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

Are Food Supplements Safe?

November 10, 2015 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

If you saw the recent headlines proclaiming that dietary supplements were responsible for 23,000 emergency room visits and 2,100 hospitalizations every year, you are probably wondering are food supplements safe to use at all. The study behind these headlines (Geller et al, New England Journal of Medicine, 373: 1531-1540, 2015) was based on an extrapolation from 63 hospitals to every hospital in the United States.

Some experts consider this to be an overestimation since it is almost 8 times higher than the 3,200 cases/year in the official FDA’s Serious Adverse Event Reporting database. However, for the purposes of this article I will accept the 23,000 numbers.

Let me start by putting the 23,000 number into perspective.

It represents about 0.015% of the 150 million people in the US who use supplements.

It represents about 1% of the emergency room admissions caused by side effects of properly prescribed medications.

In short, the headlines are over-dramatizing the dangers of dietary supplements. Dietary supplements are actually quite safe. However, even one emergency room visit due to a dietary supplement is too many – especially if it were to happen to you or a loved one. Consequently, I will analyze the study in more detail so that I can show you how to recognize and avoid those few supplements that are truly dangerous.

Are Supplements Dangerous?

Here is a breakdown of the data:

13% of the ER visits were due to allergic reactions. These were seldom serious enough to require hospitalization. This is also a type of problem that is probably unavoidable. Since many food supplements use natural ingredients, some degree of food allergies are to be expected.

13% of the ER visits were due to swallowing problems, primarily in people over the age of 65. The preventative measure here is also pretty simple. If you or a loved one has difficulty swallowing, choose pills that are small and slick, chewable, powder or liquid supplements.

20% of the ER visits were due to adverse effects caused by unsupervised ingestion of the supplements by children. The preventative measure here is pretty simple. Keep your supplements out of reach of small children – especially if they are chewable or have attractive colors. While the supplements may be perfectly safe when taken as recommended, the unsupervised ingestion of a whole bottle of almost any supplement by a small child is problematic.

41% of the ER visits were due to weight loss products (25.5%), energy products (10%), sexual enhancement products (3.4%) and bodybuilding products (2.2%). The most common adverse effect for these products were heart palpitations, chest pain, and irregular heartbeat. These are the kinds of supplements you really need to be most careful about.

Why Are Dangerous Supplements Even On The Market?

Let’s start with the obvious question: Why are weight loss, energy, sexual enhancement and bodybuilding products the ones most likely to be dangerous? To quote Pogo (now I’m really dating myself): “We have met the enemy, and he is us”

Weight Loss Products: We can listen all day long to experts tell us that we need to make lifestyle changes, and we should aim for no more than one or two pounds of weight loss per week. However, for most of us that advice goes in one ear and out the other. We want to lose weight fast, and we want it to be easy.

Energy Products: Many of us are just plain exhausted because our diets are terrible; we are under stress; and we are burning the candle at both ends. We don’t want to eat better and change our lifestyle. We want high octane energy, and we want it now.

Body Building Products: The story is similar, especially for males in the 20-34 age range. We want big muscles, and we don’t want to wait for the years of workouts it will take to build that kind of physique naturally. We want it now.

Sexual Enhancement Products: ER admissions for sexual enhancement products were 100% male. What does that say about us guys? I won’t even go there.

Most supplement manufacturers are ethical and don’t make supplements that could harm us. However, there are a few unscrupulous manufacturers who are only too happy to exploit our human weaknesses if they can make a buck in the process. They will give us exactly what we want, even if it kills us in the process.

I’ve warned about these unscrupulous manufacturers in the past. The easiest way to create products that will burn off weight effortlessly, build muscle rapidly, and give you energy are to add chemically synthesized stimulants in the amphetamine family. For example, I’ve warned you about products containing stimulants such as DMAA and DEPEA in Are Dietary Supplements Safe and BMPEA in Are Sports Supplements Safe. They all work, but they also cause heart palpitations, chest pain, and irregular heartbeat. They can land you in the emergency room, and sometimes they can kill you.

In addition to stimulants, some weight loss products use diuretics, and some energy products use dangerous levels of caffeine, both of which can cause problems. Sexual enhancement products often use herbal ingredients like yohimbe bark that can be quite dangerous

Don’t Count On The FDA To Protect You

Unfortunately, you can’t count on the FDA to protect you. For example, in the case of the DMAA scandal, the FDA did not act until the day before a big expose was to air on 60 Minutes about the deaths caused by DMAA. They were shamed into taking strong action and removing DMAA from the shelves of retailers.

Case closed, you might think, but the truth is a bit scarier. That action was back in 2013. Since then, the FDA has ignored DMAA-containing products. The Human Performance Resource Center, an initiative of the Department of Defense, recently listed 39 products containing DMAA that are readily available, either online or from retail stores. Even though the FDA has classified DMAA as an illegal ingredient, it is still readily available, and they don’t act.

This is just one of many examples I could cite. It’s not clear whether the FDA is unwilling to protect us, or if it is overwhelmed. However, it is clear that if we want to avoid dangerous supplements, it is up to us.

How Can You Protect Yourself From Dangerous Supplements?

