Dr. Steve Chaney

Are Some Omega-3 Fish Oil Supplements Better Than Others?

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Author: Dr. Stephen Chaney

truth about omega-3 fish oil supplementThe ethyl ester form of omega-3 fatty acids from fish oil has been the industry standard for high purity omega-3 fish oil supplements for many years. It is very stable, easily purified, and well absorbed by the body. What’s not to like?

If you believe some recent advertisements, there is a lot not to like about the ethyl ester form of omega-3s. These ads each claim that their particular form of omega-3s is more natural, better absorbed, and more efficiently incorporated into cell membranes, or some combination of those features. They each cite clinical studies “proving” that their products are superior. These advertisements seem so plausible and so compelling.

However, most of these advertisements come from relatively new companies that are trying to make a name for themselves in a very profitable and competitive product niche. Are the advertisements true, or is it all just smoke and mirrors? Most of these advertisements rate at least one Pinocchio.

However, it is almost impossible to tell you why I consider these advertisements omega-3 fish oil supplements to be misleading without getting a little “techie”, so let’s start with some basic definitions. I call this section “Omega-3s 101.”

 

Omega-3s 101

 

Let’s start with some basic definitions:

  • Free fatty acids (FFA) are long chain hydrocarbons with a single acid group at the end. They are only slightly water soluble. They are important intermediates in metabolism, but they are almost always combined with something else in the body.
  • Saturated fatty acids contain no double bonds, monounsaturated fatty acids contain one double bond, and polyunsaturated fatty acids contain multiple double bonds. The number of double bonds primarily affects whether they are liquids (polyunsaturated) or solids (saturated) at room temperature.
  • omega-3 fatty acidsThere are two classes of polyunsaturated fatty acids that are essential because the body cannot make them. Those with a double bond 3 carbons from the end are called omega-3s(If you think about the Greek alphabet, omega is at the end). Those with a double bond 6 carbons from the end are called omega-6s.
  • When 3 fatty acids are combined with a single molecule of glycerol they form very water insoluble compounds commonly referred to as fats or triglycerides. The proper chemical name is triacylglycerol, which is abbreviated TAG.
  • If one of the fatty acids on the glycerol chain is replaced by a compound containing phosphate and other charged residues, the resulting complex is called a phospholipid (PL). Because these compounds have a hydrocarbon surface that is attracted to fats and a highly charged surface that is attracted to water, they are good at emulsifying fats and are an important part of membrane structure. One phospholipid that is a major component of membranes is called phosphatidylcholine (PC), also known as lecithin.

Next, let’s look at how omega-3 fatty acids are metabolized:

  • The omega-3s in fish oil are primarily in the form of triglycerides, with small amounts of phospholipids. The omega-3s in most omega-3 supplements are in the form of ethyl esters for the reasons stated above.
  • Before the omega-3s leave the intestine they are hydrolyzed to free fatty acids.
  • In the cells that line the intestine the omega-3s are reconverted back into triglycerides and phospholipids and incorporated into special lipid-protein complexes for transport through the blood.
  • Once these lipid-protein complexes reach our cells, their contents are delivered to the cell where they can be stored as fat (TAG), used for energy (FFA), or incorporated into membranes (PL). It is primarily the omega-3s incorporated in cellular membranes that are thought to be responsible for the beneficial effects of omega-3s.

Finally, we should ask how one measures the bioavailability of the various forms of omega-3s:

While there are some nuances that I did not cover, the basic mechanisms of absorption and metabolism of omega-3s are remarkably similar regardless of whether they start out in the ethyl ester, triglyceride, phospholipid, or free fatty acid form. The questions then become, how does one test how efficiently the various forms are utilized by the body and how much do these individual test actually tell us?

  • When we look at what happens in the bloodstream, we need to be aware that we are looking at a combination of two effects – how rapidly the substance enters the bloodstream and how rapidly it leaves from the bloodstream. There are three important parameters we can measure when looking at delivery of omega-3s to the bloodstream:
    • The maximum concentration achieved (Cmax)
    • How rapidly that maximum concentration was achieved (Tmax)
    • The total amount in the bloodstream over time (AUC)
  • When you look at some of the ads touting specialized forms of omega-3s, they are usually based on studies looking at either the maximum levels of omega-3s in the bloodstream (Cmax) or how rapidly those maximum levels were achieved (Tmax). (One suspects the ads may have selectively featured whichever parameter made their product look best). However, the parameter that really matters is the total concentration of omega-3s achieved over time (AUC).
  • Finally, the most important question is how much of the omega-3 is actually incorporated into cellular membranes. Once again, there is more than one parameter that can be measured.
  • One can measure the level of omega-3s found in cellular membranes in a short term study (a few hours) or in a long term study following many weeks of supplementation.
  • The short term studies only measure the rate of incorporation. The long term studies measure the steady state levels attained over time, which is a much more relevant measure.
  • Once again, the ads touting specialized products are usually based on short term studies which are really measuring an initial rate of incorporation of omega-3s into cellular membranes, not on long term studies that measure the steady state level of omega-3s achieved over time.

 

Are Some Omega-3 Fish Oil Supplements Better Than Others?

omega-3 fish oil supplementThere has been a lot of confusion in the literature about whether the form of omega-3 supplements matters. Various studies have been published supporting the superiority of one form or another of omega-3s. Most of these studies have been supported by manufacturers who have a particular form of omega-3s they want to sell, and, as I mentioned above, the parameters tested seem to have been selected to make their supplement look good.  So, are some omega-3 fish oil supplements better than others?

 

Finally, someone has designed a comprehensive study to clear up all the confusion and provide answers that can be trusted (West et al, British Journal of Nutrition, 116: 788-797, 2016). Interestingly, this research was supported by a pharmaceutical company (Vifor Pharma) that does not appear to sell an omega-3 product currently. Perhaps they simply wanted to find out what worked best before designing their own product. What a novel concept!

The authors tested 4 different forms of omega-3 fish oil supplements:

  • Unmodified fish oil containing the omega-3s primarily in triglyceride form (uTAG).
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids (FFA).
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids and converted back to triglycerides (TAG)
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids and converted to ethyl esters (EE)

All 4 supplements contained 1.1 grams of EPA and 0.37 grams of DHA.

The authors conducted two studies:

  • One was a cross-over study where healthy men consumed each of the supplements in random order on different days with 14 days between tests. Blood samples were collected over the next 6 hours and levels of EPA and DHA in the blood and cellular membranes was determined.
  • The other was a long term study in which a randomized group of healthy men and women consumed one of the supplements for 12-weeks and incorporation of the EPA and DHA into cellular membranes was measured.

The results were pretty clear cut:

  • In the short term study there were no significant differences between the various supplements in the rate of uptake, maximum concentration achieved, or the total concentration over time when uptake of omega-3s into plasma triglycerides and phospholipids was measured.
  • The ethyl ester form was less efficiently incorporated into plasma free fatty acids than the other forms as reported in some previous studies, but this is perhaps the least important parameter measured, and there was large variability from subject to subject.
  • In the long term study, no significant differences were seen between the various supplements in omega-3 incorporation into cellular membranes.

The authors concluded: “Together, these findings show that in healthy individuals neither the lipid structure nor the overall fatty acid composition of supplements influence their bioavailability during dietary supplementation, despite the apparent lower postprandial availability [in short term studies] of EPA + DHA ethyl esters compared with triglycerides or free fatty acids.”

What Do These Studies Mean For You?

You can forget all those ads hyping the newest, greatest form of omega-3 fish oil supplements. Objective research has shown there is not a dimes worth of difference between the various forms of omega-3 supplements.

A far more important question is the purity of the omega-3 supplement you are using. Purity of omega-3 supplements is a huge issue. You need to remember that the EPA + DHA supplements you purchase come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

Sustainability is also an issue, so you should choose manufacturers who source their omega-3s in a sustainable manner. There are two comments I will make about sustainability so you won’t be misled.

