical industry. As an example, I came across an article in a recent issue of www.nutraingredients.com about a FDA warning letter (http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2016/ucm518533.htm) to a noni juice company. In case you are wondering, noni fruit is the latest in a long line of “magical fruits” that is going to cure everything that ails you.

The thing that brought this company to the FDA’s attention in the first place was the health claims the company made on their website. The company claimed or implied that their product would cure cancer, cure gout, cure arthritis, lower cholesterol, and help fight infections. Claims like that always invite FDA scrutiny.

What caught my attention, however, was the quote by an attorney specializing in FDA compliance issues that the studies cited on their website were “cherry picked” to support their claims. He said that the studies they cited “…do not meet the standards of third party literature…You have to include a full range [of published studies], and not just cherry pick the positive studies. It has to be a balanced presentation. It looks like they just did a literature search on noni and included only the positive studies.”

That statement caught my attention because it doesn’t just apply to just this one company. It is a practice that is common in the nutraceutical industry. Many supplement companies cherry pick studies from third party literature. They list only the studies that support their product claims and ignore the rest. That is misleading because it implies a level of proof for their product claims that does not exist. It is fundamentally dishonest. These are certainly not honest nutritional supplement companies.

Using Borrowed Science

The noni juice company cited in the FDA letter had no clinical studies to support their claims. Instead they quoted studies done with ingredients found in their product. This is what I call “borrowed science.”

I call this “borrowed science” because the studies were not actually done with their products. They were simply trying to “borrow” results done with individual ingredients and pretend that they applied them to their product.

Let me be clear. Third party studies done with ingredients found in a company’s product are of little value in predicting whether that product will provide any benefit to you. To claim otherwise is dishonest. Again, these are not honest nutritional supplement companies.

There are several reasons this is true.

In many cases, the amount of that ingredient provided by the supplement does not match the amount actually used in the clinical study they quote. The ingredient may or may not be effective at the dose provided in the supplement.

More importantly, a supplement usually contains multiple other components that may influence how a single ingredient works in your body. The other components may enhance the effectiveness of the ingredient in question, or they may inhibit it.

Without clinical trials done with their product, companies actually have no idea whether their product works or not.

Unfortunately, I see this practice all too frequently in the nutraceutical industry. Clinical trials are expensive. It’s cheaper and easier to search the literature for published studies you can “borrow” to support your product.

Honest Nutritional Supplement Companies Do Not“Cherry Pick” Studies

Even worse, many companies cherry pick studies from the literature to support the product claims they want to make.

To understand what that statement means you need to know a little bit about the scientific method. Most scientists design their experiments to disprove what other scientists have published. This is a self-correcting process that is a strength of the scientific method.

However, it also means that you will find articles in the literature supporting and refuting the benefits of almost every nutraceutical ingredient. The scientific community waits until enough studies have accumulated and then relies on the weight of evidence before drawing any conclusions.

Unfortunately, unscrupulous supplement companies decide first on what claims they want to make and quote only the studies that support those claims. This is what is referred to as “cherry picking” the studies.

The Dietary Supplement Health and Education Act of 1994 (otherwise known as DSHEA) is very clear about that. Section 5 of DSHEA states “…scientific journal articles, books and other publications can be used in the sale of dietary supplements provided…[they] are presented with other materials to create a balanced view of the scientific information…”

In plain words this legalese simply means that you can’t cherry pick studies. You can’t select only the studies that support your product claims and ignore those that don’t. Honest nutritional supplement companies would not use these deceitful practices.

However, this is a practice that I see all too often in the nutraceutical industry. It is dishonest. It is disgraceful

Are There Any Honest Nutritional Supplement Companies?

The bad news is that there are lots of supplement companies that do no clinical studies of their own. Instead they rely on borrowed science from studies that really do not provide proof that their products are either safe or effective. Even worse, many of those companies cherry pick only the studies that support their product claims and ignore studies that do not. This is a practice I regard as clearly dishonest. Those are companies I would avoid.

