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

Does Genetics Determine Weight?

October 9, 2015September 29, 2015 by Dr. Steve Chaney

Does Genetics Cause Obesity?

Author: Dr. Stephen Chaney

It’s frustrating. Try as hard as you might, you just can’t seem to lose weight. Even worse you suspect that your friends – and maybe your doctor – assume that you are cheating on your diet. It just doesn’t seem fair.

Perhaps there is a simple explanation. Maybe your genes are keeping you from losing weight. Does genetics determine weight? It has been hypothesized that some of us have a “thrifty” phenotype when it comes to weight loss while others are “spendthrifts”. The theory is that people with a “thrifty” phenotype hold on to weight more tightly when they are “fasting” (i.e. trying to lose weight) and gain weight more readily when they are “feasting” (i.e. eating excess calories).

The metabolism of the “spendthrifts” is exactly the opposite. They lose weight rapidly when fasting and gain weight slowly when feasting. Those would be all of your skinny friends who just can’t seem to understand why you have such difficulty losing weight.

Those experts who favor the “thrifty” phenotype hypothesis point out that it would have provided a tremendous survival advantage in prehistoric times when food was scarce. That’s why some of those same experts think that up to 80% of the population has the “thrifty” phenotype. When you couple the thrifty phenotype with the typical American diet and lifestyle it becomes easy to understand why we have an obesity epidemic in this country.

Is the “thrifty” phenotype hypothesis true? Could it explain why you have such difficulty losing weight? A recent study suggests the answer to those two questions may be yes. I will outline the evidence below.

Then I will address what are probably the two most important questions for you: “If the thrifty phenotype hypothesis is true and you have the thrifty phenotype, are you destined to be overweight? Is there anything you can do about it?

How The Study Was Designed

This study (Reinhardt et al, Diabetes, 64: 2859-2867, 2015) was truly a remarkable study. 15 healthy, but obese volunteers were put in a metabolic ward for a total of 11 weeks. In the metabolic ward every aspect of their metabolism was closely controlled and measured.

They were given diets that were precisely calibrated to provide a predetermined caloric (energy) input.
Urine and feces were collected and analyzed in an instrument called a bomb calorimeter to determine calorie (energy) output.
They were limited to primarily sedentary activity for the duration of the experiments, and the temperature of the metabolic ward was maintained constant. This eliminated variation in energy expenditures due to activity and temperature.
Metabolic energy expenditure was calculated by placing them in a special room designed to precisely measure oxygen consumption and CO2 production by the subjects over a 24 hour period. Don’t worry about the details. Just know that this is the gold standard for measuring energy expenditure.

Here is what the subject’s 11 weeks in the metabolic ward looked like:

During the first 3 weeks the subjects were provided with a diet designed with just enough calories to maintain their weight based on their weight and sex. If weight gain or loss was observed the calories were adjusted accordingly.

During one 24 hour period in week 3 the subjects were place on a diet that decreased their calories by 50%, (defined as “fasting” in this study) and the resulting decrease in metabolic energy expenditure was measured as described above.

During another 24 hour period in week 3 the subjects were place on a diet that increased their calories by 200% (defined as “overfeeding” in this study), and the resulting increase in metabolic energy expenditure was measured.

During the next 6 weeks the subjects were placed on calorie restricted diet that only provided 50% of the calories they needed to lose weight.

During the final 2 weeks the subjects were placed on a diet designed to provide the calories needed to maintain their new weight, whatever it was.

How Does Genetics Determine Weight?

The results of the study were quite interesting:

All of the subjects lost weight, but the amount of weight loss ranged from 5% to 12% of the original body weight.

Their starting weight did not influence their rate of weight loss during calorie restriction, but their metabolic response to fasting and overfeeding significantly affected their rate of weight loss. Specifically:

The subjects with the smallest decrease in energy expenditure during fasting and the largest increase in energy expenditure during overfeeding (the spendthrifts) lost significantly more weight during the 6 week caloric restriction period (what most of us call a diet).

The subjects with the largest decrease in energy expenditure during fasting and the smallest increase in energy expenditure during overfeeding (the thrifty) lost significantly less weight during the 6 week caloric restriction period.

The amount of caloric restriction needed to lose one pound of weight ranged from 1,558-2,993 depending on whether the subjects displayed the spendthrift or thrifty phenotype. That’s almost a 2-fold difference.

What Does This Study Mean For You?

Life isn’t fair. You probably already suspected that. Your skinny friends actually do have a much easier time losing weight than you do. In fact, they may be able to lose up to twice the amount of weight with exactly the same amount of caloric restriction.

However, the good news is that weight loss is possible – even for you. Everyone in the study lost weight – even those subjects with the thriftiest phenotype. So the question becomes what can you do to lose weight successfully? Here are 5 simple tips.

#1: Don’t give up. Stick with it. Pounds may come off slowly for you, but this study shows they will come off. You just have to keep the faith and be consistent.

#2: Watch what you eat very carefully. The researchers in this study controlled every morsel of food the subjects ate. People always lose weight more rapidly when they are in a metabolic ward. My recommendation is to track what you eat daily using one of the many available tracking apps.

#3: Be consistent with your exercise. The subjects in this study were not allowed to exercise, but that is one of the best ways to increase energy expenditure. Aerobic exercise gives you a small increase in energy expenditure during and immediately following the exercise. Weight bearing exercise gives a long term increase in energy expenditure because it increases muscle mass, and muscle burns calories faster than any other tissue.

#4: Choose a diet that preserves muscle mass (High Protein Diets and Weight Loss ) while you are losing weight.

#5: Avoid all those diets with herbal and pharmaceutical stimulants. They are dangerous and they may just kill you. Check out Are Dietary Supplements Safe.

The Bottom Line

A recent study (Reinhardt et al, Diabetes, 64: 2859-2867, 2015) did a very careful metabolic analysis and divided subjects into what they characterized as either a “thrifty” or “spendthrift” phenotype based on their changes in metabolic energy expenditure in response to fasting and overfeeding. They then looked at how those phenotypes affected weight loss during a 6 week period of caloric restriction. Does genetics cause obesity or help determine weight? Here’s what they found:

All of the subjects lost weight, but the amount of weight loss ranged from 5% to 12% of the original body weight.

Their starting weight did not influence their rate of weight loss during caloric restriction, but their metabolic response to fasting and overfeeding significantly affected their rate of weight loss. Specifically:

The subjects with the smallest decrease in energy expenditure during fasting and the largest increase in energy expenditure during overfeeding (the spendthrifts) lost significantly more weight during the 6 week caloric restriction period (what most of us call a diet).

The subjects with the largest decrease in energy expenditure during fasting and the smallest increase in energy expenditure during overfeeding (the thrifty) lost significantly less weight during the 6 week caloric restriction period.