  • Krill oil is marketed as a more sustainable source of omega-3s. Krill reserves are quite large, but they are not infinite. Krill is also the very foundation of the food chain that supports a large percentage of our ocean’s fish. We need to be very cautious about depleting our krill reserves.
  • Omega-3s derived from algae are also marketed as a more sustainable source of omega-3s. Algae-derived omega-3s have purity issues of their own, but may become an important source of omega-3s once those issues have been resolved.

 

The Bottom Line

  • The ethyl ester form of omega-3 fatty acids from fish oil has been the industry standard for high purity fish oil supplements for many years. It is very stable, easily purified, and well absorbed by the body.
  • However, in recent years, some manufacturers have been claiming that their omega-3 fish oil supplements were better utilized by the body because their supplements contained the omega-3s in triglyceride or free fatty acid forms.
  • Unfortunately, the clinical studies supporting those claims have been supported by the manufacturers making the products. There is reason to suspect that the data has been “cherry picked” to support the conclusions that support the manufacturer’s claims.
  • Finally, an independent and comprehensive study has compared the various forms of omega-3 fatty acids. It found that neither the lipid structure nor the overall fatty acid composition of omega-3 supplements influenced their bioavailability during long term dietary supplementation.
  • A far more important question is the purity of the omega-3 supplement you are using. Purity of omega-3 supplements is a huge issue. You need to remember that the EPA + DHA supplements you purchase come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

Are There Diets to Fight Depression In Women

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A Story of 6 Blind Men And An Elephant

Author: Dr. Stephen Chaney

 

 

6 blind men and a elephantAre there diets to fight depression in women?  This week’s health tip reminds me of the story of 6 blind men and an elephant. You probably remember the story. One blind man grabbed a leg and declared that an elephant is like a tree trunk. Another blind man grabbed the tail and declared that an elephant was like a rope – and so it went. Each blind man had a different version of reality, but none of them really knew what an elephant was like.

Sometimes science is like that. Every scientific study is designed to test a specific hypothesis, and sometimes we scientists can become limited by the hypothesis we are testing. We only see what we are looking for. We become like the blind men trying to figure out what an elephant really is.

That thought came to mind recently when one study claimed that an anti-inflammatory diet decreased the risk of depression by 26% in women, and another claimed that increased flavonoid intake was the secret to decreasing depression in women. Of course, both of those reports came on the heels of another study a few months ago claiming that a Mediterranean diet was the secret to decreasing depression.

If all of this sounds confusing, keep that image of the blind men and the elephant in your mind for a while. I’m going to come back to the elephant later, but let me start by evaluating the merits of the two most recent studies which claim there are diets to fight depression in women.

How Were These Studies Designed?

diets to fight depressionThe first study (Shivappa et al, British Journal of Nutrition, doi:10.1017/S0007114516002853, 2016)  was designed to test the association between the anti-inflammatory potential of their diets and the risk of depression in middle-aged Australian women. The study followed 6,438 women with an average age of 52 for 12 years.

Self-administered surveys were sent to the participants every 2-3 years (most participants completed 5 surveys during the study). A Dietary Inflammation Index (DII) was calculated based on the food frequency portion of the surveys. Depression scores were calculated based on their answers to 10 questions from a well established depression rating system.

This was a well designed study and the results were fairly straight forward. Those women consuming the most anti-inflammatory diets were 26% less likely to develop depression than the women consuming the most pro-inflammatory diets.

The second study (Chang et al, American Journal of Clinical Nutrition, doi: 10.3945/ajcn.115.124545, 2016) was designed to test the association between flavonoid intake and depression in middle aged and older American women. This study followed 82,643 women ages 36-80 for an average of 10 years.

Flavonoid intake was calculated based on food frequency questionnaires administered every 4 years. Depression was assessed based on several well established ratings systems.

Again, this was a very well designed study, and the results were quite impressive:

  • Women who consumed the largest amounts of flavonoids were 7-10% less likely to develop depression than women consuming the least flavonoids.
  • When the study was broken down into flavonoid-containing foods, citrus fruits appeared to be particularly beneficial. Women consuming >2 servings per week were 18% less likely to develop depression than women consuming <1 serving per week.
  • Tea also scored high in their analysis. Women consuming >4 cups per day were 12% less likely to develop depression than women who rarely or never consumed tea.
  • While those flavonoid-rich foods stood out, the authors emphasized that there were no “magic” foods. It was a composite of all flavonoid containing foods that was related to lower depression risk.
  • The effect of a flavonoid-rich diet was particularly beneficial for older women. For women aged 65 or older at the beginning of the study, high flavonoid intake was associated with a 17% lower risk of developing depression.

 

Diets to Fight Depression:  The Secret

diets to fight depression secretsI have just described two very well designed studies on diets to fight depression in women. One concluded that an anti-inflammatory diet reduced the risk of depression while the other concluded that diets rich in flavonoids decreased the risk of depression. I have previously described studies suggesting that omega-3 fatty acids decrease depression risk in women and that consuming junk food increases depression risk . Other studies have suggested that a Mediterranean diet may significantly reduce depression.

If you are looking for a natural solution to recurring depression, these individual reports are probably confusing and overwhelming. I call it the “study du jour” syndrome. It can lead to paralysis. You just don’t know what you should try first.

What if these individual studies were like the blind men trying to describe an elephant?  Perhaps we need to step back and see if we can find the commonality in all of these studies. We need to look for the elephant.

For example, we might start by asking what is an anti-inflammatory diet? It turns out that diets rich in fruits, vegetables, fatty fish, olive oil and legumes are anti-inflammatory, while diets rich in saturated fats, cholesterol, and refined carbohydrates are pro-inflammatory. In short, the anti-inflammatory diet is very similar to the Mediterranean diet, and fully consistent with the reported benefits of omega-3 fatty acids. The pro-inflammatory diet, on the other hand, perfectly describes a junk food diet loaded with fat, cholesterol, and simple sugars and are not diets to fight depression.

What about diets rich in flavonoids? What are those flavonoid-rich foods? It turns out that flavonoids are found primarily in plant foods, and fruits, vegetables, and whole grains.  Beverages such as tea and coffee are particularly good sources.

So the secret is that there is no secret. Your mom was right all along. Eat your fruits, vegetables and whole grains. Take your fish oil. Take a vitamin supplement to make sure you didn’t miss anything. Avoid the junk foods. You’ll be healthier, and you’ll be happier. Include these in your diets to fight depression.

What Do These Studies Mean For You?

When considered individually these studies may seem confusing. However, when you consider them altogether the evidence is overwhelming. A good diet can significantly reduce your risk of depression, and a bad diet can make your depression even worse.

Of course, diet alone will not be enough to prevent depression in everyone. A more holistic approach would be to include exercise, socialization, and some stress reduction practices. Whether stress reduction occurs through yoga, meditation, counseling or other practices will vary from individual to individual.

Of course, if your depression is severe, professional help may be needed. I regard anti-depressant medications as a very last resort, but they can be life savers for some people.

So, with the inclusion of the right foods, the above studies seem to show there are diets to fight depression in women.

 

The Bottom Line

 

  • Two very good studies have recently been published concerning diet and depression in women:
  • One study concluded that an anti-inflammatory diet reduced the risk of depression in women.
  • Another study concluded that a diet rich in flavonoids reduced the risk of depression in women.
  • Other recent studies have concluded that diets rich in omega-3s and Mediterranean diets decrease depression risk in women. Another study concluded that consuming junk foods significantly increased depression risk.
  • When considered individually these studies may seem confusing. However, when you consider them altogether the evidence is overwhelming. A good diet can significantly reduce your risk of depression, and a bad diet can make your depression even worse.
  • Your mom was right all along. Eat your fruits, vegetables and whole grains. Take your fish oil. Take a vitamin supplement to make sure you didn’t miss anything. Avoid the junk foods. You’ll be healthier, and you’ll be happier
  • Of course, diet alone will not be enough to prevent depression in everyone. A more holistic approach would be to include exercise, socialization, and some stress reduction practices. If your depression is severe, professional help may be needed. I regard anti-depressant medications as a very last resort, but they can be life savers for some people.

 

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.

Personalized Nutrition To Change Your Life?