If the FDA isn’t going to protect you, what can you do to protect yourself from dangerous supplements? There are threesimple things that you can do to protect yourself;

#1: Use common sense.

Don’t even consider those weight loss supplements that promise you’ll lose 5-10 pounds/week, or that they will make the fat melt away effortlessly.

Walk away from those bodybuilding supplements that promise to make your muscles “explode” or give you “insane energy”.

Put those energy supplements that promise a jolt of energy back on the shelf.

As for sexual enhancement products, consult your doctor before you reach for a magic pill. Your problems in the bedroom may be caused by a treatable medical condition.

#2: Make the Commitment. A holistic lifestyle change that includes weight control, exercise, diet and supplementation may be more work, but it is so much safer and more beneficial in the long run.

#3: Choose wisely. Look for a supplement company with integrity.

A company that is committed to only making products that are both safe and effective.

A company that does clinical studies to make sure their products are safe and effective and publishes those studies in peer-reviewed scientific journals.

Are food supplements safe?

The Bottom Line

A recent study reported that 23,000 emergency visits and 2,100 hospital admissions each year were caused by dietary supplements. Some experts consider this to be an overestimate. It is an extrapolation from 63 hospitals to every hospital in the United States, and it is approximately 8-fold higher than the FDAs Adverse Events database.

While the headlines sound scary, when you put the data into perspective it is clear that dietary supplements are actually quite safe. Even if we accept the 23,000 ER visits/year as accurate, this represents:

015% of the supplement users in the US.

Approximately 1% of the annual ER admissions due to side effects of properly prescribed medications.

The main value of this study is that it allows us to identify what the dangers are and what strategies can help us avoid those dangers.

13% of the ER visits were due to allergic reactions. This is probably unavoidable. Since many food supplements use natural ingredients, some degree of food allergies are to be expected.

13% of the ER visits were due to swallowing problems, primarily in people over the age of 65. If you or a loved one has difficulty swallowing, the solution is pretty simple. Choose pills that are small and slick, chewable, powder or liquid supplements.

20% of the ER visits were due to adverse effects caused by unsupervised ingestion of the supplements by children. The preventative measure here is also pretty simple. Keep your supplements out of reach of small children.

41% of the ER visits were due to weight loss products (25.5%), energy products (10%), sexual enhancement products (3.4%) and bodybuilding products (2.2%). These are the kinds of supplements you really need to be most careful about. Some supplements in this category are truly dangerous.

If we ask why these dangerous supplements exist, the answers are pretty simple.

Many Americans are looking for quick and easy solutions. They want a magic pill or powder.

A few unscrupulous supplement companies are only too happy to give them exactly what they want, even if it kills them in the process.

Unfortunately, the FDA is not doing a good enough job of protecting us from the truly dangerous supplements on the market, so we need to protect ourselves.

To protect ourselves from the dangerous supplements on the market we need to take 3 simple steps:

Use common sense. Don’t fall for the advertising hype promising quick and easy solutions.

Commit to true lifestyle change. Adopt a holistic lifestyle that includes weight control, diet, exercise, and supplementation.

Choose your supplement manufacturer wisely. Choose one with integrity – one that is committed to making supplements that are both safe and effective.

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.

Omega-3 and ADHD in Children

November 3, 2015 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Sometimes I write articles pointing out the fallacies in the headlines you’ve been reading. Other times I write articles because major studies have provided a definitive test of a current paradigm. And sometimes I write articles about small studies that have the potential to change existing paradigms. This week’s article falls in the latter category. This week’s article is on omega-3 and ADHD in children. More precisely, I’m going to review a study looking at the role of the omega-3s DHA and EPA in reducing ADHD symptoms.

Amid growing concern about the side effects and overuse of the stimulant medications used to treat ADHD symptoms in children, many parents have been looking for natural approaches for controlling ADHD symptoms. One of the most popular natural approaches has been omega-3 supplements, primarily the long chain omega-3s, DHA and EPA.

However, not everyone agrees that DHA and EPA are effective for reducing ADHD symptoms. Here is a brief summary of what we know:

Children with ADHD and learning difficulties generally have lower tissue levels of DHA and EPA than children without those deficits.

Animal studies show that DHA-deficient diets decrease neuron size and are associated with hyperactive and compulsive behavior.

Some clinical studies have reported a significant decrease in ADHD symptoms when children were given omega-3 supplements, while other studies found no effect of omega-3 supplementation on ADHD symptoms. This has led to considerable confusion as to the value of omega-3 supplementation in children with ADHD.

However, recent studies have led to a certain amount of clarity about omega-3 and ADHD in children. In particular:

Two recent meta-analyses of all high quality published studies have concluded that omega-3 supplements have a beneficial effect on ADHD symptoms, but the effect is relatively small (Bloch and Qawasmi, Journal of the American Academy of Child and Adolescent Psychiatry, 50: 991-1000, 2011; Sonuga-Burke et al. American Journal of Psychiatry, 170: 275-289, 2013).

One recent study showed that when omega-3 supplementation was combined with a stimulant medication, it improved the effectiveness of the medication, which allowed physicians to decrease the amount of medication they prescribed (Barragan et al, Journal of Attention Disorders, doi: 1177/1087054713518239, 2014).