The good news is that there are a few companies that actually support clinical studies on their key products and publish those studies in peer reviewed scientific journals. Those are companies worthy of your consideration.

There are other things to take into account in selecting the best of the best – things like the number of studies and the quality of the studies. However, that’s a topic for another day.

Many Blogs Cherry Pick As Well

I can’t leave this topic without pointing out that many popular health and nutrition blogs, including those written by some well-known doctors, do exactly the same thing.

The pressures that lead to this behavior are obvious. The very popularity of these blogs depends on them being sensational week after week.

Unfortunately, true science is rarely sensational. It’s usually pretty wishy-washy. If you do a complete search of the literature, you usually find articles that are both for and against any point of view you wish to express. Occasionally, enough evidence accumulates on one side of an issue that scientists are willing to come to a definitive conclusion, but that conclusion is hardly ever sensational.

The only way that the authors of these popular blogs can make sensational claims each week is to cherry pick only the studies that support their point of view and ignore everything else.

Unfortunately, the average reader doesn’t realize this. They see the list of references supporting the claims and believe what they read. Then these bizarre claims get reposted over and over until the general public actually starts believing that they are true.

It really is a shame that DSHEA doesn’t apply to blogs. If it did, they wouldn’t be nearly as sensational, but they would be much more accurate. They would have to report on the whole body of scientific literature, rather than cherry picking just the studies that support their point of view.

In conclusion, there are some honest nutritional supplement companies, but be sure the company you choose to believe is citing studies on their actual products and not just ingredients in their products. Also, watch out for “cherry picking.”

The Bottom Line

The FDA recently sent a warning letter to a noni juice company for making unsupported health claims for their product. The company was claiming their product could cure things like cancer, gout and arthritis. Whenever a company makes claims like that, they can expect to draw the attention of the FDA.

An outside attorney specializing in FDA compliance pointed out that the company also had no good evidence to support their product claims. The company had done no clinical studies on the products. Instead they had “borrowed” the results of third party studies done with ingredients found in their product. Even worse, they had cherry picked only the studies that supported their product claims and ignored the studies that did not.

Third party studies done with ingredients found in a company’s product are often worthless in predicting whether that product will provide any benefit to you. I discuss the reasons for that in the article above.

Cherry picking only the studies that support a company’s product claims runs afoul of the Dietary Supplement Health and Education Act of 1994 (DSHEA) requirement that companies provide a balanced view of the scientific literature relating to their products. It is also misleading and dishonest.

Unfortunately, the practice of using “borrowed science” from third party studies and cherry picking only the studies that support their product claims is common in the nutraceutical industry. Supplement companies that rely on this kind of evidence to support their product claims are dishonest and should be avoided.

For products you can trust, choose companies that support clinical studies on their key products and published those studies in peer-reviewed journals. You should also look at the number and quality of studies, but that is a topic for another day.

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.

A Bad Diet as an Adult May be the Result of Poor Feeding Habits in Infancy

November 1, 2016 by Dr. Steve Chaney

“As The Twig Bends…”

Author: Dr. Stephen Chaney

You have probably heard the saying “As the twig bends, so grows the tree.” The origin of that quote is lost in lore of medieval England, but the saying absolutely rings true when we are talking about infant nutrition and a bad diet as an adult.

Most moms naturally assume that a healthy diet is important for their infants, but many new moms have questions:

What does a healthy diet for their infant look like?

What should they do if their infant is a fussy eater?

Could what they feed their infants influence their eating patterns and their health for years to come?

Of course, there is no shortage of advice. There are the family customs handed down from generation to generation. There is lots of advice on the internet, some of it offered by people who have no knowledge of nutrition. Your pediatrician’s advice may be based on what they learned in medical school, but it is just as likely to have come from their mother.

All of that advice is well meaning, but some of it is flat out wrong!