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Author: Dr. Stephen Chaney

 

personalized nutritionCan a personalize nutrition assessment provide you with information to assist your health strategy?  We’ve been told that genetic testing is the wave of the future. We’ve been promised that genetic testing will tell us which diseases we are most likely to develop. Of course, the unspoken assumption is that if we knew which diseases were most likely to kill us, we’d be highly motivated to make the diet and lifestyle changes needed to reduce the risk of that disease.

But what if a personalized nutrition assessment based on a simple online diet survey was just as effective at getting us to make better food choices as all those fancy genetic tests? That is just what a recent study suggests.

How Was The Study Designed?

food4me surveyThe study was based on a simple online diet survey called Food4Me developed by University College Dublin and Crème Software Ltd. The Food4Me diet survey asks people how many times per week or per day they eat basic food groups and develops personalized diet recommendations based on what they are actually eating. It is a very simple, user friendly, survey requiring only 5-10 minutes to complete. Consumer satisfaction with this kind of survey is high. For example:

  • 92% of participants said that “the Food4Me website was easy to use.”
  • 76% of participants were “satisfied with the detail of information they received in their personalized nutrition report.”
  • 80% of participants felt that “the dietary advice in the report was relevant to them.”

In spite of its simplicity and ease of use, the Food4Me survey is also quite robust. Previous studies have shown that the reproducibility and validity of the Food4Me diet survey compares very favorably with much more extensive dietary analyses (For example, R. Fallaize, et al., Journal of Medical Internet Research, 16: e190, 2014).

This study (International Journal of Epidemiology, 2016, 1-11, doi:110.093/ije/dyw186)  measured the effectiveness of the Food4Me personalized nutrition reports at improving health-related behaviors. It was a 6-month randomized control study of 1269 adults from 7 European countries. It compared 4 different interventions on health-related behavior changes. The 4 interventions were:

  • standardized dietary advice
  • personalized nutrition advice based on the Food4Me survey
  • personalized nutrition advice based on the Food4Me survey plus BMI and blood biomarkers
  • personalized nutrition advice based on all that plus genetic testing

Is Personalized Nutrition The Wave Of The Future?

The results of the study were quite striking:

  • Compared to the group who just received standardized diet advice, the groups who received personalized nutrition advice were significantly more successful at improving health related behaviors. In particular, the groups receiving personalized nutrition advice:
    • personalized nutrition healthy foodConsumed less red meat.
    • Consumed less saturated fat
    • Consumed less salt
    • Got more folate from their diet
    • Had an improved “Healthy Eating Index” (a measure of overall diet quality)
  • Adding information on blood biomarkers (cholesterol, carotenoids, omega-3s, and vitamin D) and genotype received did not enhance the effectiveness of the personalized nutrition recommendations at changing health behaviors.

 

What Does This Study Mean For You?

This is a single study, but it does suggest several interesting take-home lessons.

#1: We are much more likely to follow diet advice that is personalized to us than we are to follow standardized diet advice. This should come as no surprise. We’ve had generalized diet advice like the USDA Food Guide Pyramid and, more recently, the USDA My Plate guidelines for decades, and they haven’t moved the needle. Maybe people think of generalized guidelines as applying to other people and personalized guidelines as applying to them.  Personalized nutrition seems to be more effective.

#2: This was personalized diet advice, not weird diet advice. The participants were not being told to eat as much fat as they wanted. They weren’t being told that avoiding wheat will make them slimmer and smarter. They weren’t being told to eat like a caveman. They were being given USDA-approved diet recommendations. The only difference was that the dietary recommendations were personalized to them. For example, they were only being told to eat more fruits and vegetables if, in fact, fruits and vegetables were not a regular part of their daily diet. 

#3: Blood biomarkers did not provide any additional incentive to increase health related behaviors. I wouldn’t read too much into this observation. With the exception of cholesterol, the blood biomarkers selected for this study merely reinforced the diet analysis. For example, you could ask whether low blood carotenoid levels really provided any additional incentive to change their diet for an individual who was already told their intake of fruits and vegetables was low. If the study had measured disease-related blood biomarkers, it might have found that they provided additional incentive for individuals to make positive diet changes.

#4: Genetic testing did not provide any additional incentive to increase health related behaviors. This probably simply reflects the state of the science. Current genetic tests are only weakly predictive of major diseases like heart disease, diabetes, and cancer so they provide little incentive to make major lifestyle changes. This may change in the future as we improve our understanding of genetic influences on disease risks.

Missed Opportunities

This study clearly showed that a simple online diet survey like the Food4Me personalized diet assessment is very useful for changing health-related dietary behavior. However, this study also missed several opportunities to create an even more valuable tool for improving health-related behaviors. For example, the study collected data on obesity and activity levels, but did not attempt to provide personalized lifestyle recommendations based on that data. In addition, 44% of the participants reported that they had a disease, but no attempt was made to include health goals in the personalized diet and lifestyle recommendations.

 

The Bottom Line

  • A recent study showed that personalized nutrition recommendations based on a simple online survey were much more effective than standardized dietary advice at getting people to improve health-related eating habits.
  • Adding information on blood biomarkers and genetic tests did not enhance the effectiveness of the personalized nutrition recommendations at changing health behaviors.
  • The study did not evaluate the value of adding activity levels and health goals to the assessment. That perhaps represented a missed opportunity to create an even more powerful tool for positively influencing health-related behaviors.

 

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.

Deceptive Food Labels

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What The Food And Supplement Industries Don’t Want You To Know

Author: Dr. Stephen Chaney

 

deceptive food labelsHealthy Eating Is In. We are told we need more fiber, whole grains, fruits & vegetables, nuts and omega-3s in our diet. We are being told that we should be eating “super foods” we’ve never heard of because of their amazing health benefits. As a consequence, more and more Americans are reading labels to be sure that the foods and supplements they are buying are healthy.  We trust the FDA and others not to allow us to be had by deceptive food labels.

But what if those food labels were deceptive? What if the food labels were more about marketing than about real health benefits? Is it possible that BIG FOOD Inc. and the supplement industry could actually be lying to us? Could it be that the manufacturers care more about their profits than about our health?

Deceptive Food Labels? 

Vegetable & Fruit Follies In The Supermarket

Everyone knows that fruits and vegetables are good for us. They are chock-full of vitamins, minerals, and phytonutrients as well as fiber. But who wants to spend the time peeling an orange or washing the pesticides off that broccoli? It’s much more fun to get our fruits and vegetables from chips, pasta, and breakfast cereals.

companies that use deceptive food labelsFood manufacturers are only too happy to oblige. The chemical companies make a variety of fruit and vegetable powders that food manufacturers can add to their products. For example, Powder Pure tells food manufacturers “Whether you want to add nutrition to your label, infuse full color, or formulate a specific flavor profile for your discerning consumers, Powder Pure has the right powder to enhance your presence in the marketplace.”  You will notice they are talking about adding nutrition to the label, not to the food. They are talking about “enhancing your presence in the marketplace,” not making your food healthier.

The problem is that sprinkling a little fruit and vegetable powder into a processed food will never provide the full range of nutrients that those fruits and vegetables would have provided.

Most manufacturers can’t (or won’t) specify the amounts of nutrients and phytonutrients you get from the fruit & vegetable powders they add to their processed foods, but that doesn’t stop them from making label claims like “We pop a flavorful blend of nine veggies…[in our chips]” or there is “half serving of vegetables in a 2 oz serving…[of our pasta].”  Is this using deceptive food labels?

The Fruits & Vegetables in a Capsule Con

One of my pet peeves is the food supplement manufacturers who try to tell you that they have concentrated a cornucopia of fresh fruits and vegetables in a capsule. For example, one company claims that their capsules contain apple, barley, broccoli, beet, cabbage, carrot, cranberry, date, garlic, kale, oats, orange, parsley, peach, pineapple, prunes, spinach, plant enzymes, fiber, and acidophilus.  All this in one capsule!  Does that sound like the use of deceptive food labels?

While this list sounds impressive, you need to ask whether they are providing meaningful amounts of those fruits and vegetables.  For example, the product claims to have oats.  A serving of oats is equal to 1/3 cup dry oats and weighs about 28 grams.  A capsule typically weighs about 0. 5 grams. Therefore, to get the equivalent of one serving of oats from a capsule, you would have to consume 56 capsules!  And that’s assuming that the entire capsule was filled with oats.