If you struggle to lose weight, this is a good news – bad news study.

The bad news is that life isn’t fair. You probably already suspected that. Your skinny friends actually do have a much easier time losing weight than you do.

The good news is that weight loss is possible – even for you. Everyone in the study lost weight – even those subjects with the thriftiest phenotype. So the question becomes what can you do to lose weight successfully? I’ve given you 5 simple tips 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.

Is Vitamin E Deficiency Common in the US

September 22, 2015 by Dr. Steve Chaney

Does Vitamin E Matter?

Author: Dr. Stephen Chaney

A headline claiming “Over 90% of Twentysomethings Have Suboptimal Vitamin E Status” caught my eye the other day, so I decided to investigate further. If you have been following all of the information and misinformation about vitamin E in the online media, you are probably confused – and this headline just adds to the confusion. There are probably three basic questions you want answered:

Is the latest study valid? Are most Americans vitamin E deficient?

Does it matter? Vitamin E has been described as “a vitamin in search of a disease”. If there are no diseases associated with vitamin E deficiency, should we even be concerned if most Americans are vitamin E deficient?

Is there any value to vitamin E supplementation? You will see claims that vitamin E supplementation has been proven not to work. Are these claims valid?

Let me guide you through the maze. I will start by analyzing the study behind the current headlines.

Are Americans Vitamin E Deficient?

The best food sources of vitamin E are nuts, seeds and unrefined vegetable oils, followed by green leafy vegetables. Since these foods are not abundant in the American diet, it is no surprise that previous studies have shown that 83% of US children and 91% of US adults do not consume the recommended 12 mg/day of vitamin E. Consequently, the 2015 Dietary Guidelines Advisory Committee identified vitamin E as a “shortfall nutrient”.

This study (McBurney et al, PLoS One 10(8): e0135510 doi: 10.1371/journal.pone.0135510) took the next logical step by asking whether the inadequate intake of vitamin E lead to inadequate blood levels of the vitamin. The authors analyzed data from 7,922 participants who had their blood levels of alpha-tocopherol (the most abundant form of vitamin E) determined in the 2003-2006 National Health and Nutrition Examination Survey (NHANES).

They subdivided participants into those who used no supplements (4049) and those who used supplements (3873). (Note: The supplement users were not necessarily using vitamin E supplements, but many were using a multivitamin supplement containing vitamin E). The authors compared the study participant’s blood levels of vitamin E with the Institute of Medicine standard for vitamin E deficiency (12 umol/L) and with a standard they set for adequate vitamin E levels (30 umol/L). Here are the results of their analysis:

People who did not use supplements had lower blood levels of vitamin E (24.9 umol/L) than those who used supplements (33.7 umol/L). No surprise here.

Only 0.6% of Americans were clinically deficient in vitamin E (blood levels < 12 umol/L). The prevalence of vitamin E deficiency did not vary significantly with age, gender or ethnicity.

When they looked at the people not using supplements, the percentage with suboptimal vitamin E status (blood levels < 30 umol/L) varied significantly by age, but was not significantly affected by gender or ethnicity. In this analysis the percentage with suboptimal vitamin E status was:

7% for ages 20-30.
8% for ages 31-50
2 % for ages 51 and above

Were The Headlines Correct?

Technically speaking the headlines were correct. 92.7% of Americans aged 20-30 who used no supplements had suboptimal blood levels of vitamin E as defined in this study. When you combined both supplement users and non-users, the percentage with suboptimal blood levels of vitamin E was only slightly less (87.4%). However, there are a couple of important caveats:

There is no internationally recognized standard for adequate blood levels of vitamin E. The authors had a reasonable rationale for choosing 30 umol/L as their standard for adequate blood levels, but they also acknowledged that the Estimated Average Requirement of vitamin E from food (12 mg/day) would result in a blood level of 27.9 umol/L, so their standard may be a bit high.

The average blood level of vitamin E for non-supplement users was 24.9 umol/L. While that is less than adequate, it is only slightly low – especially if the lower standard of 27.9 umol/L is used.

I think it would be more accurate to say that a large percentage of Americans have blood levels of vitamin E that are slightly below what is considered adequate but are far above what could be considered clinically deficient. The question then becomes “Does it matter?”

Does Vitamin E Matter?

Let me start with a little perspective. In the United States diseases like scurvy, pellagra and beriberi are things of the past. We simply don’t see deficiency diseases anymore. What we do see are intakes of essential nutrients that are slightly below optimal. Vitamin E is no different.

If we focus on suboptimal nutrient intake by itself, the answer would probably be that it doesn’t matter. Suboptimal nutrition is seldom enough to cause poor health by itself.

However, we also need to take into account individual differences that affect the need for essential nutrients. Poor health is much more likely to arise when suboptimal intake of one or more essential nutrients is coupled with increased needs due to genetic predisposition, risk factors that predispose to disease, and/or pre-existing disease.

With this perspective in mind, we are ready to ask whether suboptimal intake of vitamin E or any other essential nutrient matters. The answer is pretty simple. It doesn’t matter for everyone, but it matters very much for those individuals with increased needs.

If we had a good way of assessing individual nutritional needs, it would be easy to say who needed supplements and who didn’t. The problem is that we currently have no good way of assessing individual needs for essential nutrients. We simply cannot predict who will and who won’t be affected by suboptimal nutrient intake. That is why millions of Americans take supplements on a daily basis.

Is There Any Value To Vitamin E Supplementation?

That brings us to the final question. Is vitamin E supplementation a waste of money? You’ve probably already heard that most studies have failed to show any benefit from vitamin E supplementation, but you may be asking “How can that be when we also know that most Americans are getting suboptimal levels of vitamin E in their diet?”

With the perspective I described above in mind, the answer is pretty simple. Those studies have been asking the wrong question. They have been asking whether vitamin E supplements benefit everyone. They haven’t asked whether vitamin E supplements benefit people with increased needs.

When you ask that question the answer is very different. Let me give you three examples – one representing each of the kinds of increased need I described above:

In the Women’s Health Study (JAMA, 294: 56-65, 2005) vitamin E supplementation had no effect on heart attack or stroke in the general population. But when they looked at women over 65 (those at highest risk for heart disease), vitamin E supplementation reduced heart attack and stroke by 25% and cardiovascular deaths by 49%

In the Women’s Antioxidant Cardiovascular Study (Archives Internal Medicine, 167: 1610-1618, 2007) vitamin E supplementation again had no effect on cardiovascular events overall. But when they looked at the women who had cardiovascular disease at the start of the study, vitamin E supplementation decreased cardiovascular events by 23%.