Previous studies have shown that omega-3 supplementation is most effective in the children who are the most deficient in DHA and EPA at the beginning of the study. This is no surprise.

However,what you may not know is that many otherwise healthy children in this country have at least some degree of DHA and EPA deficiency. That’s because major food sources of EPA and DHA, such as salmon and sardines, are not most kid’s favorite foods.

Do Omega-3s Improve Attention Span In Children?

The most recent study (Bos et al, Neuropsychopharmacolgy, 40: 2298-2306, 2015) was a double blind, placebo controlled study looking at the effectiveness of omega-3 supplementation in reducing ADHD symptoms in boys between 8 and 14 years old. It differed significantly from most previous studies in that:

It included a matched group of boys who had not been diagnosed with ADHD.

It used a 1:1 ratio of DHA to EPA, which resulted in a greater intake of DHA than in many of the previous studies.

The study included 40 boys, aged 8-14, who had been diagnosed with ADHD and 39 matched controls who did not have ADHD. Both groups were either given margarine containing 650 mg/day of both DHA and EPA or a placebo margarine containing an equal amount of monounsaturated fatty acids for 16 weeks. Compliance with the study was measured in terms of the amount of margarine consumed and the levels of DHA and EPA found in cells obtained by a cheek swab. ADHD symptoms (particularly attention span, rule-breaking behavior and aggression) were assessed on the basis of standardized parent-rated child behavior assessments. The results of the study were:

At the start of the study, the children with ADHD scored higher on all measures of ADHD symptoms. No surprise here.

The children with the lowest omega-3 levels at the beginning of the study scored highest on all measures of ADHD symptoms. This is also not surprising given the results of previous studies.
Omega-3 supplementation increased attention span in boys with ADHD, and the improvement in attention span correlated with an increase in omega-3 status. No improvement was seen in other symptoms of ADHD (rule-breaking behavior and aggression).

Since different studies tend to use different symptom assessments to measure the severity of ADHD, this may explain why some of the previous studies on omega-3s and ADHD symptoms have come up empty. The authors also suggested that some previous studies may have come up empty because the omega-3 supplements they used were low in DHA.

What Is The Significance Of This Study?

Because this study included a control group of boys without ADHD, it offers a whole new perspective on the importance of omega-3s for children. For example, this study showed:

Omega-3 supplementation improved attention span equally well in boys with and without ADHD. This is perhaps not surprising. If you have ever had a child in the 8 to 14 year old range, you know their attention span could stand a bit of improvement.

However, when you think about it, this study represents a potential paradigm shift in how we think about omega-3s and childhood behavior. The real significance of this studyis that it suggests that omega-3 supplementation may be beneficial for any child with poor attention span, not just for children with ADHD. This interpretation would be fully consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

The Bottom Line

Previous studies have suggested that the long chain omega-3 fatty acids DHA and EPA are modestly effective at improving ADHD symptoms in children, and that they are most effective in children with the lowest omega-3 status at the beginning of the studies.

The current study showed that supplementation with DHA and EPA improved attention span in boys aged 8-14 with ADHD, but did not improve other ADHD symptoms such a rule-breaking behavior and aggression.

What does this mean to you if you have a child with ADHD?

If the ADHD symptoms are mild and mostly relate to attention span or learning skills, omega-3 supplementation alone may be enough to make a difference. Based on this study you might want to choose an omega-3 supplement that is rich in DHA.

If the ADHD symptoms are severe, you will probably need to include omega-3 supplementation as part of a more holistic natural approach for controlling the symptoms.

Finally, if a holistic natural approach is just too difficult to manage, the good news is that recent studies suggest that omega-3 supplementation makes ADHD medications more effective, which means your child’s physician may be able to reduce the dose of medication if you include omega-3 supplementation along with the medication.

This study was unique in that it also included a control group of 8-14 year old boys without ADHD and found that omega-3 supplementation was equally effective at improving attention span in children without ADHD.

This is a single study, but if it is replicated by future studies it suggests that we may need to change our paradigm. What we have been thinking about omega-3 supplementation for children may be all wrong. Perhaps we should stop thinking of it as a supplement that might help with ADHD symptoms and start thinking of it as a supplement that might help children improve their attention span and mental focus whether they have been diagnosed with ADHD or not. This would certainly be consistent with previous studies showing that omega-3 supplementation improves cognitive function and reading skills in children.

One final thought:

This study was performed with boys because they are more prone to ADHD symptoms than girls. However, based on numerous previous studies it is safe to assume that it is likely to apply equally well to girls with and without ADHD.

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.

Vitamin D and Multiple Sclerosis | Preventive Care?

October 27, 2015 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

A new study (Mokry et al, PLOS Medicine, DOI: 10.1371/journal.pmed.1001866, August 25, 2015) suggests that people who are genetically prone to low vitamin D levels are at increased risk of developing multiple sclerosis (MS). To understand the importance of this study and what it means for us, we need to first review what is already known about vitamin D and multiple sclerosis.