Broccoli is another claimed ingredient.  A serving of fresh broccoli weighs 88 grams, but roughly 80 grams of that is water.  So if you dehydrated the broccoli you would be left with about 8 grams of material. Therefore, to get a single serving of dehydrated broccoli you would have to consume 16 capsules. Again, that’s assuming that the capsules were completely filled with just broccoli.

You can do this kind of calculation with each ingredient they claim is in their capsules.  But when you add up the number of capsules needed to get a reasonable amount of each of these ingredients, the capsule total is staggering.

deceptive food labels marketingAs for essential nutrients, when you read the labels on some of these products you discover that their capsules only contain small amounts of a few essential nutrients. They simply do not provide significant amounts of the vitamins, minerals, and phytonutrients you would have been getting if you ate the real foods.

On the other hand, if the label does list significant amounts of the essential nutrients, that’s usually because purified vitamins and minerals have been added to the final product. Those products are no different from any other multivitamin supplement except that they contain insignificant quantities of fruit and vegetable powders that provide no additional health benefits. Once again, it’s all about using deceptive food labels marketing, not your good health.

Faux Protein Supplements

The same deceptive marketing practices have also entered the lucrative protein supplement marketplace. You are being told about protein products that are full of fruits & vegetables, super foods and herbs. It all sounds wonderful, but once again it is all smoke and mirrors. These companies are just mixing a little fruit and vegetable powders in with their protein powder.

You are being told that these products contain dozens of fruits and vegetables that provide vitamins and antioxidants in their natural form. However, when you read the label it is obvious that many of the vitamins and minerals in that product never saw a fruit or vegetable. They were synthesized in a chemical laboratory and added to the final product along with the fruit and vegetable powders.

You are being told that these products contain super foods that provide important phytonutrients, but none of those phytonutrients is present in sufficient quantities to be featured on the nutrition label. You are told that these products contain herbal ingredients with amazing healing powers, but none of the active ingredients of the claimed herbs are present in high enough quantities to be included on the nutrition label.

fruits and vegetablesOnce again, it is all about marketing. Manufacturers are adding fruit and vegetable powders and a pinch of herbal ingredients to their protein powders so that they can make marketing claims, but those fruit and vegetable powders and herbal ingredients aren’t present in large enough quantities to make any significant impact on your health.

Allowed Label Claims

Many of you have asked me about companies that claim their supplement has the amount of vitamin C found in 7 oranges or the amount of folic acid found in 4 cups of cooked green peas.  Those are allowed claims and are generally accurate. Just don’t assume that the vitamin C actually came from 7 oranges (it didn’t) or that their supplement has all the nutrients found in 7 oranges (it doesn’t).  Again, these companies find ways to use deceptive food labels to make sales.

 

The Bottom Line

  • We are being told that we should read labels to make sure that the foods and supplements we buy are good for us. We are also being told that we should be eating more fruits and vegetables. Food manufacturers know an emerging trend when they see one, so many of them are adding fruit and vegetable powders to the foods and supplements they manufacture. This increases the marketing appeal of their products, but does nothing to make their products healthier. It is label deception, pure and simple.

If you want to avoid being deceived by deceptive food labels, you should:

  • Ignore the label claims of fruits and vegetables added to the processed foods you see in the market. The fruit and vegetable powders added to those foods provide no proven benefit. The best place to get your fruits and vegetables is to [surprise] eat your fruits and vegetables.
  • Leave those supplements claiming to have concentrated lots of fruits and vegetables into a single capsule on the shelf. Those claims are grossly deceptive because the capsules do not contain significant amounts of the fruits and vegetables listed on the label. They do not provide the nutrients you would have gotten if you had eaten the real foods. Once again, the best way to get the fruits and vegetables you need in your diet is to actually eat fresh fruits and vegetables.
  • Forget those protein supplements that make amazing claims based on all the fruits, vegetables, super foods, and herbal ingredients they have. Once again, the fruit and vegetable powders and herbal ingredients in these products are not present in sufficient quantities to provide any significant health benefits. It is the marketing that is amazing, not the health benefits.
  • Finally, many of you have asked me about companies that claim their supplement has the amount of vitamin C found in 7 oranges or the amount of folic acid found in 4 cups of cooked green peas. Those are allowed claims and are generally accurate. Just don’t assume that the vitamin C actually came from 7 oranges (it didn’t) or that their supplement has all the nutrients found in 7 oranges (it doesn’t).

 

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.

Treatment for Carpal Tunnel Syndrome

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What Causes Carpal Tunnel Syndrome – Part 2

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

carpal tunnel syndromeThis month we will discuss treatment for carpal tunnel syndrome.  However, let’s recap a little.

In last month’s article “What Causes Carpal Tunnel Syndrome” – Part 1 I shared how carpal tunnel syndrome almost destroyed my career as a massage therapist. I also shared that I rejected surgery and drew on all of my knowledge to devise a self-treatment program that cured my carpal tunnel syndrome symptoms.

Last month, I discussed the muscles and nerves in your neck, chest, and upper arm, and how they impinge on the median nerve and refer burning and tingling into your wrist and hand.  This month the muscles we are discussing not only will cause burning and tingling, but will also cause pain in your wrist and hand.  Plus, these muscles will put a strain on your carpal tunnel and will impinge on the nerve as it travels through your carpal tunnel. Fortunately, a simple treatment will release the tight muscles and take the pressure off the nerve.

I found the solution to my problem, and I’ve been bringing it to people worldwide ever since.

Treatment for Carpal Tunnel Syndrome: Forearm and Hand

best treatment for carpal tunnel syndromeThe muscles on the top of your arm (B) are called the Extensors.

Your extensors originate at your elbow and insert into the carpal bones (back of your hand) and into your fingertips.

Your Flexor muscles (A) are on the underside of your forearm.

The flexors also originate at your elbow, they come down your forearm and merge into the tendon at your wrist. The tendons then go through your carpal tunnel and then insert into your hand and fingers.

When your hand is flat on a table and your extensors start to contract, you lift up your hand (B). But you can see that the flexors (A) on the underside of your forearm will need to lengthen to allow this movement.

flexor muscles demoWhen your flexors  are tight (commonly from repetitive movements), they won’t lengthen to allow your extensors  to pick up your hand, and the taut flexor tendons may trap your median nerve in your carpal tunnel. This is a major cause of carpal tunnel syndrome because the nerve is being trapped right in the carpal tunnel. It was one of the primary keys to my symptoms, and an important part of the treatment for carpal tunnel syndrome.

Why Muscle Tendons Cause Numbness In Your Fingers

As you look at this graphic you’ll see the flexor tendons surrounding the median nerve as they all pass through the carpal tunnel.  Also, notice the carpal bones, which are where the extensor muscles attach.  Finally,  look at the thumb muscle called Opponens Pollicis .  This muscle originates on the bridge to the carpal tunnel (called the Flexor Retinaculum), and when the muscle contracts you bring your thumb into the center of your palm.

The flexor retinaculum  is the ligament that is severed during carpal tunnel release surgery.  As you look at how close the median nerve is to the flexor retinaculum, you can see where a potential surgical mistake could sever the nerve. This accident disables the hand and isn’t reversible. Also, severing the flexor retinaculum means your thumb loses its base, and you lose strength.

This is the reason I refused surgery and sought a different carpal tunnel treatment.

elbow stretchingAs I studied each muscle and saw how they each impacted the median nerve, I realized that if I released the spasms in each muscle that it would take the pressure off the nerve.  And, sure enough, that’s exactly what happened!

It took me about 90 minutes to figure this out (it will only take you 15 minutes to do all of the treatment for carpal tunnel syndrome  to yourself), but in just that short amount of time I released ALL of the pain and numbness in my hand and wrist.  I was beyond being thrilled — I saved my career!

Eventually I figured out how to put this entire process into my Basic Self-Treatment System DVD program  to teach people all over the world how to eliminate the symptoms of carpal tunnel syndrome. I even developed a specialized tool to help people get the correct pressure and focus for each spasm.