In the Heart Outcome Prevention Evaluation Study (Diabetes Care, 27: 2767, 2004; Atherosclerosis, Thrombosis & Vascular Biology, 24: 136, 2008) vitamin E supplementation had no effect overall on heart attacks or cardiovascular deaths. But when they looked at a population who had a haptoglobin genotype that significantly increases the risk of heart disease, vitamin E supplementation significantly decreased the risk of both heart attacks and cardiovascular deaths.

The Bottom Line

Recent headlines saying that over 90% of young Americans have suboptimal vitamin E status are technically correct, but a bit overstated. It probably would have been more accurate to say that most Americans have slightly suboptimal vitamin E status.

The important question then becomes “Do marginal nutritional deficiencies matter?” The answer is pretty simple. Marginal nutritional deficiencies do not matter for everyone. However, they matter very much for those people who have increased needs for that nutrient due to genetic predisposition, risk factors for disease or pre-existing disease.

If we had a good way of assessing individual nutritional needs, it would be easy to say who needed supplements and who didn’t. However, we don’t have a good way of assessing increased needs for most nutrients, which is why many Americans use supplements on a daily basis.

As for all of those studies saying that vitamin E supplementation has no benefit, they are a bit misleading because they are asking the wrong question. They are asking whether vitamin E supplementation benefits everyone. They are not asking whether vitamin E supplementation benefits people with increased needs. When you ask that question the answer is very different (see examples 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.

Repetitive Strain Injury From Sleeping

September 15, 2015 by Dr. Steve Chaney

Get Off To A Great Start Every Morning

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

How Can Sleep Cause Repetitive Strain Injury?

For most of us during sleep we stay in one position for hours at a time. So if you wake up with back pain after sleeping, you are experiencing the side effects of muscles held in one position for hours. This is an example of repetitive strain injury or repetitive stress injury.

Because the muscles have to contract to pull your body into your favorite sleeping position and then the muscles stay in a shortened position for hours this can cause pain and tension in your back.

When you wake up with back pain after sleeping you may think you need a new mattress. You might, but it’s definitely worthwhile to address the tight muscles first as they may be the whole problem.

Have you ever seen a dog do their “downward dog” stretch after a nap? Before the dog bounces back into the world it takes time to awaken its body. This is your pain relief “role-model” for stretching your back after sleeping. You’ll be amazed at how simply moving in bed before starting your day eliminates pain and tension.

Let’s get started! While still in bed begin moving around; raise your arms over head and stretch your legs out and flex your feet. Maybe roll to each side stretching the sides of your body. Try these 3 stretches we recommend

Repetitive Strain Injury Treatment: 3 Stretches After Sleeping

The following stretches will help relieve symptoms of repetitive strain injury due to sleeping in one position for long periods.

When you are ready bring yourself to a seated position (still in bed!).

One at a time, bring your arm across the front of your body. Pull your shoulder and shoulder blade toward the front, but without moving the rest of your trunk. This is a great stretch for your triceps, shoulders and upper back.

Next stretch! Bring your feet together, as pictured here.Start with a straight spine then slowly roll your chin into your chest, rounding your back. Mmmmm…this feels good!

And finally, try this juicy spinal twist.Sit with left leg straight out or you can bend it as pictured. Cross the right foot over the left leg, press your right hand behind you, place your left elbow on your right knee now twist. Stretch as far as you are comfortable. Try holding it 15-20 seconds.

This stretch will even help to loosen your hips if you sit as pictured!

As with all stretches, start out easy – stretching should feel GOOD. You’ll feel the tension ease as the blood starts flowing.The tight muscles that cause back pain after sleeping can hamper your entire day, but doing these simple stretches will make a world of difference!

Wishing you well,

Julie Donnelly

About The AuthorJulie 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.

Are Supplements Worth It?

September 8, 2015 by Dr. Steve Chaney

A Cost, Benefit Analysis of Supplementation

Author: Dr. Stephen Chaney

Are supplements worth it? There is no question that supplements add to the family budget. As families juggle their budgets it is natural to wonder whether the supplements they are buying are worth the cost.

It is only natural to ask questions like: “What is the cost, benefit ratio of supplementation?” “Is there any evidence that supplementation today will save us money in health care costs down the road?”

If a recent study is accurate, the answer to that last question may be a resounding yes!

How the Study Was Designed

A number of studies in the past have suggested that supplementation reduces health care costs, but they have suffered from a variety of methodological pitfalls so their conclusions could not be considered definitive.

In a time of skyrocketing health care costs coupled with governments tightening their budgets worldwide, it has become increasingly important for those governments to determine what the most cost effective public health interventions are. Thus, the question of whether supplementation can decrease health care costs has become paramount.

Therefore, an international group of scientists decided to do a systematic review and meta-analysis of the cost effectiveness of supplementation (Elia et al, Clinical Nutrition, doi: 10.1016/j.clnu.2015.07.012). They included only the highest quality previous studies in their analysis. After screening 16,598 published studies they excluded all but 19 in their final evaluation. The studies that they included had the following characteristics.

The subjects were supplementing with a commercially available multi-nutrient supplement that also contained protein and calories (i.e. a meal replacement supplement). Subjects consuming disease-specific supplements or immune-enhancing supplements were excluded from the study.

Subjects were studied in a wide variety of settings, including both free living individuals in the community and those in care homes

In some cases the supplementation was begun while they were in the hospital and continued when they went home. In other cases supplementation was begun while they were at home and continued after admission to the hospital.

Subjects were of all ages.

Are Supplements Worth It — The Money?

From a public health perspective the conclusion from this study was clear. Supplementation with a basic meal replacement supplement saves money. It is an effective public health intervention.

Overall, supplementation decreased health care costs by 8.1%.

For studies lasting less than 3 months, supplementation reduced health care costs by 9.2%. These were most often short-term pre- and/or post-operative supplementation studies. The cost savings ranged from $300-$530 per patient.

For studies lasting more than 3 months, supplementation reduced health care costs by 5%. These were mostly long-term community studies.

Overall, the costs savings attributable to supplementation were most apparent in short term studies involving a hospital component and in those studies involving younger patients.

The first observation was expected, but the second was a bit of a surprise. The general assumption is that elderly patients are more likely to suffer from malnutrition and benefit from supplementation. These data suggest that suboptimal nutrition may be more prevalent in younger adults than generally anticipated.

The reduction in health care costs was primarily due to:

Significant (16.5%) reduction in hospital admissions.

Decreased length of stay in the hospital.

Decreased infections.

Reduced post-operative complications.

Reduced falls and functional limitations in the elderly.

Although, it did not factor into the cost analysis, those subjects using the meal replacement supplement reported greater quality of life as well. Are supplements worth it? For some, a greater quality of life would help answer that question.

Strengths and Weaknesses of the Study

This was an excellent study, but it does have some important limitations.