Fortunately, the Centers for Disease Control and the US Food and Drug Administration have sponsored a major study called the longitudinal Infant Feeding Practices Study II (IFPD II) to answer these and other important questions about infant feeding practices.

How The Study Was Set Up

The initial phase of the study was performed between May 2005 and June 2007, and the study design was reported in 2008 (Fein et al., Pediatrics, 122: S28-S35, 2008). During this phase of the study, investigators simply collected information on infant feeding practices from ~2000 mothers when their infants were between 1 month and 1 year of age.

The purpose of this phase of the investigation was simply to collect baseline data so that subsequent studies could correlate infant feeding practices with diet and health outcomes as these children got older.

This was a very comprehensive survey of infant feeding practices and health status:

The first neonatal feeding practices survey was sent when the infant was ~ 1 month old.
Between ages 2 to 7 months, nine more surveys were sent out on an approximately monthly basis. These surveys asked about infant feeding, health, care, and related issues.
After 7 months additional surveys were sent out every 7 weeks until the infant was 12 months old.
In addition, the study included two maternal dietary surveys, one during pregnancy and a second one 4 months after delivery.

A Bad Diet Can Begin in Infancy

In phase 2 of the study multiple investigators followed up with ~1,500 of these children at age 6 to find out how infant feeding practices correlated with their diet and health as they reached early childhood. These studies were all published in a special edition of the journal Pediatrics in 2014 (Pediatrics, 134: Supplement 1, September 2014). Key findings from these studies were:

Duration of Breastfeeding Is Positively Correlated With A Healthier Diet At Age 6(C.G. Perrine et al, Pediatrics, 134: S50-S55, 2014). Specifically:

Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.

Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.

However, no correlation was seen between the duration of breastfeeding and consumption of milk, sweets and salty snacks in this study.

The authors of this study made the interesting comment that the taste of breast milk varies somewhat depending on what the mother has eaten that day. In contrast, commercial infant formulas taste the same every time and are often somewhat sweeter than breast milk. They hypothesized that this normal variation in the taste of breast milk may make toddlers and young children more willing to accept new foods such as fruits and vegetables. Here, you can already start to see breastfeeding longer may help avoid a bad diet later.

Of course, the authors cannot eliminate the possibility that mothers who breastfeed longer are also choosier about what they feed their children.

Fruit and Vegetable Intake In Infancy Is Positively Correlated With Fruit and Vegetable Intake At Age 6(K.A. Grimm et al, Pediatrics, 134: S63-S69, 2014). Specifically:

33% of 6-year-olds in their survey consumed fruit less than once daily and 20% consumed vegetables less than once daily.

More importantly, children in their study who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.

The authors of the study made the interesting observation that a liking of things that are sweet or salty is hardwired into the human brain. A single exposure to sweet and salty foods during infancy may be all that it takes to create a lifelong craving for those kinds of foods and leading to a bad diet.

In contrast, it may take repeated exposure to fruits and vegetables during infancy to develop a familiarity and preference for those kinds of foods. One of the authors of this study reported in a previous study that infants who were offered green beans for the first time squinted and wrinkled their noses. However, many of those same infants opened their mouths to try a spoonful if parents persisted.

Once again, there are other factors to consider, such as the kind of diet parents are modeling for their children.

Consumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Consuming Them At Age 6(S. Park et al, Pediatrics, 134: S56-S62, 2014). This study speaks for itself, but it is troubling. I shudder every time I see a young mother wheeling her baby through a store with a soft drink in their baby bottle. Is this a bad diet for an infant?

The implication of these studies and several other studies published in that issue of Pediatrics is clear. Bad diets do begin in infancy. However, there is a positive side to these studies. Good diets also begin in infancy, and you are in charge of what your infant puts in their mouth.

Bad Health Begins In Infancy

These studies are critically important because bad diets are not just a victimless crime. Bad diets affect health. Eventually, they kill people. Here are two examples from this set of studies that show how an infant’s diet affects their health – one positively and one negatively.