A Simple Treatment for Carpal Tunnel  Syndrome For Your Thumb

(Pictures and description are excerpts from The Julstro System for Hand/Wrist Pain and Numbness in my Carpal Tunnel Syndrome Book)

elbow carpal tunnel exercisesTo release the spasms in your thumb muscle, place your opposite elbow into the thick portion of your thumb as shown in the picture to the left.

Step 2:

Use your fingertips to guide your elbow along the muscle.  Move your elbow in a line from the center of your wrist to the base of your thumb.

Use sufficient pressure to really feel the muscle and the tender points which are spasms in the muscle fibers.

When you find a spasm, hold the pressure for 30 seconds and then deeply move back and forth a little bit.

If you are experiencing hand/wrist pain or numbness, before you make the decision to go for surgery it is worthwhile to read everything you can about muscles, numb fingers, and carpal tunnel pain relief in my Carpal Tunnel Syndrome book. You can’t undo surgery!  So, try the treatment for carpal tunnel syndrome demonstrated here.

Wishing you well,

Julie Donnelly

 

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.

Skin Damage From Sun

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Author: Dr. Stephen Chaney

skin damage from sunSkin damage from sun is a real danger.  The dog days of summer are here. For some of us that means staying inside as much as possible. Others want to enjoy the fleeting days of summer as much as possible before summer turns to fall, and fall turns to winter. That means lots of outdoor activities in the sun – such as outdoor sports, working in the yard, and vacations in fun locations with lots of sun. So it’s time to ask the perennial question “How much sun exposure should I be getting?”

Some people like to aim for as much sun exposure as possible. When I was a teenager everybody was searching for “the perfect tan”. Back then it was popular to slather your skin with tanning oils that allowed you to just baste yourself in the sun without your skin drying up. (Did I just date myself again?)

Other people like to follow their dermatologist’s advice and use SPF maximum (the sun shall never touch my skin) sunscreens. And, just to be on the safe side they also follow their dermatologist’s advice to limit sun exposure between 10 AM and 4 PM and wear a hat, sunglasses, and protective clothing whenever possible. I can see the hat and sunglasses, but the protective clothing isn’t particularly compatible with the summer heat in my native North Carolina. Believe me, you want to wear as little as possible here in the summer.

Skin Damage From Sun

sun exposureNow that we’ve explored the extremes, let’s return to the central theme of this health tip which is “How much sun exposure should I really be getting?” Let’s start by focusing on the vanity factor – skin aging. Let’s face it. Excessive sun exposure increases the risk of skin cancer. However, skin aging is the consequence most people really care about. This is the concern that has most people reaching for the sunscreen before they head out the door.

A recent clinical study clearly showed that sunscreen usage helps prevent skin aging (Hughes et al, Annals of Internal Medicine, 158: 781-790, 2013). Now you might be saying to yourself “This is nothing new. I’ve heard that for years.” Yes, that advice has been around for a long time. But the problem is that the old advice was never based on actual clinical studies, only studies done on hairless mice. So first, let me analyze this clinical study for you and then put the findings into perspective.

The good news is that this was a very well done clinical study. The authors enrolled 903 adults under the age of 55 from sunny Australia into the study for a 4.5-year period from 1992 to 1996. The study was restricted to adults younger than 55 years because, in that age range, skin aging is primarily caused by sun exposure rather than the normal aging process. The study also excluded people who were already using sunscreen on a daily basis. Variables such as skin color, skin reaction to sun exposure, amount of time spent outdoors, sunburn history, and smoking status were determined at baseline and used to normalize the results.

Half of the participants were given a sunscreen with an SPF 15 factor and were instructed to use this sunscreen on a daily basis. The other half were given nothing and were just instructed to keep doing what they had been doing (It was deemed unethical to give them a placebo sunscreen as it could cause skin damage from sun). Compliance was assessed by measuring the weight of the returned sunscreen bottles every three months and by using a biennial application frequency questionnaire. Compliance wasn’t perfect, but of those enrolled in the sunscreen portion of the study 77% used sunscreen 3 to 4 times per week, compared to 33% of the control group.

Skin damage from sun was assessed by taking an impression of the back of the left-hand and analyzing it for the number and depth of lines and the flattening of the skin. And the results were fairly clear-cut. Those study participants who used sunscreen on a daily basis had 24% less sun damage over the 4.5-year period than the control group. I am not an expert, but dermatologists who have evaluated this study say that a 24% decrease in sun damage is visibly significant.

What Does This Study Mean For You?

It turns out that the old advice that too much sun exposure can cause significant skin damage as we get older is actually true. Who would have guessed? If the threat of skin cancer isn’t enough to dissuade you from pursuing the perfect tan, perhaps the thought of ugly, wrinkled skin as you get older will do it.

On the flip side, however, we need to remember that sun exposure is also required for vitamin D formation. And recent studies show that up to 80% of Americans have low levels of 25-hydroxy vitamin D, the biologically relevant form of vitamin D, in their blood – perhaps because many of us actually follow our dermatologist’s advice and never go out of the house without sunscreen, sunglasses, hat, and protective clothing to help prevent skin damage from sun.

Recent clinical studies have linked low levels of 25-hydroxy vitamin D with a number of health concerns. That has led one prominent dermatologist who studies vitamin D, Dr. Michael Holick, to recommend that we should be getting 10 to 15 minutes of unprotected sun exposure during midday – a recommendation that many of his colleagues consider to be heretical.

How Can You Have Your Cake And Eat It Too?

vitamin DSo what is a person to do? How can we reconcile the need to improve our vitamin D status with our desire to have a healthy, good looking skin well into our golden years? The simple answer is to make sure that we are getting plenty of vitamin D in our diet. The most recent RDAs are 600 IU per day of vitamin D in children and adults up to the age of 70 and 800 IU per day for adults over 70.

Many experts are even recommending that we get 1000 to 2000 IU of vitamin D per day. The Institute of Medicine (the group that actually sets the RDAs) considers that to be in the safe range for vitamin D intake. If you are thinking of exceeding that dosage, my advice would be to first get your 25-hydroxy vitamin D levels determined (20-50 ng/ml or 50-125 nmol/L is considered optimal) and then consult with your doctor as to what the best dosage of vitamin D is for you.

And, if you are relying on supplements for your vitamin D intake, you should be sure to choose a company that manufactures their supplements according to pharmaceutical standards. A recent study(E. S. LeBlanc et al, JAMA Internal Medicine, 173:585-586, 2013)  analyzed commercially available vitamin D supplements and found some brands in which the potency from bottle to bottle ranged from 9% to 140% of what was on the label. That is unacceptable.

 

The Bottom Line

  • A recent study has confirmed what we have been told for years, namely that regular use of an SPF 15 sunscreen reduces skin aging. Specifically, the study showed that regular sunscreen use reduced skin aging by 24% over a 4.5-year period in people 55 years old or younger.
  • On the other hand, sun exposure is required for our bodies to synthesize the active form of vitamin D. Vitamin D experts like Dr. Michael Holick recommend that we get at least 10-15 minutes of unprotected sun exposure a day during the summer months to assure that our bodies make the vitamin D we need for optimal health.
  • If you want both young looking skin and optimal vitamin D status, you will probably want to consider a vitamin D supplement. Recommendations for how much and what kind of vitamin D supplement are found 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.

DHA Supplements During Pregnancy

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Author: Dr. Stephen Chaney

 

dha supplementation saves moneyA recent study has estimated that taking DHA supplements during pregnancy, specifically in the last two trimesters, could save the US healthcare system close to $6 billion/year (Shireman et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 111: 8-10, 2016) .

Another study has come to similar conclusion in Australia (Ahmed et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 102-103: 5-11, 2015) .

When you have two well done studies by different investigators in different countries that come to the same conclusion, it is time to take the studies seriously and start to ask some important questions. For example:

  • Are these studies true?
  • Should we change our public health recommendations during pregnancy?
  • Is this just a public health issue, or does it affect you personally?