MS is an autoimmune disease in which the immune system attacks the myelin sheath that coats our nerves. Conceptually, that’s the equivalent of a fraying cord on a lamp. Eventually, the cord is going to start shorting out and the lamp won’t work very well. On a very basic level MS is similar. As our myelin sheath is damaged over time, our nervous system starts working less well.

The earliest evidence that vitamin D status might be associated with MS was the observation that the prevalence of MS was highest for people who lived in northern regions with little exposure to sunlight.

Numerous studies since then have shown that MS patients generally have lower 25-hydroxy vitamin D levels in their blood.

These studies clearly show an association between low vitamin D status and MS, but association does not prove causation. There are two limitations of association studies that significantly reduce their predictive value – reverse causation and confounding factors.Those are both somewhat highfalutin scientific terms, so let me put them in plain English – and in terms that are relevant to our discussion of vitamin D status and MS.

Reverse causation simple means that the MS might have caused low vitamin D status. For example, individuals with MS might spend less time outdoors because of their physical limitations. That would result in less sun exposure, which would decrease their blood levels of 25-hydroxy vitamin D.

A confounding factor would be something else that increased the risk for MS and happened to be associated with low vitamin D status. Suppose, for example, that exercise decreased the risk of MS. People who spend most of their time inside in front of a TV or computer screen would have low levels of exercise and low sun exposure. If it was the lack of exercise rather than the low vitamin D status that actually predisposed to MS, lack of exercise would be a confounding factor for any clinical study comparing vitamin D status with risk of developing MS.

What Can Genetics Tell Us About The Relationship Between Vitamin D and Multiple Sclerosis?

The authors of this study had previously identified mutations in 4 genes that decrease blood levels of 25-hydroxy vitamin D (the most commonly used measure of vitamin D status). In this study(Mokry et al, PLOS Medicine, DOI: 10.1371/journal.pmed.1001866, August 25, 2015)they analyzed the frequency of those genetic mutations in 14,498 MS cases compared with 24,091 healthy controls. Their study showed:

Genetic mutations that decrease 25-hydroxy vitamin D levels are associated with a significant increase in the risk of developing MS.

Based on the relationship of those mutations with 25-hydroxy vitamin D levels, they calculated that every 50% increase in 25-hydroxy vitamin D levels was associated with a 50% decreased risk of developing MS.

This was a very large, well designed study. It has some limitations of its own, but because it used a genetic approach it largely avoids the concern about reverse causation and confounding factors. In short, this study strongly supports the conclusion from previous studies that low vitamin D status significantly increases the risk of developing MS.

The authors concluded “The identification of vitamin D as a causal susceptibility factor for MS may have important public health implications, since vitamin D insufficiency is common, and vitamin D supplementation is both relatively safe and cost effective.”

Is Vitamin D Supplementation Effective In Preventing And Treating MS?

The authors of the study also concluded “These findings provide the rationale for further investigating the therapeutic benefits of vitamin D supplementation in preventing the onset and progression of MS.”

While more studies are still needed, the Nurses’ Health Study (Munger et al, Neurology, 62: 60-65, 2004) provides pretty convincing evidence that vitamin D supplementation can prevent the onset of MS. That study followed 187,563 nurses for at least 4 years, during which time 173 of them developed MS. The study showed that supplementation with 400 IU/day of vitamin D reduced the risk of developing MS by 40%.

The efficacy of vitamin D supplementation in preventing the progression of MS is much less well established. Several studies have shown that low vitamin D status is associated with higher levels MS relapse and more rapid progression of MS symptoms.However, studies of vitamin D supplementation conducted to date have been too small and too short in duration to be definitive.

What Is The Significance Of This Study?

On one hand MS is a very rare disease, affecting around 0.1% of the adult population. On the other hand, it is a debilitating disease. If something as simple as assuring adequate vitamin D status can reduce the risk of developing MS by 40-50%, it is an important public health measure, especially since 40% of the US population has insufficient blood levels of vitamin D (Looker et al, American Journal of Clinical Nutrition, 88: 1519-1527, 2008).

What Does This Study Mean For You?

What does this study mean for you and me? We already know that adequate vitamin D status is essential for building strong bones, and there is pretty good evidence that adequate vitamin D status is important for a strong immune system. Now we can add autoimmune diseases to the list. It is pretty clear that adequate vitamin D status is important for preventing MS. It may help prevent other autoimmune diseases as well.

One interesting wrinkle for MS is that it may be vitally important to assure adequate vitamin D in our younger years. Studies looking at people who grow up in northern latitudes and then move south and vice versa suggest that the risk of developing MS is much more strongly associated with sun exposure during the first 10-15 years of life than with sun exposure later in life.

It is, therefore, not just important that we assure adequate vitamin D status for ourselves. It may be even more important that we assure that our kids and grandkids have adequate vitamin D status.

The problem is that in today’s world we are told to slather industrial strength sunscreen on ourselves from head to foot before we leave the house and very few foods in nature provide significant amounts of vitamin D, so most of us rely primarily on vitamin D fortified dairy products and supplements to assure adequate intake of vitamin D. Click here for the latest RDA recommendations for vitamin D intake.