While the systematic review and meta-analysis was very well done, it is limited by the quality of the studies that were included in the analysis, and most of those studies had one or more limitations. The authors acknowledged the need for future large scale, prospective studies, that are designed specifically to measure the cost effectiveness of supplementation.

The authors focused almost entirely on the cost benefit analysis. No information was provided on:

The health of these subjects

Why they were using a meal replacement supplement

Whether they decided to use the meal replacement supplement on their own or whether it was recommended by their doctor.

Thus, it is a bit difficult to extrapolate these data from a public health perspective to an individual perspective – the question of whether supplementation reduces health care costs sufficiently to be cost effective for you and me.

This study showed that even a basic meal replacement supplement has a significant effect on reducing health care costs in a variety of settings. However, it provides no information on whether individuals would obtain even greater benefit if they included other supplements in their program.

The Bottom Line

A recent study has shown that even a simple meal replacement supplement can be an effective public health intervention because it significantly reduces health care costs and improves quality of life.
The most significant reductions in health care costs came from:
- A significant (16.5%) reduction in hospital admissions.
- Decreased length of stay in the hospital.
- Decreased infections.
- Reduced post-operative complications.
- Reduced falls and functional limitations in the elderly.
The cost savings were most significant when the meal replacement supplement was used just prior to or following hospital admission for a surgical procedure. This argues strongly for a basic program of nutrition supplementation whenever you are preparing for surgery.However, as the saying goes “Stuff happens”. We don’t always know the precise date and time of our next hospital admission. This may be one case where an ounce of prevention is definitely worth a pound of cure.
The study did include some long term studies of free living individuals in the community, but it is difficult to directly extrapolate from this study to the question of how much a basic meal replacement supplement might reduce health care costs for healthy individuals like you and me.However, many of the things we do to improve our health – buy organic, go on a diet program, purchase a gym membership, or go on a supplement program, for example – cost us money. It is studies like this that suggest at least a portion of those costs may be offset by reduced health care costs down the road.
Finally, this study only looked at the cost effectiveness of a basic meal replacement supplement. It does not provide any information on whether addition of other supplements might provide even greater health care savings.There are studies suggesting that a holistic approach to supplementation may reduce disease burden long term (for example; Nutr J. 2007 Oct 24; 6:30). A detailed cost effectiveness analysis has not been performed on those studies, so we cannot say how much money they might save in reduced health care costs over the long term. However, if a holistic program of diet, exercise and supplementation keeps me out of the doctor’s office and out of the hospital, I’m happy.

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.

Artificial Sweeteners And Diabetes

September 1, 2015 by Dr. Steve Chaney

Another Myth Bites The Dust

Author: Dr. Stephen Chaney

Artificial sweeteners and diabetes; is there a relationship?

Once again, artificial sweeteners have come up empty. They were supposed to help you lose weight, but several recent clinical studies have suggested that artificially sweetened beverages are just as likely to lead to weight gain as sugar sweetened beverages, see Do Diet Sodas Make You Fat.

What about type 2 diabetes? There have been several clinical trials that have suggested that excess consumption of sugar sweetened beverages may increase your risk of developing type 2 diabetes (For example, Basu et al, Am J Pub Health, 103: 2071-2077, 2013; Malik et al, Diabetes Care, 33: 2477-2483, 2010).

As a consequence if you are at risk of developing type 2 diabetes, you’ve probably been advised by your doctor or dietitian to switch from sugar sweetened beverages to artificially sweetened beverages or natural fruit juices. But, does that really work? Maybe not.

In fact, some studies have suggested that excess consumption of artificially sweetened beverages or fruit juice may be just as likely to lead to type 2 diabetes as consuming sugar sweetened beverages (For example, Greenwood et al, Br J Nutr, 112: 725-734, 2014; Xi et al, PloS One, 9:e93471, 2014).

A Systematic Study Of Beverage Consumption And Diabetes Risk

However, this has been a very controversial topic. The problem is that it is devilishly difficult to design studies that provide definitive answers to these important questions.

To start with there are problems with confounding factors. For example,

It is pretty well established that consumption of sugar sweetened beverages leads to obesity and obesity leads to type 2 diabetes, but many of the studies did not adjust the data for obesity.

In addition, many people who are overweight often switch to artificially sweetened beverages in the mistaken belief that they will help them lose weight. Once again, many of the published studies did not correct for that.

There are also problems with study design. For example, many of the studies did not directly compare sugar sweetened and artificially sweetened beverages in the same population group. If the population groups are different enough between studies, it can be a little like trying to compare apples to oranges.

Because of these limitations an international team of experts designed a major systematic review and meta-analysis (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) of all reasonably well designed prospective studies that measured the effect of beverage consumption on the development of type 2 diabetes over time.

They evaluated the data from 17 studies that represented 38,253 people who developed type 2 diabetes over a period of at least two years. They used the most rigorous statistical analysis methods available, and they interpreted their results very cautiously.

In short, this was a major study. So, what did the study show?

Is There a Relationship Between Artificial Sweeteners And Diabetes?

On face value, the data appeared to be fairly clear:

An additional one serving per day of a sugar-sweetened beverage increases your risk of developing type 2 diabetes by 18%. When you correct for obesity, the increased risk is 13%. (Note: we are talking about an 8 ounce serving here, not a 32 ounce Big Gulp or 64 ounce Double Gulp).

An additional one serving per day of an artificially-sweetened beverage increases your risk of developing type 2 diabetes by 25%. When you correct for obesity, the increased risk is 8%.

An additional one serving per day of fruit juice increases your risk of developing type 2 diabetes by 5%. When you correct for obesity, the risk actually increases to 7%.

In short, if you want to decrease your risk of developing type 2 diabetes, none of these options is a particularly good choice.

How Were These Data Interpreted

Of course, the strength of any meta-analysis is limited by the quality of the studies that were included in the meta-analysis. It is the old GIGO (garbage in, garbage out) principle. The authors acknowledged that limitation and analyzed in great detail the quality of the individual studies included in their meta-analysis. Their conclusions were as follows:

The quality of the data on sugar sweetened beverages was strong enough that they could conclude that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.

They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.

However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

The Bottom Line

If you are overweight or otherwise at risk of developing type 2 diabetes, you have probably been advised to switch from sugar-sweetened beverages to either artificially sweetened beverages or fruit juices. A major study has just turned that advice on its head!

This study (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) was a systematic review and meta-analysis of 17 previously published clinical studies that measured the effect of beverage consumption on the development of type 2 diabetes over time. Based on a very careful analysis of the data from this meta-analysis the authors concluded:

The quality of the data on sugar sweetened beverages was strong enough that they could unequivocally state that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.

They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.

However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

So what kind of beverages should you consume if you don’t want your beverage intake to contribute to type 2 diabetes?

Water is always the first choice.

Milk, protein shakes and similar beverages can also be an excellent choice as long as you take the calories into account. The protein content of those beverages generally slows the rate of sugar uptake. Look for products with a low glycemic index.