The Value of DHA Supplements During Pregnancy

dha supplements during pregnancyThe US study was called “Kansas University DHA Outcomes Study” (KUDOS). It studied health outcomes for 197 pregnant moms who gave birth to a single baby at the Kansas University Hospital between 2006 and 2010. The moms came from the Kansas City metropolitan area and consisted of 42% moms who self-identified as Black and 58% as other races.

The women were randomly assigned to consume 3 capsules per day containing either 600 mg DHA or a placebo containing corn and soybean oil during their second and third trimesters (starting around 14.5 weeks after gestation). Multiple pregnancy outcomes were assessed, but the main focus was on early preterm birth (infants born before 34 week’s gestation). That’s because a recent meta-analysis has reported that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58% (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) .

The results of the KUDOS study were:

  • Taking DHA supplements during pregnancy, specifically in the last two trimesters, reduced early preterm birth from 4.8% to 0.6%.
  • DHA supplementation reduced average hospital costs per infant born in the Kansas Medical Center by $1678. This was primarily because of a significant reduction in the average length of time spent in the neonatal intensive care unit because of the reduction in early preterm births.
  • When the cost of supplementation was taken into account, there was a 10-fold return in hospital cost savings for every dollar spent on supplementation.
  • When the authors extrapolated this analysis to the 4 million live births in the US each year, they estimated a potential savings of $6.6 billion.
  • This corresponds to a net savings of $5.94 billion to the US health care system if you take into account the cost of providing all pregnant women in the US with 600 mg of DHA/day during the last two trimesters of pregnancy.

The authors of the KUDOS study concluded “…a public health policy to increase DHA intake during pregnancy could result in significant cost savings to the health care system in our country”.

Are These Studies True?

truthTruth in science is always elusive. It requires many years of research and multiple clinical studies. However, two well done studies in two different countries have concluded that taking DHA supplements during pregnancy significantly reduces health care costs. In addition, a recent meta-analysis of 6 published clinical studies (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) has concluded that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58%.

These are all small studies, but their results are remarkably consistent. If you were to generalize the conclusions of all these studies into a statement saying “Omega-3 fatty acid supplementation during pregnancy significantly reduces health care costs”, there is a good probability that statement would be true. However:

  • The exact cost savings is uncertain.
  • The source of omega-3s (DHA, EPA, or a mixture of the two) is uncertain.
  • The amount of omega-3 fatty acids needed to reduce early preterm births is uncertain.

Let’s look at each of these in turn:

Cost Savings of Using DHA Supplements During Pregnancy

  • On the minus side, 42% of the women in the KUDOS study were Black, while the national average is 16%. That is significant because the rate of early preterm births is twice as high for black women as it is for White and Asian women. If the results of the KUDOD study were extrapolated to the percentage of Black women in the US population, the cost savings to the US health care system would only be around $4 billion – still a pretty substantial number!
  • On the plus side, the initial hospital costs associated with early preterm birth are just the tip of the iceberg. There are also considerable long-term expenses for special education services associated with disabling conditions common with premature infants.  A recent study (Mangham et al, Pediatrics 123: e312-e327, 2009) calculated the costs of preterm birth in the UK from birth to 18 years of age and came up with an estimate of $4.567 billion in US dollars. If we assume that omega-3 supplementation results in a 58% decrease in early preterm birth (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) and extrapolate that cost savings to the US population, the total cost savings would be $13.2 billion. Now we’re talking real money!

Source of Omega-3s:

  • DHA has been the focus of the two most recent studies on cost savings because of the role of DHA in nerve, brain and visual development, but EPA is also likely to be important in neonatal development. In addition, the efficiency of conversion of EPA to DHA is very high.
  • In fact, when we look at the individual studies included in the meta-analysis described above (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016), DHA, EPA, and EPA+DHA supplementation all gave comparable reductions in early preterm births.

Amount of Omega-3s:

  • While the 600 mg/day used in the KUDOS study is probably a good starting point, the individual studies in the meta-analysis used a wide range of dose. All of them seemed to have at least some efficacy in reducing early preterm births. Obviously, more studies are needed to determine the optimal dose.

What Does This Mean For You?

All this talk about reducing health care costs may seem esoteric. You may be wondering “What does this have to do with me?”

  • Don’t be lulled to complacency by the estimated cost savings of $1678/birth mentioned above. That is the average costs of all births. Early preterm births represent only 4.78% of all the births in the study. If you give birth to a baby earlier than 34 weeks of gestation, there is a high probability your infant will end up in the neonatal intensive care unit and your health care costs will be orders of magnitude more than $1678. How that affects your wallet will depend on your insurance plan.
  • Early preterm birth is associated with increased risk of global and selective cognitive defects. These can range from relatively mild impairment of IQ, memory, executive function, non-verbal skills, and motor skills to much more serious conditions like cerebral palsy, mental retardation, and disorders of psychological development. The possibility of avoiding those kinds of defects in your child is priceless.

 

The Bottom Line

  • Recent studies in the US and Australia have shown that taking 600 mg of DHA supplements during pregnancy during the last two trimesters  significantly reduces early preterm births (infants born before 34 weeks gestation) resulting in an estimated savings to the US health care system of around $6 billion/year.
  • Other studies suggest that supplementation with EPA and EPA+DHA mixtures give similar results.
  • Discussions of cost savings to the US healthcare system sound somewhat esoteric. However, if you are pregnant or considering becoming pregnant, there are real benefits to you associated with reducing the risk of early preterm birth. That is because:
  • The costs associated with early preterm births are substantial. How much they affect your wallet will depend on your health insurance policy.
  • Early preterm births are associated with a variety of global and selective cognitive defects (for details, read the article above). The possibility of avoiding those kinds of defects in your child is priceless.

 

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 The FODMAP Diet Reduce Gas and Bloating

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Author: Dr. Stephen Chaney

 

fodmap dietCan the FODMAP diet help reduce gas, bloating, diarrhea, and constipation? Everyone suffers from one or more of these symptoms, but nobody talks about them. For some they represent an annoyance. For others they can be incapacitating.

When the symptoms become frequent and start to affect quality of life, the medical community starts to give them names. When the symptoms occur at least 3 days/month for at least 3 months and there are no known diseases causing the symptoms, it is called irritable bowel syndrome (IBS). If the symptoms are also associated with inflammation, it is called inflammatory bowel disease (IBD). The principle forms of IBD are Crohn’s disease and ulcerative colitis.

A Primer On IBS And IBD

IBS is fairly common. Between 10-15% of the US population has been diagnosed with IBS, but experts estimate that as much as 25% of the population experiences symptoms consistent with IBS.

It is also important to understand that IBS is a collection of symptoms, not a disease. The only difference between IBS and the gas, bloating, and diarrhea (or constipation) that many people experience on a fairly regular basis is the frequency and severity of symptoms – and that is an arbitrary distinction. Someone experiencing those symptoms an average of 2 days/month is not significantly different than someone experiencing those symptoms 3 times/month.

While severe IBS can be incapacitating, it does not appear to cause lasting damage to the intestine or predispose to other diseases. Finally, the causes of IBS are largely unknown. Stress, obesity, and food sensitivities may all play a role.

IBD is much less common (0.4% of the US population), but much more severe. It can cause permanent damage to the intestine and can predispose to several diseases, including cancer. For that reason, you should always consult with your physician if you have severe, chronic gastrointestinal issues.

Standard treatment of IBS and IBD has traditionally consisted of recommendations to:

  • Reduce weight if overweight
  • Increase exercise
  • Reduce stress
  • Limit caffeine and alcohol
  • Limit fatty foods
  • If diarrhea is the primary symptom, limit dairy products, fruits, and sweeteners such as sorbitol and xylitol.
  • If constipation is the primary symptom, increase dietary fiber

These interventions generally provide only partial relief of the symptoms, so medications are frequently prescribed to control the symptoms. Unfortunately, many of those medications have significant side effects.

Fortunately, research over the past decade suggests that there is a natural, holistic approach that can significantly reduce the symptoms associated with IBS and IBD, thus decreasing the reliance on medications to treat those diseases. It is something called the FODMAP diet. The FODMAP diet is rapidly becoming the standard of care for IBS and IBD, and the same diet also appears to significantly improve symptoms in people who merely experience gas, bloating, and diarrhea more frequently than they would like. More importantly, the principles behind the FODMAP diet can help almost everyone who experiences occasional gas, bloating, diarrhea and/or constipation.