Some people do appear to need greater than RDA levels of vitamin D because they don’t metabolize vitamin D efficiently. They can have adequate intake of vitamin D, but their blood levels of 25-hydroxy vitamin D are low. I recommend that you ask your doctor to check your 25-hydroxy vitamin D levels at your next physical. If they are low, work out a vitamin D supplementation regimen with your doctor to bring your 25-hydroxy vitamin D levels into the optimal range.

The Bottom Line

A recent study showed that genetic mutations which decrease 25-hydroxy vitamin D levels are associated with a significantly increased risk of developing MS. Based on the relationship of those mutations with 25-hydroxy vitamin D levels, the investigators calculated that every 50% increase in 25-hydroxy vitamin D levels was associated with a 50% decreased risk of developing MS. This study strongly supports the conclusion from previous studies that low vitamin D status significantly increases the risk of developing MS.

An earlier Nurses’ Health Study has shown that supplementation with 400 IU/day of vitamin D decreases the risk of developing MS by 40%.

The authors of the most recent study concluded “The identification of vitamin D as a causal susceptibility factor for MS may have important public health implications, since vitamin D insufficiency is common, and vitamin D supplementation is both relatively safe and cost effective.” I agree.

While MS is a very rare disease, it can be devastating. This alone, is a good enough reason to be sure that you maintain adequate vitamin D status.

There is evidence that vitamin D status in our childhood years may be more important than our vitamin D status in later years for determining our risk of developing MS. It is, therefore, not just important that we assure adequate vitamin D status for ourselves. It may be even more important that we assure that our kids and grandkids have adequate vitamin D status.

While these and other studies demonstrate the health benefits of maintaining adequate vitamin D status, many Americans don’t do a good job of it. Government surveys show that 40% of Americans are deficient in vitamin D. That’s because we are continually being advised to slather on industrial strength sunscreen before we leave the house, and most naturally occurring foods are relatively poor sources of vitamin D.

While the evidence that vitamin D supplementation is effective for preventing MS is strong, evidence that vitamin D supplementation can slow the progression of MS is inconclusive at present. More and better studies are needed before we will have a definitive answer to this question.

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.

Natural Treatment for Hip Pain

October 20, 2015 by Dr. Steve Chaney

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Do You Love Sports?

Do You Exercise Frequently?

Do You Have Aches & Pains?

Wish there was a natural treatment for hip pain? Exercising and playing sports is a “pluses and minuses” situation because it’s great to build muscle and burn fat, but it can also cause joint pain.

And athletes are especially vulnerable for hip pain.

Today I taught a serious triathlete an at-home hip pain treatment. Up until now he has been side-lined because of chronic hip pain. He’s an excellent runner and a top cyclist, but both of these sports have caused hip pain so extreme that he had to seek treatment.

The Cause of Hip Pain

The hip has powerful muscles attached to it so you can stand, sit, bend, maintain balance and move your body in an infinite number of ways. Each muscle needs to work perfectly with the other supporting muscles. As one contracts the opposing muscle needs to lengthen.

For example, sitting for extended periods of time is a key cause of pain all the way from your low back to your knees! In order for you to be able to sit various muscles contract including your psoas and iliacus muscles (front of pelvis), meanwhile your quadratus lumborum (low back) and rectus femoris (front of thigh) must lengthen.

As you stand those muscles switch roles – unless one or more of them have shortened because of a phenomenon called “muscle memory”. When this happens the tight muscle pulls on the bone causing tightness in the pelvis which leads low back pain, groin pain, sciatica or pain in the front of your hip.

Pain on the outside of your hip happens because these muscles are rotating your pelvis forward and down, and this rotation causes the muscles on the outside of your hip to torque. This torquing causes spasms (muscles knots or trigger points) to form in your hip muscles and the pull refers pain to your entire hip area.

If you play a sport that involves kicking your leg out to the side, such as soccer or ice skating, you are repetitively straining your hip muscles, specifically your tensor fascia lata, gluteus minimus and gluteus medius. These muscles apply tension on the outside of the pelvis and on the top of the thigh bone making your entire hip hurt!

A Natural Treatment for Hip Pain

To release the muscles on the outside of your hip, take the Trigger Point Therapy Ball and place it directly on the side-seam of your pants, between your hip bone and your thigh bone. This is the location of your tensor fascia lata muscle, which is a key muscle when treating for hip pain.

Lie down on the ball (as pictured). You may need to ease into it if your muscle is very tight. The goal is to be able to lie on the ball without feeling pain.

This could take a few minutes if your muscle is in spasm.

Once you are able to lie on the ball without pain, begin to move your body so the ball moves down to the insertion point (top of your thigh bone).

Then move so the ball rolls along your entire pelvis and sacrum.

As you move along feel for any tender spots. Each tender spot is a trigger point (muscle knot or spasm) that is causing your hip pain.

When you feel a trigger point allow your body to rest there for 30-60 seconds for a full muscle release.

Need More Help?

There are so many muscles involved in hip pain that I suggest you watch the Focused Flexibility Training Foundation video. The Foundation video is a comprehensive demonstration of muscle release techniques from head-to-toe.