High intensity or long endurance exercise requires a lot of carbohydrate, so sugars in rehydration or recovery sports supplements are well tolerated. However, those same sports drinks would be a concern if used as part of a sedentary lifestyle.

Finally, tea, coffee, and non-caffeinated herbal teas are excellent choices as long as you learn to enjoy them without adding sugar or artificial sweeteners.

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.

Leucine And Muscle Gain

August 25, 2015 by Dr. Steve Chaney

Should Your Post-Workout Protein Shake Contain Added Leucine?

Author: Dr. Stephen Chaney

If you are an athlete – or just someone who is exercising to create a lean and healthy body, you are probably interested in increasing your lean muscle mass following each workout. You may already use leucine. Of course, if you read any of the “muscle magazines”, you’ve seen the ads. “Explode Your Muscles.” “Double Your Gains.” They all claim to have the perfect post-workout protein shake, backed by science. They all sound so tempting, but you know that some of them have to be scams.

I told you about some of the sports supplements to avoid in previous “Health Tips From the Professor”. In this issue, I’m going to ask “What does the perfect post-workout protein shake look like?”

For years athletes have been using protein beverages containing branched chain amino acids after their workouts to maximize muscle gain and recovery. There was some science behind that practice, but the major questions were unanswered. Nobody really knew:

How much protein is optimal?

What kind of protein is optimal?

What amount of branched chain amino acids is optimal?

Are some branched chain amino acids more important than others?

Does the optimal amount of branched chain amino acids depend on the amount of protein?

As a consequence, after workout protein supplements were all over the map in terms of protein source, protein amount, branched amino acid amount and type of branched chain amino acids. Fortunately, recent research has clarified many of these questions.

How Much Protein Do You Need and What Kind?

Recent research has shown that the optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young adults (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older adults (Symons et al, Am J Clin Nutr 86: 451-456, 2007).

More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young adults and 30 gm for older adults (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).

Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, pea, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

Leucine: The Only Branched Chain Amino Acid To Stimulate Muscle Protein

It turns out that leucine is the only branched chain amino acid that actually stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.

Recent research has shown that 2-3 gm of leucine (2 gm for young adults; 3 gm for older adults) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

Unanswered Questions About Optimizing Muscle Gain Post-Workout

Do the other branched chain amino acids play a supporting role, or is leucine alone sufficient to drive post-workout muscle gain?

Can leucine still help maximize post-workout muscle gain if protein intake is inadequate? If so, how much leucine is needed?

Does Leucine Enhancement Improve Low Protein Shakes?

A recent study (Churchward-Venne et al, Am J Clin Nutr, 99: 276-286, 2014) seems to answer those two questions. The authors compared the effect of 5 protein-amino acid combinations on muscle protein synthesis in 40 young men (~21 years old) following unilateral knee-extensor resistance exercise. The protein shakes contained:

25 gm of whey protein, which naturally contains 3 gm of leucine (high protein)

6.25 gm of whey protein, which naturally contains 0.76 gm of leucine (low protein)

6.25 gm of whey protein with 3 gm of leucine (low protein, low leucine)

6.25 gm of whey protein with 5 gm of leucine (low protein, high leucine)

6.25 gm of whey protein with 5 gm of leucine + added isoleucine and valine (the other branched chain amino acids). (low protein, branched chain amino acids).

The results were clear cut:

The high protein shake (25 gm of protein) was far superior to the low protein shake (6.25 gm of protein) at enhancing post workout protein synthesis. This is consistent with numerous other published clinical reports.

Adding 3 gm of leucine to the low protein shake had no effect on post-workout protein synthesis, but 5 gm of added leucine made the low protein shake just as effective as the high protein shake at supporting post-workout protein synthesis.

In short, leucine can improve the effectiveness of a low protein shake, but you need more leucine than if you chose the high protein shake to begin with.

Adding extra branched chain amino acids actually suppressed the effectiveness of leucine at enhancing post-workout protein synthesis. These data suggest:

Leucine probably is the major amino acid responsible for the muscle gain reported in many of the previous studies with branched chain amino acids.

If the other branched chain amino acids play a supporting role in the muscle gain, the quantities that occur naturally in the protein are probably enough. Adding more may actually reduce the effectiveness of leucine at stimulating muscle gain.

While this is a single study, it is consistent with numerous other recent clinical studies. It simply helps clarify whether leucine can increase the effectiveness of a low protein supplement. It also clarifies the role of branched chain amino acids.

Also, while this study focused on protein synthesis, numerous other studies have shown that optimizing post-workout protein and leucine intake results in greater muscle gain (for example, Westcott et al., Fitness Management, May 2008)

The Bottom Line

Research on post-workout nutrition to optimize muscle gain from the workouts has come a long way in recent years. It is now actually possible to make rational choices about the best protein supplements and foods to support your workouts.

If you are a young adult (17-30), you should aim for 15-20 gm of protein and about 2 gm of leucine after your workout.

If you are an older adult (50+), you should aim for 20-25 gm of protein and 3 gm of leucine after your workout.

If you are in between you are on your own. Studies haven’t yet been done in your age group, but it’s reasonable to assume that you should aim for somewhere between the extremes.

If you are getting the recommended amounts of whey protein, the leucine level may also be optimal. If you are using other protein sources you may want to choose ones with added leucine.

The research cited above shows that you can make a low protein supplement effective by adding lots of leucine, but that’s going to require artificial flavors and sweeteners to cover up the taste of that much leucine. I would recommend choosing one that provided adequate protein to begin with.

While the research in this area is still somewhat fluid, I would avoid protein supplements with added branched chain amino acids other than leucine. If the paper I cited above is correct, you probably get all of the other branched chain amino acids you need from your protein and adding more may actually interfere with the effect of leucine on muscle gain.

I’d pretty much forget all the other “magic ingredients” in post-workout supplements. If you’re a novice there is some evidence that arginine and HMB may be of benefit, but if you have been working out for more than 6 months, the evidence is mixed at best. As for the rest, the clinical studies are all over the map. There’s no convincing evidence that they work.

Whey protein is the best choice for enhancing muscle gain immediately after your workout. Soy, pea, and casein are better choices for sustaining muscle gain over the next few hours. If you’re looking at meat protein, chicken is a particularly good choice. Four ounces of chicken will provide the protein and leucine you need to sustain muscle gain for several hours.

Even if you are not working out, recent research on dietary protein and leucine has important implications for your health. In a recent “Health Tips From the Professor” High Protein Diets and Weight Loss, I shared research showing that optimizing protein and leucine intake helps to increase muscle retention and maximize fat loss when you are losing weight.