Duration of Breastfeeding Is Positively Correlated With A Healthier Immune System At Age 6(R. Li et al, Pediatrics, 134: S13-S20, 2014). This study showed that longer breastfeeding and later introduction of foods was associated with lower rates of ear, throat, and sinus infections. This conclusion is not exactly new. It strongly supports what a number of previous studies have shown.

Consumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Obesity At Age 6(L. Pan et al, Pediatrics, 134: S29-S35, 2014). This finding is not surprising. The study mentioned above showed that consumption of sugar-sweetened beverages during infancy doubles the odds of consuming them at 6. Moreover, previous studies have clearly shown that consumption of sugar-sweetened beverages is associated with obesity in children.

However, this finding is troubling because obese children often become obese adults, and obesity is associated with many serious health issues.

Again, the implication of these studies is clear. Both bad health and good health can be strongly influenced by feeding habits established in infancy.

The Bottom Line

A major clinical study supported by the Centers for Disease Control and Prevention and the US Food and Drug Administration monitored infant feeding patterns during the first year and compared those patterns with diet habits and health outcomes at age 6.

The duration of breastfeeding was positively associated with a healthier diet and a stronger immune system at age 6. Specifically:

Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.

Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.

Infants who were breastfed for 12 months or longer were significantly less likely to suffer from of ear, throat, and sinus infections.

The pattern of fruit and vegetable consumption established in late infancy was maintained through at least age 6. Specifically:

Children who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.

Consumption of sugar-sweetened beverages during infancy has a negative impact on both diet and health through at least age 6. Specifically:

Consumption of sugar-sweetened drinks during infancy doubles the chances that children will still be consuming sugar-sweetened beverages and will be obese at age 6.

This study strongly confirms what many smaller studies have suggested for years. It reinforces the importance of breastfeeding for at least the first 12 months and slowly transitioning to healthy foods rather than sugar-sweetened beverages and junk foods. It shows that what we feed our infants may influence their diet and their health for a lifetime.

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 Help Prevent Asthma Attacks?

October 25, 2016 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

What do the experts say about vitamin D helping to prevent asthma attacks? You’ve seen the headlines. Vitamin D is no longer just for healthy bones. It has become the latest “miracle” nutrient. If you believe everything you read, vitamin D can prevent or cure everything from multiple sclerosis to diabetes, heart disease, and cancer. Unfortunately, the evidence for many of those claims is weak.

However, the effect of vitamin D on the severity of asthma symptoms appears to be an exception. That relationship appears to be on much more solid ground.

A review published last year(S.K. Bantz et al, Annals of Pediatrics and Child Health, 3: pii: 1032, 2015) concluded “We emphasize that all children, especially those who are asthmatic, should be assessed to ensure adequate intake or supplementation with at least the minimum recommended doses of vitamin D. The simple intervention of vitamin D supplementation may provide significant clinical improvement in atopic disease, especially asthma.” [Note: Atopic disease refers to diseases characterized by a hyperallergenic response, such as eczema, hay fever, and asthma.]

That was followed by the recent publication of a Cochrane Review that concluded “Vitamin D is likely to offer protection against severe asthma attacks”. To understand the significance of that statement you need to understand that this is not just another clinical study or another review. Cochrane Reviews are conducted by an international group of experts and are considered the “Gold Standard” for evidence-based medicine.

You may remember that famous commercial: “When E.F. Hutton speaks, people listen.” In this case: “When Cochrane Reviews speak, doctors listen.”

Let’s look briefly at how the review was conducted, and then examine exactly what the review said, and what it didn’t say.

Does Vitamin D Help Prevent Asthma Attacks?

One of the characteristics of Cochrane Reviews that set them apart from many of the other reviews that you find in the literature is that they include only the highest quality clinical studies in their analysis. This is one of the things that gives them such credibility.