After you release the knots in your muscles it is now the best time to stretch. In the Focused Flexibility Training system the two lower body sessions effectively stretch the muscles of your hip

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.

Magnesium Supplements Benefits | Reduce Diabetes Risk?

October 13, 2015 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

I came across an article the other day suggesting that one of the magnesium supplements benefits might be improved blood sugar control in pre-diabetics with low blood levels of magnesium (Guerrero-Romero et al, Diabetes & Metabolism, 41: 202-207, 2015). Considering that…

A 2014 CDC report stated that 1/3 of adult Americans are pre-diabetic, and…
Most people with pre-diabetes will go on to develop type 2 diabetes in 10 years or less, and…
Diabetes is the 7^th leading cause of death in this country, and…
60% of Americans don’t get enough magnesium in their diets…

…this could be a really big deal! Because of this I scrutinized the paper very carefully and reviewed the literature on magnesium intake and the incidence of type 2 diabetes.

Do Magnesium Supplements Improve Blood Sugar Control?

This was a relatively small study (116 adults, age 30-65), but it was well designed. All of the subjects had mild impairments in blood sugar control (i.e. were pre-diabetic), and all of them had low blood magnesium levels (≤1.8 mg/dL). This is a significant improvement over most previous studies of magnesium supplementation and blood sugar control because blood magnesium levels were not determined in many of those studies.

The study was double-blind, placebo controlled.Subjects received either 382 mg of magnesium or a placebo each day for 16 weeks, at which time blood sugar control and blood magnesium levels were re-measured. All subjects were put on a weight maintenance diet consisting of 55% healthy carbohydrates, 25% healthy fats, and 20% healthy proteins and told to exercise for at least 30 minutes three times per week.

Adherence to the diet and exercise regimen was 91% in both the supplement and placebo groups. Adherence to magnesium supplementation was 85% as measured by an increase in blood magnesium levels.

At the end of 16 weeks:

Improvement in blood sugar control was observed in 50% of the people in the magnesium group compared to 7% in the placebo group. This was significantly different.

Triglyceride levels were significantly decreased while HDL and blood magnesium levels were significantly increased in the magnesium group compared to the placebo group.

Side effects of magnesium supplementation were mild abdominal pain (7.6%) and diarrhea (6.0%).

The authors concluded:

“Our present results demonstrate the efficacy and safety of magnesium supplementation in the reduction of plasma glucose levels and in the improvement of glycemic status [blood sugar control] of pre-diabetic individuals who have low serum magnesium levels.”

“Our results support the hypothesis that, as a complement to lifestyle intervention programs, people with pre-diabetes and low blood levels of magnesium also should take magnesium supplements to decrease plasma glucose levels and potentially decrease the transition rate from pre-diabetes to diabetes.”

Magnesium and Blood Sugar Control

While the results of the recent study were impressive, it was a single, relatively small study, so I did a thorough review of the literature to put this study in perspective. This is what I found:

A major study that followed 2,582 participants enrolled in the Framingham Heart Study for 7 years (Hruby et al., Diabetes Care, 37: 419-427, 2014) concluded that those who consumed the most magnesium (400 mg/day) had a 50% reduction in the risk of developing type 2 diabetes compared to those who consumed the least (240 mg/day).

Several other studies comparing magnesium intake to diabetes risk have come to similar conclusions.

A meta-analysis of 13 studies with 536,318 people (Dong et al, Diabetes Care, 34: 2116-2122, 2011) concluded that the risk of diabetes was decreased by 14% for every 100 mg of magnesium consumed.

Most, but not all, intervention studies like the one described above have shown that magnesium supplementation reduced blood glucose levels and improved blood sugar control.

However, most of these studies did not measure blood magnesium levels. This is a significant drawback because if the majority of subjects in a particular study had adequate blood magnesium levels at the beginning of the study, one would not expect additional magnesium to improve blood sugar control.

A study of 4257 participants in the 1999-2000 National Health and Nutrition Examination Survey (Ford &Mokdad, Journal of Nutrition, 133: 2879-2882, 2003) concluded that around 60% of the adult US population was getting sub-optimal levels of magnesium from their diet.

The RDAs for magnesium range from 310-420 mg/day depending on age and gender, while intakes of magnesium ranged from 144-326 mg/day depending on age, gender and ethnicity. Those taking supplements had significantly greater magnesium intake than non-supplement users.

However, dietary recall studies almost always overestimate the percentage of the population that is deficient in any particular nutrient. Blood nutrient levels are usually considered a better indicator of nutrient deficiency, and some experts estimate that 20-30% of the US population may have blood levels of magnesium that are less than optimal.

Unfortunately, in the case of magnesium it is unclear whether even blood levels are an adequate indicator of nutrient status. That’s because only 1% of your body’s magnesium is found in the blood. The rest is locked up in your tissues where it is much more difficult to determine whether your magnesium status is adequate or not.

The Bottom Line

A recent study showed that magnesium supplementation improves blood sugar control in pre-diabetics with low blood magnesium levels. The authors concluded that magnesium supplementation along with lifestyle change may be effective in slowing the progression from pre-diabetes to type 2 diabetes.