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

Emergency Treatment for Calf Cramps

August 18, 2015 by Dr. Steve Chaney

To Stretch or Not To Stretch

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

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

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

Emergency Treatment for Calf Cramps

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

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

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

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

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

Follow These Steps To Release Your Calf Cramps

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

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

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

Wishing you well,

Julie Donnelly

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

About The Author

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.

Alternatives To Statins

August 11, 2015 by Dr. Steve Chaney

How Do Stanols And Sterols Lower Cholesterol?

Author: Dr. Stephen Chaney

Are there alternatives to statins? If you have been looking for natural approaches for lowering your cholesterol and protecting your heart, you’ve probably been hearing a lot about plant stanols and sterols lately.

What Are Stanols and Sterols & What Do They Do?

Just what are plant stanols and sterols and why does the National Institutes of Health (NIH) recommend them as a natural approach for lowering cholesterol?

Stanols and sterols are natural substances found in plants that have a structural resemblance to cholesterol. Because they look a lot like cholesterol, they compete with cholesterol for absorption from the intestine into the mucosal cells lining the intestine. However, once they get into the intestinal mucosal cells they are recognized as foreign and are immediately pumped back into the intestine so that they never get into the bloodstream.

Let me give you an analogy. Let’s think of the intestinal mucosal cells as a nightclub. The doorman doesn’t check IDs. He lets everyone into the club. Pretty soon the word gets around and stanols and sterols start lining up at the door. If a cholesterol molecule comes along, he gets discouraged by the line and doesn’t even try to get in. What the stanols and sterols don’t know is that there is a bouncer inside the club who does check IDs throws everyone who doesn’t belong there out the back door.

When you think about it, this is the best of all possible worlds. Cholesterol molecules don’t get into the bloodstream and neither do the stanols and sterols.

Alternatives to Statins: How Do Stanols and Sterols Lower Cholesterol?

As part of their Therapeutic Lifestyle Change Program the NIH recommends that people with elevated cholesterol consume 2 grams of plant stanols and sterols a day because over 80 clinical studies have proven that they work.

Two grams a day of stanols and sterols is sufficient to lower LDL cholesterol (the bad kind) by 9 to 13%. And many other clinical studies have shown that lowering LDL cholesterol by that much will lower your risk of a heart attack by 18-26%.

No wonder the NIH is so bullish on stanols and sterols!

Answers To The Questions You Didn’t Think To Ask

Here are answers to some questions that you haven’t even thought of yet:

#1: If 2 grams a day is good, would more be better?

No. Studies clearly show that 2 grams/day is optimal. Higher intakes do not lead to a significantly greater reduction in LDL cholesterol.

#2: Are there any side effects from consuming plant stanols & sterols on a daily basis?

No. That’s the great thing. Plant sterols and stanols are natural substances that we consume every day – and clinical studies have shown that they have no side effects.

#3: Is there some magical stanol/sterol combination that is more effective than others (as some supplement manufacturers would have you believe)?

No. Numerous studies have shown that stanols and sterols from many different sources have exactly the same effect and that it doesn’t matter whether they are esterified or not.

#4: Can I get 2 grams a day of stanols and sterols from my diet?

It’s unlikely. Even the best natural sources (usually fruits and vegetables) only have 5 to 40 mg per serving. If you are a vegetarian you can expect to get around 700 mg from your diet. If you consume a typical American diet you get around 250 mg and if you eat a lot of fast food you are probably getting less than 100 mg.

#5: I’ve noticed that food manufactures have started fortifying foods with stanols and/or sterols. Is this a good choice for me?

Not necessarily. You need to remember that Big Food Inc is not always your friend. To get 2 grams of stanols from Benecol you would need to consume 280 calories, 4 grams of saturated fat and 1.2 grams of trans fat. Two grams of stanols from Promise activ Super-Shot only costs you 70 calories, but it comes with artificial colors and 8 grams of sugar plus sucralose.

#6: When should I consume stanols and sterols if I want to maximize my LDL cholesterol reduction?

Any time from 30 minutes prior to your meal to with your meal is ideal – but the plant sterols and stanols will exert their beneficial effects for several hours so the time that you take the stanols & sterols is not critical.

#7: Are plant sterols and stanols a source of dietary fiber?

No. Plant stanols & sterols and dietary fiber work by different mechanisms – but they do complement each other in lowering LDL cholesterol. As a matter of fact, the NIH Therapeutic Lifestyle Program recommends 10-25 grams/day of soluble fiber along with the 2 grams/day of stanols and sterols. You should consider stanols/sterols and dietary fiber as a powerful one-two punch in your battle to lower your LDL cholesterol naturally.

#8: I’m already taking a statin drug. Is it OK to take plant stanols & sterols as well?

Absolutely. The NIH recommends that people using statin drugs also follow their Therapeutic Lifestyle Change Program – which includes 2 grams of plant stanols and sterols a day. In fact, because the effects of statins and plant sterols & stanols are additive, you may be able to reduce your dosage of statins or eliminate them entirely – which means less cost and less risk of side effects to you. [Note: You should partner with your physician in determining the dosage of statins to take.]

What I do not recommend is that you go off your statin drug and switch to a supplement containing stanols and sterols without consulting your doctor. Stanols and sterols have a more modest cholesterol lowering effect (and fewer side effects) than statin drugs. So if you were to just go off your statin and switch to a stanol/sterol supplement, your cholesterol levels might actually go up.

#9: Should I ask my doctor before taking plant stanols & sterols?

I always recommend that you keep your doctor informed about what you are doing. However, because the NIH recommends plant sterols and stanols for people with elevated cholesterol, your doctor is very likely to approve.

The Bottom Line

Plant stanols and sterols can be an important part of a holistic approach to lowering cholesterol naturally. In fact, the NIH recommends 2 grams/day of plant stanols and sterols as part of its Therapeutic Lifestyle Change Program for lowering cholesterol.

2 grams/day of plant stanols and sterols lowers LDL cholesterol (the bad kind) by an average of 9 to 13%, which is sufficient to decrease your heart attack risk by 18-26%.

Here are the answers to the most common questions I receive about stanols and sterols (for the full response read the article above)

2 grams of stanols & sterols a day is optimal. More is not better.

There are no side effects to adding stanols & sterols to your diet.

There is no “magical” sterol/stanol formulation. They all work about the same.

It is very unlikely that you can get 2 grams/day of stanols & sterols from your diet.

It is best to consume stanols & sterols before or with a meal, but the exact timing isn’t crucial.

Stanols & sterols are not the same as dietary fiber, but stanols/sterols and dietary fiber complement each other as part of a holistic approach to lower cholesterol.

It is OK to take stanols & sterols along with a statin drug. In fact, this is part of the approach recommended by the NIH Therapeutic Lifestyle Change Program. However, I do not recommend going off of a statin drug and substituting stanols & sterols without the permission of your doctor.