What Is The FODMAP Diet?

The FODMAP diet was devised over a decade ago by a group of scientists in Australia. Basically, they identified all of the kinds of foods that were known to cause gas, bloating, diarrhea, and/or constipation in susceptible people and put together a diet that was low in all of them.

FODMAP is an acronym that stands for:

  • F – fermentable carbohydrates
  • O – oligo-saccharides
  • D – di-saccharides
  • M – mono-saccharides
  • P – polyols

Of course, that statement comes under the “Aren’t you glad you asked?” category. It is meaningless to most people. A better way to understand this is to look at foods in the FODMAP category. They include:

  • gas and bloatingLactose, found in milk and milk products (especially for people who lack the enzyme lactase)
  • Fructose in high concentrations, found in foods like apples, pears, honey and agave syrup. (30-40% of individuals have problems absorbing fructose).
  • Fructans, found in foods like wheat, onions and garlic.
  • Galacto-oligosaccharides, found in foods like beans, lentils, and soybeans.
  • Polyols such as sorbitol and mannitol, found in fruits such as cherries, apricots, and apples, and as sweeteners added to many “sugar-free” foods.

These are all foods that are poorly digested or poorly absorbed, so they are fermented by intestinal bacteria. It is the fermentation of these foods by intestinal bacteria that causes the gas, bloating, and diarrhea.

Does The FODMAP Diet Work?

The evidence that the FODMAP diet is effective is pretty impressive. For example:

What Does This Mean For You?

On the surface, this seems to be a good news, bad news story.

good news bad newsThe good news is that the FODMAP diet is incredibly effective at decreasing frequent gas, bloating, abdominal discomfort, diarrhea and constipation – and it really doesn’t matter whether you have been diagnosed with IBS or IBD, or you are just someone who suffers from those symptoms more frequently than you would like.

The bad news is that the FODMAP diet is very restrictive. You can appreciate that when you look at the list of high FODMAPs foods you need to avoid. That means:

  • The diet is very difficult to stick to long term. In the follow up study described above only 30% of the participants were able to stick with the diet for the full 16 months.
  • The diet restricts so many foods that you would really need the guidance of a registered dietitian to design a nutritionally adequate diet plan.

 

The reality, however,is that very few people actually need to restrict all the high FODMAP foods to enjoy significant relief from their symptoms. Clinically, most physicians test various FODMAPs in their IBS and IBD patients and only restrict the ones that cause symptoms. You can do exactly the same thing yourself. Start by reducing groups of high FODMAP foods on the list. Once you have identified which food groups cause your symptoms, you can test foods within that group one by one.

The most important news is that the FODMAP diet concept may help many people who struggle with occasional gas, bloating, and diarrhea. Let me give you one example:

  • Let’s suppose you have discovered that foods made from wheat flour cause you g.i. problems. You have concluded that you are gluten intolerant and carefully avoid foods containing gluten, but you still have occasional gas, bloating and diarrhea. You might be sensitive to the fructans in wheat, not the gluten. If so, a quick glance at the FODMAPs list suggests a number of fructan-containing foods you may be sensitive to that you would never have expected if you just focused on avoiding gluten. For example:
  • Vegetables: garlic, onions, asparagus, artichokes and snow peas might be causing you trouble.
  • Fruits: grapefruit, nectarines, plums and watermelon could be causing you problems.
  • Processed foods: Inulin, a naturally occurring fiber, found in Jerusalem artichokes, is primarily a fructan. Inulin and several other naturally occurring fructans are added to many processed foods to increase their fiber content. These foods might also be causing you trouble.

This is just the tip of the iceberg. Most of us have probably identified one or two problem foods that we know give us gas. By using the FODMAPs list we may be able to identify other foods we should avoid.

 

The Bottom Line

  • By restricting all foods known to cause gas, bloating, diarrhea and constipation in susceptible individuals, scientists and clinicians have created something called the FODMAP diet.
  • The FODMAP diet has proven to be very effective at reducing those symptoms in people with IBS or IBD, but it is also equally effective at eliminating symptoms in individuals who simply suffer from gas, bloating, abdominal pain, diarrhea and/or constipation more frequently than they would like.
  • The low FODMAP diet is also very restrictive, but the good news is that most people don’t need to eliminate all of the foods in the diet. You can systematically test and eliminate the individual foods that cause your symptoms.
  • Most importantly, the FODMAP concept can help us identify problem foods that we might have otherwise never suspected of giving us gas. You will find an example of how this concept works in the article above.
  • Gas, bloating, abdominal pain, diarrhea and constipation can also be caused by a number of serious diseases. For that reason, you should always consult with your physician if you have severe and chronic gastrointestinal issues.

 

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

What Causes Carpal Tunnel Syndrome?

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The Symptoms of Carpal Tunnel Syndrome Are Caused By Tight Muscles

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

what causes carpal tunnel syndromeWhat causes carpal tunnel?

In 1997 I was diagnosed with carpal tunnel syndrome: wrist pain, tingling and numb fingers. The pain and burning was horrible, it prevented me from even picking up a pencil or holding a glass. As a massage therapist it was devastating, my hands are my livelihood! I tried everything and finally had to close down my therapy practice because the pain was so severe. I knew I wasn’t going to go for surgery, but carpal tunnel syndrome was a hurdle that was pushing me out of work and I didn’t know where to turn.

Finally, I started to think of the logic of the body.  While everyone was looking at my wrist and forearm, the median nerve that causes the symptoms of carpal tunnel syndrome doesn’t start in my arm, but where does it start?  Research showed that the nerve actually starts in your NECK!  Who would have thought this would be what causes carpal tunnel!

I found the solution to my problem, and I’ve been bringing it to people worldwide ever since.

How Muscles in Your Neck Can Be What Causes Carpal Tunnel Syndrome Symptoms

muscles cause carpal tunnel syndromeA bundle of nerves called the Brachial Plexus  (see three lines in neck of drawing) comes out of your cervical vertebrae and at the top of your shoulder the fibers divide into three nerves:

  1.  The Median Nerve – which goes to your thumb and first two fingers
  2. The Ulnar Nerve – which goes to your ring and pinky fingers
  3.  The Radial Nerve – which goes to your wrist

Your Scalenes muscle is in front of, and in back of the brachial plexus.

When the scalenes are in spasm, they put pressure on the bundle of nerves and it can cause tingling and numbness to be felt all the way to your fingers. The purple shading shows the referred pain pattern for the scalenes spasms.  This can be what causes carpal tunnel and in my case this was the primary cause of the carpal tunnel syndrome symptoms I had in my thumb and first two fingers.

By the way, your scalenes also cause that burning feeling you get between your shoulder blades.  You are rubbing your back, but the cause of the pain is actually in your neck!

How Muscles in Your Chest and Upper Arm Can Cause the Symptoms of Carpal Tunnel Syndrome

coracoid processThe bundle of nerves goes along the front of your body and at the top of your shoulder it breaks into the three nerves (listed above) and they go under a bone called the coracoid process  (a part of your scapula/shoulder blade).

There are three muscles that attach to your coracoid process, (the biceps , pectoralis minor  , and the coracobrachialis ). When any of them are in spasm, they will pull the bone down onto the three nerves causing tingling and numbness to radiate down your arm and into your wrist &/or hand. This is one of the symptoms of carpal tunnel syndrome, yet most medical practitioners don’t consider these muscles when searching for the cause of numbness in your fingers.

 

Treatment for Carpal Tunnel Syndrome

A Julstro Self-Treatment That Releases Tension in Your Shoulder and Off the Nerves to Your Hand

treatment for carpal tunnel syndromeYou can self-treat your upper arm muscles that are putting pressure on the coracoid AND also on your shoulder joint.

Simply make a fist and press into your biceps, using your opposite hand to help push your elbow so you can go deeper into your biceps.