This study is consistent with a number of previous studies suggesting that increased magnesium intake is associated with decreased risk of developing type 2 diabetes.

This study is also consistent with the principle that supplementation works best in situations where there is a demonstrated need for a particular nutrient, in this case magnesium (the study participants were selected in part on the basis of low blood levels of magnesium).

Other studies have shown that around 60% of the population is getting inadequate magnesium from their diet.Dietary recall studies probably overestimate the percentage of the population that is magnesium deficient, but most experts agree that a significant percentage of the US population likely have less than optimal magnesium status.

You probably don’t need mega-doses of magnesium to support good blood sugar control. The clinical study described above used 382 mg/day of magnesium, but most dietary recall studies suggest that dietary intake of magnesium in this country is only 100-200 mg/day below RDA recommendations.

Assuring an adequate intake of magnesium is only one component of a holistic approach for reducing the risk of developing type 2 diabetes. Other important components are weight control, exercise, and a healthy diet that restricts sugars and starches.

Good dietary sources of magnesium include leafy green vegetables (5-6 servings = RDA), nuts (5-6 servings = RDA), orwhole wheat bread or brown rice (8-9 servings = RDA).

Supplementation with ≥300 mg of magnesium can cause gas, bloating and diarrhea in sensitive individuals. If you are supplementing with magnesium, I recommend a sustained release supplement.

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.

ADHD Diet VS Medication for ADHD

October 6, 2015 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

I came across a headline in our local newspaper recently that said “Try Nutrition, Not Drugs, for ADHD”. The article made claims like “No good evidence exists to support the ADHD disease hypothesis” and “…on numerous occasions we have seen ADHD symptoms completely disappear without medication”.

As a scientist, I am always a little skeptical about bold claims that run counter to established scientific wisdom. However, the authors of this article implied that their claims were based on a 2012 article in Pediatrics, which is a highly respected journal in its field, so I decided to investigate the article (Millichap and Yee, Pediatrics, 129: 1-8, 2012).

The article was written by two pediatricians with extensive experience treating children with ADHD. The article turned out to be a pretty thorough review of the literature on nutritional approaches for controlling ADHD. It did not approach the rigor of a meta-analysis study. Rather, it is what I refer to as an “interpretive review”. By that I mean that the clinical studies were interpreted in part on the basis of their clinical experience in treating children with ADHD.

Interpretive reviews can be either good or bad, depending on the objectiveness of the reviewers. In this case, I was familiar with many of the clinical studies they reviewed and found their interpretations to be accurate, so I decided to share their conclusions with you.

Is an ADHD Diet Better Than Medication For ADHD?

They reviewed all of the major nutritional approaches that have been used over the years to control ADHD. Let me start by saying that they are not wild-eyed proponents of “a nuts and berries diet cures all”. In fact, they use medications as the primary intervention for most of their ADHD patients. They advocate an ADHD diet approach when:

Medicines fail or there are adverse reactions (side effects).

The parents or the patients prefer a more natural approach.

There are symptoms or signs of a mineral deficiency (more about that below).

There is a need to substitute an ADHD-free healthy diet for an ADHD-linked diet (Simply put, if the child’s diet is bad enough, there are multiple benefits from switching to a healthier diet – a possible reduction in ADHD symptoms is just one of them.)

I will summarize their key findings below:

Do Omega-3 Fatty Acids Reduce ADHD Symptoms?

The authors reported that a number of studies have shown that children with ADHD tend to have low levels of essential fatty acids, especially the omega-3 fatty acids. They cite several studies which showed significant improvement in reading skills and reductions in ADHD symptoms when children with ADHD were give omega-3 supplements, but also noted that other studies showed no effect.They postulated that some children may benefit more from omega-3 supplementation than others.

They routinely use doses of 300-600 mg of omega-3s with their ADHD patients. They find that this intervention reduces ADHD symptoms in many children, but does not completely eliminate the need for medications.

My Two Cents: I have previously reported on the improvement in reading skills(Omega-3’s Improve Reading Skills) and reduction in ADHD symptoms (Can Fish Oil Make Children Smarter?) when children were given omega-3 supplements. In both cases, it was the children with the lowest omega-3 levels who benefitted most. No surprise there. Whether it will help your child is anyone’s guess. However, it is a natural approach with no side effects. It is certainly worth trying.

Does the Elimination of Food Additives Reduce ADHD Symptoms?

The current interest in food additives and ADHD originated with the Feingold diet. The Feingold diet eliminated food additives, foods with salicylates (apples, grapes, luncheon meats, sausage, hot dogs and drinks containing artificial colors and flavors), and chemical preservatives (e.g. BHA and BHT). It was popularized in the 1970s when some proponents claimed that it reduced ADHD symptoms in 50% of the children treated. After clinical studies showed that only a small percentage of children actually benefitted from this diet, it rapidly fell out of favor.

However, Millichap and Yee pointed out that more recent studies have shown that the subset of children who responded to the Feingold diet were not a “statistical blip”. A recent review of the literature reported that when children with suspected sensitivities to food additives were challenged with artificial food colors, 65–89% of them displayed ADHD symptoms.