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.

Soy and Hot Flashes

August 4, 2015 by Dr. Steve Chaney

Will Soy Put Out The Fire?

Author: Dr. Stephen Chaney

There has been a lot of controversy in recent years about soy and hot flashes. The question is whether soy isoflavones reduce the hot flashes associated with menopause.

And this is an important question! Because of concerns about increase heart attack risk with hormone replacement therapy (HRT) many women have been looking for natural alternatives to HRT for reducing hot flashes and other symptoms of menopause. They’ve been asking whether soy isoflavones are effective, and the answers that they’ve been getting have been confusing.

For example, you can still find many experts and health professionals who will tell you that soy isoflavones have no proven effect on menopause symptoms.

That is somewhat surprising since two recent meta-analyses (Howes et al, Maturitas, 55: 203-211, 2006; Williamson-Hughes, Menopause, 55: 203-211, 2006) and a 2010 expert panel of The North American Menopause Society have all concluded that soy isoflavones alleviate hot flashes.

Will Soy Put Out The Fire?

However, clear guidance in this area was sorely needed, so Taku et al (Menopause, DOI: 10.1097/gme.0b013e3182410159, 2012) performed an even larger meta-analysis that included 19 published clinical trials – some of which had been published after the previous two meta-analyses were performed.

I’ve talked about meta-analyses before, so you probably already know that they are very powerful because they combine the results of many individual clinical trials into a single data analysis.

But you also may remember me telling you that meta-analyses can be misleading if they introduce bias because of the kinds of clinical studies that they exclude from their analysis.

So I examined the design of this meta-analysis very carefully. It excluded clinical trials that:

were not double blind, placebo controlled and designed in such a manner that the placebo was indistinguishable from the soy isoflavone preparation.

contained other substances in addition to the soy isoflavones (The presence of other substances in the preparation might have influenced the response).

There were several other well justified reasons for excluding some studies from the meta-analysis, but they were technical in nature. In my opinion this was a very well designed study.

And the results were clear cut. An average of 54 mg of soy isoflavones (some studies used a little less, some a little more) was sufficient to reduce:

the frequency of hot flashes by 21% – and –
the severity of hot flashes by 26%

Soy and Hot Flashes: What This Study Mean For You?

The results of this study were highly statistically significant. So if you are suffering from hot flashes and are wondering whether soy isoflavones will put out the fire, the answer appears to be YES.

That’s the good news.

The bad news is that 21-26% is not a huge effect.

And, if you look at the individual clinical studies it is apparent that the response is highly variable. Some women experience major relief from hot flashes and other menopause symptoms, while other women experience little or no relief.

The reason for this variability is not known, but it is likely that the effectiveness of soy isoflavones on reducing hot flashes is modified by other components of the diet and by lifestyle factors such as obesity, exercise and stress.

Soy and hot flashes; the bottom line.

My take on this is that soy isoflavones should not be thought of as a “magic bullet” that will make hot flashes go away by themselves, but rather as a proven part of a holistic approach that encompasses a healthy diet, exercise, weight control and stress reduction

The Bottom Line

A recent meta-analysis of 19 published clinical studies showed that soy isoflavones reduced the frequency of hot flashes by 21% and the severity of hot flashes by 26%.

The results were highly statistically significant, but 21-26% reduction in symptoms is not a huge effect.

When they looked at the individual clinical studies it was apparent that the response is highly variable. Some women experienced major relief from hot flashes and other menopause symptoms, while other women experienced little or no relief.

My take on this is that soy isoflavones should not be thought of as a “magic bullet” that will make hot flashes go away by themselves, but rather as a proven part of a holistic approach that encompasses a healthy diet, exercise, weight control and stress reduction

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

How To Prevent Memory Loss?

July 28, 2015 by Dr. Steve Chaney

A New Study Shows B Vitamins and Omega-3s May Prevent Memory Loss

Author: Dr. Stephen Chaney

Want to know how to prevent memory loss? Every once in a while a breakthrough study comes along that has the potential to change paradigms. A recent study (Jerneren et al, Am J Clin Nutr, 102: 215-221, 2015) looking at the potential of B vitamins and omega-3s to slow brain shrinkage in the elderly is just such a study. It has the potential to forever change the way we think about preserving brain health as we age.

One of the most terrifying aspects of aging is the thought that we might literally lose our minds. On one hand, it seems to be an almost inevitable part of the aging process. Every year millions of older Americans develop mild cognitive impairment, and as they age many of them progress on to dementia or Alzheimer disease. In fact, one recent study (Plassman et al, Ann Neurol, 70: 418-426, 2014) estimated that for individuals 72 and older in the United States every 6 years:

8 million will develop mild cognitive impairment.
4 million will develop dementia.
3 million will develop Alzheimer disease.

Unfortunately, there is no effective drug treatment for preventing this cognitive decline, and there don’t appear to be any promising new drugs on the horizon. So it is only natural to ask whether there are diet and lifestyle changes that might reduce the rate of cognitive decline as we age.

As I discussed in previous issues of “Health Tips From the Professor” there are clinical studies suggesting that B vitamins and omega-3 fatty acids can both slow the brain shrinkage and cognitive decline associated with aging. Unfortunately, there are also clinical studies that have come up empty. They have found no effect of B vitamins or omega-3 fatty acids on brain shrinkage or cognitive decline. Because of these conflicting clinical results, many experts are simply not ready to endorse natural approaches for preventing cognitive decline.

That’s what makes the current study (Jerneren et al, Am J Clin Nutr, 102: 215-221, 2015) paradigm-changing. If this study is correct, you need both B vitamins and omega-3 fatty acids together to prevent cognitive decline. Neither one will work without the other.

That would explain a lot! The previous studies have not been designed to test the effects of both B vitamins and omega-3 fatty acids simultaneously. Whether or not the diets of previous study participants were adequate with respect to B vitamins and omega-3s was a matter of pure chance. If the diets were adequate in both B vitamins and omega-3s, the study outcome might be positive. If the diets were only adequate in just one or the other, the outcome would almost assuredly be negative.

Why Might B Vitamins and Omega-3s Both Be Required for Brain Health?

It is easy to understand why B vitamins and omega-3s each might be important for preventing cognitive decline individually. Cognitive decline is closely associated with elevated levels of homocysteine, a toxic amino acid metabolite, and multiple clinical studies have shown that the combination of folic acid, vitamin B12 and vitamin B6 is effective at lowering homocysteine levels.

The omega-3 fatty acids are an integral part of the myelin sheath that coats our neurons. You can think of myelin as being like the plastic coating on an electrical wire that allows the electrical current to travel from one end of the wire to the other without shorting out. Myelin plays essentially the same role for our neurons.