This particular Cochrane Review included seven trials involving a total of 435 children and two trials involving a total of 658 adults. Most trial participants had mild to moderate asthma. The duration of the trials ranged from four to 12 months. All studies were placebo controlled and used close to RDA recommended doses of vitamin D.

The results were pretty clear cut:

Vitamin D supplementation reduced the average number of severe asthma attacks requiring treatment with oral steroids by 36%. This conclusion was based on 3 high-quality studies involving 680 participants. Here, these studies clearly show vitamin D does help prevent asthma attacks.

Vitamin D supplementation reduced the number of acute asthma attacks requiring emergency room visits and/or hospitalizations by 50%. This conclusion was based on 7 high-quality studies with 963 participants. These studies also show vitamin D helps prevent asthma attacks.

None of the studies reported any severe adverse effects from vitamin D supplementation. (Compare that with all warnings associated with those ads for asthma medications you see on TV.)

However, they did not see any effect of vitamin D supplementation on day-to-day asthma symptoms.

What Does This Study Mean For You?

This study strongly suggests that vitamin D supplementation in the RDA range (600 IU for ages 1-70 and 800 IU for adults over 70) significantly reduces the risk of severe asthma attacks requiring steroids or hospitalization. Thus, if you or your child have asthma, vitamin D supplementation in the RDA range just makes sense.

However, this study also suggest that vitamin D is not a panacea that will make all asthma symptoms disappear.

Also, even Cochrane Reviews have limitations.

None of the studies included in this review looked at vitamin D status prior to the study. We simply don’t know whether vitamin D supplementation might be effective at reducing day-to-day asthma symptoms in individuals who were vitamin D deficient.

The studies included in this review did not include asthma sufferers with severe symptoms. Again, we don’t know whether vitamin D supplementation might make day-to-day symptoms more tolerable and easily controlled for people with severe asthma symptoms

One final thought: Blood levels of 25-hydroxy-vitamin D are the best indicators of vitamin D status. For reasons that we don’t understand, not everyone consuming RDA levels of vitamin D ends up with optimal levels (50-75 nmoles/L). For that reason, it is a good idea to get your blood levels of 25-hydroxy-vitamin D tested as part of your annual physical exam.

If you are already getting RDA levels of vitamin D and your 25-hydroxy-vitamin D levels are not in the optimal range, you may want to supplement with extra vitamin D. Just be sure to monitor your 25-hydroxy-vitamin D levels on a regular basis to make sure they don’t exceed the optimal range.

So, according to the Cochrane Review, vitamin D does help prevent asthma attacks.

The Bottom Line

A recent Cochrane Review concluded that vitamin D supplementation in the RDA range (600 IU for ages 1-70 and 800 IU for adults over 70) significantly reduces the risk of severe asthma attacks requiring steroids or hospitalization in both children and adults. This is significant because Cochrane Reviews are considered the Gold Standard for evidence-based medicine.

Thus, if you or your child have asthma, vitamin D supplementation in the RDA range just makes sense.

However, blood levels of 25-hydroxy-vitamin D are the best measure of vitamin status, and not everyone consuming RDA levels of vitamin D ends up with optimal levels (50-75 nmoles/L). If you are already getting RDA levels of vitamin D in your diet and your 25-hydroxy-vitamin D levels are not in the optimal range, you may want to supplement with extra vitamin D. Just be sure to monitor your 25-hydroxy-vitamin D levels on a regular basis to make sure they don’t exceed the optimal range.

This Cochrane Review did not find any effect of vitamin D supplementation on day-to-day asthma symptoms.

However, even Cochrane Reviews have limitations.

None of the studies included in this review looked at vitamin D status prior to the study. We simply don’t know whether vitamin D supplementation might be effective at reducing day-to-day asthma symptoms in individuals who were vitamin D deficient.

The studies included in this review did not include asthma sufferers with severe symptoms. Again, we don’t know whether vitamin D supplementation might make day-to-day symptoms more tolerable and easily controlled for people with severe asthma symptoms

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.