My Two Cents: I have previously reported on the effects of artificial food colors on ADHD (Do Artificial Colors Cause Hyperactivity?). The studies I reviewed in this article reported that up to 28% of children with ADHD were sensitive to the amount of artificial food colors in the typical western diet and that removing those food colors resulted in a significant improvement in ADHD symptoms. Plus, those studies were just looking at food colors – not the hundreds of other food additives in the average American child’s diet.

I consider food additives to be problematic for many reasons. Even if doesn’t reduce their ADHD symptoms, eliminating as many of those food additives as possible is probably a good idea. It doesn’t need to be complicated. Just replacing processed foods and sodas with fresh fruits and vegetables and with low fat milk and natural fruit juices diluted with water to reduce their sugar content might make a significant difference in your child’s ADHD symptoms.

Food Sensitivities

Even natural foods can be a problem for children with food sensitivities, and it appears that there may be a large percentage of hyperactive children with food sensitivities. Millichap and Yee reported that elimination diets (diets that eliminate all foods which could cause food sensitivity) improve behavior in 76-82% of hyperactive children.

Even though this approach can be very effective Millichap and Yee don’t normally recommend it for their patients because it is difficult and time-consuming. The elimination diet is very restrictive and needs to be followed for a few weeks. Then individual foods need to be added back one at a time until the offending food(s) are identified. (They reported that antigen testing is not a particularly effective way of identifying food sensitivities associated with hyperactivity)

My Two Cents: I have previously reported on the link between food sensitivities and hyperactivity (What Causes ADHD?). I agree with Millichap and Yee that elimination diets are difficult and view this as something to be tried after all other natural approaches have failed. However, if there is a particular food that causes hyperactivity in your child, identifying it and eliminating it from their diet could just be something that will benefit them for the rest of their life.

Sugar

This is a particularly interesting topic. Many parents are absolutely convinced that sugary foods cause hyperactivity in their children, but the experts are saying that clinical studies have disproven that hypothesis. They claim that sugar has absolutely no effect on hyperactivity.

Millichap and Yee have an interesting perspective on the subject. They agree that clinical studies show that a sugar load does not affect behavior or cognitive function in small children, but they point to numerous clinical studies showing that the reactive hypoglycemia that occurs an hour or two after a sugar load adversely affects cognitive function in children, and that some children are more adversely affected than others.

My Two Cents: Reducing intake of refined sugars in your child’s diet makes sense for many reasons, especially considering the role of sugar intake in obesity. If your child has a tendency towards reactive hypoglycemia, it may also reduce ADHD symptoms.

Does Eliminating Iron and Zinc Deficiencies Reduce ADHD Symptoms?

Millichap and Yee reporting some studies suggested that iron and zinc deficiencies may be associated with ADHD symptoms, and recommend supplementation with an iron or zinc supplement when there is a documented deficiency.

My Two Cents: A simpler and less expensive approach would be a children’s multivitamin to prevent the possibility of iron or zinc deficiency. Of course, I would recommend that you choose one without artificial colors, preservatives and sweeteners.

Does Eating A Healthy Diet Reduce ADHD Symptoms?

Millichap and Yee closed their review by discussing a recent study in Australia that reported a significant reduction in ADHD symptoms in children eating “Healthy” diets (fish, vegetables, tomato, fresh fruit, whole grains & low fat dairy products) compared to children eating “Western” diets (Fast foods, red meat, processed meats, processed snacks, high fat dairy products & soft drinks). This is the ADHD diet approach, along with omega-3 supplementation, that they recommend most frequently for their patients.

My Two Cents: I wholeheartedly agree. In fact, if you and your family were to follow a “Healthy” diet instead of a “Western” diet it would likely have numerous health benefits. Plus, you are automatically removing ADHD triggers like food additives and sugar from your child’s diet.

The Bottom Line

A recent review of natural approaches for controlling ADHD symptoms (Millichap and Yee, Pediatrics, 129: 1-8, 2012) is both good news and bad news. The good news is that there are multiple nutritional approaches that can significantly reduce ADHD symptoms. These include:

Use of omega-3 supplements. They recommended 300-600 mg/day.

Removal of food additives (particularly food colors) from the diet.

Identification of food sensitivities and removal of those foods from the diet.

Reducing the amount of simple sugars in the diet.

Elimination of iron and zinc deficiencies if they exist (Iron deficiency is relatively common in American children. Zinc deficiency is not.) Alternatively, I recommend a children’s multivitamin to prevent iron and zinc deficiencies in the first place.

Eating a healthy diet rather than a Western diet. This also has the benefit of reducing the amount of food additives and sugars in the diet.

The bad news is that each of these approaches seems to work only in a subset of children with ADHD.

If you are a parent who is interested in a natural alternative to ADHD stimulant medications this means you may need to be patient and try several natural approaches until you find the one(s) that work(s) best for your child. The benefit of making the effort is that all of these approaches will also improve the health of your child in other important ways, and none of them have any side effects.

Unfortunately, the physician with only about 10 minutes to spend with each patient (which is increasingly the medical model in this country), may not have time to explore natural options. Medications are much easier to prescribe. You may need to be the one who takes the responsibility of exploring natural alternatives for your child.

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 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.

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.