But what is the possible connection between B vitamins and omega-3s with regard to brain health? The authors of this study had an interesting hypothesis. It turns out that when homocysteine levels are elevated due to B vitamin deficiency methionine levels and the levels of a number of downstream metabolites, including phosphatidylcholine, are reduced – and phosphatidylcholine is what delivers omega-3 fatty acids to the brain.

If their hypothesis is correct, adequate levels of B vitamins are required to deliver omega-3 fatty acids to the brain. That means that omega-3 fatty acids would only be effective at preventing brain shrinkage and/or cognitive decline in studies where the subjects were receiving adequate B vitamins as well.

Conversely, if we assume, as the authors suggested, that the real role of B vitamins is to assure the presence of enough phosphatidylcholine to deliver omega-3 fatty acids to the brain, B vitamins would be effective only in clinical studies where the subjects were also getting sufficient omega-3s from their diet.

B Vitamins and Omega-3s Together May Be How To Prevent Memory Loss

The study itself included 168 adults over the age of 70 (average age = 77) with mild cognitive impairment at the beginning of the study. Half of them were given a high dose B vitamin supplement (800 ug folic acid, 500 ug vitamin B12, and 20 mg vitamin B6), and the other half were given a placebo.

Brain MRI scans were performed at the beginning of the study and again 2 years later to measure brain volume. Blood levels of omega-3 fatty acids were assessed at the beginning of the study. When the data were analyzed at the end of the study, the subjects with blood omega-3 levels of >590 umole/L were classified as having high omega-3 status, and subjects with blood omega-3 levels <390 umole/L were classified as having low omega-3 status.

The results were pretty striking:

B vitamin treatment reduced brain shrinkage by up to 70% over a two year period in adults over the age of 70.

The B vitamin treatment was only effective when the subjects were deficient in B vitamins at the beginning of the study, as indicated by elevated homocysteine levels.

The B vitamin treatment was also only effective in subjects with high omega-3 status. The B vitamin treatment had no benefit in subjects with low omega-3 status.

What Is The Significance Of This Study?

In today’s scientific world, “gold standard” clinical studies are considered to be those in which a single variable is evaluated in a double-blind, placebo-controlled clinical trial. Unfortunately, this reductionist approach can sometimes lead to misleading and confusing results.

For example, I once attended a session in which a world renowned expert was giving his talk on colon cancer. He said, “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B-vitamins, exercise and weight control. But I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they’re advising?” You’ve heard experts saying: “Don’t worry about the fat” “Don’t worry about calcium.” “Don’t worry about B-vitamins.” “Don’t worry about fiber.” “None of them can be shown to decrease the risk of colon cancer.” Is that the message that we should be giving people? Or should we really be saying what that doctor said many years ago – that a lifestyle that includes all of those things significantly decreases the risk of colon cancer?

Similarly, in a recent “Health Tips From the Professor” I shared a study, Alzheimers Hope, showing that a holistic program involving exercise, a healthy diet, socialization and memory training significantly reduced cognitive decline in the elderly. Once again, it has been very difficult to reproducibly show that any of those interventions individually prevent cognitive decline.

That is what makes the current study so exciting. It is a single study, and it is a relatively small study. It definitely needs to be repeated. However, it has the potential to be a paradigm-shifting study.

Previous studies looking at the effect of B vitamins and omega-3s on brain shrinkage and/or cognitive decline have been inconsistent. Many have shown a benefit, but some have not. But, until now, none of the studies have looked at B vitamins and omega-3s together. If this study is correct, all future studies should examine the effect of both B vitamins and omega-3s together. The paradigm will have been forever changed.

Does It Matter?

The important question is whether this is just an academic discussion or does it really matter? If most older adults were getting adequate amounts of omega-3s and B vitamins in their diet, this would merely be an academic discussion. Unfortunately, that is not the case.

Our oceans and rivers are becoming more and more polluted, and many people are avoiding fish because of concerns about heavy metal or PCB contamination. There is also an increasing emphasis on eating “sustainable” fish. That usually means the fish are farm raised, and farm raised fish are the most likely to be contaminated with PCBs, which is unfortunate. For example, I recently went to a nice restaurant that had a delicious sounding salmon dish on their menu. They could guarantee that the salmon was sustainably raised, but they couldn’t guarantee it was PCB-free. I chose not to eat the salmon.

It is no wonder that many adults aren’t getting enough omega-3s in their diet. In a recent “Health Tips From the Professor,” Do women get enough omeg-3 during pregnancy I reported a study showing that a shocking 75% of pregnant and lactating Canadian women were not getting enough omega-3s in their diet! Other studies suggest those of us in the United States don’t do much better.

We don’t do much better with respect to B vitamins either. For example:

The most frequent cause of B12 deficiency is the age related loss of the ability to absorb vitamin B12 in the upper intestine. This affects 10-30% of people over the age of 50.

Chronic use of acid-suppressing medications such as Prilosec, Nexium, Tagamet, Pepcid and Zantac also decreases B12 absorption and increases the risk of B12 deficiency. Millions of Americans use those drugs on a daily basis.

Overall, B12 deficiency has been estimated to affect about 40% of people over 60 years of age.

Deficiency of the enzyme methylenetetrahydrofolate reductase (MTHFR) substantially increases the requirement for folic acid. About 10% of the US population has this enzyme deficiency.

About 25% of Americans have low blood levels of B6

Clearly, this is not just an academic argument. Millions of older Americans are deficient in B vitamins or omega-3s or both.

The Bottom Line

A recently published study looked at the effect of high dose B vitamin supplementation on brain shrinkage over a two year periods in adults over 70 (average age 77) with mild cognitive impairment at the beginning of the study. This study differed from all previous studies in that it also measured omega-3 fatty acid levels in the blood at the beginning of the study to assess omega-3 status.

B vitamin treatment reduced brain shrinkage by up to 70% over the two year period compared to placebo.

The B vitamin treatment was only effective when the subjects were deficient in B vitamins at the beginning of the study, as indicated by elevated homocysteine levels.

The B vitamin treatment was also only effective in subjects with high omega-3 status at the beginning of the study. If they had low omega-3 status, the B vitamin supplementation was ineffective.

This study has the potential to forever shift the paradigm for preventing cognitive decline in the elderly. Past studies have looked at the effect of B vitamins and omega-3s at reducing cognitive decline separately, and these studies have been inconsistent. If this study is correct, consistent benefits will only be seen when both B vitamins and omega-3 fatty acids are present at adequate levels.

This is a concern because millions of older Americans are deficient in B vitamins or omega-3s or both.

How to prevent memory loss? Of course, B vitamins and omega-3s are just part of a holistic approach for preventing cognitive decline. Weight control, exercise, a healthy diet, adequate sleep, socialization, and memory training (mental exercise) are also important if we want to retail our full mental capacity into our 90s and beyond.

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.