Hold the pressure for 15-30 seconds and then continue the pressure while you S-L-O-W-L-Y open your arm.  Release the pressure, bend your arm, and repeat 2-3 times

End of Part 1 –

Next month I will show the muscles of your lower arm and hand and why they can be what causes carpal tunnel syndrome symptoms. Plus, you’ll get a self-treatment that is great for taking the pressure off your carpal tunnel.

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.

American Omega-3 Deficiency

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Is There an American Omega-3 Deficiency?

Author: Dr. Stephen Chaney

omega 3 deficiencyOmega-3s have been controversial in recent years.  However, virtually everyone agrees that omega-3 intake in North American is low. But, would you believe that the United States and Canada are dead last with respect to omega-3 status – that we are among the countries with the lowest omega-3 status in the world? Is there an American omega-3 deficiency?  That is what a recent study suggests!

Omega-3 Deficiency in Americans

Previous studies have suggested that the American and Canadian diets were deficient in long chain omega-3s like EPA and DHA, but those studies were based on 24-hour diet recalls or food frequency surveys which might underrepresent the true amount of omega-3s in the diet. Therefore, a group of investigators from the United States and Canada decided to look at blood levels of EPA and DHA.

This study (Stark et al, Progress In Lipid Research, 63: 132-152, 2016) was a meta-analysis of 298 studies that recorded blood levels of EPA and DHA. These studies were from 36 counties and distinct regions around the world. They converted all of the measurements to a common unit expressed as percent by weight of EPA + DHA relative to the total weight of fatty acids in the blood.

American omega-3 deficiencyThey combined all studies from a given country or region to give an average value of percent EPA + DHA and then divided the countries and regions into four groupings based on the average weight percentage of EPA + DHA in the blood. If all that seems confusing, the figure on the right (taken from Stark et al, Progress In Lipid Research, 63: 132-152, 2016) should clear things up.

  • Red = very low (< 4%) EPA + DHA levels
  • Orange = low (4-6%) EPA + DHA levels
  • Yellow = moderate (6-8%) EPA + DHA levels
  • Green = adequate (>8%) EPA + DHA levels
  • Grey = no valid measurements in those countries

It is clear from this study that most Americans and most Canadians don’t do a very good job of incorporating omega-3 fatty acids into their diet, as several previous dietary surveys have suggested.  This could contribute to omega-3 deficiency.

Is The United States Dead Last In Omega-3 Status?

The global map of EPA + DHA blood levels certainly suggests that the United States is among a handful of countries with the very lowest omega-3 status. There are a few caveats, however.

  • As the large areas of grey indicate, there are a number of countries with no valid omega-3 blood measurements. The United States might have lots of company in the very low omega-3 status category.
  • There are some very large countries like Russia which have relatively few omega-3 blood measurements, and those measurements are only from a few regions of the country. The average omega-3 status for the entire country might be lower than indicated in this map.

On the other hand, there are lots of omega-3 blood measurements from countries like Japan, so it is clear that there are countries with much better omega-3 status than the United States.

What Does This Study Mean To You?

The important questions are, of course:Does it matter? What do these blood levels of EPA + DHA actually mean? Is < 4% EPA + DHA low enough to matter? What are the health consequences of low omega-3 status?  If you have an omega-3 deficiency, what are the risks?

Let’s start with the first question: How do we translate a blood level of EPA + DHA into how much we should be getting in our diet? While there is no established Dietary Reference Intake for EPA + DHA, several expert panels and international organizations have made recommendations for EPA + DHA intake. Those recommendations generally range from 250 mg/day to 500 mg/day for general health and 500 mg/day to 1,000 mg/day for heart health. Unfortunately, most people in the United States and Canada consume less than 200 mg/day of omega-3 fatty acids, and most of those are short chain omega-3s that are inefficiently converted to the long chain EPA and DHA.

More importantly, a recent study (Patterson et al, Nutrition Research, 35: 1040-1051, 2015) has examined how much additional EPA + DHA must be consumed by someone eating a typical North American diet to significantly improve their omega-3 status. It showed that:

  • 200 mg/day of EPA + DHA is required to improve omega-3 status from very low to low.
  • 500 mg/day of EPA + DHA is required to improve omega-3 status from very low to moderate.
  • 1250 mg/day of EPA + DHA is required to improve omega-3 status from very low to adequate.

omega-3 for heart healthIt is no surprise that these numbers correlate so well. My recommendation would be to consume at least 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.

Now let’s look at the last question: What are the health consequences of low omega-3 status? There are multiple health benefits associated with optimal omega-3 status, but the best evidence is for the beneficial effects of omega-3s on fetal and infant neurodevelopment and heart health. For example:

  • In case you have been confused by recent studies suggesting that omega-3s have no effect on heart health you should know that most of those studies were looking at the effect of EPA + DHA in patients who were already taking 3 or 4 heart medications. The studies actually concluded omega-3s provided no additional benefits in people already taking multiple heart medications. That is a totally different question.

Where Should You Get Your Omega-3s?

fish oil supplementsNow that you know how important the long chain omega-3s, EPA and DHA, are for your health, and you know that most of us have a very poor omega-3 status and therefore have an omega-3 deficiency , your next questions are likely to be: “What’s the best way to improve my omega-3 status?” and “Where can I find EPA and DHA in my diet?” The answer is complicated.

  • Cold water, oily fish like salmon are a great source of EPA and DHA. Unfortunately, our oceans are increasingly polluted and some of those pollutants are concentrated even more in farm raised fish. A few years ago a group of experts published a report in which they analyzed PCB levels in both wild caught and farm-raised fish from locations all around the world (Hites et al, Science 303: 226-229, 2004) . Based on PCB levels alone they recommended that some wild caught salmon be consumed no more than once a month and some farm raised salmon be consumed no more than once every other month!

Unfortunately, when you buy salmon in the grocery store or your favorite restaurant, you can ask whether the salmon is wild or farm-raised, but you have no idea where the salmon came from. You have no idea how safe it is to eat. I love salmon and still eat it on occasion, but not nearly as frequently as I used to.

As an aside, the buzzword nowadays is sustainability. I support sustainability. However, the easiest way to assure that fish are sustainable is to raise them in fish farms. When a waiter tells me how sustainable the “catch of the day” is, I ask them how polluted it is. If they can’t answer, I don’t buy it. My health is more important to me than sustainability.

  • Nuts, seeds, and canola oil are good sources of ALA, a short chain omega-3 fatty acid. These food sources are less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA is only around 5-10%. In other words, you need to eat a lot of ALA-rich foods to enjoy the health benefits associated with EPA and DHA.
  • That leaves fish oil supplements, but you need to remember that the EPA + DHA supplements you purchase in the health food store come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

 

The Bottom Line

 

  • A recent study has shown that most Americans are deficient in long chain omega-3s like EPA and DHA. In fact, the mainland United States and Canada were tied with half a dozen other countries for the lowest omega-3 status in the world.  Omega-3 deficiency in Americans seems to be the worst.
  • That is unfortunate because recent studies have shown that optimal blood levels of EPA and DHA are associated with a number of health benefits, especially fetal and infant neurodevelopment and heart health.
  • Other studies suggest that most Americans should consume an extra 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.
  • Unfortunately, it is not easy get those levels of EPA and DHA from our diet:
  • Oily, cold water fish are a great source of EPA and DHA, but our oceans are increasingly polluted and experts recommend that some fish that are the best sources of EPA and DHA be consumed no more than once a month. The situation is even worse for farm-raised fish.
  • Of course, nowadays the buzzword for fish is sustainability, but sustainability does not guarantee purity. Sustainable fish can be just as polluted as the worst of the farm raised fish.
  • seeds and canola oil are great sources for ALA, a short chain omega-3 fatty acid. This source of omega-3s is less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA in our bodies is only around 5-10%.
  • Fish oil supplements can be a convenient source of the EPA and DHA you need, but the fish oil often comes from polluted fish and many manufacturers have inadequate purification methods and quality control standards. If you choose fish oil supplements as your source of omega-3s, be sure to choose a manufacturer with stringent quality control standards. Otherwise, neither you nor the manufacturer will know whether their omega-3 supplement is pure.

 

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

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